The community pharmacy setting for diabetes prevention: A mixed methods study in people with 'pre-diabetes'.

BACKGROUND: Diabetes Prevention Programs (DPPs) comprising intensive lifestyle interventions may delay or even prevent the onset of type 2 diabetes in people with pre-diabetes. However, engagement with DPPs is variable with session times and transportation being reported amongst barriers; this may be addressed by community pharmacy (CP) involvement given its recognition for accessibility. OBJECTIVES: To explore factors influencing engagement with the National Health Service (NHS) DPP and the role of CP in diabetes prevention. METHODS: Nine hundred and sixty-two questionnaires were posted to people with pre-diabetes identified from five general practices in Norfolk, England between November 2017 and May 2018. Follow-up semi-structured interviews (n = 10) and a focus group (n = 6) were conducted with a sample of questionnaire respondents. Questionnaire data were analysed quantitatively using SPSS and qualitative data analysed inductively using thematic analysis. Themes relating to engagement and the role of CP in pre-diabetes were further analysed using the COM-B model of behaviour change. RESULTS: A total of 181 (18.8%) questionnaire responses were received, a quarter of whom reported to have either dropped out or declined attending the national DPP. DPP engagers were more likely to report the program location and session times as convenient. Community pharmacy was perceived as an acceptable setting for delivering diabetes prevention services (DPS) and a preferable alternative for regular pharmacy users and people with work and social commitments. Participants felt that opportunity to engage with CP DPS is enhanced by its accessibility and flexibility in making appointments. Knowledge about the DPS provided in CP and previous experience with CP services were central influences of capability and motivation to engage respectively. CONCLUSIONS: This research outlines factors that could influence engagement with community pharmacy-based DPS and provides evidence to inform intervention development. Further research would be required to determine the feasibility and cost-effectiveness of such interventions.

Interpersonal counselling for adolescent depression delivered by youth mental health workers without core professional training: a feasibility randomised controlled trial study protocol.

BACKGROUND: Depression is a common health problem during adolescence and is associated with adverse academic, social and health outcomes. To meet the demand for treatment for adolescent depression, there is a need for evidence-based interventions suitable for delivery outside of specialist Child and Adolescent Mental Health Services (CAMHS). Interpersonal Counselling for Adolescents (IPC-A) is a brief manualised intervention for adolescent depression suitable for delivery by staff who are not qualified health professionals following participation in a brief training course. While initial piloting within Local Authority services has generated promising results, the effectiveness and cost-effectiveness of IPC-A has yet to be established. This study aims to assess the feasibility of a randomised controlled trial (RCT), evaluating the effectiveness and cost-effectiveness of IPC-A delivered by staff without core professional training in comparison to current provision. METHOD: Feasibility RCT with process evaluation using ethnographic methodology. Eligible young people (n = 60) will be randomised in a 1:1 ratio to receive either IPC-A or treatment as usual (TAU). Participants will be assessed pre-randomisation (baseline) and followed up at 5, 10 and 23 weeks post-randomisation. A parallel process evaluation will generate understanding of intervention implementation across services and explore the acceptability of the intervention from the perspective of young people and other key stakeholders. PARTICIPANTS: Young people aged 12-18 years presenting to non-specialist services with symptoms of depression. Youth workers, young people and stakeholders will participate in the process evaluation. DISCUSSION: The need for effective and accessible interventions for young people with mild/sub-threshold depression who, in most cases, do not meet the threshold for mainstream mental health services is long overdue. The primary output of this feasibility trial will be the design of the subsequent full-scale trial. If the results of the current study indicate that this would be feasible, we intend to progress to a multi-site, assessor-blind, superiority RCT of the effectiveness and cost-effectiveness of IPC-A in comparison to TAU for adolescents presenting to non-specialist services with depressive symptoms. If satisfactory solutions to any problems encountered cannot be identified, alternative research designs will be considered. If proven effective, an IPC-A training programme could be implemented. TRIAL REGISTRY: ISRCTN registry, ISRCTN82180413 , Registered 31 December 2019.

A systematic review exploring characteristics of lifestyle modification interventions in newly diagnosed type 2 diabetes for delivery in community pharmacy.

OBJECTIVES: The aim of this systematic review was to examine the characteristics of effective lifestyle modification interventions designed for patients with newly diagnosed type 2 diabetes mellitus (T2DM) in order to determine elements that have the potential to be delivered in the community pharmacy setting. KEY FINDINGS: Seven studies, comprising three each of the interventions diet and structured education and one of supported exercise, were identified. Interventions were conducted in hospital diabetes clinics and clinics situated in both urban and rural areas. Interventions were delivered face to face by highly skilled personnel including physicians, nurses and dietitians. Duration of interventions ranged from 3 months to 5 years. SUMMARY: Structured education and dietary interventions in newly diagnosed type 2 diabetes effectively controlled blood glucose levels without pharmacological intervention. Important characteristics included face to face, individualised and multicomponent interventions with a duration of at least 6 months. These characteristics demonstrate potential for delivery in a community pharmacy setting, given its current involvement in delivering face to face, individual services with diet and lifestyle components. Further research is required to provide evidence for ideal intervention duration and frequency as well as training requirements for pharmacists.

The community pharmacy setting for diabetes prevention: Views and perceptions of stakeholders.

BACKGROUND: Diabetes prevention programmes delay or prevent the onset of type 2 diabetes in people with pre-diabetes. To increase accessibility, national guidelines recommend delivering diabetes prevention programmes in primary care settings, including community pharmacy. This study aimed to explore the English community pharmacy setting as an option for delivering diabetes prevention services. METHODS: Two focus groups and nine semi-structured interviews were conducted with stakeholders including, community pharmacists, general practitioners and commissioners. The topic guide was framed using the COM-B theoretical model for behaviour change to elicit practitioners' capability, opportunity and motivation to engage with providing or referring to community pharmacy diabetes prevention services. Data were analysed thematically, and barriers/facilitators mapped to the COM-B framework. RESULTS: Five themes were identified: 'Pre-diabetes management and associated challenges', 'The community pharmacy setting', 'Awareness of community pharmacy services', 'Relationships and communication' and 'Delivery of community pharmacy services'. Community pharmacy was highlighted as an accessible setting for delivering screening and follow-on lifestyle interventions. Key factors for enhancing the capability of community pharmacy teams to deliver the interventions included training and appropriate use of skill mix. Delivering diabetes prevention services in collaboration with general practices was identified as key to the provision of integrated primary care services. Whilst financial incentives were identified as a motivating factor for delivery, service promotion to patients, public and healthcare professionals was perceived as crucial for enhancing engagement. CONCLUSIONS: This research highlights a role for community pharmacy in diabetes prevention. New service models should seek to integrate community pharmacy services in primary care to facilitate patient engagement and better communication with general practices.