School practices in supporting children with asthma in Malta.

OBJECTIVE: The objective of this study was to obtain information about teachers' knowledge, attitudes, practices and beliefs about medication related to working with children having asthma in state primary schools in Malta. This study provides information about management in a country with a high prevalence of asthma among children, and limited availability of school nurses. METHODS: A cross-sectional electronic survey investigating beliefs about medicines, asthma knowledge, attitude toward students with asthma, self-efficacy and practice in an asthma exacerbation, current practices, views, experiences and training relating to asthma was sent to all participating state primary schools in Malta. RESULTS: A total of 167 teachers from 26 schools answered the questionnaire. The majority of respondents (56%) were unaware of children's conditions and limited information about children's asthma was provided to them. Only 20% of teachers reported receiving training on how to support children with asthma. Overall, teachers reported low asthma knowledge scores (mean score of 5.5 ± 3.3 out of a possible maximum of 14), and poor self-efficacy with only 6% agreeing that they can support a student having an asthma exacerbation on their own rather than sending the student to hospital. The study also demonstrated a strong interest by teachers to receive asthma education. CONCLUSIONS: Interventions with regard to identifying students with asthma, asthma training for teachers, individualized asthma action plans, enhanced communication between school staff, parents and the medical team, and standard guidelines/policy are needed to provide a supportive school environment for primary school children with asthma.

Medication-Related Outcomes and Health Equity: Evidence for Pharmaceutical Care.

Marginalised people experience diminished access to pharmaceutical care and worse medication-related outcomes than the general population. Health equity is a global priority. This article explores the key evidence of health inequity and medication use, structures the causes and contributory factors and suggests opportunities that can be taken to advance the pharmaceutical care agenda so as to achieve health equity. The causes of, and contributors to, this inequity are multi-fold, with patient- and person-related factors being the most commonly reported. Limited evidence is available to identify risk factors related to other aspects of a personal medication use system, such as technology, tasks, tools and the internal and the external environments. Multiple opportunities exist to enhance equity in medication-related outcomes through pharmaceutical care research and practice. To optimise the effects and the sustainable implementation of these opportunities, it is important to (1) ensure the meaningful inclusion and engagement of members of marginalised groups, (2) use a person-centred approach and (3) apply a systems-based approach to address all of the necessary components of a system that interact and form a network as work processes that produce system outcomes.

Evidence of successful interprofessional education programs-models, barriers, facilitators and success: a systematic review of European studies.

PURPOSE: Interprofessional education (IPE) has been highly promoted as a means of enhancing interprofessional practice and thereby having a positive impact on healthcare systems and patient outcomes. Various documents mention that sufficient evidence has been accumulated to demonstrate the effectiveness of IPE, yet it is not completely clear what type of evidence is being alluded to. The objective of this review was to gather evidence about IPE programs that resulted in effective long-term outcomes in healthcare. Secondary outcomes included identification of the types of models that met the success criteria, barriers and facilitators of such successful programs if any. DESIGN/METHODOLOGY/APPROACH: A systematic search was conducted in PubMed, Web of Science, CINAHL and Scopus. The review considered studies that targeted undergraduate and postgraduate students among more than one health profession and included those in the English language published between 2010 and end of 2020. FINDINGS: Five studies have been identified and described in this review. These papers evaluated different IPE programs and models. RESEARCH LIMITATIONS/IMPLICATIONS: 1. This systematic review investigated the evidence of the existence of IPE programs and the findings show there is no robust specific evidence of long-term impact on healthcare and on patients' outcomes. 2. The conclusion from this review is that it is still unclear what format constitutes a successful and efficient program. 3. Appropriate longitudinal studies need to be designed to identify the impact of IPE on long-term health outcomes. ORIGINALITY/VALUE: Overall, the studies show that although there is an emphasis on practice-based learning, there is no robust specific evidence of long-term impact on healthcare and on patients' outcomes. Appropriate longitudinal studies need to be designed to identify the impact of IPE on long-term health outcomes.

Assessing medication-related burden of community-dwelling individuals with chronic conditions in a small island state.

OBJECTIVES: Medication taking in the management of chronic conditions causes a significant burden on individuals. The aim of this study was to explore the medication-related burden in ambulatory adult patients with chronic conditions in Malta. METHODS: A cross-sectional survey utilising the living with medicines questionnaire V3 (LMQ V3) was conducted in Maltese residents over the age of 18 years, taking at least 1 medication for a chronic condition and recruited through community events. The overall LMQ score, the domain scores and the visual analog scale data were analysed to determine relationships with the demographic factors. RESULTS: A total of 337 responses were analysed revealing a moderate (42.4%) to high medication (36.8%) related burden. The drivers of medication-related burden were primarily: 'side-effects of prescribed medication' (r = -0.843, p < 0.001), 'attitudes/concerns about medicine use' (r = -0.830, p < 0.001) and 'impact/interferences to day-to-day life' (r = -0.820, p < 0.001). Lack of autonomy to vary the dosage regimen resulted in a higher burden (r = -0.260, p < 0.001). Males experienced an overall higher burden (p = 0.046) especially related to practical difficulties (p = 0.04), cost-related burden (p = 0.04) and side-effects of prescribed medication (p = 0.01). CONCLUSION: Medication-related burden is complex and multi-faceted as demonstrated by the findings of this study. Healthcare professionals should seek to identify and address factors causing this burden to improve patient outcomes.

Attitudes towards COVID-19 vaccination, vaccine hesitancy and intention to take the vaccine.

BACKGROUND: The pandemic is at a paradoxical stage, with vaccine roll out initiated but a significantly elevated level of infection and death. Hope for recovery lies in high equitable vaccine uptake. OBJECTIVE: The study aimed to: i) explore attitudes and factors influencing attitudes, towards the COVID-19 vaccine amongst people living in Malta, ii) identify the reasons as to why individuals are unsure or unwilling to take the vaccine. METHODS: Two consecutive, short, anonymous online surveys using social media platforms were used to gather data from adult individuals. The first study was open to residents in Malta, while the second study invited international participation. Study 1 consisted of 17 questions inspired by the Theories of Planned Behaviour and Reasoned Action. Study 2 asked participates whether they were willing, unwilling or unsure of taking the vaccine and their reasons for being unsure or unwilling. RESULTS: A total of 2,529 individuals participated in Study 1 and 834 in Study 2. In both studies respondents were predominantly female having a tertiary education. Over 50% declared that they were willing to take the vaccine, with males being more willing (t=5.83, df=1164.2, p<0.00005). Opinions of significant others- family and friends (r=0.22, p<0.005) and health professionals (r=0.74, p<0.005) were associated with willingness to take the vaccine. Vaccine hesitancy was present in the study population with 32.6% being unsure and 15.6% declaring that they were not willing to take the vaccine. Females were more likely to be unsure (Chi-squared=14.63, df=4, p=0.006). Lack of vaccine safety was the main reason cited for unwillingness to take the vaccine. Predictors for willingness to take the vaccine were: i) The belief that the COVID-19 vaccine will protect the health of the people who take it; ii) Valuing the advice of health professionals regarding the effectiveness of COVID-19 vaccine; iii) Having taken the influenza vaccine last year and; iv) Encouraging their elderly parents to take the vaccine. CONCLUSIONS: COVID-19 vaccination information campaigns should promote group strategies, focusing on emphasising the safety of the vaccine and offer reassurance, especially to women.

Current Asthma Management Practices by Primary School Teaching Staff: A Systematic Review.

BACKGROUND: The likelihood of children with asthma experiencing an exacerbation at school is significantly high when considering that they spend a substantial part of their day at school. This study, therefore, aimed to systematically review the literature to determine current asthma management practices by primary school teaching staff and any existing supporting legislation/policies/guidelines. METHODS: Search terms were adapted to search literature across databases: CINAHL, Cochrane Library, Education Database-ProQuest, IPA, MEDLINE, SCI. Primary research studies, reviews, systematic reviews, and meta-analyses in English about primary school teaching staff dated between 2007 and 2017 were included. Primary outcomes comprised teaching staff' practices regarding asthma management and supporting guidelines, policies, or legislation. RESULTS: Analysis of the 13 papers eligible for full review identified that: teachers were unable to deal with an asthma exacerbation; they lacked knowledge regarding exercise-induced asthma and that there was poor communication between schools and parents of children with asthma. The only documented relevant asthma legislation found pertained to New York schools. CONCLUSIONS: Limited evidence regarding asthma management practices and inadequate asthma management knowledge amongst teaching staff highlight the need for supporting teaching staff with asthma policies and guidelines to minimize risks associated with inappropriate asthma management.

Ethical aspects pertaining to the use of pharmacogenetic tests.

Administering medication safely and with confidence is important for both the patient and the prescriber. The individualised adjustment of a medicine dose, based solely on clinical outcomes or the change of a prescribed drug, possibly delays positive patient outcomes. This could lead to suboptimal patient management. Additionally, it could also have a negative pharmacoeconomic impact. The application of pharmacogenetics addresses this matter by refining and improving the safety and efficacy of medicines through a genotype-based prediction of responses. It also stratifies clinical trial populations in drug development in order to identify which patient genotypes benefit most from the drug under study. Although this emerging science presents a lot of prospects, it also raises a significant number of ethical questions. The problem with stratifying patient populations is addressed by promoting responsible and accountable scientific and intellectual liberty. This will avoid discrimination towards vulnerable populations. Therefore, there is a need to encourage informed consent and confidentiality, as well as to promote autonomy, justice, and equity by developing worldwide equivalent ethical, legal, and regulatory frameworks.

Provision of pharmaceutical care by community pharmacists: a comparison across Europe.

OBJECTIVE: To investigate the provision of pharmaceutical care by community pharmacists across Europe and to examine the various factors that could affect its implementation. METHODS: A questionnaire-based survey of community pharmacies was conducted within 13 European countries. The questionnaire consisted of two sections. The first section focussed on demographic data and services provided in the pharmacy. The second section was a slightly adapted version of the Behavioral Pharmaceutical Care Scale (BPCS) which consists of three main dimensions (direct patient care activities, referral and consultation activities and instrumental activities). RESULTS: Response rates ranged from 10-71% between countries. The mean total score achieved by community pharmacists, expressed as a percentage of the total score achievable, ranged from 31.6 (Denmark) to 52.2% (Ireland). Even though different aspects of pharmaceutical care were implemented to different extents across Europe, it was noted that the lowest scores were consistently achieved in the direct patient care dimension (particularly those related to documentation, patient assessment and implementation of therapeutic objectives and monitoring plans) followed by performance evaluation and evaluation of patient satisfaction. Pharmacists who dispensed higher daily numbers of prescriptions in Ireland, Germany and Switzerland had significantly higher total BPCS scores. In addition, pharmacists in England and Ireland who were supported in their place of work by other pharmacists scored significantly higher on referral and consultation and had a higher overall provision of pharmaceutical care. CONCLUSION: The present findings suggest that the provision of pharmaceutical care in community pharmacy is still limited within Europe. Pharmacists were routinely engaged in general activities such as patient record screening but were infrequently involved in patient centred professional activities such as the implementation of therapeutic objectives and monitoring plans, or in self-evaluation of performance.

Mixed-methods approach to determine adherence, knowledge and behavioral determinants associated with medication wastage.

BACKGROUND: While literature quantifying medication wastage and assessing public's knowledge and practices about medication disposal is substantial, less attention is given to the public's knowledge and behavior pertaining to medication wastage prevention. This study aimed to determine the public's knowledge of medication wastage, any association between knowledge and adherence, and behavioral determinants potentially leading to wastage. METHODS: A mixed-method explanatory sequential approach was adopted with a quantitative survey followed by qualitative semi-structured interviews. Maltese residents ≥18 years attending social/educational events were recruited in this mixed-methods study. Participants completed a structured questionnaire comprising: 1) demographics; 2) medication adherence using 'Tool for Adherence Behaviour Screening' dichotomized into 'good adherence'/'suboptimal adherence'; 3) eight knowledge statements each carrying one point (total, 0 = lowest; 8 = highest); 4) and whether they had unused medication at home. Chi-square analysis determined associations between demographics and adherence, and having unused medication. Multiple regression was performed to predict knowledge based on demographics, adherence, having regular medication and having unused medication, p  ≤0.05. Questionnaire respondents expressing interest in participating in semi-structured face-to-face interviews, based on the Theoretical Domains Framework (TDF), were recruited consecutively until data saturation. Interviews were audio-recorded, transcribed and analyzed using the Framework Approach. RESULTS: Of the 524 individuals attending 14 events, 80.5% completed the questionnaire (mean age±standard deviation (SD): 65 ±â€¯13 years). Thirty-one percent (n = 130/422) of respondents reported having unused medication and 18.8% (58/309 taking chronic medication) classified as 'optimal' adherence. Mean ±â€¯SD knowledge score was 4.7 ±â€¯1.5. Knowledge and adherence were not significantly related. Most prevalent TDF domains influencing wastage emerging from 15 interviews were knowledge, beliefs about consequences and behavioral regulation. CONCLUSION: Public's knowledge about medication wastage and adherence were inadequate, necessitating implementation of tailored educational interventions based on behavioral determinants recognized within this study. Identified inadequate behavior around disposal mandates inclusion of environmental/social planning issues when developing policies.

The 'Necessity-Concerns Framework' as a means of understanding non-adherence by applying polynomial regression in three chronic conditions.

OBJECTIVE: The 'Necessity-Concerns Framework' is an important framework which can support healthcare professionals in targeting patients' medication beliefs and decisions on adherence. Our aim was to determine how the interdependence of 'necessity' and 'concerns' beliefs for medication adherence compares across three chronic conditions. METHODS: Patients diagnosed with asthma, cardiovascular conditions or diabetes attending out-patient clinics completed a self-administered questionnaire. The questionnaire gathered information regarding demographics, medication adherence using the 'Tool for Adherence Behaviour Screening', presence of unused medication in households and medication beliefs using the 'Beliefs about Medicines Questionnaire-Specific'. Polynomial regression was applied to determine the multidimensional interdependence of 'necessity' and 'concerns' beliefs for adherence. P-values ≤ 0.05 were taken to be significant. RESULTS: Confirmatory polynomial regression rejected the differential score model in all three groups. For each condition, exploratory polynomial regression found that linear terms indicated the best fitting model for predicting adherence. In all groups, adherence increased as necessity beliefs increased and concerns decreased. Patients suffering from cardiovascular conditions and diabetes with low necessity and low concerns beliefs reported higher medication adherence compared to those with high necessity and high concerns beliefs. DISCUSSION: Alleviating patients' concerns can enhance medication adherence and potentially curb the issue of medication wastage.

Consumer internet purchasing of medicines using a population sample: A mixed methodology approach.

BACKGROUND: Malta has an average of 3-4 private community pharmacies per locality, providing patients with easy access to medicines yet according to general statistics gathered from European organisations, Internet is used to purchase various online products with medicines being amongst them. OBJECTIVES: To identify patterns around internet purchasing of medicines among Maltese residents. METHODS: The study followed a mixed methods approach, employing a cross-sectional survey followed by semi-structured interviews. A random sample of 1996 residents were selected from the Maltese electoral register to participate in a postal questionnaire designed to gather data about purchasing prescription-only-medicines (POM) as well as over-the-counter (OTC) medicines. Results were analysed using descriptive statistics and Chi-square to establish associations between responses. Five interviews investigated participants' concerns related to sourcing of medicines. The participants were purposively chosen from the questionnaire respondents. Data were analysed using thematic analysis. RESULTS: The survey had a 22% response rate (N = 444) (60% female; mean age 52 years ±â€¯17). Two (0.45%) participants reported purchasing POMs online in the past, while 4.3% (n = 19) purchased OTCs including vitamins, supplements and herbal combinations. The main reasons for OTC online purchasing were lack of local availability (n = 6; 1.4%) and lower price (n = 11; 2.5%). A total of 89% (n = 395) of respondents provided a reason for not purchasing online, with safety issues being the primary reason for 41% (n = 181) of these. Interviewees expressed disregard towards internet purchasing of medicines that was evident from the themes that emerged: definition of 'medicines', health autonomy and trust in self-care, relationships and trust in health professional, restrictions of medicine supply, influence of cost, need for options. CONCLUSIONS: The Maltese appear to be rather cautious and do not purchase POMs online, citing the risks that may be associated with internet purchasing. With regards to OTCs, a small percentage purchase these online and exposing them to risks associated with unauthorised sites.

An analysis of gender differences in self-reported health, use of medicines and access to information sources about medicines among adolescents.

Adolescence is a key period in the emergence of gender differences in health that persist into adulthood. Knowledge about health-related gender differences among adolescents could be instrumental in informing policy and practice to effect health improvement among this age group. The main objectives of this study were therefore to investigate gender differences in self-reported health complaints and use of medicines during the preceding 3 months and access to information sources about medicines among adolescents in Malta. A self-administered questionnaire was distributed among adolescents attending secondary schools in Malta. A stratified random sample design generated a sample size of 514 students. Common health complaints, use of medicines, and sources of information about medicines were investigated by means of author-designed checklists. The analytical sample was formed from 474 usable questionnaires collected from students aged 14-16 years, of which 53.8% were females. In general, a female excess emerged for health complaints and use of medicines except for sport injuries and use of vitamins. Gender differences were statistically significant for a female excess in the retrieval of information from the package insert (p < .001), parents or adult relatives (p < .01) and friends or schoolmates (p < .05). The findings of this study underscore the need for awareness of gender differences in the health of adolescents among health care providers, policy makers, and educators. An important implication of the findings is that the health needs of adolescents could be more equitably addressed by adopting a holistic patient-oriented approach particular to the health needs of each individual.

Educational intervention to enhance adherence to short-term use of antibiotics.

BACKGROUND: Non-adherence to short-term antibiotics is considered to be one of the factors leading to medicines wastage, and this can increase misuse of medicine taking, promote antibiotic resistance and cause environmental pollution. Interventions developed to enhance adherence to short-term antibiotics should be easily implementable into daily practice. No studies utilising Normalization Process Theory to develop interventions aiming to enhance adherence to antibiotics were identified. OBJECTIVES: To assess whether an intervention supported by an educational leaflet enhances adherence and reduces cost in relation to wastage of unused antibiotics amongst patients taking short-term antibiotics in community; and to determine a possible association between adherence and patients' general medicines' beliefs. METHODS: Fourteen community pharmacies were randomly selected: seven pharmacies used an educational leaflet (intervention) to counsel patients; seven pharmacies acted as control. Patients with an antibiotic prescription were recruited until 200 patients per group was reached. Two focus groups based on Normalization Process Theory were held with pharmacists from the intervention group to refine the leaflet. After finishing the antibiotics, patients were contacted to assess adherence, storage, knowledge about antibiotic resistance and beliefs about medicines using 'Beliefs about Medicines Questionnaire-General' (BMQ-General). RESULTS: Ten percent from intervention group and 24% from control were non-adherent (p = < 0.0005), with a 2.8-fold more in the percentage cost of wasted antibiotics in control group. 'General-benefit' belief was significantly higher for intervention group (p = 0.044). For control group, higher 'general-overuse' beliefs were significantly associated with non-adherence (p = <0.0005). CONCLUSIONS: An educational intervention has significantly enhanced adherence to prescribed short-term antibiotics and reduced wastage.

Medication and Medication Wastage: Short-Term and Long-Term Effects of an Educational Intervention Among School Children.

Background. Education should support the gradual development of students' necessary abilities to empower them in participating in decision-making together with health care professionals. Aim. The aim of this study was (1) to evaluate baseline knowledge regarding medication and medication wastage among primary school children and (2) to determine the short- and long-term effects of an educational intervention. Methods. Ten primary state schools around Malta were invited to participate; 5 accepted participation (3 control and 2 intervention). Children aged 9 to 12 years attending the sixth grade completed a self-reported questionnaire containing 20 questions, with total scores ranging from 0 to 20. Students from the intervention classes filled in a questionnaire pre and post an educational seminar. All students answered the questionnaire again after 8 months. ANOVA (analysis of variance) with repeated measures was used to compare difference between preintervention and postintervention mean scores. Results. Overall, 40.8% (160/392) of children participated. Mean ± SD age was 10 ± 0.4years; 52.5% (n = 84) were boys. Average preintervention knowledge score for all 5 schools was 11.5 ± 3.6, with 43.1% (n = 69) obtaining responses ≥13 (median). A repeated-measures ANOVA with a Greenhouse-Geisser correction determined that mean knowledge scores differed significantly between preintervention and postintervention (F[1, 81.000] = 75.190, P < .0005). Intervention students retained a significant increase in knowledge scores at 8 months (P = .026). Discussion and Conclusion. The significantly improved knowledge score following the educational intervention both in the short- and long-term demonstrated the success of the intervention. These findings provide a basis for the introduction of education about medication and medication wastage in schools.

Health locus of control: Its relationship with medication adherence and medication wastage.

BACKGROUND: Non-adherence is a significant factor contributing to medication wastage. Whilst there is some evidence on the influence of patients' health locus of control in relation to adherence, there has been little inquiry into its relationship with mediation wastage. OBJECTIVES: To determine the relationship between medication adherence and health locus of control as well as medication wastage and health locus of control in patients with chronic conditions. METHODS: Outpatients having a diagnosis of asthma, cardiovascular conditions, or diabetes participated in a cross-sectional study employing a self-administered questionnaire. The questionnaire determined presence of unused medication (wastage), adherence using 'Tool for Adherence Behaviour Screening' (TABS), and health locus of control using 'Multidimensional Health Locus of Control' (MHLC) scale Form C. Logistic regression was performed to ascertain the effects of MHLC and demographics in relation to adherence and wastage. MHLC beliefs were divided into 8 types of health locus of control. One-Way ANOVA was used to assess differences between conditions and belief types. P-values ≤ .05 were considered significant. RESULTS: There were 330 patients recruited (58% male; age, mean±(SD): 61 ± 15 years; 110 asthma, 110 cardiovascular, 110 diabetes). In terms of health locus of control, females had higher 'doctors' beliefs (p = .054) and significantly lower 'other people' beliefs (p = < .0005). Lower 'chance' beliefs (p = .016) were associated with adherence. Lower 'doctors' beliefs and higher 'other people' beliefs were significantly associated with wastage (p = < .0005). There was a significant difference in adherence (p = < .0005) and in wastage (p = .002) between the eight types of health control. 'Yea-sayers' had the least presence of unused medication, followed by 'pure internal' believers. 'Pure powerful others external' had the highest presence of unused medication. CONCLUSIONS: Healthcare professionals should take into account patients' health locus of control beliefs whilst conducting an intervention with patients; this can impact positively medication adherence and minimisation of medication wastage.

Methodological considerations in clinical outcomes assessment of pharmacy-based minor ailments management: A systematic review.

BACKGROUND: The accessibility of services within community pharmacies provides an ideal opportunity to manage minor ailments, yet over £1.1 billion is spent by the National Health Service (NHS) in the United Kingdom (UK) in managing minor ailments in high cost settings. There is a need to review the evidence base around clinical effectiveness of pharmacy-based management of minor ailments since the absence of such may lead to under-utilisation of pharmacy services and non-implementation of available pharmacy service models. This study aimed to systematically review the methodological approaches used to assess clinical outcomes of pharmacy-based management of minor ailments in the research literature. METHODS: A systematic review was conducted to identify relevant literature using the following databases: Medline, EMBASE, CINAHL, IPA, CRD, CDSR, and Google Scholar from publication year 2000 onwards. Studies were included if they evaluated clinical outcomes of pharmacy-based management of any minor ailments, with or without a comparator setting such as Emergency Departments (EDs) or general practices. Screening and selection of titles, abstracts and full texts followed by data extraction and quality assessment (QA) was conducted. Paired researchers, from the team, reviewed papers using a protocol based on the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). QA was undertaken using the Critical Appraisal Skills Programme (CASP). Reporting was conducted in accordance with PRISMA checklist and statements. RESULTS: A total of 19 studies were included. The majority of studies were observational, conducted in community pharmacies, and did not use a comparator participant group nor a comparator setting. Interventions included counselling, medicines supply and provision of advice on the management of minor ailments. One study used the randomised controlled trial (RCT) design with majority of the study utilising observational design. A range of clinical outcomes including symptom severity, pattern, resolution, and quality of life were reported. Methods used for the assessment of clinical outcomes were, overall, poorly reported. This included a lack of information on the development and validation of the data collection tools and the timing of baseline and follow-up data collection. Adverse clinical outcomes data were collected by only seven studies. CONCLUSIONS: Currently, there are methodological limitations in the studies that have sought to assess clinical outcomes of pharmacy-based management of minor ailments. Such lack of high quality evidence may contribute to failings to shift care from high cost settings, such as EDs and general practices. Generation of high quality evidence is likely to influence public choices when seeking care for minor ailments. There is scope for development of a core outcomes set specific to minor ailments management and development of a validated methodology for measuring such outcomes in a research study.

Applying lean methodology to improve parenteral chemotherapy and monoclonal antibody documentation processes based on Normalisation Process Theory.

OBJECTIVE: To determine the impact of lean thinking on the original time required to prepare the necessary documentation in relation to the preparation of parenteral chemotherapy/monoclonal antibodies. METHOD: Four pharmacists and one pharmacy technician from the oncology hospital (Malta) all participated in eight focus groups linked to the different constructs of Normalisation Process Theory (NPT): coherence, cognitive participation, collective action and reflexive monitoring. The value stream documentation process was mapped by analysing all steps in the process where each activity must add value for the patient; tools of lean thinking were applied. Points causing delay in processing were considered critical; possible changes to minimise time waste were discussed and implemented. Time spent on critical points was measured by timing in minutes each step of the process 1 month before and after the changes had been implemented and calculating the mean±SD. An audit was performed comparing the process with standard operating procedures to determine whether any steps required quality improvement. RESULTS: Three critical points were identified: time required to search for pharmacy patient medication records for chemotherapy/monoclonal antibodies required on the day; time to generate preparation labels; and time to generate worksheets. Overall, a total of 122±8.6 min (p=0.06) were saved per day, a 37% decrease from the original documentation time. Five deficiencies were identified in the documentation process audit; corrective action was proposed. CONCLUSIONS: By applying lean thinking, non-value-added steps leading to time waste in the documentation process were eliminated. This concept could be implemented by using NPT as part of a strategic system to reduce waste.

Erratum to: Clinical pharmacist evaluation of medication inappropriateness in the emergency department of a teaching hospital in Malta.

[This corrects the article on p. 181 in vol. 10, PMID: 24155835.].

Psychometric properties of the Belief about Medicines Questionnaire (BMQ) in the Maltese language.

BACKGROUND: Investigating beliefs about medicines has been of interest over the past years, with studies aiming to better understand theoretical reasons behind development of such beliefs. OBJECTIVE: This study aimed to produce a culturally and contextually appropriate version of the Beliefs about Medicines Questionnaire (BMQ) in the Maltese language and to assess its psychometric properties. METHODS: Medication beliefs were evaluated using the BMQ which is divided into two sections: BMQ-General (sub-scales: Overuse and Harm, 4 items per sub-scale) and BMQ-Specific (sub-scales: Necessity and Concerns, 5 items per sub-scale). Following translation/back translation, the Maltese version of the BMQ was applied to patients having asthma, diabetes, cardiovascular disease or depression who attended out-patients' clinics at the main state general hospital in Malta between June and September 2013. Cronbach's alpha coefficient, alpha, was used to determine internal consistency of the BMQ and Principal Component Analysis using Varimax rotation with Kaiser normalisation was carried out to analyse component loading of the items on the respective sub-scales. RESULTS: The Maltese version of the BMQ showed acceptable internal consistency for the harm scale (alpha=0.56), the necessity scale (alpha=0.73) and the concerns scale (alpha=0.66), however the overuse scale gave poor internal consistency (alpha=0.48) due to the item on natural remedies which posed some difficulty in the Maltese sample. The final solution for Principal Component Analysis yielded a four-factor structure representing the 4 sub-scales of the BMQ, with results being comparable to previous studies out in different languages. CONCLUSION: The Maltese version of the BMQ was found to have acceptable psychometric properties for the beliefs about medicines in the Maltese population.

Provision of pharmaceutical care by community pharmacists across Europe: Is it developing and spreading?

RATIONALE, AIMS, AND OBJECTIVES: Pharmaceutical care involves patient-centred pharmacist activity to improve medicines management by patients. The implementation of this service in a comprehensive manner, however, requires considerable organisation and effort, and indeed, it is often not fully implemented in care settings. The main objective was to assess how pharmaceutical care provision within community pharmacy has evolved over time in Europe. METHOD: A cross-sectional questionnaire-based survey of community pharmacies, using a modified version of the Behavioural Pharmaceutical Care Scale (BPCS) was conducted in late 2012/early 2013 within 16 European countries and compared with an earlier assessment conducted in 2006. RESULTS: The provision of comprehensive pharmaceutical care has slightly improved in all European countries that participated in both editions of this survey (n = 8) with progress being made particularly in Denmark and Switzerland. Moreover, there was a wider country uptake, indicating spread of the concept. However, due to a number of limitations, the results should be interpreted with caution. Using combined data from participating countries, the provision of pharmaceutical care was positively correlated with the participation of the community pharmacists in patient-centred activities, routine use of pharmacy software with access to clinical data, participation in multidisciplinary team meetings, and having specialized education. CONCLUSIONS: The present study demonstrated a slight evolution in self-reported provision of pharmaceutical care by community pharmacists across Europe, as measured by the BPCS. The slow progress suggests a range of barriers, which are preventing pharmacists moving beyond traditional roles. Support from professional bodies and more patient-centred community pharmacy contracts, including remuneration for pharmaceutical care services, are likely to be required if quicker progress is to be made in the future.