How prepared are pharmacists to support atrial fibrillation patients in adhering to newly prescribed oral anticoagulants?

Background The New Medicines Service (NMS) was implemented in the United Kingdom in 2011 and first evaluated in 2014, showing 10% increase on adherence. Objective To assess community pharmacists' current practice, knowledge and confidence in supporting patients' adherence as part of the NMS for patients on Oral Anti-Coagulants (OACs) for stroke prevention in Atrial Fibrillation. Setting Community pharmacists in London. Method An online cross-sectional survey was sent to pharmacists from their Local Pharmaceutical Committees and advertised by the Royal Pharmaceutical Society. Analysis was undertaken in SPSs v23 considering a confidence level of 95%. Main outcome measures pharmacists reported confidence of providing the NMS on OACs; training needs and skills for supporting adherence. Results A total of 257 valid responses were analysed (6.8% response rate; {Cronbach's α = 0.676-0.892}). Data indicates that over a 2-month period, 25% of pharmacists had completed ≥6 NMS consultations for all OACs, of which 11% for new oral anticoagulants (NOACs). The key priorities in counselling items during the NMS consultation were to discuss actions to take when bleeding occurs, followed by supporting adherence. Pharmacists were more confident in their knowledge, skills and access to resources for Vitamin-K Antagonists (VKAs) than for NOACs (p < 0.005). Results also highlight pharmacists' unfamiliarity with alert cards, lower for NOACs than VKAs (p < 0.001), albeit perceived as critically important. Half the sample mentioned to use the British National Formulary as information resource. Conclusion Results suggest the provision of NMS for NOACs is low. Supporting pharmacists with tailored education and adherence support might foster dissemination.

Listening to patients with cancer: using a literary-based research method to understand patient-focused care.

OBJECTIVE: In spite of considerable attention, patients diagnosed with cancer continue to report poor experiences of care. The root causes of this remain unclear. This exploratory study aimed to investigate new ways of understanding the experience of patients with cancer, using a literary-based research approach. DESIGN: Interviews were undertaken with four patients diagnosed with high-grade brain cancers at least 6 months from diagnosis and with people (n=5) identified by the patients as important in their care pathway. Interview transcripts were analysed by humanities academics as pieces of literature, where each patient's story was told from more than one person's perspective. The academics then came together in a facilitated workshop to agree major themes within the patient experiences. The themes were presented at a patient and carer event involving 70 participants to test the validity of the insights. RESULTS: Insights into the key issues for patients with cancer could be grouped into six themes: accountability; identity; life context; time; language; rigour and emotion. Patients often held a different perspective to the traditionally held medical views of what constitutes good care. For example, patients did not see any conflict between a doctor having scientific rigour and portraying emotion. CONCLUSIONS: One key feature of the approach was its comparative nature: patients often held different views from those traditionally held by physicians of what constitutes health and good outcomes. This revealed aspects that may be considered by healthcare professionals when designing improvements. Proposals for further testing are discussed, with a particular emphasis on the need for sensitivity to individual differences in experiences.