Shared decision making and experiences of patients with long-term conditions: has anything changed?

BACKGROUND: Medication problems among patients with long-term conditions (LTCs) are well documented. Measures to support LTC management include: medicine optimisation services by community pharmacists such as the Medicine Use Review (MUR) service in England, implementation of shared decision making (SDM), and the availability of rapid access clinics in primary care. This study aimed to investigate the experience of patients with LTCs about SDM including medication counselling and their awareness of community pharmacy medication review services. METHODS: A mixed research method with a purposive sampling strategy to recruit patients was used. The quantitative phase involved two surveys, each requiring a sample size of 319. The first was related to SDM experience and the second to medication counselling at discharge. Patients were recruited from medical wards at St. George's and Croydon University Hospitals.The qualitative phase involved semi-structured interviews with 18 respiratory patients attending a community rapid access clinic. Interviews were audio-recorded and transcribed verbatim. Thematic analysis using inductive/deductive approaches was employed. Survey results were analysed using descriptive statistics. RESULTS: The response rate for surveys 1 and 2 survey was 79% (n = 357/450) and 68.5% (240/350) respectively. Survey 1 showed that although 70% of patients had changes made to their medications, only 40% were consulted about them and two-thirds (62.2%) wanted to be involved in SDM. In survey 2, 37.5% of patients thought that medication counselling could be improved. Most patients (88.8%) were interested in receiving the MUR service; however 83% were not aware of it. The majority (57.9%) were interested in receiving their discharge medications from community pharmacies. The interviews generated three themes; lack of patient-centered care and SDM, minimal medication counselling provided and lack of awareness about the MUR service. CONCLUSION: Although patients wanted to take part in SDM, yet SDM and medication counselling are not optimally provided. Patients were interested in the MUR service; however there was lack of awareness and referral for this service. The results propose community pharmacy as a new care pathway for medication supply and counselling post discharge. This promotes a change of health policy whereby community-based services are used to enhance the performance of acute hospitals.

Novel saccharinate-bridged palladium complexes for efficient C-O bond activation displaying promising luminescence properties.

The synthesis of mono- and dinuclear cyclometallated palladium(II) complexes with deprotonated saccharinate ligands displaying different coordination modes is described. The new compounds were prepared by direct reaction between saccharine and the corresponding hydroxo-complexes [{Pd(µ-OH)(C^N)}(2)] (C^N = 2-(2-pyridyl)phenyl (Phpy) I; = 7,8-benzoquinolyl (Bzq) II), showing a general formula [{Pd(µ-sac)(C^N)}(2)] with saccharinate 1 displaying a bridging -NCO-coordination mode. Bridge splitting with neutral ligands (L = pyridine (py) 2, quinoline (quinol) 3 or acridine (acrid) 4) yielded new mononuclear derivatives with saccharinate acting as an N-monodentated ligand. Structural characterization by X-ray diffraction of complexes I1, I2 and II2 confirmed the proposed formulae. All complexes emit in the solution and solid state at room temperature. Emission features between 640-680 nm in the solid state for complexes I1 and II1 are significantly red-shifted if compared to the emission in solution. These broad emissions are consistent with the simultaneous presence of (3)ππ* and (3)MMLCT transitions indicating the existence of a strong intramolecular Pd-Pd ground state interaction. The dimeric complexes have also shown to catalyze Suzuki-Miyaura cross-coupling of coumaryl tosylate and aryl boronic acids under phosphine-free conditions. Initial studies suggest the involvement of palladium nanoparticles, which has been further investigated using mercury-drop test and poisoning experiments.