Use of the FebriDx® point-of-care-test for lower respiratory tract infections in primary care: a qualitative interview study.

BACKGROUND: FebriDx® is a single-use, analyser-free, point-of-care test with markers for bacterial (C-reactive protein [CRP]) and viral (myxovirus resistance protein A [MxA]) infection, measured on a finger-prick blood sample. AIM: As part of a larger feasibility study, we explored the views of healthcare professionals (HCPs) and patients on the use of FebriDx® to safely reduce antibiotic prescriptions for lower respiratory tract infections (LRTI) in primary care. DESIGN & SETTING: Remote semi-structured qualitative interviews METHOD: 22 participants (12 patients who underwent FebriDx® testing and 10 HCPs from general practices who conducted testing) participated in interviews which were analysed thematically. RESULTS: Patients' and HCPs' express positive views about use of the test. They felt FebriDx was a useful tool to inform prescribing decisions and provided a visual aid to support shared decision-making and appropriate antibiotic use. Most felt it would be feasible to integrate use into routine primary care consultations. Some practical difficulties with blood collection and interpreting results which impacted on usability were identified. Some patients' reactions to negative test results suggested the need for better communication alongside use of the test. CONCLUSION: FebriDx® was perceived as a useful tool to guide antibiotic prescribing and support shared decision making. Initial practical problems with testing and communicating results are potential barriers to use. Training and practice on using the test and effective communication are likely to be important elements in ensuring patient understanding and satisfaction and successful adoption.

Impact of pharmacy medicine information service advice on clinician and patient outcomes: an overview.

BACKGROUND: Pharmacy-led medicine information (MI) services are available in many countries to support clinicians and patients make decisions on use of medicines. OBJECTIVES: To establish what impact, if any, pharmacy-led MI services have on clinician and patient outcomes. METHODS: All published works indexed in Embase or PubMed, meeting this review's inclusion and exclusion criteria, that wholly or partially attempted to measure the effects of MI advice were retrieved and assessed. RESULTS: Twenty studies were reviewed. Five broad themes were identified describing study findings, three were specific to clinicians: their views on the effect MI answers had; actions they took; and influence on their decision making. A fourth theme centred on patient utilisation of advice, and the fifth on 'process measures' attempting to determine MI worth. DISCUSSION: Studies report on positive patient outcomes as a direct result of MI advice. Clinicians and patients acted upon the advice provided. Clinicians also reported using MI advice as a 'safety net', to check, reassure or confirm what to do. MI advice also demonstrated economic worth, although these studies are old. CONCLUSION: MI Service advice appears to affect clinician and patient outcomes. However, study design limitations require findings be viewed cautiously.

What effect does medicine advice provided by UK Medicines Information pharmacists have on prescriber practice and patient care: a qualitative primary care study.

RATIONALE, AIMS AND OBJECTIVES: UK Medicines Information (UKMI) is pharmacist-led service funded by the National Health Service providing evidence-based advice about medicines to health care professionals. Service evaluations have repeatedly shown high user satisfaction but few studies have assessed how this advice influences the care patients receive. Furthermore, no study has assessed how prescribers actually use this information in shaping their decision making. The aim was to explore how UKMI advice influences prescriber decision making and patient care. METHODS: Doctors and dentists (referred to as prescribers) working in primary care in England and Wales who received reactive medicines advice from a medicines information centre were contacted by telephone to determine how they used the advice provided. Forty semi-structured interviews were analysed and coded using constant comparative content analysis. RESULTS: Five key themes were identified that affected prescriber decision making, these were: prescriber action, patient outcome, medicines information advice, risk management and time factors. Prescribers acted directly on the advice provided enabling them to provide the right care for their patients. Advice had a positive effect on how they viewed a medication problem and empowered them to make decisions that appeared to confer greater confidence in managing patient problems. A favourable patient outcome was described by over half of the prescribers, for example, the advice enabled them to provide patient reassurance, avoid a potential allergic reaction, stabilize the patient's condition or stop treatment. CONCLUSIONS: Medicines information advice empowered prescribers in helping them to make decisions about medicines that shaped patient care.

Utility and value of a medicines information service provided by pharmacists: a survey of health professionals.

OBJECTIVES: many health professionals lack the time and skills to search for and appraise information on medicines. A solution might be to use others skilled in evidence appraisal, who make recommendations or provide information tailored to patients' needs. The objectives of this study were to assess how advice provided to health professionals by the northwest of England regional medicines information centre is used, whether it is useful for patient care and to measure satisfaction with the service. METHODS: a questionnaire was designed and sent to health professionals who contacted the centre between September 2008 and March 2009. Enquirers contacting the centre more than once were sent a questionnaire only in response to their first enquiry during the study period. Non-responders were sent a reminder. KEY FINDINGS: questionnaires were sent to 672 enquirers; 68% were returned. Nearly all respondents used the advice provided. Of the 430 respondents who provided data on how they used the information, 81% used it to manage a current patient and 29% to plan the care of future patients; nearly all considered it useful. Where data were given (n = 366), half used it to check if current or proposed management was appropriate, 45% to make changes to therapy and 35% to advise another health professional. In addition to patient care, one-quarter (n = 105/430) of respondents used the information for continuing professional development and 16% (n = 69/430) for training or teaching. CONCLUSIONS: health professionals value the enquiry-answering service and use the advice provided for patient care, continuing professional development and educating patients and other health professionals. The service is responsive, supporting the care of patients needing immediate and future management.

Medicine-related questions handled by community pharmacists: an exploratory study.

OBJECTIVES: The objectives of this study were to determine what type of medicine-related questions community pharmacists were asked and to ascertain whether responses given were appropriate. METHODS: All community pharmacists from three Primary Care Trusts were invited to participate in a week-long exploratory study. Piloted data-collection forms were self-completed. Data were analysed descriptively using Microsoft Excel and statistical tests conducted with Minitab. KEY FINDINGS: Sixty-six medicines-related questions were answered by participating pharmacists. The type of questions asked were varied and asked by patients, the general public and health care professionals. Most answers (over 80%) were assessed as being appropriate; only four questions raised concern with assessors that possible patient harm may have resulted. Almost half (42%) of the questions were answered without consultation to any reference source. CONCLUSIONS: Despite the small-scale nature of the study the findings show that community pharmacists provide a good-quality service that is easily accessible to all people. However, the failure to use reference sources may impact on pharmacists' ability to answer medicine-related questions fully.

Sustainable development and public health: a national perspective

The increasing policy focus on sustainable development offers new opportunities to align the public health narrative with that of sustainable development to promote both sustainable health for the population, and a sustainable health care system for England. This paper provides some insights into ways in which potential linkages between the two areas can be made meaningful across a wide range of policies at a national level. (AU)

Sustainable development and public health: a national perspective.

The increasing policy focus on sustainable development offers new opportunities to align the public health narrative with that of sustainable development to promote both sustainable health for the population, and a sustainable health care system for England. This paper provides some insights into ways in which potential linkages between the two areas can be made meaningful across a wide range of policies at a national level.