Improving paediatric antimicrobial stewardship in remote and regional Queensland hospitals: development and qualitative evaluation of a tailored intervention for intravenous-to-oral antibiotic switching.

OBJECTIVES: Timely intravenous-to-oral antibiotic switching for children is important for paediatric antimicrobial stewardship (AMS). However, low decision-making confidence and fragmentation of patient care can hamper implementation, with difficulties heightened regionally where AMS programmes for children are lacking. The aim of this study was to develop and evaluate user-led creation and implementation of an intervention package for early intravenous-to-oral switching at regional hospitals in Queensland, Australia. DESIGN: Guided by theory, a four-phase approach was used to: (1) develop multifaceted intervention materials; (2) review materials and their usage through stakeholders; (3) adapt materials based on user-feedback and (4) qualitatively evaluate health workers experiences at 6 months postintervention. SETTING: Seven regional hospitals in Queensland, Australia. PARTICIPANTS: Phase 2 included 15 stakeholders; health workers and patient representatives (patient-guardians and Indigenous liaison officers). Phase 4 included 20 health workers across the seven intervention sites. RESULTS: Content analysis of health worker and parent/guardian reviews identified the 'perceived utility of materials' and 'possible barriers to use'. 'Recommendations and strategies for improvement' provided adjustments for the materials that were able to be tailored to individual practice. Postintervention interviews generated three overarching themes that combined facilitators and barriers to switching: (1) application of materials, (2) education and support, and (3) team dynamics. Overall, despite difficulties with turnover and problems with the medical hierarchy, interventions aided and empowered antibiotic therapy decision-making and enhanced education and self-reflection. CONCLUSIONS: Despite structural barriers to AMS for switching from intravenous-to-oral antibiotics in paediatric patients, offering a tailored multifaceted intervention was reported to provide support and confidence to adjust practice across a diverse set of health workers in regional areas. Future AMS activities should be guided by users and provide opportunities for tailoring tools to practice setting and patients' requirements.

Pharmacy practitioners' lived experiences of culture in multicultural Australia: From perceptions to skilled practice.

OBJECTIVES: The Code of Ethics of pharmacy practitioners in Australia recognises the obligation to provide care to patients in a culturally safe and responsive manner. The aim of this exploratory study was to examine how Australian community pharmacists understand and experience the concept of 'culture' in their everyday practice environment. METHODS: Voluntary, semi-structured interviews were conducted at community pharmacy placement sites in South-East Queensland, Australia. Pharmacists were asked to recall an incident that evoked their cultural awareness during the course of their practice. The question stated, verbatim: "We are preparing our students to be pharmacists in a highly multicultural community. Can you think of an incident where you learnt something about another person's culture or it made you more aware of your own culture? Please briefly describe the incident." Reportable responses were collected from 59 of the 92 visited pharmacists. These responses were audio-recorded and transcribed. The data were collated and analysed through iterative, reflexive, thematic analysis using constant comparison. RESULTS AND SIGNIFICANCE: The responses provided a rich selection of lived experiences within Australian multicultural pharmacy practice, describing professional dilemmas, fears and the strategies employed to overcome practice challenges. Six main response categories were identified: (i) Language/communication challenges, (ii) Cultural attitudes and behaviours, (iii) Exposure to culture due to pharmacy location, (iv) Religion, gender, and age, (v) Prejudiced/perceived racist attitudes and discrimination towards 'other' cultures, (vi) Perceived 'sameness' of different cultures. The study has provided valuable insights into community pharmacists' experiences of culture in their day-to-day professional practice, also highlighting the associated strategies used to maintain a high standard of practice. There is merit in ensuring that the pharmacy curriculum and professional development programs are designed to respond to the ethical obligation of pharmacists to practise in a culturally safe, responsive manner that acknowledges and incorporates the importance of culture, cultural differences and intercultural relations, while addressing culturally unique needs in a skilled and professional manner.

Utilisation of Healthcare Services and Medicines by Pakistani Migrants Residing in High Income Countries: A Systematic Review and Thematic Synthesis.

Migration, as a global phenomenon, gives rise to many challenges for healthcare professionals providing care to migrant populations. Migrants originating from diverse cultural backgrounds have unique beliefs and healthcare needs, and their utilisation of healthcare services and medicines is influenced by a number of factors. This review aims to assess the factors influencing the utilisation of healthcare services and medicines among Pakistani migrants residing in high income countries. The databases searched included PubMed/Medline, Scopus, EMBASE, Web of Science, CINAHL, and IPA. Of the 2566 publications initially obtained, 37 met the inclusion criteria. They included eight countries-the United Kingdom, United States of America, Canada, Denmark, Norway, Australia, United Arab Emirates and Cyprus. Eight descriptive themes emerged and two analytical constructs were established, as a result of thematic synthesis of included publications. The profile of utilisation of healthcare services and medicines among Pakistani migrants was multifaceted and influenced by their individual circumstances (socioeconomic characteristics; personal beliefs, preferences, and experiences; individual culture and religion; family and friends; and language and communication), and host country characteristics (work environment; healthcare organisation, access and affordability; and health professionals' education, practices, and preferences). Awareness of population-specific characteristics of migrant communities is important to promote and implement culturally appropriate healthcare practices and service provision.

An underutilised resource for Antimicrobial Stewardship: a 'snapshot' of the community pharmacists' role in delayed or 'wait and see' antibiotic prescribing.

OBJECTIVES: Various strategies have been implemented in primary care to address the inappropriate use of antibiotics, with varying degrees of success. One such intervention is delayed or 'wait and see' prescribing, where the prescriber indicates to wait a few days before dispensing the antibiotic. The aim of this study was to explore community pharmacists' perceptions and practice experiences with delayed antibiotic prescribing. METHODS: An online survey was advertised in two professional pharmacy organisations' e-newsletters for community and internship pharmacists in Queensland, Australia, from January to April 2016. KEY FINDINGS: We received 120 responses. 103 (86%) worked in a community pharmacy. Sixty per cent of the respondents would not dispense the delayed antibiotic prescription if a patient presented to the pharmacy within 24 h of seeing a doctor. Instead, they would advise the patient to wait and fill the prescription if they are not improving. CONCLUSION: The concept of delayed or a 'wait and see' antibiotic prescription was well received by the participating community pharmacists. These healthcare professionals are well placed to be effective stewards of antibiotics and can play an important role in collaboration with other healthcare professionals to optimise the quality use of antibiotics in primary care.

Australian mental health consumers and carers expect more health management information from community pharmacy.

OBJECTIVE: To identify the health management information needs of Australian mental health consumers and carers and explore the role of community pharmacy in meeting those needs. METHOD: Interviews and focus groups were conducted with a purposive convenience sample of 74 mental health consumers and carers across three Australian states, representing metropolitan, rural and remote settings, including those with culturally and linguistically diverse backgrounds. Recruitment and interviews continued until data saturation was reached. Interviews and group discussions were digitally recorded and transcribed verbatim, and data were managed using NVivo® software. A 'coding framework' or set of themes was created, and all transcripts were coded accordingly. Thematic analysis was informed by a general inductive approach. RESULTS: Participants had unmet needs for information from community pharmacy. They expressed the requirement for receiving easy-to-understand, relevant medication information about mental health management from community pharmacy staff, communicated in a respectful way, with clear and comprehensive medication labelling, while respecting consumer privacy. CONCLUSION: The information needs of mental health consumers and carers remain largely unmet within Australian community pharmacy. This was particularly evident regarding the provision of information about adverse effects of medicines. The overall perceived lack of information is experienced as disempowering. PRACTICE IMPLICATIONS: Australian community pharmacy is well placed to respond to the unmet demand for information needs of mental health consumers and carers. While many community pharmacies are embracing the principles of patient-centred care, there is an opportunity to optimise the quality of care provided to mental health consumers and carers.

Communication Capacity Building through Pharmacy Practice Simulation.

Objective. To examine the effectiveness of simulated learning modules (SLMs) encompassing EXcellence in Cultural Experiential Learning and Leadership (EXCELL) core competencies in enhancing pharmacy students' professional communication skills. Methods. Students completed three hours of preparatory lectures and eight hours of workshops comprising six SLMs themed around pharmacy practice and pharmacy placements. Each SLM comprised role-plays with actors, facilitation using EXCELL Social Interaction Maps (SIMs), and debriefing. Evaluations of SLMs included quantitative and qualitative survey responses collected before, during and after workshops, and after placements. Facilitators reflected on SLMs as a pedagogic modality. Results. Student feedback was positive about SLMs as an effective learning tool. The majority indicated areas of new learning and found SLMs enhanced their professional skills and confidence. Facilitator feedback was positive, and suggested SLM optimization strategies. Conclusion. Student and teaching team recommendations will inform future curriculum development including the optimization of SLMs in pharmacy education.

Implementing simulated learning modules to improve students' pharmacy practice skills and professionalism.

BACKGROUND: Effective communication enables healthcare professionals and students to practise their disciplines in a professional and competent manner. Simulated-based education (SBE) has been increasingly used to improve students' communication and practice skills in Health Education. OBJECTIVE: Simulated learning modules (SLMs) were developed using practice-based scenarios grounded in effective communication competencies. The effect of the SLMs on Pharmacy students' (i) Practice skills and (ii) Professionalism were evaluated. METHODS: SLMs integrating EXCELL competencies were applied in the classroom to study their effect on a number of learning outcomes. EXcellence in Cultural Experiential Learning and Leadership (EXCELL) Program is a schematic, evidence-based professional development resource centred around developing participants' self-efficacy and generic communication competencies. Students (N=95) completed three hours of preliminary lectures and eight hours of SLM workshops including six scenarios focused on Pharmacy Practice and Experiential Placements. Each SLM included briefing, role-plays with actors, facilitation, and debriefing on EXCELL social interaction maps (SIMs). Evaluations comprised quantitative and qualitative survey responsed by students before and post-workshops, and post-placements, and teachers' reflections. Surveys examine specific learning outcomes by using pharmacy professionalism and pharmacy practice effectiveness scales. Responses were measured prior to the commencement of SLMs, after completion of the two workshops and after students completed their block placement. Self-report measures enabled students to self-assess whether any improvements occurred. RESULTS: Student responses were overwhelmingly positive and indicated significant improvements in their Pharmacy practice and professionalism skills, and commitment to professional ethics. Qualitative feedback strongly supported students' improved communication skills and confidence. Teacher reflections observed ecological validity of SLMs as a method to enhance professionalism and communication skills, and suggested ways to improve this teaching modality. CONCLUSION: Inclusion of SLMs centred on practice and professionalism was evaluated as an effective, teaching strategy by students and staff. The integration of SIMs in SLMs has potential for wider application in clinical teaching.

Implementing simulated learning modules to improve students' pharmacy practice skills and professionalism / Implantación de módulos de aprendizaje simulados para mejorar las habilidades de farmacia práctica y el profesionalismo en los estudiantes

Background: Effective communication enables healthcare professionals and students to practise their disciplines in a professional and competent manner. Simulated-based education (SBE) has been increasingly used to improve students’ communication and practice skills in Health Education. Objective: Simulated learning modules (SLMs) were developed using practice-based scenarios grounded in effective communication competencies. The effect of the SLMs on Pharmacy students’ (i) Practice skills and (ii) Professionalism were evaluated. Methods: SLMs integrating EXCELL competencies were applied in the classroom to study their effect on a number of learning outcomes. EXcellence in Cultural Experiential Learning and Leadership (EXCELL) Program is a schematic, evidence-based professional development resource centred around developing participants’ selfefficacy and generic communication competencies. Students (N=95) completed three hours of preliminary lectures and eight hours of SLM workshops including six scenarios focused on Pharmacy Practice and Experiential Placements. Each SLM included briefing, role-plays with actors, facilitation, and debriefing on EXCELL social interaction maps (SIMs). Evaluations comprised quantitative and qualitative survey responsed by students before and post-workshops, and post-placements, and teachers’ reflections. Surveys examine specific learning outcomes by using pharmacy professionalism and pharmacy practice effectiveness scales. Responses were measured prior to the commencement of SLMs, after completion of the two workshops and after students completed their block placement. Self-report measures enabled students to self-assess whether any improvements occurred. Results: Student responses were overwhelmingly positive and indicated significant improvements in their Pharmacy practice and professionalism skills, and commitment to professional ethics. Qualitative feedback strongly supported students’ improved communication skills and confidence. Teacher reflections observed ecological validity of SLMs as a method to enhance professionalism and communication skills, and suggested ways to improve this teaching modality. Conclusion: Inclusion of SLMs centred on practice and professionalism was evaluated as an effective, teaching strategy by students and staff. The integration of SIMs in SLMs has potential for wider application in clinical teaching (AU)

Antecedentes: La comunicación efectiva permite a los profesionales de la salud y estudiantes ejercer sus disciplinas de un modo profesional y competente. La educación basada en la simulación (SBE) se ha usado crecientemente para mejorar la comunicación de los estudiantes y las habilidades prácticas. Objetivo: Se desarrollaron módulos de aprendizaje simulados (SLM) usando escenarios basados en la práctica y apoyados en competencias de comunicación efectiva. Se evaluó el efecto de los SLM en (i) las habilidades prácticas y (ii) el profesionalismo de los estudiantes de farmacia. Métodos: Se utilizaron en clase SLM que integraban las competencias EXCELL para estudiar su efecto en varios resultados de aprendizaje. El programa EXCELL (EXcellence in Cultural Experiential Learning and Leadership) es un recurso de desarrollo profesional basado en la evidencia centrado en desarrollar la autoeficacia de los participantes y sus competencias genéricas de comunicación. Los estudiantes (N=95) completaron tres horas de sesiones teóricas y ocho horas de talleres SLM que incluían seis escenarios centrados en los lugares de prácticas tuteladas. Cada SLM incluía un resumen, role-plays con actores, facilitación y un resumen final con deliberación sobre mapas de interacción social (SIM) del EXCELL. Las evaluaciones contenían cuestionarios cualitativos y cuantitativos respondidos por los estudiantes antes y después de los talleres y después de las prácticas, y las reflexiones de los profesores. Los cuestionarios examinaban resultados de aprendizaje específicos usando escalas de profesionalismo en farmacia y de efectividad del ejercicio farmacéutico. Las respuestas se midieron antes del comienzo de los SLM, después de completar dos talleres, y después de que los estudiantes completasen su bloque de prácticas tuteladas. Las mediciones autocomunicadas permitieron a los estudiantes a auto-evaluar si existían mejoras. Resultados: Las respuestas de los estudiantes fueron extremamente positivas e indicaron mejoras significativas en su práctica y profesionalismo, y compromiso con la ética profesional. El feed-back cualitativo soportó fuertemente la mejora de habilidades de comunicación y confianza. Las reflexiones del profesor observaban una validez natural de los SLM como método para aumentar el profesionalismo y las habilidades de comunicación, y sugirieron modos de mejorar esta modalidad docente. Conclusión: La inclusión de SLM centrados en la práctica y el profesionalismo fue evaluada como una estrategia docente efectiva por los estudiantes y el personal. La integración de los SIM en los SLM tiene un potencial para otras aplicaciones en la docencia clínica (AU)

Privacy and confidentiality: perspectives of mental health consumers and carers in pharmacy settings.

OBJECTIVES: The study aims to explore within the community pharmacy practice context the views of mental health stakeholders on: (1) current and past experiences of privacy, confidentiality and support; and (2) expectations and needs in relation to privacy and confidentiality. METHODS: In-depth interviews and focus groups were conducted in three states in Australia, namely Queensland, the northern region of New South Wales and Western Australia, between December 2011 and March 2012. KEY FINDINGS: There were 98 participants consisting of consumers and carers (n = 74), health professionals (n = 13) and representatives from consumer organisations (n = 11). Participants highlighted a need for improved staff awareness. Consumers indicated a desire to receive information in a way that respects their privacy and confidentiality, in an appropriate space. Areas identified that require improved protection of privacy and confidentiality during pharmacy interactions were the number of staff having access to sensitive information, workflow models causing information exposure and pharmacies' layout not facilitating private discussions. Challenges experienced by carers created feelings of isolation which could impact on care. CONCLUSIONS: This study explored mental health stakeholders' experiences and expectations regarding privacy and confidentiality in the Australian community pharmacy context. A need for better pharmacy staff training about the importance of privacy and confidentiality and strategies to enhance compliance with national pharmacy practice requirements was identified. Findings provided insight into privacy and confidentiality needs and will assist in the development of pharmacy staff training material to better support consumers with sensitive conditions.

Review of community pharmacy staff educational needs for supporting mental health consumers and carers.

Development of a mental health education package for community pharmacy staff should be informed by mental health consumers/carers' needs, expectations and experiences, and staff knowledge, skills and attitudes. This review (1) explored research on community pharmacy practice and service provision for mental health consumers/carers, and (2) identified validated methods for assessing staff knowledge, skills and attitudes about mental illness to inform the development of a training questionnaire. A literature scan using key words knowledge, skills, attitudes, and beliefs combined with community pharmacy, pharmacist, and pharmacy support staff, and mental illness, depression, anxiety was conducted. A small number of studies were found that used reliable methods to assess pharmacists' training needs regarding mental illness and treatment options. There was little published specifically in relation to depression and anxiety in community pharmacy practice. No studies assessed the training needs of pharmacy support staff. A systematic analysis of pharmacy staff learning needs is warranted.

Mental health consumer and caregiver perceptions of stigma in Australian community pharmacies.

BACKGROUND: The stigma of mental illness can be a barrier to effective medication management in the community pharmacy setting. This article explored mental health consumers' or caregivers' experiences of stigma in Australian community pharmacies. MATERIALS: Semi-structured interviews and focus groups were conducted with a purposive sample of consumers or caregivers (n = 74). Interview transcripts were analysed using a general inductive approach. DISCUSSION: Stigma presented a barrier to effective mental health management. Self-stigma impeded consumers' community pharmacy engagement. Positive relationships with knowledgeable staff are fundamental to reducing stigma. CONCLUSIONS: Findings provide insight into the stigma of mental illness in community pharmacies.

Trust and safe spaces: mental health consumers' and carers' relationships with community pharmacy staff.

BACKGROUND: Trusting relationships between mental health consumers and health care providers are critical in the management and recovery process. Although community pharmacy staff are well placed to form relationships with mental health consumers and carers, little is known about the existence, nature or significance of consumer-staff relationships. OBJECTIVES: The aim of this study was to explore mental health consumers' and carers' perceptions of community pharmacy services, and describe the nature of their relationships with pharmacy staff. METHODS: Focus groups and semi-structured interviews were conducted with a convenience sample of 74 mental health consumers or carers who self-selected into the study. Thematic analysis was undertaken to explore participants' perspectives. RESULTS: Positive experiences of pharmacy services were perceived to encourage consumers' and carers' trust in pharmacists and promote relationship development. This was enhanced when participants felt that elements of patient-centred care were part of the pharmacy services provided. Although some participants perceived community pharmacy to have a limited role in mental health, those who had established relationships highlighted the current role of pharmacists in their care, and appeared to welcome further extensions of pharmacists' role in mental health. CONCLUSIONS: Trusting relationships between consumers and carers and community pharmacy staff were deemed to be important in mental health care and contributed to consumers' and carers' views of pharmacy as a safe health care space. Community pharmacy services that included core elements of patient-centred care appeared to facilitate relationship formation and associated benefits. Education and training is needed for community pharmacy staff to improve mental health knowledge and promote positive engagement with consumers and carers.

Consumers' experiences and values in conventional and alternative medicine paradigms: a problem detection study (PDS).

BACKGROUND: This study explored consumer perceptions of complementary and alternative medicine (CAM) and relationships with CAM and conventional medicine practitioners.A problem detection study (PDS) was used. The qualitative component to develop the questionnaire used a CAM consumer focus group to explore conventional and CAM paradigms in healthcare. 32 key issues, seven main themes, informed the questionnaire (the quantitative PDS component - 36 statements explored using five-point Likert scales.) RESULTS: Of 300 questionnaires distributed (Brisbane, Australia), 83 consumers responded. Results indicated that consumers felt empowered by using CAM and they reported positive relationships with CAM practitioners. The perception was that CAM were used most effectively as long-term therapy (63% agreement), but that conventional medicines would be the best choice for emergency treatment (81% agreement). A majority (65%) reported that doctors appeared uncomfortable about consumers' visits to CAM practitioners. Most consumers (72%) believed that relationships with and between health practitioners could be enhanced by improved communication. It was agreed that information sharing between consumers and healthcare practitioners is important, and reported that "enough" information is shared between CAM practitioners and consumers. Consumers felt comfortable discussing their medicines with pharmacists, general practitioners and CAM practitioners, but felt most comfortable with their CAM practitioners. CONCLUSIONS: This PDS has emphasized the perceived importance of open communication between consumers, CAM and conventional providers, and has exposed areas where CAM consumers perceive that issues exist across the CAM and conventional medicine paradigms. There is a lot of information which is perceived as not being shared at present and there are issues of discomfort and distrust which require resolution to develop concordant relationships in healthcare. Further research should be based on optimisation of information sharing, spanning both conventional and CAM fields of healthcare, due to both the relevance of concordance principles within CAM modalities and the widespread use of CAM by consumers.

Medication management reviews for people from the former Yugoslavia now resident in Australia.

AIM: The objective of this prospective study was to conduct medication management reviews (MMR) in people from a non-English speaking background (NESB) (Bosnian/Serbian/Croatian, from former Yugoslavia, currently residing in Australia) in their native language in order to identify medication-related problems (needs analysis) and implement appropriate therapeutic interventions, in collaboration with their general practitioners (GPs). METHODS: Twenty-five participants entered the study. Each was interviewed and medication-related issues were identified by the health care team. RESULTS: Various interventions (over 150 for the whole group, an average of 6 per participant), based on actual and potential medication-related problems, were designed to improve the use of medicines. The MMRs introduced effective changes into the participants' health care. Psychological (e.g., feeling depressed) and sociological factors (e.g., costs of medicines, not understanding labels written in English) were identified as having significant impacts on medication management. CONCLUSIONS: These data confirmed there are avoidable medication-related problems in people from a NESB. GPs and pharmacists working in health care teams with a trained interpreter could greatly improve medication use through regular review and a team approach to problem identification and solving.