Patient feedback on hospital pharmacists' consultation skills: A feasibility study using the Interpersonal Skills Questionnaire (ISQ).

BACKGROUND: Improvement in practitioners' consultation skills (CSs) can be driven by patient feedback, however, to date, no study has been conducted with reference to pharmacy consultations. The Interpersonal Skills Questionnaire (ISQ) is potentially appropriate for collecting patient feedback on pharmacists' CSs. This study aims to explore the feasibility of collecting patient feedback on hospital pharmacists' CSs using the ISQ, to identify the acceptability of the feedback process, and to identify methods to enhance the process in the future. METHODS: The study was conducted in a teaching hospital, United Kingdom, between 2018 and 2019. A diverse sample of pharmacists with patient-facing roles was purposively selected. The study comprised three phases. Pharmacists collected feedback from patients following their consultation using the ISQ utilising a third person whenever possible (phase-1). Data analysis and individual report writing was conducted by a private company. Interviewing a sample of patient participants by telephone (phase-2), and interviewing pharmacists face-to-face after receiving feedback reports (phase-3). All interviews were transcribed verbatim and thematically analysed. The study received approval by the NHS Health Research Authority. RESULTS: Six pharmacists were included. Of the 119 distributed ISQs, 111 were returned (response rate 93%). Patients were mostly recruited by their consulting pharmacists (72%, n = 80). All pharmacists and 14 patients were interviewed. Participants were positive about patient feedback and its role in enhancing CSs. Most did not encounter any problem with the process, however, some pharmacists struggled to find a third person. The ISQ was mostly viewed suitable to assessing pharmacy consultations. Some reports highlighted areas to improve (e.g. protecting patient's privacy). CONCLUSIONS: Collecting feedback is feasible, acceptable and may enhance CSs, however, the process was associated with challenges such as finding a third person. Several measures should be considered to make the process more feasible within the hospital pharmacy setting.

Exploring the views of community pharmacists on patient feedback on their consultations.

OBJECTIVES: To explore community pharmacists' (CPs) views on patient feedback on their consultations. METHODS: The study was conducted at community pharmacies in the East of England. Pharmacists employed at a large multiple pharmacy were invited to a telephone/face-to-face interview. Interviews were audio-recorded and thematically analysed. KEY FINDINGS: Six pharmacists participated and interviews yielded four main themes. Pharmacists shared views on benefits of collecting feedback (e.g. improving their consultations), potential barriers (e.g. bias) and associated resolutions (e.g. using anonymous questionnaires). Peer feedback was also suggested. CONCLUSIONS: Patient feedback is welcomed by CPs and perceived useful for improving their consultations.

COVID-19 Pandemic Challenges and Lessons Learned by Pharmacy Educators Around the Globe.

The coronavirus identified in 2019 (COVID-19) has affected peoples' lives worldwide. This pandemic forced both pharmacy faculty members and students to adapt to a new teaching and learning environment not only in the United States but around the globe. Pharmacy educators faced challenges and opportunities to convert classroom learning and experiences, as well as student assessments, to a remote or online format. The unique approaches taken to overcome difficulties in various countries showed pharmacy faculty members' resilience in the face of adversity and their determination to continue providing education to students. The pandemic also shed light on areas needing improvement for pharmacy educators to work on in the future.

Clinical and cost effectiveness of a multi-professional medication reviews in care homes (CAREMED).

OBJECTIVES: With 70% of care home residents experiencing a medication error every day in the UK, better multi-professional working between medical practitioners, pharmacists and care homes was recommended. The aim of this study was to determine the effectiveness (falls reduction) and cost-effectiveness, of a multi-professional medication review (MPMR) service in care homes for older people. METHOD: A total of care homes in the East of England were cluster randomised to 'usual care' or two multi-professional (General practitioner, clinical pharmacist and care homes staff) medication reviews during the 12-month trial period. Target recruitment was 900 residents with 10% assumed loss to follow-up. Co-primary outcome measures were number of falls and potentially inappropriate prescribing assessed by the Screening Tool of Older Persons Prescriptions. KEY FINDINGS: A total of 826 care home residents were recruited with 324 lost to follow-up for at least one primary outcome measure. The mean number of falls per resident per annum was 3.3 for intervention and 3.0 for control (P = 0.947). Each resident was found to be prescribed 0.69 (intervention) and 0.85 (control) potentially inappropriate medicines after 12 months (P = 0.046). No significant difference identified in emergency hospital admissions or deaths. Estimated unadjusted incremental mean cost per resident was £374.26 higher in the intervention group. CONCLUSIONS: In line with other medication review based interventions in care homes, two MPMRs improved medication appropriateness but failed to demonstrate improvements in clinical outcomes. From a health system perspective costs where estimated to increase overall and therefore a different model of medicines management is required.

Does it matter whether the recipient of patient questionnaires in general practice is the general practitioner or an independent researcher? The REPLY randomised trial.

BACKGROUND: Self-administered questionnaires are becoming increasingly common in general practice. Much research has explored methods to increase response rates but comparatively few studies have explored the effect of questionnaire administration on reported answers. METHODS: The aim of this study was to determine the effect on responses of returning patient questionnaires to the respondents' medical practice or an independent researcher to questions relating to adherence and satisfaction with a GP consultation. One medical practice in Waveney primary care trust, Suffolk, England participated in this randomised trial. Patients over 18 years initiated on a new long-term medication during a consultation with a GP were randomly allocated to return a survey from their medical practice to either their medical practice or an independent researcher. The main outcome measures were self reported adherence, satisfaction with information about the newly prescribed medicine, the consultation and involvement in discussions. RESULTS: 274 (47%) patients responded to the questionnaire (45% medical practice, 48% independent researcher (95% CI -5 to 11%, p = 0.46)) and the groups appeared demographically comparable, although the high level of non-response limits the ability to assess this. There were no significant differences between the groups with respect to total adherence or any of the satisfaction scales. Five (4%) patients reported altering doses of medication in the medical practice group compared with 18 (13%) in the researcher group (P = 0.009, Fisher's exact test). More patients in the medical practice group reported difficulties using their medication compared to the researcher group (46 (35%) v 30 (21%); p = 0.015, Fisher's exact test). CONCLUSION: Postal satisfaction questionnaires do not appear to be affected by whether they are returned to the patient's own medical practice or an independent researcher. However, returning postal questionnaires relating to detailed patient behaviours may be subject to response biases and further work is needed to explore this phenomena.

Patient feedback questionnaires to enhance consultation skills of healthcare professionals: A systematic review.

OBJECTIVE: To identify patient feedback questionnaires that assess the development of consultation skills (CSs) of practitioners. METHODS: We conducted a systematic search using seven databases from inception to January 2017 to identify self-completed patient feedback questionnaires assessing and enhancing the development of CSs of individual practitioners. Results were checked for eligibility by three authors, and disagreements were resolved by discussion. Reference lists of relevant studies and Open Grey were searched for additional studies. RESULTS: Of 16,312 studies retrieved, sixteen were included, describing twelve patient feedback questionnaires that were mostly designed for physicians in primary care settings. Most questionnaires had limited data regarding their psychometric properties, except for the Doctor Interpersonal Skills Questionnaire (DISQ). Most studies conducted follow-up, capturing positive views of practitioners regarding the process (n = 14). Feedback was repeated by only three studies, demonstrating different levels of improvement in practitioners' performance. CONCLUSION: Identified questionnaires were mainly focused on physicians, however, to support using patient feedback, questionnaires need to be validated with other practitioners. PRACTICE IMPLICATIONS: Several patient feedback questionnaires are available, showing potential for supporting practitioners' development. Valid questionnaires should be used with appropriate practitioners in developing more evidence for the impact they may have on actual consultations.

The UK Pharmacy Care Plan service: Description, recruitment and initial views on a new community pharmacy intervention.

INTRODUCTION: The UK government advocates person-centred healthcare which is ideal for supporting patients to make appropriate lifestyle choices and to address non-adherence. The Community Pharmacy Future group, a collaboration between community pharmacy companies and independents in the UK, introduced a person-centred service for patients with multiple long-term conditions in 50 pharmacies in Northern England. OBJECTIVE: Describe the initial findings from the set up and delivery of a novel community pharmacy-based person-centred service. METHOD: Patients over fifty years of age prescribed more than one medicine including at least one for cardiovascular disease or diabetes were enrolled. Medication review and person-centred consultation resulted in agreed health goals and steps towards achieving them. Data were collated and analysed to determine appropriateness of patient recruitment process and quality of outcome data collection. A focus group of seven pharmacists was used to ascertain initial views on the service. RESULTS: Within 3 months of service initiation, 683 patients had baseline clinical data recorded, of which 86.9% were overweight or obese, 53.7% had hypertension and 80.8% had high cardiovascular risk. 544 (77.2%) patients set at least one goal during the first consultation with 120 (22.1%) setting multiple goals. A majority of patients identified their goals as improvement in condition, activity or quality of life. Pharmacists could see the potential patient benefit and the extended role opportunities the service provided. Allowing patients to set their own goals occasionally identified gaps to be addressed in pharmacist knowledge. CONCLUSION: Pharmacists successfully recruited a large number of patients who were appropriate for such a service. Patients were willing to identify goals with the pharmacist, the majority of which, if met, may result in improvements in quality of life. While challenges in delivery were acknowledged, allowing patients to identify their own personalised goals was seen as a positive approach to providing patient services.

Development of a core outcome set for effectiveness trials aimed at optimising prescribing in older adults in care homes.

BACKGROUND: Prescribing medicines for older adults in care homes is known to be sub-optimal. Whilst trials testing interventions to optimise prescribing in this setting have been published, heterogeneity in outcome reporting has hindered comparison of interventions, thus limiting evidence synthesis. The aim of this study was to develop a core outcome set (COS), a list of outcomes which should be measured and reported, as a minimum, for all effectiveness trials involving optimising prescribing in care homes. The COS was developed as part of the Care Homes Independent Pharmacist Prescribing Study (CHIPPS). METHODS: A long-list of outcomes was identified through a review of published literature and stakeholder input. Outcomes were reviewed and refined prior to entering a two-round online Delphi exercise and then distributed via a web link to the CHIPPS Management Team, a multidisciplinary team including pharmacists, doctors and Patient Public Involvement representatives (amongst others), who comprised the Delphi panel. The Delphi panellists (n = 19) rated the importance of outcomes on a 9-point Likert scale from 1 (not important) to 9 (critically important). Consensus for an outcome being included in the COS was defined as ≥70% participants scoring 7-9 and <15% scoring 1-3. Exclusion was defined as ≥70% scoring 1-3 and <15% 7-9. Individual and group scores were fed back to participants alongside the second questionnaire round, which included outcomes for which no consensus had been achieved. RESULTS: A long-list of 63 potential outcomes was identified. Refinement of this long-list of outcomes resulted in 29 outcomes, which were included in the Delphi questionnaire (round 1). Following both rounds of the Delphi exercise, 13 outcomes (organised into seven overarching domains: medication appropriateness, adverse drug events, prescribing errors, falls, quality of life, all-cause mortality and admissions to hospital (and associated costs)) met the criteria for inclusion in the final COS. CONCLUSIONS: We have developed a COS for effectiveness trials aimed at optimising prescribing in older adults in care homes using robust methodology. Widespread adoption of this COS will facilitate evidence synthesis between trials. Future work should focus on evaluating appropriate tools for these key outcomes to further reduce heterogeneity in outcome measurement in this context.

A drop-in clinic for patients with poorly-controlled diabetes: a community pharmacy feasibility study.

BACKGROUND: Preparatory work suggests that there may be a role for the pharmacist in managing sub-optimal medication adherence and dose titration of prescribed medicines in patients with type 2 diabetes. Patients have reported that they are receptive towards pharmacists becoming involved in their care providing that this is integrated into the care received from their medical practice. OBJECTIVE: To determine whether a community pharmacy diabetes drop-in clinic is feasible and acceptable to patients with poorly controlled type 2 diabetes. SETTING: Five community pharmacies in Norfolk, UK. METHOD: Poorly controlled patients, as defined by a national general practitioner incentive scheme, were invited to participate in the study by a letter posted by their medical practice. One 4-h, pharmacist clinic, where participants were able to "drop-in", was conducted in five pharmacies every week for 4-6 weeks. Questionnaires before and after the consultation were used to determine the clinic's effect on satisfaction with, and beliefs about, medicines and adherence along with participant satisfaction. Pharmacists had the opportunity to provide feedback via "debrief" interviews. MAIN OUTCOME MEASURE: As a feasibility study, a combination of outcomes were explored including information satisfaction and adherence. RESULTS: Thirty-three (9.6 %) of the 342 paients with type 2 diabetes posted letters were recruited from four pharmacies. Follow-up questionnaire completion rate was 88 %. The clinic demonstrated little change in the parameters measured over 3 months. All of the participants rated their general impression of the service as good or very good and all would be happy to recommend the service to others with diabetes. Sixteen participants (59 %) stated that it would make them more likely to consult their pharmacist in the future. Pharmacists enjoyed providing the service as it allowed them to interact more formally, and for longer, with patients. CONCLUSION: This research has demonstrated that a community pharmacy drop-in clinic is feasible and likely to be acceptable to both patients and pharmacists; however, cost effectiveness of such a service should be explored in future studies.

The current and future roles of community pharmacists: views and experiences of patients with type 2 diabetes.

BACKGROUND: The current UK government agenda is for community pharmacists to assume greater responsibility for medication management in patients with chronic conditions. This agenda may require a significant change in the way patients currently interact with their community pharmacist. OBJECTIVES: To explore the experiences and views of patients with type 2 diabetes regarding the current and proposed future role of community pharmacists. METHODS: This study used focus groups to collect experiences and views of patients with type 2 diabetes. A National Health Service (NHS) ethics committee approved this study. Pharmacists identified all patients with type 2 diabetes to whom they provided an information sheet and a consent form which included a request to supply basic demographic details. Focus group members were purposively sampled to gain a diverse range of opinions. Two researchers independently coded and thematically analyzed the transcripts. The researchers discussed the emergent themes to ensure all valid themes had been identified. RESULTS: Twenty-five participants attended one of 4 focus groups. Two broad themes were identified: the place of pharmacy in the wider primary care team and pharmacy as a healthcare destination. Participants who had been living with diabetes for a long time and those who felt they had received a lower level of care from the medical practice were more likely to acknowledge contributions of pharmacists in their care for advice on side effects, drug interactions and supply than participants with a good relationship with their general practitioner (GP) or practice nurse and whose diabetes was well controlled. CONCLUSIONS: Participants with type 2 diabetes identified a role for pharmacists in their care linked to their perceived expertise on medicines. However, the extent to which they would engage with the pharmacist depended on the quality of relationship with their GP or practice nurse.

An audit of prescribing for type 2 diabetes in primary care: optimising the role of the community pharmacist in the primary healthcare team.

The Government has identified that the pharmacist should have greater involvement in the management of long-term conditions. The aim of this audit was to determine the adherence to National Institute for Health and Clinical Excellence guidelines for type 2 diabetes patients and identify whether there is a potential role for pharmacists in their long-term management. All prescribing, in 194 patients, was within guidance for anti-hyperglycaemics. In all, 87.4% of patients prescribed an anti-hypertensive were prescribed an angiotensin-converting enzyme inhibitor or equivalent. A large number of patients remain uncontrolled with respect to blood glucose or blood pressure. There are four potential reasons for this: patients require additional therapy; current therapy has not been optimised; current therapy is not working; or the patient is not fully adherent. Therefore, there may be a role for the pharmacist either in therapy optimisation or improving patient adherence to current therapy in order to support more patients reaching national targets.

The views of pharmacists who participated in a community pharmacy randomised controlled trial.

OBJECTIVE: Examining case studies of research projects can prove useful to determine what design aspects can be changed to improve the robustness and feasibility of future projects. METHODS: Pharmacists who took part as research partners in a feasibility study of an eczema support service that failed to achieve its recruitment objectives were asked to attend a focus group to determine their views about factors that may have affected pharmacist recruitment rate. KEY FINDINGS: Pharmacists expressed positive opinions about being involved in research in principle and remaining engaged for further projects. However, they identified problems in their relationship with the medical practices, their unfamiliarity with this particular study design and the challenges this brought. They also experienced frustration from delays to the research timetable holding back their contribution to the research. CONCLUSION: In this case study, pharmacists described how and why they wanted a study process to be made as simple and easy as possible for the participants and themselves to engage in, so as to maintain their own and participants' engagement in studies.

Impact of active monitoring on lithium management in Norfolk.

BACKGROUND: Lithium has been used in the fields of rheumatology and psychiatry since the 1800s and it is now generally considered to be a gold standard treatment for bipolar disorders. However, lithium is known to have significant side effects and requires close serum level monitoring to ensure levels remain within the therapeutic range to minimize the risk of serious adverse effects or toxicity. This article reviews the monitoring of lithium and reports on the implementation of a regional lithium register and database within Norfolk. METHODS: Recorded blood results from the Norfolk lithium database were extracted for the first full year of operation across the region, 2005/6, and from the most recent full year 2011/12. The number of lithium monitoring tests, U&Es and thyroid function tests conducted on all people registered on the database were compared between the two sample years. RESULTS: In 2005/6 there were a significant number of people not receiving the recommended number of four or more serum lithium test per year (68.3%) and the majority of people had two or three tests (62%). By 2011/12 this had noticeably increased with the majority of patients having four or more tests per year (68.5%) and the number having only two or three tests reducing dramatically (26.4%). CONCLUSION: Improved rates of lithium testing and monitoring have been demonstrated since the introduction of the Norfolk database helping to achieve national targets. Consequently, the chances of adverse events from insufficient monitoring have been minimized.

A cost-consequences analysis of an adherence focused pharmacist-led medication review service.

OBJECTIVES: The aim of this project was to conduct an economic evaluation of the Norfolk Medicines Support Service (NMSS), a pharmacist-led medication review service for patients identified in primary care as non-adherent. METHODS: The cost-consequences analysis was based on a before and after evaluation of the NMSS. Participants completed a self-reported adherence and health-related quality of life questionnaire prior to the review, at 6 weeks and 6 months. Service provision, prescribing and secondary care costs were considered and the mean cost before and after the intervention was calculated. KEY FINDINGS: One-hundred and seventeen patients were included in the evaluation. The mean cost per patient of prescribing and hospital admissions in the 6 months prior to the intervention was £2190 and in the 6 months after intervention £1883. This equates to a mean cost saving of £307 per patient (parametric 95% confidence interval: £1269 to £655). The intervention reduced emergency hospital admissions and increased medication adherence but no significant change in health-related quality of life was observed. CONCLUSION: The costs of providing this medication review service were offset by the reduction in emergency hospital admissions and savings in medication cost, assuming the findings of the evaluation were real and the regression to the mean phenomenon was not involved. This cost-consequences approach provides a transparent descriptive summary for decision-makers to use as the basis for resource allocation decisions.