The Carer Assessment of MedicaTion Management GuidanCe for People With Dementia at Hospital Discharge (CATCH) Tool: Exploratory Factor Analysis.

PURPOSE: The Carer Assessment of medicaTion management guidanCe for people with dementia at Hospital discharge (CATCH) tool was developed to examine the carer's experiences of medication management guidance delivery at discharge. This study explored its factor structure, characterized carers' experiences at discharge, and identified predictors of carer preparedness to manage medications at discharge. METHODS: A cross-sectional survey of carers across Australia was distributed. Survey responses were analyzed descriptively, and exploratory factor and regression analyses were performed. RESULTS: A total of 185 survey responses were completed. Exploratory factor analysis revealed 2 factors in the CATCH tool: (1) shared and supported decision-making in medication management (16 items loading 0.47 to 0.93); 2) provision of medication management guidance that is easy to understand (4 items loading (0.48 to 0.82). Internal consistency was acceptable (Cronbach alpha >0.8). Almost 18% of participants stated that they were not included in decisions about medications for people with dementia. The carer reported that the measure of how guidance is provided was positively related to their confidence in the management of medications postdischarge and satisfaction ( P < 0.05 for both). CONCLUSIONS: The CATCH tool can give the patient and carer an opportunity to provide feedback on key elements of medication management guidance delivered at discharge.

A realist synthesis of interprofessional patient safety activities and healthcare student attitudes towards patient safety.

Interprofessional education (IPE) has been used for instilling a positive safety culture within healthcare, yet what interventions work to change healthcare student attitudes and how improved patient safety outcomes are best achieved with this intervention, is unclear and challenging to evaluate. A realist synthesis was undertaken to ascertain how, why, and in what circumstances IPE activities result in a positive change to student attitudes to patient safety. Database searches of CINAHL, MEDLINE, Scopus, and Eric were undertaken in April 2022 to identify relevant studies. Synthesis with a realist framework of analysis, coupled with the development of a program theory was conducted to identify interactions among contexts, intervention, mechanisms, and outcomes (CIMO). Twenty-three articles eligible for inclusion articulated environments in which varied contexts, interventions, and mechanisms were activated to influence student attitudes to patient safety. Findings from this realist synthesis informs awareness into the methods of delivering and evaluating IPE activities and offers new perspectives for educators in planning and evaluating future IPE from a collaborative and positive safety culture perspective.

Clinical practice guideline for deprescribing opioid analgesics: summary of recommendations.

INTRODUCTION: Long term opioids are commonly prescribed to manage pain. Dose reduction or discontinuation (deprescribing) can be challenging, even when the potential harms of continuation outweigh the perceived benefits. The Evidence-based clinical practice guideline for deprescribing opioid analgesics was developed using robust guideline development processes and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology, and contains deprescribing recommendations for adults prescribed opioids for pain. MAIN RECOMMENDATIONS: Eleven recommendations provide advice about when, how and for whom opioid deprescribing should be considered, while noting the need to consider each person's goals, values and preferences. The recommendations aim to achieve: implementation of a deprescribing plan at the point of opioid initiation; initiation of opioid deprescribing for persons with chronic non-cancer or chronic cancer-survivor pain if there is a lack of overall and clinically meaningful improvement in function, quality of life or pain, a lack of progress towards meeting agreed therapeutic goals, or the person is experiencing serious or intolerable opioid-related adverse effects; gradual and individualised deprescribing, with regular monitoring and review; consideration of opioid deprescribing for individuals at high risk of opioid-related harms; avoidance of opioid deprescribing for persons nearing the end of life unless clinically indicated; avoidance of opioid deprescribing for persons with a severe opioid use disorder, with the initiation of evidence-based care, such as medication-assisted treatment of opioid use disorder; and use of evidence-based co-interventions to facilitate deprescribing, including interdisciplinary, multidisciplinary or multimodal care. CHANGES IN MANAGEMENT AS A RESULT OF THESE GUIDELINES: To our knowledge, these are the first evidence-based guidelines for opioid deprescribing. The recommendations intend to facilitate safe and effective deprescribing to improve the quality of care for persons taking opioids for pain.

Situated learning in community environments (SLICE): Systems design of an immersive and integrated curriculum for community-based learning.

PURPOSE: We sought to design a micro-curriculum to structure supervised clinical placements for junior medical students within a variety of community-based settings of differing clinical disciplines. Given the gaps in the literature, this paper reflects on the opportunities and challenges of our design, implementation, and evaluation strategies in constructing an integrated task-based micro-curriculum for interprofessional community-based learning in year 2 of a four-year graduate entry program. METHODS: The design was informed by a systems thinking framework and guided by contemporary curricular theories on self-directed and interprofessional learning. Extensive consultations with stakeholders were undertaken. Alignment with relevant national level documents and curricular frameworks was ensured. RESULTS: The systems thinking approach provided first, an experience of applying thinking tools for a deeper understanding of how various parts of this micro-curriculum and subsystems should be integrated. Second, applying the toolkit uncovered tension points on which leverage could optimise future enhancements. Eighteen types of health professions were recruited including 105 general practitioners and 253 healthcare practitioners from a range of disciplines. CONCLUSION: Systems thinking allows for the identification of various interacting elements within the curriculum to be considered as part of an integrated whole. Insights from this model could inform the design of similar innovative curricula.

The role of community pharmacy in wound care: a scoping review.

OBJECTIVE: To scope the literature describing the role of pharmacy in wound care in the community setting. METHOD: A systematic scoping review was conducted including peer-reviewed and grey literature. A search was undertaken using CINAHL, Embase, Informit, International Pharmaceutical Abstracts and MEDLINE, and a Google search of the top 200 results via three virtual private networks were used to identify relevant grey literature. Keywords relating to pharmacy, pharmacist, wound, wound management and wound care were used. Descriptions of wound care activities were extracted, grouped by similarity, and mapped to the International Pharmaceutical Federation's (FIP) Global Competency Framework Version 2 (GbCFv2). RESULTS: Of 2928 potentially relevant articles and 600 web search results, 55 articles from the database search and 11 results from the Google search met the eligibility criteria. After mapping 14 identified roles to the FIP GbCFv2, it was apparent that the scope of practice for wound care spanned across all four competency domains: pharmaceutical public health; pharmaceutical care; professional/personal; and organisational and management. CONCLUSION: The role of community pharmacy in wound care is multifaceted and within the scope of entry-level competency for pharmacists. These roles comprise wound related and non-wound-specific, clinical and non-clinical activities.

Co-design and evaluation of a multidisciplinary teaching resource on mental health recovery involving people with lived experience.

BACKGROUND: Students from a range of health disciplines need to learn from people with lived experience of mental distress and recovery to develop recovery capabilities for mental health practice. AIMS: The aims of this study are to describe the co-design of a teaching resource, to explore the experience of people with lived experience during the resource development, and to evaluate the outcome of the resource on student recovery capabilities. METHOD: Using a sequential mixed method, a project group consisting of six people with lived experience and 10 academics from five health disciplines was convened to co-develop teaching resources. People with lived experience met independently without researchers on several occasions to decide on the key topics and met with the research team monthly. The teaching resource was used in mental health subjects for two health professional programmes, and the Capabilities for Recovery-Oriented Practice Questionnaire (CROP-Q) was used before and after to measure any change in student recovery capabilities. Scores were compared using the Wilcoxon signed rank test. The people with lived experience were also interviewed about their experience of being involved in constructing the teaching resources. Interviews were audiotaped, transcribed, and analysed thematically. RESULTS: The finished resource consisted of 28 short videos and suggested teaching plans. Occupational therapy and nursing student scores on the CROP-Q prior to using the educational resource (n = 33) were 68 (median) and post scores (n = 28) were 74 (median), indicating a statistically significant improvement in recovery capability (P = 0.04). Lived experience interview themes were (i) the importance of lived experience in education; (ii) personal benefits of participating; (iii) co-design experience; and (iv) creating the resource. CONCLUSION: Co-design of teaching resources with people with lived experience was pivotal to the success and quality of the final product, and people with lived experience described personal benefits of participating in resource development. More evidence to demonstrate the use of the CROP-Q in teaching and practice is needed.

Correction: Predictors of Health Information-Seeking Behavior: Systematic Literature Review and Network Analysis.

[This corrects the article DOI: 10.2196/21680.].

Predictors of Health Information-Seeking Behavior: Systematic Literature Review and Network Analysis.

BACKGROUND: People engage in health information-seeking behavior to support health outcomes, and being able to predict such behavior can inform the development of interventions to guide effective health information seeking. Obtaining a comprehensive list of the predictors of health information-seeking behavior through a systematic search of the literature and exploring the interrelationship of these predictors are critical first steps in this process. OBJECTIVE: This study aims to identify significant predictors of health information-seeking behavior in the primary literature, develop a common taxonomy for these predictors, and identify the evolution of the concerned research field. METHODS: A systematic search of PsycINFO, Scopus, and PubMed was conducted for all years up to and including December 10, 2019. Quantitative studies identifying significant predictors of health information-seeking behavior were included. Information seeking was broadly defined and not restricted to any source of health information. Data extraction of significant predictors was performed by 2 authors, and network analysis was conducted to observe the relationships between predictors with time. RESULTS: A total of 9549 articles were retrieved, and after the screening, 344 studies were retained for analysis. A total of 1595 significant predictors were identified. These predictors were categorized into 67 predictor categories, with the most central predictors being age, education, gender, health condition, and financial income. With time, the interrelationship of predictors in the network became denser, with the growth of new predictor grouping reaching saturation (1 new predictor identified) in the past 7 years, despite increasing publication rates. CONCLUSIONS: A common taxonomy was developed to classify 67 significant predictors of health information-seeking behavior. A time-aggregated network method was developed to track the evolution of the research field, showing the maturation of new predictor terms and an increase in primary studies reporting multiple significant predictors of health information-seeking behavior. The literature has evolved with a decreased characterization of novel predictors of health information-seeking behavior. In contrast, we identified a parallel increase in the complexity of predicting health information-seeking behavior, with an increase in the literature describing multiple significant predictors.

Measuring and assessing the competencies of preceptors in health professions: a systematic scoping review.

BACKGROUND: In healthcare, preceptors act as a role model and supervisor, thereby facilitating the socialisation and development of the preceptee into a professional fit to practice. To ensure a consistent approach to every preceptorship experience, preceptor competencies should be measured or assessed to ensure that the desired outcomes are achieved. Defining these would ensure quality management and could inform development of an preceptor competency framework. This review aimed to evaluate the evidence for preceptor competencies and assessment in health professions. METHODS: This study followed the PRISMA ScR scoping review guidelines. A database search was conducted in Embase, Medline, CINAHL and IPA in 2019. Articles were included if they defined criteria for competency, measured or assessed competency, or described performance indicators of preceptors. A modified GRADE CERQual approach and CASP quality assessment were used to appraise identified competencies, performance indicators and confidence in evidence. RESULTS: Forty one studies identified 17 evidence-based competencies, of which 11 had an associated performance indicator. The competency of preceptors was most commonly measured using a preceptee completed survey (moderate to high confidence as per CERQual), followed by preceptor self-assessment, and peer-assessment. Preceptee outcomes as a measure of preceptor performance had good but limited evidence. CONCLUSIONS: Competencies with defined performance indicators allow for effective measurement and may be modifiable with training. To measure preceptor competency, the preceptor perspective, as well as peer and preceptee assessment is recommended. These findings can provide the basis for a common preceptor competency framework in health professions.

Self-care-seeking behaviors in the community pharmacy: A cross-sectional exit survey of Australian consumers.

OBJECTIVES: To characterize over-the-counter (OTC) medicine requests of Australian pharmacy consumers, to explore the factors predicting consumer behavior, and to examine the relationship between characteristics of consumers' requests and their satisfaction with the pharmacy. DESIGN: Paper-based cross-sectional survey consisting of multiple choice, Likert scale, and open-ended questions. SETTING AND PARTICIPANTS: Surveys were administered in person to consumers exiting Australian community pharmacies between October 2018 and May 2019. Consumers who had purchased or requested an OTC medicine, could read and write in English, and were aged 18 years or older were eligible to participate. Data were analyzed descriptively and through logistic regression modelling. OUTCOME MEASURES: Respondent demographics, nature of the OTC request (whether direct-product, self-select, or symptom-based), reason(s) for OTC request, staff involved, and satisfaction with the visit to the pharmacy (0 = not at all satisfied, and 5 = extremely satisfied). RESULTS: Six-hundred and five consumers from 51 pharmacies were surveyed. Most of the pharmacies were located in metropolitan Sydney (n = 48). The respondents were predominantly female (n = 353, 58%), 20-29 years of age (n = 202, 33%), and university-educated (n = 266, 44%). Sixty-five percent of requests (n = 395) were direct-product requests or self-selected, and the remaining were symptom-based (n = 210). Most OTC medicines requested were for the respondents' own use (n = 457, 76%). One-third (n = 197) of the requests were for respiratory conditions. Prior use of the medicine and a higher level of education were significant predictors of direct-product requests (P < 0.05, R2 = 0.22). The satisfaction scores ranged from 2 to 5 out of 5 (median = 5, interquartile range: 4, 5). CONCLUSION: Most requests were direct-product requests. Prior use and a higher level of education predicted the decision to directly request a product. Consumer satisfaction with their experience at the pharmacy was high.

Effect of hospital simulation tutorials on nursing and pharmacy student perception of interprofessional collaboration: Findings from a pilot study.

Interprofessional learning (IPL) during formal training enables interprofessional collaboration (IPC) in the workforce; however, on-campus IPL opportunities are seldom incorporated into curricula. We describe the development and implementation of two hospital simulation tutorials between nursing and pharmacy students. Students were required to provide "usual care" to a simulated patient at admission and discharge. A pre-post survey design was used to evaluate changes in Interdisciplinary Education Perception Scale (IEPS) score and student perceived educational value of the tutorials. The tutorials had a positive effect on IEPS scores (p < 0.001), whereas gender and profession did not appear to influence scores (p = 0.082 and p = 0.923, respectively). Tutorials were rated either good or very good by 89.9% of students and 79.6% of students reporting new insights into the other profession This tutorial format could be easily adapted by other institutions as an engaging and rewarding strategy to better prepare students for IPC the workforce.

Psychotropic polypharmacy in Australia, 2006 to 2015: a descriptive cohort study.

AIMS: To describe psychotropic polypharmacy in Australia between 2006 and 2015. METHODS: We used pharmaceutical claims from a national 10% sample of people with complete dispensing histories to estimate the annual prevalence of the combined use (overlap of >60 days exposure) of ≥2 psychotropics overall and within the same class or subclass (class and subclass polypharmacy). We also estimated the proportion of polypharmacy episodes involving one, two, three and four or more unique prescribers. RESULTS: The prevalence of class polypharmacy between 2006 and 2015 in people dispensed specific psychotropic classes was 5.9-7.3% for antipsychotics, 2.1-3.7% for antidepressants and 4.3-2.9% for benzodiazepines. The prevalence of antipsychotic polypharmacy was higher than expected given the prevalence of antipsychotic exposure and combinations of sedating agents were notably common. Overall, 26.7% of polypharmacy episodes involved multiple prescribers but having multiple prescribers occurred more frequently for class and subclass polypharmacy and people with four or more concomitant psychotropics. DISCUSSION: Psychotropic polypharmacy is common, despite limited evidence of risks and benefits. Increases in polypharmacy with multiple prescribers may be due to poor communication with patients and between health care professionals.

Psychotropic medication use in Australia, 2007 to 2015: Changes in annual incidence, prevalence and treatment exposure.

OBJECTIVE: To examine changes in annual patterns of psychotropic medication use in Australia from 2007 to 2015. METHODS: We used a 10% sample of individual-level nationwide dispensing claims for concessional beneficiaries dispensed psychotropic medications (stratified by class, subclass) to investigate annual trends and changes in the incidence and prevalence of use, median annual duration of exposure, proportion of people with single psychotropic dispensing and median defined daily doses per person dispensed each medicine per year. RESULTS: Over the study period, there was a 26.1% decrease in the incidence and a 2.6% increase in the prevalence of all psychotropic medicine use. We observed a decrease in the annual incidence and prevalence of antidepressants (11.6% and 16.8%, respectively) but increases in the median annual duration of exposure (7.4%). Amitriptyline had the highest proportion of single dispensings of all antidepressants throughout the study period (26.5% in 2015) and defined daily doses per person dispensed each medicine per year increased by 20% for antidepressants overall. Benzodiazepine use decreased across all measures over the study period apart from long-term use (exposure for >240 days of the year), which in 2015 was 23.6% of those dispensed a benzodiazepine. We observed a relative increase in the incidence and prevalence of antipsychotic use (14.2% and 26.8%, respectively), and haloperidol had the highest proportion of single dispensings of any antipsychotic throughout the study period (47.5% in 2015). We observed a relative increase in the incidence and prevalence of attention-deficit hyperactivity disorder medication use of 114.0% and 101.8%, respectively, over the study period. CONCLUSION: Increasing doses and treatment durations of antidepressants warrants further investigation due to concerns about overuse. Single dispensings of amitriptyline and haloperidol may indicate off-label use and long-term use of benzodiazepines remains problematic. Despite increases in attention-deficit hyperactivity disorder medication use, prevalence of use is still much lower than the estimated prevalence of attention-deficit hyperactivity disorder in the adult population.

Factors influencing the current practice of self-medication consultations in Eastern Indonesian community pharmacies: a qualitative study.

BACKGROUND: Research has shown that the current practice of pharmacy staff when providing self-medication consultations in Indonesia is suboptimal. To improve the performance of pharmacy staff when providing self-medication consultations in community pharmacies, the factors that influence current practice need to be understood. The aim of this study is to identify the factors that influence current practice of pharmacy staff when handling self-medication consultations in Eastern Indonesian community pharmacies. METHODS: Fifteen in-depth interviews were conducted with pharmacists, pharmacy technicians, pharmacy owners, and counter attendants. Thematic analysis was used to generate findings. RESULTS: The current practice of pharmacy staff when handling self-medication consultations is directly influenced by the professionalism of pharmacy staff and patient responses to the consultations. These factors are in turn affected by the organisational context of the pharmacy and the external pharmacy environment. The organisational context of the pharmacy includes staffing, staff affordability, and the availability of time and facilities in which to provide consultations. The external pharmacy environment includes the number of trained pharmacy staff in the research setting, the relevance of pharmacy education to the needs of pharmacy practice, the support offered by the Indonesian Pharmacists Association, a competitive business environment, and the policy environment. CONCLUSION: Complex and inter-related factors influence the current practice of pharmacy staff when providing self-medication consultations in community pharmacies in this research setting. Multiple strategies will be required to improve consultation practices.

Information-gathering for self-medication via Eastern Indonesian community pharmacies: a cross-sectional study.

BACKGROUND: Gathering sufficient information when handling self-medication requests in community pharmacies is an important factor in assisting patients to obtain appropriate health outcomes. Common types of information usually gathered include patient identity, signs and symptoms, action taken, medical history, and current medications being used. The aims of the study were (1) to describe the types and amount of information gathered by Eastern Indonesian community pharmacy staff when handling self-medication requests, and (2) to identify factors associated with the reported amount of information gathered. METHODS: Patient simulation and pharmacy staff interviews were used. First, patient simulation was conducted using 2 cough scenarios and 1 diarrhoea scenario. Second, a structured interview was administered to eligible pharmacy staff in the setting. The types and amount of information gathered during patient simulation encounters and reported during pharmacy staff interviews were noted. A regression analysis was performed to identify factors associated with the amount of information gathered from the interview data. RESULTS: The most frequent types of information gathered in patient simulation encounters were the nature of symptoms (88% in one of the cough scenarios) and patient identity (96% in the diarrhoea scenario). Other types of information were gathered in <40% of encounters in each scenario. From the pharmacy staff interviews, >90% of the 173 interviewees reported that they gathered information on patient identity, nature of symptoms, and associated symptoms. Information on medical history and medication used was gathered by 20% and 26% respectively of the 173 interviewees. The majority of pharmacy staff asked 0 to 2 questions in the patient simulation encounters compared to 5 questions pharmacy staff reported as their usual practice during the interviews. Being qualified as a pharmacist or a pharmacy technician was one of the factors positively associated with the reported amount of information gathered. CONCLUSION: There were deficits in the types of information gathered when pharmacy staff handling self-medication requests. Having a pharmacy educational background and additional work experience in the pharmacy was positively associated with the reported amount of information gathered. There could be other factors contributing to shortcomings in the actual practice which need to be explored.

Development of an adaptation framework to implement a new professional pharmacy service (PPS) to a new environment.

The effective provision of professional pharmacy services is critical to support the delivery of primary health care. Structured frameworks and theoretical strategies are required to facilitate successful service implementation processes, outcomes and sustainability. This commentary discusses the considerations of what framework (adoption versus adaptation) would be suitable when implementing a new professional pharmacy service to a new environment. Utilizing Minor Ailments Services (MASs) as an exemplar as a professional pharmacy service case study, the research that underpinned these considerations enabled the development of a sequential, phased framework. There is the potential to utilize this framework for future evolving professional pharmacy services in the new setting.

Survey content validation evaluating the dissemination and implementation of deprescribing guidelines.

BACKGROUND: Policies, protocols and processes within organisations can facilitate or hinder guideline adoption. There is limited knowledge on the strategies used by organisations to disseminate and implement evidence-based deprescribing guidelines or their impact. METHODS: We aimed to develop an online survey targeting key organisations involved in deprescribing guideline endorsement, dissemination, modification or translation internationally. Survey questions were drafted, mirroring the six components of the reach, effectiveness, adoption, implementation and maintenance (RE-AIM) framework. Content validation was undertaken and established by a panel of clinicians, researchers and implementation experts. RESULTS: A 52-item survey underwent two rounds of content validation. The minimum threshold (I-CVI > 0.78) for relevance and importance was met for 39 items (75%) in the first round and 44 of 48 items (92%) in the second round. The expert panel concluded that the adoption, implementation and effectiveness survey sections were largely relevant and important to this topic, whereas the reach and maintenance sections were harder to understand and may be less pertinent to the research question. CONCLUSIONS: A 44-item survey investigating dissemination and implementation strategies for deprescribing guidelines has been developed and its content validated. Widespread survey distribution may identify effective strategies and inform dissemination and implementation planning for newly developed guidelines.

Evaluation of Mental Health First Aid training and simulated psychosis care role-plays for pharmacy education.

OBJECTIVE: This study explored the impact of Mental Health First Aid (MHFA) training and simulated psychosis care role-plays on pharmacy students' stigma, confidence and behaviors when supporting people experiencing mental health symptoms or crises. METHODS: MHFA training was delivered to final year pharmacy students. Post-MHFA training, students were invited to participate in simulated psychosis care role-plays (co-designed and content validated with mental health stakeholders) with trained actors. Role-plays were observed by peers, tutors and mental health consumer educators (MHCEs). Students immediately engaged in self-assessment, feedback and debrief discussions with peers, tutors and MHCEs. Quantitative analyses (ANOVA and chi-square tests) were conducted on scores awarded by each rater (self, tutor, MHCE) and for each scenario (n=3). Students completed a 15-item survey exploring mental health stigma and mental health confidence, at three timepoints (pre-MHFA training, post-MHFA training, post-role-plays). Survey scores were analyzed using paired t-tests. RESULTS: Of 209 MHFA-trained students, 86 participated in role-play. Self-assessment mean score was lowest and MHCEs' mean score highest. Post-MHFA training, 14 survey item scores significantly improved, implying reduced stigma and increased confidence in providing psychosis care. Post-role-play scores suggested improvements in 12 survey items. CONCLUSION: Psychosis care role-plays are associated with short-term improvements in pharmacy students' stigma and mental health confidence post-MHFA training; students' self-assessment scores are lower than tutors and MHCEs. It is recommended that future studies further integrate observed behaviors with self-reported data and use simulated patients in clinical practice to evaluate MHFA outcomes longitudinally.