Initial evaluation of a brief pharmacy-led intervention to modify beliefs about medicines and facilitate adherence among patients hospitalised with acute coronary syndrome.

OBJECTIVES: Medication non-adherence is common among patients with acute coronary syndrome (ACS) and is associated with poor clinical outcomes. To date, pharmacists have been underutilised in the delivery of adherence interventions. Across two studies, we assessed the feasibility, acceptability and effectiveness of a novel pharmacy-led intervention for patients hospitalised with ACS. METHODS: The theory-based intervention was comprised of two personalised sessions addressing perceptual (negative/erroneous treatment beliefs) and practical (suboptimal action planning) barriers to adherence. Study 1: A single-arm, feasibility and acceptability study was conducted to determine proof-of-concept. Pre-post-comparisons using the Beliefs about Medicines Questionnaire-Specific (BMQ-S) were made. Study 2: A non-randomised controlled before-after pilot study was conducted with the intervention delivered by a team of clinical pharmacists. Follow-up data were collected at 6 and 12 weeks post-discharge. Primary outcome measures included the BMQ-S and the Medication Adherence Report Scale 5. RESULTS: Study 1: 15 patients received the intervention and reported higher BMQ-S necessity scores post-intervention. The intervention was deemed highly acceptable to patients; therefore, further testing was sought. Study 2: A total of 56 patients were recruited: control (n=29) versus treatment (n=27). At 6-week follow-up, the treatment group had higher BMQ-S necessity scores (M=21.8, SD=3.1) compared with control (M=19.8, SD=2.7; p=0.045), although this effect was not maintained at 12 weeks. No differences were reported in the other outcome measures. CONCLUSIONS: Although the intervention was acceptable to patients, poor fidelity in delivery raises questions about its feasibility in practice. Furthermore, there was some impact on patients' beliefs about medications but no effect on adherence. These findings demonstrate the importance of conducting feasibility and acceptability studies when developing adherence innovations in clinical care. Future studies should consider enhancing the training process to ameliorate fidelity issues.

The transition from hospital to home following acute coronary syndrome: an exploratory qualitative study of patient perceptions and early experiences in two countries.

OBJECTIVES: Following acute coronary syndrome (ACS), it is standard practice for stable patients to be discharged as quickly as possible from hospital. If patients are not adequately supported at this time, issues such as readmission can occur. We report findings from an exploratory qualitative study investigating the perceptions and early experiences of patients transitioning from hospitals in the UK and USA to home following ACS. METHODS: Within 1 month of discharge, we conducted semi-structured telephone interviews with patients hospitalised for ACS (UK: n = 8; USA: n = 9). Data were analysed using the Framework Method. KEY FINDINGS: We identified four superordinate themes. Coping, adjustment and management: Patients were still adjusting to the physical limitations caused by their event but most had begun to implement positive lifestyle changes. Gaps in care transition: Poor communication and organisation postdischarge resulted in delayed follow-up for some patients causing considerable frustration. Quality of care from hospital to home: Patients experienced varied inpatient care quality but had largely positive interactions in primary/community care. Pharmacy input during care transition was viewed favourably in both countries. Medication-taking beliefs and behaviour: Patients reported good initial adherence to treatment but side effects were a concern. CONCLUSIONS: ACS patients experienced gaps in care early in the transition from hospital to home. Poor communication and uncoordinated support postdischarge negatively impacted patient experience. Further research is needed to determine how patients' early experiences following ACS can affect longer-term outcomes including healthcare engagement and treatment maintenance.

Clinical pharmacy services in a London hospital, have they changed?

BACKGROUND: The development of clinical pharmacy, has created a need for pharmacists to demonstrate the service they provide to hospital boards. OBJECTIVES: To describe and compare the type and frequency of clinical pharmacy contributions to individual patients admitted to a large teaching hospital within a 1 week study period over four consecutive years 2009-2012. METHOD: This study was a prospective 1 week study over 4 years (2009-2012). Pharmacists used data collection sheets to record the primary reason and outcome of interventions made. RESULTS: The most frequent reasons for pharmacists intervening in patient care have been due to efficacy of medication and for safety to prevent an adverse drug reaction. The percentage of accepted interventions by the medical team was similar ranging from 85 to 92 %. CONCLUSIONS: Pharmacists consistently carried out interventions to patient care over a 4 year period and provide the Trust with a service that focuses on ensuring safety and efficacy of the medications administered. Impact of findings on practice Daily clinical pharmacy services in a UK teaching hospital allow pharmacists to contribute to protecting patients from the adverse effects of medications. Pharmacists most frequently intervene to patient care for the reasons of medication efficacy and safety and to prevent adverse drug reactions.

Information about medicines to cardiac in-patients: patient satisfaction alongside the role perceptions and practices of doctors, nurses and pharmacists.

OBJECTIVE: To explore the satisfaction of cardiac in-patients regarding the information they received about their medicines, and the role perceptions and practices of practitioners whose responsibility it was to provide such information. METHOD: A questionnaire was constructed by selecting medicine information topics from a validated instrument, the Satisfaction with Information about Medicines Scale. Patients and practitioners were recruited from cardiac wards at a London teaching hospital providing tertiary care. RESULTS: Questionnaires were returned by 140 patients and 52 doctors, 53 nurses and 4 pharmacists. Patients were satisfied with information about the action and usage of medicines but were significantly less satisfied with information about potential problems with their medicines. In parallel, practitioners provided more information about the action and usage of medicines than its potential problems. CONCLUSIONS: Information gaps existed largely around potential problems with medicines which reflected the general lack of focus on these issues by the healthcare professionals studied. There was no consensus between doctors, nurses and pharmacists on perceptions of role responsibility of information provision. PRACTICE IMPLICATIONS: Patients may become non-adherent to their medicines if insufficient information is provided. Role responsibilities should be co-ordinated when information about medicines is provided by a range of practitioners.

Identification of patients attending accident and emergency who may be suitable for treatment by a pharmacist.

BACKGROUND: Several studies have demonstrated that 25-40% of Accident & Emergency department attendances are for conditions that could be managed by the patient's general practitioner. The number of these who could be appropriately managed by a community pharmacist, has not previously been established. OBJECTIVE: To establish the frequency with which patients attend an inner city A&E department with problems that could be managed by a community pharmacist. METHODS: A cross-sectional, retrospective review of A&E records for adult patients (>16 years) was conducted during the first two weeks of March 1999. Application of recognised criteria identified patients whose conditions were suitable for treatment by a pharmacist. Associated patient characteristics were investigated. RESULTS: During the study period 2636 adult patients attended the A&E department. Pharmacist management was considered appropriate in 8% of adult attendances (95% CI 6.8-8.9). The most commonly presented symptoms considered appropriate for pharmacist treatment included those of upper respiratory, gastrointestinal and pain conditions and reflect those previously identified in the literature. CONCLUSIONS: A pharmacist could manage an estimated 8% of adult attendances at this A&E department. Efforts should be made to increase the awareness of the general public of the role of a community pharmacist to reduce demand on A&E and GP services.