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BACKGROUND: Patients with chronic obstructive pulmonary disease (COPD) are frequently readmitted to hospital resulting in avoidable healthcare costs. Many different interventions designed to reduce hospital readmissions are reported with limited evidence for effectiveness. Greater insight into how interventions could be better designed to improve patient outcomes has been recommended. AIM: To identify areas for optimisation within previously reported interventions provided to reduce COPD rehospitalisation to improve future intervention development. METHODS: A systematic review was conducted by searching Medline, Embase, CINAHL, PsycINFO, and CENTRAL in June 2022. Inclusion criteria were interventions provided to patients with COPD in the transition from hospital to home or community. Exclusion criteria were lack of empirical qualitative results, reviews, drug trials, and protocols. Study quality was assessed using the Critical Appraisal Skills Programme tool and results were synthesised thematically. RESULTS: A total of 2,962 studies were screened and nine studies included. Patients with COPD experience difficulties when transitioning from hospital to home. It is therefore important for interventions to facilitate a smooth transition process and give appropriate follow-up post-discharge. Additionally, interventions should be tailored for each patient, especially regarding information provided. CONCLUSION: Very few studies specifically consider processes underpinning COPD discharge intervention implementation. There is a need to recognise that the transition itself creates problems, which require addressing, before introducing any new intervention. Patients report a preference for interventions to be individually adapted-in particular the provision of patient information. Whilst many intervention aspects were well received, feasibility testing may have enhanced acceptability. Patient and public involvement may address many of these concerns and greater use of process evaluations should enable researchers to learn from each other's experiences. TRIAL REGISTRATION: The review was registered in PROSPERO with registration number CRD42022339523.
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Alta do Paciente , Doença Pulmonar Obstrutiva Crônica , Humanos , Assistência ao Convalescente , Doença Pulmonar Obstrutiva Crônica/terapia , HospitaisRESUMO
Interprofessional education (IPE) during undergraduate education and training has been found to improve collaboration between health care students. This supports interprofessional working in clinical practice to enhance patient safety and care delivery.Undergraduate students from pharmacy and medical programmes worked online in pairs to review notes of hospital patients due to be discharged. Students were tasked to complete a discharge letter and undertake an online consultation with a simulated patient prior to discharge. Online interactions were recorded and assessed using a validated tool to measure interprofessional professionalism. Students undertook this intervention in different pairings with different patient cases for three iterations after receiving feedback and undertaking a reflective exercise.The aim was to investigate the student learning and development that could be used to inform intervention optimisation and scale-up.Qualitative data were collected from different sources. Method triangulation was employed to develop a comprehensive understanding of the student learning and development. Data was collected from written feedback provided by the assessment team, student reflections on their performance, and from semi-structured interviews conducted with the student pairs and one to one with the assessment team. Content and thematic analysis was used to analyse these data and the Kirkpatrick/Barr evaluation model provided a framework to organise the themes.Eighteen students (nine from each professional programme) completed the study and a total of 27 IPE sessions were conducted. The assessment team completed 54 assessment tools and 31 student reflections were received (from a maximum of 36). Students were interviewed in their interprofessional pairs to yield nine interview transcripts and one interview was conducted with the assessment team.Students reported and were observed to improve in interprofessional collaboration over the three iterations following feedback and rehearsal opportunities. Longitudinal observation and assessment of student interprofessional working in changing teams provided the opportunity to capture the influence of interdependence on student performance and assessment of competence.
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Relações Interprofissionais , Estudantes de Medicina , Humanos , Educação Interprofissional , Aprendizagem , Pesquisa QualitativaRESUMO
BACKGROUND: Interprofessional education (IPE) has been identified as a strategy towards improving competence at interprofessional working and collaboration within teams. Entrustable professional activities (EPAs) provide a framework for translating competencies into elements of clinical practice, some of which in healthcare are inherently interprofessional. However, it is challenging to reconcile that entrustment decisions about student competence in an interprofessional activity are made about an individual without considering the dynamics and tensions between interprofessional team members and the task itself. This can influence students' development and demonstration of competence at interprofessional collaboration. METHODS: In this study, undergraduate medical and pharmacy students worked in pairs online (Zoom) to undertake the hospital discharge process (a professional activity reliant on interprofessional collaboration) for a simulated patient, producing a hospital discharge letter and completing a consultation with the simulated patient. The online sessions were recorded and interprofessional behaviours were assessed using a validated scale completed by an interprofessional assessment team. Students undertook this IPE intervention three times after receiving feedback and a period of reflection each time. RESULTS: Eighteen students participated across the entire intervention and 27 one-hour online IPE sessions were completed and recorded. Students demonstrated statistically significant improvements in interprofessional behaviours across the three iterations (p < 0.05 for all the sessions). The discharge letter students produced also improved over the three sessions (p = 0.01). Students found the educational sessions useful and relevant. CONCLUSION: This online IPE intervention provided the students with an authentic opportunity to work collaboratively. At the end of each iteration, students received feedback about their work as a team and about the discharge letter, helping students to reflect and purposefully develop their performance. The IPE intervention with this assessment strategy is feasible and allows student development to be captured but has proved to be time and resource intensive.
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Farmácia , Estudantes de Medicina , Humanos , Projetos Piloto , Estudos de Viabilidade , Educação Interprofissional , Alta do Paciente , HospitaisRESUMO
OBJECTIVES: Interprofessional education (IPE) aims to provide students with the opportunity to develop and demonstrate the team working behaviours and skills that will lead to positive patient outcomes. This systematic review aims to identify and critically appraise the assessment tools used after a pre-licensure IPE intervention and provide guidance on which tool to use according to the focus of the intervention. METHODS: In July 2019, the following electronic databases were searched: MEDLINE, ERIC, CINHAL, EMBASE and NEXUS website. All studies involving pre-licensure health care students exposed to an IPE intervention and undertook an assessment measuring student knowledge, skills, behaviour, or change in organisational practice or a benefit to patients were included. Studies that used tools relying on self-assessment only were excluded. Constructive alignment of the IPE intervention with the assessment was evaluated and quality assessment of the studies and critical appraisal of the validity evidence for the tools was undertaken. RESULTS: From 9502 returned studies, 39 studies met the inclusion criteria and were analysed. These were rated as good in terms of methodological quality. Acquisition of knowledge was the most commonly assessed outcome, mainly with pre/post knowledge tests, followed by behaviour change, which was measured by a range of validated tools. Patient benefit was defined as change in clinical effectiveness, patient safety or patient satisfaction. Constructive alignment of the IPE aim with the assessment was limited due to issues with study reporting. Tools measuring behaviour change demonstrate mixed adherence to quality standards around reliability, validity and scales and scoring. CONCLUSIONS: Various methods have been used to identify change following IPE; however, choosing the most appropriate tool to support and align with the aim of the IPE intervention is crucial. We have critically appraised the available tools and offered an indication of their quality. This has informed the production of a decision aid to support the selection of the appropriate IPE assessment tool depending on the purpose of the intervention. More studies using these tools in rigorous study designs are required to substantiate the evidence base.
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Atenção à Saúde , Educação Interprofissional , Humanos , Licenciamento , Segurança do Paciente , Reprodutibilidade dos TestesRESUMO
In the current study, the ex vivo permeation of ropinirole hydrochloride (RH) across porcine buccal mucosa in the presence of three permeation enhancers, namely N-trimethyl chitosan (TMC) (positively charged) a chitosan derivative, sulfobutyl ether-ß-cyclodextrin (SBE-ß-CD) (negatively charged) and hydroxypropyl-ß-cyclodextrin (HP-ß-CD) (neutral), was investigated. Buccal permeation studies were conducted using Franz diffusion cells. Cumulative amounts of RH were plotted versus time. The presence of the permeation enhancers significantly increased the transport of the drug across the porcine buccal epithelium compared to its plain congener (RH solution). The rank order effect of the permeation enhancers for the transport of RH across buccal epithelium was TMC ≥ SBE-ß-CD > HP-ß-CD > RH solution. The presence of TMC increased 1.34-fold the transport of RH across buccal epithelium, whereas an increase of 1.23- and 1.28-fold was reported in the presence of HP-ß-CD and SBE-ß-CD, respectively. Infrared spectroscopy (IR) was employed to investigate the interaction of permeation enhancers with the epithelial lipids of porcine buccal mucosa corroborating the permeation results. Finally, light microscopy was performed to assess the histological changes in the porcine epithelium. Formation of vacuoles, spongiosis and acantholysis linear detachment and destruction of the epithelium resulted from the presence of the permeation enhancers. The data suggest that all enhancers tested, and particularly TMC, increase the transport of RH across buccal epithelium.
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Sistemas de Liberação de Medicamentos , Indóis/administração & dosagem , Animais , Quitosana , Mucosa Bucal , Permeabilidade , Suínos , beta-CiclodextrinasRESUMO
AIM: We set out to determine the potential contribution of community pharmacists to improve the transfer of care of patients from secondary to primary care settings. METHOD: We systematically reviewed the literature on interventions that involved community pharmacy post-discharge. We considered all relevant studies, including both randomized and non-randomized controlled trials, irrespective of patient population. Our primary outcome was any impact on patient and medication outcomes, while the secondary outcome was to identify intervention characteristics that influenced all reported outcomes. RESULTS: We retrieved 14 studies that met our inclusion criteria. There were four studies reporting outcomes relating to the identification and rectification of medication errors that were significantly improved with community pharmacy involvement. Other patient outcomes such as medication adherence and clinical control were not unanimously positively or negatively influenced via the inclusion of community pharmacy in a transfer of care post-discharge intervention. Some inconsistencies in implementation and process evaluation of interventions were found across the reviewed studies. This limited the accuracy with which true impact could be considered. CONCLUSIONS: There is evidence that interventions including a community pharmacist can improve drug related problems after discharge. However, impact on other outcomes is not consistent. Further studies are required which include process evaluations to describe fully the context of the intervention so as to determine better any influencing factors. Also applying more stringent controls and closer adherence to protocols in both intervention and control groups would allow clearer correlations to be made between the intervention and the outcomes.
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Serviços Comunitários de Farmácia , Continuidade da Assistência ao Paciente , Erros de Medicação/prevenção & controle , Farmacêuticos , Atenção Primária à Saúde , Papel Profissional , Atenção Secundária à Saúde , HumanosRESUMO
INTRODUCTION: The General Medical Council (GMC) expects that medical students graduate with an awareness of how the diversity of the patient population may affect health outcomes and behaviours. However, little guidance has been provided on how to incorporate diversity teaching into medical school curricula. Research highlights the existence of two different models within medical education: cultural competency and cultural humility. The Southampton medical curriculum includes both models in its diversity teaching, but little was known about which model was dominant or about the students' experience. METHODS: Fifteen semi-structured, in-depth interviews were carried out with medical students at the University of Southampton. Data were analysed thematically using elements of grounded theory and constant comparison. RESULTS: Students identified early examples of diversity teaching consistent with a cultural humility approach. In later years, the limited diversity teaching recognised by students generally adopted a cultural competency approach. Students tended to perceive diversity as something that creates problems for healthcare professionals due to patients' perceived differences. They also reported witnessing a number of questionable practices related to diversity issues that they felt unable to challenge. The dissonance created by differences in the largely lecture based and the clinical environments left students confused and doubting the value of cultural humility in a clinical context. CONCLUSIONS: Staff training on diversity issues is required to encourage institutional buy-in and establish consistent educational and clinical environments. By tackling cultural diversity within the context of patient-centred care, cultural humility, the approach students valued most, would become the default model. Reflective practice and the development of a critical consciousness are crucial in the improvement of cultural diversity training and thus should be facilitated and encouraged. Educators can adopt a bidirectional mode of teaching and work with students to decolonise medical curricula and improve medical practice.
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Atitude do Pessoal de Saúde , Competência Cultural/educação , Diversidade Cultural , Currículo , Educação Médica/organização & administração , Conscientização , Feminino , Proteínas de Homeodomínio , Humanos , Entrevistas como Assunto , Masculino , Proteínas de Plantas , Resolução de Problemas , Estudantes de Medicina/psicologiaRESUMO
Toward the development of microparticulate carriers for nasal administration, N-trimethylchitosan chloride (TMC) of low molecular weight (LMW) and high molecular weight (HMW) and low degree of quaternization (16% and 27%, respectively) was co-formulated into microparticles comprising of dipalmatoylphosphatidylcholine (DPPC) and poly(lactic-co-glycolic) acid (PLGA) via the spray-drying technique. The chitosan derivatives were characterized by means of nuclear magnetic resonance (NMR), differential scanning calorimetry (DSC), and Fourier transfrom infrared (FTIR) spectroscopy. The size and morphology of the produced microparticles were assessed by scanning electron microscopy (SEM), whereas their mucoadhesive properties were investigated by means of atomic force microscopy-force spectroscopy (AFM-FS). The results showed that microparticles exhibit mucoadhesion when TMC is present on their surface above a threshold of TMC (>0.3% w/w).
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Quitosana/química , Portadores de Fármacos/química , Microesferas , Administração Intranasal , Quitosana/administração & dosagem , Quitosana/síntese química , Portadores de Fármacos/administração & dosagem , Portadores de Fármacos/síntese química , Eletrólitos/química , Microscopia de Força Atômica , Peso Molecular , Tamanho da Partícula , Polímeros/química , Propriedades de SuperfícieRESUMO
BACKGROUND: Mobile health clinics have been used to provide healthcare to underserved communities, especially during the COVID-19 pandemic. Student-led clinics, operated by undergraduate health students, offer valuable training while serving these populations. AIM: This cross-sectional study investigated the demographic characteristics and services provided by a mobile health clinic run by undergraduate pharmacy students, assessing its potential to reach underserved communities. METHOD: The mobile health clinic operated from October 2023 to April 2024, staffed by 36 fourth-year pharmacy students. Services included cardiovascular disease risk screening and lifestyle advice. Demographic and service data were collected using an electronic primary care system and analysed with descriptive statistics. RESULTS: The clinic served 716 users, with a demographic breakdown of 53.2% female and 46.8% male, predominantly aged 31-60 years. Users were ethnically diverse. Services provided included blood pressure (91.3%), BMI (91.3%), and diabetes risk assessments (54.9%). Many users reported low risk for smoking and alcohol consumption, but varied levels of physical activity. Referrals were made for cardiovascular disease risk and lifestyle support. CONCLUSION: The mobile health clinic effectively reached a diverse, underserved population, providing essential health services and facilitating student training. Further research is needed to evaluate the long-term impact and cost-effectiveness of such clinics, and the follow-up care for referred patients.
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OBJECTIVES: Digital literacy is increasingly crucial in pharmacy practice, and relevant education and training are required to prepare the future workforce. This study aims to explore the current and planned inclusion of digital literacy education in the undergraduate curricula of UK pharmacy schools. METHODS: A mixed-methods approach was conducted with two phases. The first involved a content analysis of published curricula from all 30 UK pharmacy schools. The second phase included a survey based on the Health Education England Digital Capabilities Framework, distributed to academic staff across all pharmacy schools. KEY FINDINGS: Data from 14 pharmacy schools' curricula were included in the analysis, with 10 reporting digital literacy education. Key themes identified from the analysed documents included understanding of health informatics, applied informatics, information technology skills, and the emerging digital health technology. Nineteen respondents from 16 schools participated in the survey; digital literacy inclusion was reported by 18 participants. There was variable alignment of digital literacy competencies with the Health Education England framework. Digital literacy was mainly integrated into existing teaching sessions, predominantly through self-learning (n = 12). Electronic Health Records and remote counselling were the main focus areas within the curricula. Challenges in implementing digital literacy include a lack of expertise (n = 13), and time constraints (n = 10). CONCLUSIONS: The trend towards embedding digital literacy in UK pharmacy curricula is clear, but disparities suggest the need for a more unified strategy. Recommendations include establishing a specific digital literacy framework aligned with professional needs, improving accessibility and transparency in curricula documents, and investing in faculty development.
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Currículo , Educação em Farmácia , Estudantes de Farmácia , Humanos , Educação em Farmácia/métodos , Reino Unido , Inquéritos e Questionários , Faculdades de Farmácia , Alfabetização Digital , Informática Médica/educaçãoRESUMO
OBJECTIVES: An independent evaluation was undertaken to investigate the perceived impact of installing digital screens in a group of community pharmacies as an approach to provide public health messaging. METHODS: Community pharmacy staff were interviewed prior to screen installation to investigate experience and perceptions of conventional public health campaigns using written materials. Staff were interviewed after the digital screen installation to investigate their opinions of the installation and its impact on public health delivery in the pharmacy. Patients and public representatives were recruited to visit the pharmacies and asked to complete a survey about what they observed and thought about the public health messaging. Interviews were transcribed verbatim and thematically analysed. Surveys consisted of open, closed, and rating questions. The results of which were descriptively analysed. KEY FINDINGS: Community pharmacy staff found paper-based campaigns work-intensive and created paper wastage. The digital screen installation was received positively by pharmacy staff and patient, and public representatives found them eye-catching and engaging. Staff were unable to report any conversations with members of the public triggered by the screens, but the patient and public volunteers were able to recall some of the health messages. CONCLUSIONS: Digital messaging is common practice and digital screens are already in use in areas where patients and the public have conventionally been in attendance, e.g. GP surgeries. Digital screens in community pharmacy for public health messaging could be considered an inevitable progression for public health messaging given concerns about wastage and up-to-date information. The impact, however, on triggering healthier choices and lifestyles requires further investigation.
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Serviços Comunitários de Farmácia , Promoção da Saúde , Saúde Pública , Humanos , Serviços Comunitários de Farmácia/organização & administração , Promoção da Saúde/métodos , Inquéritos e Questionários , Farmacêuticos , Feminino , MasculinoRESUMO
OBJECTIVES: Preventative services are required to address the risk factors for chronic conditions such as cardiovascular disease. The National Health Service Health Checks in England were introduced to provide such services. One School of Pharmacy established a student-led clinic to provide this service to the local community. The clinic was provided by undergraduate pharmacy students and delivered free of charge within a central city locality. The aim was to explore the impact of the clinic on user thoughts and motivations around healthy living and investigate user experience. METHODS: A sequential explanatory mixed methods approach was used consisting of a survey that measured users' thoughts about their health and well-being and experience of the clinic. Qualitative interviews explored the user experience and barriers and facilitators to making healthier lifestyle choices. RESULTS: One hundred and fifty-four members of the public accessed the clinic over the evaluative period. Ninety-six (60%) completed the pre-post survey and 12 participated in follow-up interviews. Users reported statistically significant improvements in how informed, competent and motivated they felt towards making healthier lifestyle choices after the clinic consultation. Interview findings highlighted the positive user experience, reported appreciation for clinic accessibility, availability of healthy lifestyle education, and a desire for more preventative services being as readily available. CONCLUSIONS: The student-led clinic has demonstrated positive impacts on user experience, knowledge, competence, and motivation to make healthier lifestyle choices. The clinic provides proof-of-concept for pharmacy students to deliver preventative community services that aim to improve population health at a time when primary care is experiencing unprecedented challenges.
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Estudantes de Farmácia , Humanos , Estudantes de Farmácia/psicologia , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Inglaterra , Serviços Preventivos de Saúde , Adulto Jovem , Inquéritos e Questionários , Clínica Dirigida por Estudantes/organização & administração , Idoso , Motivação , Estilo de Vida Saudável , Conhecimentos, Atitudes e Prática em Saúde , Acessibilidade aos Serviços de Saúde , AdolescenteRESUMO
OBJECTIVES: Authentic work-based learning is crucial to facilitate the development and preparedness for training healthcare professionals. Such experiences are challenging to design and secure within the clinical environment. One School of Pharmacy established a student-led clinic to provide undergraduate pharmacy students the opportunity to practise physical assessment and communication skills with members of the public. The aim of this study was to explore students' thoughts and perspectives on this experience. METHODS: Undergraduate students were invited to participate in a semi-structured interview after their clinic experience. Transcriptions of the interviews were analysed by reflexive thematic analysis. RESULTS: Twelve students agreed to an interview that took place between October and December 2022. Three themes were identified from the qualitative data which related to external factors that influenced student experience of the clinic, for example, organizational issues and impact of the physical environment; interactions within the clinic environment; and internalized learning for example, professional growth and development, and the appreciating the learning opportunity. CONCLUSIONS: In the current climate, where securing valuable work-based learning opportunity is challenging, student-led clinics offer an environment that is well-received by students and appears to facilitate student professional development. Student clinics are receiving more attention and investment across undergraduate healthcare programmes around the world given advantages such as these. However, they need to be well integrated and structured into the existing training and education and students need appropriate induction to prepare them for the experience and manage expectations.
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Educação em Farmácia , Estudantes de Farmácia , Estudantes de Farmácia/psicologia , Humanos , Educação em Farmácia/métodos , Clínica Dirigida por Estudantes/organização & administração , Atitude do Pessoal de Saúde , Feminino , Masculino , Serviços Preventivos de Saúde/organização & administração , Percepção , Entrevistas como AssuntoRESUMO
OBJECTIVES: Conduct a scoping review to identify the approaches used to integrate digital literacy into undergraduate pharmacy programs across different countries, focusing on methods for education, training, and assessment. MATERIALS AND METHODS: Following the Joanna Briggs Institute methodology, we searched 5 electronic databases in June 2022: MEDLINE (Ovid), PubMed, Embase, Scopus, and CINAHL. Three independent reviewers screened all articles; data extraction was conducted by 2 reviewers. Any discrepancies were arbitrated by 2 additional reviewers. RESULTS: Out of 624 articles, 57 were included in this review. Educational and training approaches for digital literacy in undergraduate pharmacy programs encompassed a theoretical understanding of health informatics, familiarization with diverse digital technologies, and applied informatics in 2 domains: patient-centric care through digital technologies, and the utilization of digital technologies in interprofessional collaboration. Blended pedagogical strategies were commonly employed. Assessment approaches included patient plan development requiring digital information retrieval, critical appraisal of digital tools, live evaluations of telehealth skills, and quizzes and exams on health informatics concepts. External engagement with system developers, suppliers, and other institutes supported successful digital literacy education. DISCUSSION AND CONCLUSION: This scoping review identifies various learning objectives, teaching, and assessment strategies to incorporate digital literacy in undergraduate pharmacy curricula. Recommendations include acknowledging the evolving digital health landscape, ensuring constructive alignment between learning objectives, teaching approach and assessments, co-development of digital literacy courses with stakeholders, and using standardized guidelines for reporting educational interventions. This study provides practical suggestions for enhancing digital literacy education in undergraduate pharmacy programs.
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Educação em Farmácia , Farmácia , Humanos , Alfabetização , Currículo , AprendizagemRESUMO
OBJECTIVES: Inappropriate prescribing, particularly for analgesia, is a recognised global problem. This leads to increased morbidity and mortality and presents a significant challenge for patients and the healthcare system. There is a need to identify strategies that best identify inappropriately prescribed analgesia (IPA). This study aims to explore the perspectives and experiences of community pharmacists (CPs) about addressing IPA. METHODS: Semi-structured interviews informed by the Behaviour Change Wheel model and the Theoretical Domains Framework (TDF) were conducted with consenting community pharmacists. Transcripts were coded using a capability, opportunity, motivation model of behaviour (COM-B) model. The COM-B components were mapped to the TDF and behaviour change techniques (BCTs) were identified to address these. KEY FINDINGS: A total of 12 pharmacists who work in community pharmacies in England were interviewed between March and May 2021. COM-B components were identified through analysis and mapped to nine TDF domains. Component 1 referred to 'Capability' of CPs to be involved in addressing IPA (knowledge). Component 2 pertained to 'Opportunity' to identify IPA (e.g. social influence). The 'Motivation' component linked to five TDF domains (e.g. goals). Seventeen BCTs were identified to support CPs in addressing IPA (e.g. environmental context and resources domain mapped to 2 BCTs 'restructuring the physical and social environment'). CONCLUSIONS: CPs expressed mixed perceptions about their involvement in the deprescribing of IPA as part of their daily practice, but they stated that social and environmental barriers needed to be addressed to facilitate their involvement. The identified BCTs provide evidence-based strategies to help the involvement of CPs to identify IPA.
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Analgesia , Farmacêuticos , Humanos , Atitude do Pessoal de Saúde , Pesquisa Qualitativa , Prescrição InadequadaRESUMO
There has been a sustained interest in transfer of care (ToC) services, from hospital to home, in the past twenty years. In England, an electronic referral (e-referral) service from hospital to community pharmacy has been provided since 2014. However, to date, there has been little information about service implementation and delivery. This study investigates the barriers to this referral process in hospital and community pharmacy settings, and barriers to providing subsequent community pharmacy interventions from the perspectives of the service leaders (SLs), hospital pharmacy staff (HPS) and community pharmacists (CPs). Semi-structured face-to-face or telephone interviews were conducted with the key informants from two tertiary hospitals and nine pharmacies. The Consolidated Framework for Implementation Research (CFIR) tool informed the data collection tools and data analysis. A total of three SLs, ten HPS and nine CPs were interviewed. Data analysis identified various barriers to the provision of the e-referral service. Some were related to (1) patient engagement, e.g., patients' awareness/acceptance of the service, (2) the SLs and other National Health Service hospitals, e.g., lack of monitoring of the service progress, (3) the HPS, e.g., resource limitations, or (4) the CPs, e.g., lack of understanding/appreciation of the service. In-depth understanding of barriers related to the provision of e-referral service are essential to drive improvement and facilitate wider diffusion and adoption. The use of implementation science and behaviour change model as a lens to assess this service enables the identification of certain behaviours that can be modified to produce the required change to drive better implementation and delivery.
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Serviços Comunitários de Farmácia , Farmácias , Humanos , Alta do Paciente , Medicina Estatal , Farmacêuticos , Encaminhamento e Consulta , Centros de Atenção Terciária , Papel Profissional , Atitude do Pessoal de SaúdeRESUMO
BACKGROUND: There are increasing concerns regarding the abusive potential of gabapentinoids putting at risk patients with neuropathic pain requiring long-term pain management. The evidence to support this is rather inconcusive. AIM: This systematic review aimed to evaluate the safety and efficacy of gabapentinoids in the management of neuropathic pain with a focus on randomised controlled trials (RCTs) and categorising the side effects according to the body systems they were affecting. METHOD: Searches were conducted in MEDLINE (PubMed), EMBASE, Web of Science, PsycoINFO, and CINAHL (EBSCO), and included RCTs to identify and critically appraise studies investigating safety and therapeutic effects of gabapentionoids in adults with neuropathic pain. Data extraction was conducted using an established Cochrane form and the risk-of-bias tool was used in the assessment of quality. RESULTS: 50 studies (12,398 participants) were included. The majority of adverse events pertained to the nervous system (7 effects) or psychiatric (3 effects) disorders. There were more adverse effects reported with pregabalin (36 effects) than with gabapentin (22 effects). Six pregabalin studies reported euphoria as a side effect, while no studies reported euphoria with gabapentin. This was the only side effect that may correlate with addictive potential. Gabapentioids were reported to significantly reduce pain compared to placebo. CONCLUSION: Despite RCTs documenting the adverse events of gabapentionoids on the nervous system, there was no evidence of gabapentinoid use leading to addiction, suggesting an urgent need to design studies investigating their abusive potential.
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Ácidos Cicloexanocarboxílicos , Neuralgia , Adulto , Humanos , Gabapentina/efeitos adversos , Pregabalina/efeitos adversos , Analgésicos/efeitos adversos , Ácido gama-Aminobutírico/efeitos adversos , Aminas/efeitos adversos , Ácidos Cicloexanocarboxílicos/efeitos adversos , Neuralgia/tratamento farmacológico , Neuralgia/induzido quimicamente , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
BACKGROUND: Limited published research exists on the role of pharmacists in general practice (primary care pharmacists) in facilitating post-hospital discharge care of patients. AIM: To summarise and map the nature and extent of current evidence on the role of primary care pharmacists in facilitating patient discharge from secondary to primary care and to inform future practice and research. METHOD: Six electronic databases were systematically searched from inception to March 2022 for studies published in the English language that described and/or evaluated primary care pharmacist-led interventions for patients following hospital discharge. Grey literature and reference lists of included studies were also searched. Two authors independently screened articles for selection. A structured, pilot-tested form was used for data extraction. RESULTS: Twenty articles were included. The majority of studies (n = 17; 85%) were conducted in the USA. The most frequently reported intervention made by primary care pharmacists were medication reviews (n = 18) and medication reconciliation (n = 16). Studies have demonstrated the emerging roles of pharmacists involving collaboration with other healthcare professionals, review of laboratory monitoring, referrals, and follow-up. A wide range of outcomes such as the impact on hospital readmission rates, healthcare utilisation and reduction of potential adverse drug events were reported. CONCLUSION: Pharmacists in general practice can offer a range of interventions in facilitating transfer of care of patients from secondary to primary care with positive patient and healthcare utilisation outcomes. However, more rigorous research evidence is required to establish the effectiveness, generalisability, acceptability, and sustainability of these services.
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Medicina Geral , Farmacêuticos , Humanos , Atenção à Saúde , Pessoal de Saúde , Alta do PacienteRESUMO
There are 5.3 million informal carers in the United Kingdom who take on caring responsibilities for family and friends. Informal carers can be forgotten patients within health and care services, yet because of carer burden, they are at risk of deterioration in health and wellbeing. There are higher levels of anxiety, depression, burnout and low self-esteem amongst carers but, to our knowledge work to date has mainly focused on supporting carers to provide better care for their family member, and less on carers' health and wellbeing. There is increasing interest in social prescribing as a method of linking patients with community-based services to improve health and wellbeing. Initiatives have included social prescribing via community pharmacies which are already recognized to be accessible for support and signposting. The coming together of community pharmacy services and social prescribing could represent a framework to better support carers in their mental health and wellbeing.