Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 36
Filtrar
1.
BMC Med Educ ; 24(1): 762, 2024 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-39010110

RESUMO

BACKGROUND: Competence in delirium care begins with pre-registration education for health care professionals. Although a common complication for hospitalised patients, delirium is avoidable and reversible. Delirium requires early recognition in person-centred care. Students need to learn how to identify and effectively care for 'at risk' patients. AIM: To identify and examine literature on how pre-registration health care professional students are prepared to recognise, assess, and deliver interventions to prevent delirium in practice, using digital/web based educational interventions. METHOD: Mixed methods systematic review with narrative synthesis. A protocol was registered with PROSPERO. The review questions and search strategy were guided by the Population, Phenomena of Interest, Context (PICo) framework. The PRISMA framework guided the screening, data extraction and analysis. Database searches (MEDLINE, Web of Science, Embase, CINAHL, Cochrane Central Register of Controlled Trials, PsycINFO & Scopus) were undertaken in April 2023 for publications from 2012 to 2023. Covidence software [30] was used to extract and manage the data. Quality appraisal was guided by the Crowe Critical Appraisal Tool (CCAT) [31]. FINDINGS: Ten papers were included: mixed methods (2), qualitative (1) and quantitative (7). Medical students were the most studied group (n = 5), followed by student nurses (n = 4) and mixed nursing and medical students (n = 1). Length of learning experience varied from 12 min virtual reality (VR) to a two-week 'geriatrics' elective. Learning was enhanced by player autonomy, engagement, safety, applicability, choices, multiple perspectives and moral reasoning opportunities. DISCUSSION: Digital programmes should be visually appealing, interactive with opportunities for practice and timely appropriate feedback.


Assuntos
Delírio , Humanos , Delírio/diagnóstico , Delírio/prevenção & controle , Delírio/terapia , Estudantes de Medicina , Competência Clínica , Educação a Distância , Pessoal de Saúde/educação
2.
BMC Med Educ ; 24(1): 677, 2024 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-38890662

RESUMO

BACKGROUND: Dementia is a prevalent global health issue, necessitating comprehensive education for healthcare practitioners and students. Nursing and pharmacy students, provide support across healthcare settings often working as frontline caregivers. Therefore, it is imperative to equip these students with a profound understanding of dementia. The aim of this study was to evaluate whether a serious dementia game co-designed with stakeholders, students, and people living with dementia improved the attitudes of nursing and pharmacy students. METHODS: A pretest-posttest design was used to assess the attitudes of health professions students (nursing and pharmacy) towards dementia. The Approaches to Dementia Questionnaire (ADQ) was administered before and after playing a serious Dementia Game. The ADQ measured the total score, Hope subscale, and Recognition of Personhood subscale. Matched pairs t-test was used for analysis conducted with IBM SPSS statistics 27. RESULTS: A diverse cohort of 505 participants from one university in Northern Ireland participated, with 461 matched pairs used for analysis. Both nursing and pharmacy students demonstrated a significant increase in overall dementia attitudes post-gameplay, with nursing students showing an increase from 79.69 to 83.59 and pharmacy students from 75.55 to 79.86. Subscales for Hope (Nursing = 28.77 to 31.22, Pharmacy = 26.65 to 29.20). and Recognition of Personhood also exhibited significant improvement (Nursing = 50.93 to 52.38, Pharmacy = 48.89 to 50.67). Demographic data revealed predominantly female participants, a lack of personal connections to dementia, and varied training experiences. DISCUSSION: The study highlights the efficacy of the serious Dementia Game in enhancing attitudes to dementia amongst health professions students, indicating its potential as an educational tool. The study contributes to the growing body of evidence supporting serious games and gamification in healthcare education.


Assuntos
Atitude do Pessoal de Saúde , Demência , Estudantes de Enfermagem , Humanos , Demência/enfermagem , Masculino , Feminino , Irlanda do Norte , Estudantes de Enfermagem/psicologia , Adulto , Estudantes de Farmácia/psicologia , Adulto Jovem , Conhecimentos, Atitudes e Prática em Saúde , Inquéritos e Questionários , Conscientização
3.
BMC Prim Care ; 25(1): 201, 2024 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-38844848

RESUMO

BACKGROUND: There is limited research examining the views of general practice pharmacists (GPPs) on their role and their impact in general practice. The aim of this study was to explore GPPs' views regarding this role and its potential impact within general practice in Northern Ireland (NI). METHODS: A paper-based self-administered questionnaire was mailed to 319 general practices in NI in 2022, directed to the GPP who spent most time at the practice. A variety of closed and open questions were included in six sections. Responses to closed questions were analysed descriptively whilst open question responses were analysed using content analysis. To ascertain associations between variables (e.g. GPP prescribing status, working arrangements and aspects of collaboration with GPPs), Fisher's exact test was employed with an a priori significance level of p < 0.05. RESULTS: 155 responses were received equating to a response rate of 48.5%. Most participants (72.3%) were female, independent prescribers (71%), and 64.5% were currently using their independent prescriber qualification. Services that were provided by most GPPs were medication reconciliation (99.4%) and medication reviews (97.4%). The most common method of communication between GPPs and general practitioners (GPs) was face-to-face (89.0%). Telephone was the most common method of communication between GPPs, community pharmacists (97.4%) and patients (98.7%). Most GPPs (> 80%) showed positive attitudes towards collaboration with GPs and those who worked in multiple practices were more likely to agree with the Attitudes Towards Collaboration Instrument for pharmacists (ATCI-P) statements compared to those who worked in a single practice (p < 0.05). Less than 40% (36.8%) of GPPs agreed that patients were aware of the role they provided. The majority of GPPs (80.6%) expressed positive views on their impact on primary care. Analysis of the free-text comments revealed the need for more GPP patient-facing activities, GPP-specific training, and promotion of the GPP role. CONCLUSION: The findings indicated that GPPs had largely positive views about their role and their impact on primary care. The results may be helpful for practices and service commissioners. Further research is necessary to explore the perspectives of patients regarding the role of the GPP and to enhance patients' awareness of the GPP.


Assuntos
Atitude do Pessoal de Saúde , Medicina Geral , Farmacêuticos , Papel Profissional , Humanos , Irlanda do Norte , Estudos Transversais , Feminino , Farmacêuticos/psicologia , Masculino , Papel Profissional/psicologia , Inquéritos e Questionários , Adulto , Pessoa de Meia-Idade
4.
Age Ageing ; 53(5)2024 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-38706393

RESUMO

BACKGROUND: Community pharmacists potentially have an important role to play in identification of frailty and delivery of interventions to optimise medicines use for frail older adults. However, little is known about their knowledge or views about this role. AIM: To explore community pharmacists' knowledge of frailty and assessment, experiences and contact with frail older adults, and perceptions of their role in optimising medicines use for this population. METHODS: Semi-structured interviews conducted between March and December 2020 with 15 community pharmacists in Northern Ireland. Interviews were transcribed verbatim and analysed thematically. RESULTS: Three broad themes were generated from the data. The first, 'awareness and understanding of frailty', highlighted gaps in community pharmacists' knowledge regarding presentation and identification of frailty and their reluctance to broach potentially challenging conversations with frail older patients. Within the second theme, 'problem-solving and supporting medication use', community pharmacists felt a large part of their role was to resolve medicines-related issues for frail older adults through collaboration with other primary healthcare professionals but feedback on the outcome was often not provided upon issue resolution. The third theme, 'seizing opportunities in primary care to enhance pharmaceutical care provision for frail older adults', identified areas for further development of the community pharmacist role. CONCLUSIONS: This study has provided an understanding of the views and experiences of community pharmacists about frailty. Community pharmacists' knowledge deficits about frailty must be addressed and their communication skills enhanced so they may confidently initiate conversations about frailty and medicines use with older adults.


Assuntos
Serviços Comunitários de Farmácia , Idoso Fragilizado , Farmacêuticos , Papel Profissional , Humanos , Idoso , Idoso Fragilizado/psicologia , Masculino , Feminino , Irlanda do Norte , Conhecimentos, Atitudes e Prática em Saúde , Atitude do Pessoal de Saúde , Entrevistas como Assunto , Fragilidade/psicologia , Fragilidade/diagnóstico , Fragilidade/tratamento farmacológico , Pessoa de Meia-Idade , Adulto , Pesquisa Qualitativa
5.
BMC Health Serv Res ; 24(1): 534, 2024 Apr 26.
Artigo em Inglês | MEDLINE | ID: mdl-38671437

RESUMO

BACKGROUND: People with vision impairment encounter many difficulties when it comes to medicines use. However, evidence indicates that there are major gaps in pharmaceutical care service provision worldwide and limited research on interventions to optimise medication use for this patient population. The Theoretical Domains Framework (TDF) provides a method for theoretically understanding individuals' behaviour and informing development of interventions. The aim of this research was to (a) identify the barriers and facilitators to the provision of medication dispensing and counselling services by pharmacists to patients with vision impairment, and (b) identify key TDF domains to be targeted in a future intervention. METHODS: Semi-structured interviews were conducted with pharmacists from different pharmacy practice settings/areas in Saudi Arabia. The 14-domain TDF was utilised as the theoretical lens through which pharmacists' behaviours were examined. Interviews were conducted in Arabic or English, either face-to-face or over the telephone based on the participant's preference. Following transcription, interviews conducted in Arabic were translated into English before analysis. Data analysis involved using the framework method and content analysis to identify important barriers and facilitators to the provision of dispensing and counselling services to those with vision impairment. Key TDF domains that could be targeted in a future intervention were then identified using a consensus-based approach. RESULTS: Twenty-six pharmacists were interviewed. Pharmacists' experience in pharmacy practice ranged from two to 28 years. A range of barriers and facilitators were highlighted as important in providing services to those with vision impairment. Eight domains were identified as 'key domains' including: 'Knowledge', 'Skills', 'Beliefs about capabilities', 'Goals', 'Memory, attention, and decision processes', 'Environmental context and resources', 'Social influences', and 'Behavioural regulation'. CONCLUSIONS: Barriers and facilitators identified by pharmacists will inform the development of an intervention to ensure its applicability to everyday practice. Future research will focus on the process of developing the proposed intervention through targeting key TDF domains to improve medication dispensing and counselling by pharmacists to patients with vision impairment.


Assuntos
Aconselhamento , Entrevistas como Assunto , Farmacêuticos , Pesquisa Qualitativa , Humanos , Farmacêuticos/psicologia , Masculino , Feminino , Arábia Saudita , Aconselhamento/métodos , Adulto , Transtornos da Visão/tratamento farmacológico , Transtornos da Visão/psicologia , Pessoa de Meia-Idade , Atitude do Pessoal de Saúde
6.
BMC Med Educ ; 24(1): 475, 2024 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-38689311

RESUMO

BACKGROUND: Delirium is a common symptom of acute illness which is potentially avoidable with early recognition and intervention. Despite being a growing concern globally, delirium remains underdiagnosed and poorly reported, with limited understanding of effective delirium education for undergraduate health profession students. Digital resources could be an effective approach to improving professional knowledge of delirium, but studies utilising these with more than one profession are limited, and no evidence-based, interdisciplinary, digital delirium education resources are reported. This study aims to co-design and evaluate a digital resource for undergraduate health profession students across the island of Ireland to improve their ability to prevent, recognise, and manage delirium alongside interdisciplinary colleagues. METHODS: Utilising a logic model, three workstreams have been identified. Workstream 1 will comprise three phases: (1) a systematic review identifying the format, methods, and content of existing digital delirium education interventions for health profession students, and their effect on knowledge, self-efficacy, and behavioural change; (2) focus groups with health profession students to determine awareness and experiences of delirium care; and (3) a Delphi survey informed by findings from the systematic review, focus groups, and input from the research team and expert reference group to identify resource priorities. Workstream 2 will involve the co-design of the digital resource through workshops (n = 4) with key stakeholders, including health profession students, professionals, and individuals with lived experience of delirium. Lastly, Workstream 3 will involve a mixed methods evaluation of the digital resource. Outcomes include changes to delirium knowledge and self-efficacy towards delirium care, and health profession students experience of using the resource. DISCUSSION: Given the dearth of interdisciplinary educational resources on delirium for health profession students, a co-designed, interprofessional, digital education resource will be well-positioned to shape undergraduate delirium education. This research may enhance delirium education and the self-efficacy of future health professionals in providing delirium care, thereby improving practice and patients' experiences and outcomes. TRIAL REGISTRATION: Not applicable.


Assuntos
Delírio , Grupos Focais , Humanos , Delírio/diagnóstico , Delírio/terapia , Delírio/prevenção & controle , Irlanda , Técnica Delphi , Estudantes de Ciências da Saúde , Educação de Graduação em Medicina , Conhecimentos, Atitudes e Prática em Saúde
7.
BMC Geriatr ; 24(1): 328, 2024 Apr 10.
Artigo em Inglês | MEDLINE | ID: mdl-38600444

RESUMO

BACKGROUND: Studies have shown that potentially inappropriate prescribing (PIP) is highly prevalent among people with dementia (PwD) and linked to negative outcomes, such as hospitalisation and mortality. However, there are limited data on prescribing appropriateness for PwD in Saudi Arabia. Therefore, we aimed to estimate the prevalence of PIP and investigate associations between PIP and other patient characteristics among PwD in an ambulatory care setting. METHODS: A cross-sectional, retrospective analysis was conducted at a tertiary hospital in Saudi Arabia. Patients who were ≥ 65 years old, had dementia, and visited ambulatory care clinics between 01/01/2019 and 31/12/2021 were included. Prescribing appropriateness was evaluated by applying the Screening Tool of Older Persons Potentially Inappropriate Prescriptions (STOPP) criteria. Descriptive analyses were used to describe the study population. Prevalence of PIP and the prevalence per each STOPP criterion were calculated as a percentage of all eligible patients. Logistic regression analysis was used to investigate associations between PIP, polypharmacy, age and sex; odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. Analyses were conducted using SPSS v27. RESULTS: A total of 287 PwD were identified; 56.0% (n = 161) were female. The mean number of medications prescribed was 9.0 [standard deviation (SD) ± 4.2]. The prevalence of PIP was 61.0% (n = 175). Common instances of PIP were drugs prescribed beyond the recommended duration (n = 90, 31.4%), drugs prescribed without an evidence-based clinical indication (n = 78, 27.2%), proton pump inhibitors (PPIs) for > 8 weeks (n = 75, 26.0%), and acetylcholinesterase inhibitors with concurrent drugs that reduce heart rate (n = 60, 21.0%). Polypharmacy was observed in 82.6% (n = 237) of patients and was strongly associated with PIP (adjusted OR 24.1, 95% CI 9.0-64.5). CONCLUSIONS: Findings have revealed a high prevalence of PIP among PwD in Saudi Arabia that is strongly associated with polypharmacy. Future research should aim to explore key stakeholders' experiences and perspectives of medicines management to optimise medication use for this vulnerable patient population.


Assuntos
Demência , Prescrição Inadequada , Humanos , Feminino , Idoso , Idoso de 80 Anos ou mais , Masculino , Prescrição Inadequada/prevenção & controle , Estudos Retrospectivos , Estudos Transversais , Acetilcolinesterase/uso terapêutico , Lista de Medicamentos Potencialmente Inapropriados , Polimedicação , Demência/diagnóstico , Demência/tratamento farmacológico , Demência/epidemiologia
8.
Cochrane Database Syst Rev ; 10: CD008165, 2023 10 11.
Artigo em Inglês | MEDLINE | ID: mdl-37818791

RESUMO

BACKGROUND: Inappropriate polypharmacy is a particular concern in older people and is associated with negative health outcomes. Choosing the best interventions to improve appropriate polypharmacy is a priority, so that many medicines may be used to achieve better clinical outcomes for patients. This is the third update of this Cochrane Review. OBJECTIVES: To assess the effects of interventions, alone or in combination, in improving the appropriate use of polypharmacy and reducing medication-related problems in older people. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, CINAHL and two trials registers up until 13 January 2021, together with handsearching of reference lists to identify additional studies. We ran updated searches in February 2023 and have added potentially eligible studies to 'Characteristics of studies awaiting classification'. SELECTION CRITERIA: For this update, we included randomised trials only. Eligible studies described interventions affecting prescribing aimed at improving appropriate polypharmacy (four or more medicines) in people aged 65 years and older, which used a validated tool to assess prescribing appropriateness. These tools can be classified as either implicit tools (judgement-based/based on expert professional judgement) or explicit tools (criterion-based, comprising lists of drugs to be avoided in older people). DATA COLLECTION AND ANALYSIS: Four review authors independently reviewed abstracts of eligible studies, and two authors extracted data and assessed the risk of bias of the included studies. We pooled study-specific estimates, and used a random-effects model to yield summary estimates of effect and 95% confidence intervals (CIs). We assessed the overall certainty of evidence for each outcome using the GRADE approach. MAIN RESULTS: We identified 38 studies, which includes an additional 10 in this update. The included studies consisted of 24 randomised trials and 14 cluster-randomised trials. Thirty-six studies examined complex, multi-faceted interventions of pharmaceutical care (i.e. the responsible provision of medicines to improve patients' outcomes), in a variety of settings. Interventions were delivered by healthcare professionals such as general physicians, pharmacists, nurses and geriatricians, and most were conducted in high-income countries. Assessments using the Cochrane risk of bias tool found that there was a high and/or unclear risk of bias across a number of domains. Based on the GRADE approach, the overall certainty of evidence for each pooled outcome ranged from low to very low. It is uncertain whether pharmaceutical care improves medication appropriateness (as measured by an implicit tool) (mean difference (MD) -5.66, 95% confidence interval (CI) -9.26 to -2.06; I2 = 97%; 8 studies, 947 participants; very low-certainty evidence). It is uncertain whether pharmaceutical care reduces the number of potentially inappropriate medications (PIMs) (standardised mean difference (SMD) -0.19, 95% CI -0.34 to -0.05; I2 = 67%; 9 studies, 2404 participants; very low-certainty evidence). It is uncertain whether pharmaceutical care reduces the proportion of patients with one or more PIM (risk ratio (RR) 0.81, 95% CI 0.68 to 0.98; I2 = 84%; 13 studies, 4534 participants; very low-certainty evidence). Pharmaceutical care may slightly reduce the number of potential prescribing omissions (PPOs) (SMD -0.48, 95% CI -1.05 to 0.09; I2 = 92%; 3 studies, 691 participants; low-certainty evidence), however it must be noted that this effect estimate is based on only three studies, which had serious limitations in terms of risk of bias. Likewise, it is uncertain whether pharmaceutical care reduces the proportion of patients with one or more PPO (RR 0.50, 95% CI 0.27 to 0.91; I2 = 95%; 7 studies, 2765 participants; very low-certainty evidence). Pharmaceutical care may make little or no difference to hospital admissions (data not pooled; 14 studies, 4797 participants; low-certainty evidence). Pharmaceutical care may make little or no difference to quality of life (data not pooled; 16 studies, 7458 participants; low-certainty evidence). Medication-related problems were reported in 10 studies (6740 participants) using different terms (e.g. adverse drug reactions, drug-drug interactions). No consistent intervention effect on medication-related problems was noted across studies. This also applied to studies examining adherence to medication (nine studies, 3848 participants). AUTHORS' CONCLUSIONS: It is unclear whether interventions to improve appropriate polypharmacy resulted in clinically significant improvement. Since the last update of this review in 2018, there appears to have been an increase in the number of studies seeking to address potential prescribing omissions and more interventions being delivered by multidisciplinary teams.


Assuntos
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Assistência Farmacêutica , Humanos , Idoso , Polimedicação , Qualidade de Vida , Hospitalização
9.
Br J Gen Pract ; 73(731): e407-e417, 2023 06.
Artigo em Inglês | MEDLINE | ID: mdl-37230784

RESUMO

BACKGROUND: Practice-based pharmacists (PBPs) have been introduced into general practice across the UK to relieve some of the pressures within primary care. However, there is little existing UK literature that has explored healthcare professionals' (HCPs') views about PBP integration and how this role has evolved. AIM: To explore the views and experiences of GPs, PBPs, and community pharmacists (CPs) about PBPs' integration into general practice and their impact on primary healthcare delivery. DESIGN AND SETTING: A qualitative interview study in primary care in Northern Ireland. METHOD: Purposive and snowball sampling were used to recruit triads (a GP, a PBP, and a CP) from across five administrative healthcare areas in Northern Ireland. Sampling of practices to recruit GPs and PBPs commenced in August 2020. These HCPs identified the CPs who had most contact with the general practices in which the recruited GPs and PBPs were working. Semi-structured interviews were recorded, transcribed verbatim, and analysed using thematic analysis. RESULTS: Eleven triads were recruited from across the five administrative areas. Four main themes in relation to PBPs' integration into general practices were revealed: evolution of the role; PBP attributes; collaboration and communication; and impact on care. Areas for development were identified such as patient awareness of the PBP role. Many saw PBPs as a 'central hub-middleman' between general practice and community pharmacies. CONCLUSION: Participants reported that PBPs had integrated well and perceived a positive impact on primary healthcare delivery. Further work is needed to increase patient awareness of the PBP role.


Assuntos
Medicina Geral , Clínicos Gerais , Humanos , Farmacêuticos , Pesquisa Qualitativa , Medicina de Família e Comunidade , Atitude do Pessoal de Saúde
10.
J Am Geriatr Soc ; 71(8): 2462-2475, 2023 08.
Artigo em Inglês | MEDLINE | ID: mdl-36942992

RESUMO

BACKGROUND: A concern with long-term opioid use is the increased risk arising when opioids are used concurrently with drugs that can potentiate their associated adverse effects. The drugs most often encountered are benzodiazepines (BZDs) and gabapentinoids. Our study objectives were to examine trends in the concurrent use of opioids and BZDs, or gabapentinoids, in a Canadian nursing home population over an 11-year period, and current resident-level correlates of this concurrent use. METHODS: We conducted a population-based, repeated cross-sectional study among Ontario nursing home residents (>65 years) dispensed opioids between April 2009 and February 2020. For the last study year, we examined cross-sectional associations between resident characteristics and concurrent use of opioids with BZDs or gabapentinoids. Linked data on nursing home residents from clinical and health administrative databases was used. The yearly proportions of residents who were dispensed an opioid concurrently with a BZD or gabapentinoid were plotted with percent change derived from log-binomial regression models. Separate modified Poisson regression models estimated resident-level correlates of concurrent use of opioids with BZDs or gabapentinoids. RESULTS: Over the study period, among residents dispensed an opioid there was a 53.2% relative decrease (30.7% to 14.4%) in concurrent BZD and a 505.4% relative increase (4.4% to 26.6%) in concurrent gabapentinoid use. In adjusted models, increasing age and worsening cognition were inversely associated with the concurrent use of both classes, but most other significantly related covariates were unique to each drug class (e.g., sex and anxiety disorders for BZD, pain severity and presence of pain-related conditions for gabapentinoids). CONCLUSIONS: Co-administration of BZDs or gabapentinoids in Ontario nursing home residents dispensed opioids remains common, but the pattern of co-use has changed over time. Observed covariates of concurrent use in 2019/20 suggest distinct but overlapping resident populations requiring consideration of the relative risks versus benefits of this co-use and monitoring for potential harm.


Assuntos
Analgésicos Opioides , Benzodiazepinas , Humanos , Analgésicos Opioides/efeitos adversos , Benzodiazepinas/efeitos adversos , Estudos Transversais , Ontário/epidemiologia , Casas de Saúde
11.
Res Social Adm Pharm ; 19(4): 628-633, 2023 04.
Artigo em Inglês | MEDLINE | ID: mdl-36641297

RESUMO

BACKGROUND: With increasing numbers of pharmacists working in general practices and undertaking patient-facing roles, it has been recognised that they must have the necessary clinical skills. However, previous studies have highlighted that practice-based pharmacists (PBPs) do not feel confident regarding their clinical skills, and it is unclear what skills are needed. OBJECTIVE: To develop a core set of clinical skills (CSs) required for pharmacists who intend to practise as independent prescribers working in general practice/family medicine. METHODS: Based on a previous study, 18 CSs were selected for inclusion in a three-round Delphi consensus questionnaire. These skills were rated by a Delphi panel on a 9-point Likert scale (ranging from 1 = limited importance to 9 = critical). The Delphi panel comprised designated leads of pharmacist independent prescribing programmes in each United Kingdom educational provider listed on the General Pharmaceutical Council website. A CS was included in the core set if 80% or more of participants scored between 7 and 9, and 15% or less scored between 1 and 3. RESULTS: Following Round 1, seven CSs met the criteria for inclusion: 'Measuring heart rate (radial pulse)', 'Assessing respiratory rate', 'Measuring blood pressure (manual, e.g. with aneroid sphygmomanometer)', 'Measuring blood pressure (automated, i.e. electronic blood pressure monitor)', 'Measuring peripheral oxygen saturation (using pulse oximeter)', 'Measuring temperature', 'Measuring Peak Expiratory Flow Rate'. After two further rounds, a further four CSs were included consisting of 'Undertaking a urinalysis', 'Respiratory examination (includes inspection, palpation, percussion and listening to breath sounds)', 'Screening for/assessment of depression and anxiety using a validated questionnaire (e.g. Patient Health Questionnaire-9 [PHQ-9] scoring)', and 'Patient assessment via National Early Warning Score (NEWS)'. No consensus was reached on nine CSs. CONCLUSION: This study has produced a core set of CSs for prescribing pharmacists. This study may contribute to standardisation of training and assessment for pharmacist prescribers working in general practice/family medicine.


Assuntos
Competência Clínica , Medicina Geral , Humanos , Medicina de Família e Comunidade , Farmacêuticos , Técnica Delphi
12.
Pilot Feasibility Stud ; 8(1): 203, 2022 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-36088445

RESUMO

BACKGROUND: For older populations with multimorbidity, polypharmacy (use of multiple medications) is a standard practice. PolyPrime is a theory-based intervention developed to improve appropriate polypharmacy in older people in primary care. This pilot study aims to assess the feasibility of the PolyPrime intervention in primary care in Northern Ireland (NI) and the Republic of Ireland (ROI). METHODS: This external pilot cluster randomised controlled trial (cRCT) aimed to recruit 12 general practitioner (GP) practices (six in NI; six in the ROI counties that border NI) and ten older patients receiving polypharmacy (≥ 4 medications) per GP practice (n = 120). Practices allocated to the intervention arm watched an online video and scheduled medication reviews with patients on two occasions. We assessed the feasibility of collecting GP record (medication appropriateness, health service use) and patient self-reported data [health-related quality of life (HRQoL), health service use)] at baseline, 6 and 9 months. HRQoL was measured using the EuroQol-5 dimension-5 level questionnaire (EQ-5D-5L) and medication-related burden quality-of-life (MRB-QoL) tool. An embedded process evaluation and health economics analysis were also undertaken. Pre-specified progression criteria were used to determine whether to proceed to a definitive cRCT. RESULTS: Twelve GP practices were recruited and randomised. Three GP practices withdrew from the study due to COVID-related factors. Sixty-eight patients were recruited, with 47 (69.1%) being retained until the end of the study. GP record data were available for 47 patients for medication appropriateness analysis at 9 months. EQ-5D-5L and MRB-QoL data were available for 46 and 41 patients, respectively, at 9 months. GP record and patient self-reported health service use data were available for 47 patients at 9 months. Health service use was comparable in terms of overall cost estimated from GP record versus patient self-reported data. The intervention was successfully delivered as intended; it was acceptable to GPs, practice staff, and patients; and potential mechanisms of action have been identified. All five progression criteria were met (two 'Go', three 'Amend'). CONCLUSION: Despite challenges faced during the COVID-19 pandemic, this study has demonstrated that it may be feasible to conduct an intervention to improve appropriate polypharmacy in older people in primary care across two healthcare jurisdictions. TRIAL REGISTRATION: ISRCTN, ISRCTN41009897 . Registered 19 November 2019. CLINICALTRIALS: gov, NCT04181879 . Registered 02 December 2019.

13.
BMJ Open ; 12(9): e064545, 2022 09 22.
Artigo em Inglês | MEDLINE | ID: mdl-36137621

RESUMO

OBJECTIVES: To examine the views and experiences of community pharmacists in Northern Ireland (NI) regarding changes in community pharmacy practice/processes in preparation for, and response to, the COVID-19 pandemic. DESIGN: Cross-sectional telephone-administered questionnaire. SETTING AND PARTICIPANTS: Geographically stratified representative sample of 130 community pharmacists in NI between March and May 2021. OUTCOME MEASURES: Community pharmacists' responses to questions focusing on their preparation, experience and response to the COVID-19 pandemic. Descriptive analysis was conducted including frequencies and percentages. Free-text comments were summarised using thematic analysis. RESULTS: One hundred and thirty pharmacists completed the questionnaire. Pharmacists responded comprehensively to implementing infection control measures, for example, management of social distancing in the shop (96.2%), making adjustments to premises, for example, barriers/screens (95.4%), while maintaining medicines supply (100.0%) and advice to patients (93.1%). Newly commissioned services were provided, for example, emergency supply service (93.1%), influenza vaccination for healthcare workers (77.7%) and volunteer deliveries to vulnerable people (54.6%). Pharmacists were least prepared for the increased workload and patients' challenging behaviour, but the majority (96.9%) reported that they felt better prepared during the second wave. Pharmacists agreed/strongly agreed that they would be able to re-establish normal services (87.7%), were willing to administer COVID-19 vaccines (80.7%) and provide COVID-19 testing (60.8%) in the future. CONCLUSIONS: Community pharmacists remained accessible and maintained supply of essential medicines and advice to patients throughout the pandemic. Provision of modified and additional services such as vaccination reinforced the clinical and public health role of pharmacy.


Assuntos
COVID-19 , Serviços Comunitários de Farmácia , Atitude do Pessoal de Saúde , COVID-19/epidemiologia , COVID-19/prevenção & controle , Teste para COVID-19 , Vacinas contra COVID-19 , Estudos Transversais , Humanos , Irlanda do Norte/epidemiologia , Pandemias , Farmacêuticos , Papel Profissional , Inquéritos e Questionários
14.
BMJ Open ; 12(9): e064549, 2022 09 22.
Artigo em Inglês | MEDLINE | ID: mdl-36137632

RESUMO

OBJECTIVES: To explore community pharmacists and key stakeholders' perspectives and reflections on the community pharmacy workforce's preparedness for, and response to, COVID-19, including lessons for future public health crises. DESIGN, SETTING AND PARTICIPANTS: Qualitative study using semistructured interviews (via telephone or online videoconferencing platform), with community pharmacists and a range of key stakeholders (representing other health professions, professional/governing organisations concerned with community pharmacy and patient advocacy groups) from across Northern Ireland. Data were analysed using thematic analysis and constant comparison. RESULTS: Thirty interviews were conducted with community pharmacists (n=15) and key stakeholders (n=15). Four themes were identified: (1) adaptation and adjustment (reflecting how community responded quickly to the need to maintain services and adjusted and adapted services accordingly); (2) the primary point of contact (the continuing accessibility of community pharmacy when other services were not available and role as a communication hub, particularly in relation to information for patients and maintaining contact with other healthcare professionals); (3) lessons learnt (the flexibility of community pharmacy, the lack of infrastructure, especially in relation to information technology, and the need to build on the pandemic experience to develop practice); and (4) planning for the future (better infrastructure which reinforced concerns about poor technology, coordination of primary care services and preparing for the next public health crisis). There was a general view that community pharmacy needed to build on what had been learnt to advance the role of the profession. CONCLUSIONS: The strengths of community pharmacy and its contribution to healthcare services in the COVID-19 pandemic were noted by community pharmacists and acknowledged by key stakeholders. The findings from this study should inform the policy debate on community pharmacy and its contribution to the public health agenda.


Assuntos
COVID-19 , Serviços Comunitários de Farmácia , Farmácias , COVID-19/epidemiologia , Atenção à Saúde , Humanos , Irlanda do Norte/epidemiologia , Pandemias , Farmacêuticos , Papel Profissional
15.
Int J Pharm Pract ; 30(4): 297-304, 2022 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-35532337

RESUMO

OBJECTIVES: To identify studies that delivered an intervention to frail older people to improve medicines optimisation; identify the outcomes reported in these studies; and assess the effectiveness of these interventions on chosen study outcomes. METHOD: Eight electronic databases and four trial registries were systematically searched from the date of inception to April 2020. Inclusion criteria were randomised controlled trials and non-randomised studies of interventions to improve medicines optimisation (including administration, adherence, deprescribing, prescribing and/or medication review) in community-dwelling older people (aged ≥65 years) with a frailty diagnosis. Only studies published in English were included. A narrative synthesis was conducted, and quality was assessed using an appropriate risk of bias tool. KEY FINDINGS: Searches identified 601 articles; one study met the criteria for inclusion. The single eligible study used a quasi-experimental pre-test-post-test study design to evaluate the impact of a pharmacist-led, team-based medication review for 54 frail older patients living in primary care. Improvements in the total number of medications and prescribing appropriateness were observed. The study was judged to be at an overall serious risk of bias. CONCLUSION: There is a dearth of high-quality evidence demonstrating the effectiveness of medicines optimisation interventions for older people with frailty within primary care. Due to the strong association between patients' level of frailty and adverse outcomes, it is important that future research focuses on proactive interventions which may be beneficial to this patient population.


Assuntos
Fragilidade , Idoso , Fragilidade/tratamento farmacológico , Humanos , Vida Independente , Preparações Farmacêuticas , Farmacêuticos , Atenção Primária à Saúde
16.
Int J Geriatr Psychiatry ; 37(6)2022 Apr 27.
Artigo em Inglês | MEDLINE | ID: mdl-35524704

RESUMO

OBJECTIVE: This systematic review aimed to assess the types and effectiveness of interventions that sought to reduce anticholinergic burden (ACB) in people with dementia (PwD) in primary care. METHODS: One trial registry and eight electronic databases were systematically searched to identify eligible English language studies from inception until December 2021. To be eligible for inclusion, studies had to be randomised controlled trials (RCTs) or non-randomised studies (NRS), including controlled before-and-after studies and interrupted time-series studies, of interventions to reduce ACB in PwD aged ≥65 years (either community-dwelling or care home residents). All outcomes were to be considered. Quality was to be assessed using the Cochrane Risk of Bias tool for RCTs and ROBINS-I tool for NRS. If data could not be pooled for meta-analysis, a narrative synthesis was to be conducted. RESULTS: In total, 1880 records were found, with 1594 records remaining after removal of duplicates. Following title/abstract screening, 13 full-text articles were assessed for eligibility. None of these studies met the inclusion criteria for this review. Reasons for exclusion were incorrect study design, ineligible study population, lack of focus on reducing ACB, and studies conducted outside the primary care setting. CONCLUSIONS: This 'empty' systematic review highlights the lack of interventions to reduce ACB in PwD within primary care, despite this being highlighted as a priority area for research in recent clinical guidance. Future research should focus on development and testing of interventions to reduce ACB in this patient population through high-quality clinical trials.

17.
BMC Prim Care ; 23(1): 6, 2022 01 14.
Artigo em Inglês | MEDLINE | ID: mdl-35172734

RESUMO

BACKGROUND: There is limited United Kingdom (UK) literature on general practice-based pharmacists' (PBPs') role evolution and few studies have explored general practitioners' (GPs') experiences on pharmacist integration into general practice. Therefore, this study aimed to investigate GPs' experiences with, views of, and attitudes towards PBPs in Northern Ireland (NI). METHODS: A paper-based self-administered questionnaire comprising four sections was mailed in 2019 to 329 general practices across NI and was completed by one GP in every practice who had most contact with the PBP. Descriptive analyses were used and responses to open-ended questions were analysed thematically. RESULTS: The response rate was 61.7% (203/329). There was at least one PBP per general practice. All GPs had face-to-face meetings with PBPs, with three-quarters (78.7%, n = 159) meeting with the PBP more than once a week. Approximately two-thirds of GPs (62.4%, n = 126) reported that PBPs were qualified as independent prescribers, and 76.2% of these (n = 96/126) indicated that prescribers were currently prescribing for patients. The majority of GPs reported that PBPs always/very often had the required clinical skills (83.6%, n = 162) and knowledge (87.0%, n = 167) to provide safe and effective care for patients. However, 31.1% (n = 61) stated that PBPs only sometimes had the confidence to make clinical decisions. The majority of GPs (> 85%) displayed largely positive attitudes towards collaboration with PBPs. Most GPs agreed/strongly agreed that PBPs will have a positive impact on patient outcomes (95.0%, n = 192) and can provide a better link between general practices and community pharmacists (96.1%, n = 194). However, 24.8% of GPs (n = 50) were unclear if the PBP role moved community pharmacists to the periphery of the primary care team. An evaluation of the free-text comments indicated that GPs were in favour of more PBP sessions and full-time posts. CONCLUSION: Most GPs had positive views of, and attitudes towards, PBPs. The findings may have implications for future developments in order to extend integration of PBPs within general practice, including the enhancement of training in clinical skills and decision-making. Exploring PBPs', community pharmacists' and patients' views of this role in general practice is required to corroborate study findings.


Assuntos
Medicina Geral , Clínicos Gerais , Atitude do Pessoal de Saúde , Estudos Transversais , Humanos , Farmacêuticos
18.
Trials ; 22(1): 449, 2021 Jul 14.
Artigo em Inglês | MEDLINE | ID: mdl-34261527

RESUMO

BACKGROUND: The PolyPrime intervention is a theory-based intervention aimed at improving appropriate polypharmacy in older people (aged ≥65 years) in primary care. The intervention consists of an online video which demonstrates how general practitioners (GPs) can prescribe appropriate polypharmacy during a consultation with an older patient and a patient recall process, whereby patients are invited to scheduled medication review consultations with GPs. The aim of the process evaluation is to further examine the implementation of the PolyPrime intervention in primary care. This will involve investigating whether the PolyPrime intervention can be delivered as intended across two healthcare systems, how acceptable the intervention is to GPs, practice staff and patients, and to identify the intervention's likely mechanisms of action. METHODS: The PolyPrime study is an external pilot cluster randomised controlled trial (cRCT) which aims to recruit 12 GP practices across Northern Ireland [NI] (n=6) and the six counties in the Republic of Ireland (ROI) that border NI (n=6). Practices have been randomised to intervention or usual care. An embedded process evaluation will assess intervention fidelity (i.e. was the intervention delivered as intended), acceptability of the intervention to GPs, practice staff and patients and potential mechanisms of action (i.e. what components of the intervention were perceived to be effective). Quantitative data will be collected from data collection forms completed by GPs and practice staff and a feedback questionnaire completed by patients from intervention arm practices, which will be analysed using descriptive statistics. Qualitative data will be collected through semi-structured interviews with GPs and practice staff and audio-recordings of medication review appointments from the intervention arm practices which will be transcribed and analysed using the framework method. Quantitative and qualitative data will be triangulated to provide an overall assessment of intervention fidelity, intervention acceptability, and mechanisms of action. DISCUSSION: This process evaluation will add to feasibility data from the pilot cRCT by providing evidence on the fidelity of implementing the intervention package across two healthcare systems, the acceptability of the intervention and potential mechanisms of action. TRIAL REGISTRATION: ClinicalTrials.gov ISRCTN41009897 . Registered on 19 November 2019. ClinicalTrials.gov NCT04181879 . Registered 02 December 2019.


Assuntos
Clínicos Gerais , Polimedicação , Idoso , Humanos , Irlanda do Norte , Atenção Primária à Saúde , Ensaios Clínicos Controlados Aleatórios como Assunto , Encaminhamento e Consulta
19.
Curr Epidemiol Rep ; 8(3): 108-115, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34306966

RESUMO

PURPOSE OF REVIEW: The global phenomenon of population aging is impacting the health and care needs of society. The use of medications by older adults is acknowledged to be the most common form of medical intervention for many acute and chronic conditions and prescribing in this population continues to increase. In this narrative review, we summarise the age-related factors that should be considered when prescribing for older adults, address some of the perennial challenges related to medicine use in older people, and highlight important emerging research in this area. RECENT FINDINGS: A range of age-related factors should be considered when prescribing for older adults. However, the evidence base still lacks data pertaining to older adults due to their continued under-representation in clinical trials. Multimorbidity, polypharmacy, and inappropriate prescribing continue to remain prevalent among older adults, although recent research has been focused on the development and evaluation of complex interventions to address these challenges. SUMMARY: Further high-quality studies of interventions to improve and support medication use in older adults are needed, ensuring that older adults are well represented in such trials and consideration is given to the measurement of patient- and provider-focused outcomes.

20.
Pilot Feasibility Stud ; 7(1): 77, 2021 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-33741071

RESUMO

BACKGROUND: The use of multiple medications (polypharmacy) is a concern in older people (≥65 years) and is associated with negative health outcomes. For older populations with multimorbidity, polypharmacy is the reality and the key challenge is ensuring appropriate polypharmacy (as opposed to inappropriate polypharmacy). This external pilot cluster randomised controlled trial (cRCT) aims to further test a theory-based intervention to improve appropriate polypharmacy in older people in primary care in two jurisdictions, Northern Ireland (NI) and the Republic of Ireland (ROI). METHODS: Twelve GP practices across NI (n=6) and the six counties in the ROI that border NI will be randomised to either the intervention or usual care group. Members of the research team have developed an intervention to improve appropriate polypharmacy in older people in primary care using the Theoretical Domains Framework of behaviour change. The intervention consists of two components: (1) an online video which demonstrates how a GP may prescribe appropriate polypharmacy during a consultation with an older patient and (2) a patient recall process, whereby patients are invited to scheduled medication review consultations with GPs. Ten older patients receiving polypharmacy (≥4 medications) will be recruited per GP practice (n=120). GP practices allocated to the intervention arm will be asked to watch the online video and schedule medication reviews with patients on two occasions; an initial and a 6-month follow-up appointment. GP practices allocated to the control arm will continue to provide usual care to patients. The study will assess the feasibility of recruitment, retention and study procedures including collecting data on medication appropriateness (from GP records), quality of life and health service use (i.e. hospitalisations). An embedded process evaluation will assess intervention fidelity (i.e. was the intervention delivered as intended), acceptability of the intervention and potential mechanisms of action. DISCUSSION: This pilot cRCT will provide evidence of the feasibility of a range of study parameters such as recruitment and retention, data collection procedures and the acceptability of the intervention. Pre-specified progression criteria will also be used to determine whether or not to proceed to a definitive cRCT. TRIAL REGISTRATION: ISRCTN, ISRCTN41009897 . Registered 19 November 2019. ClinicalTrials.gov, NCT04181879 . Registered 02 December 2019.

SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA