RESUMO
BACKGROUND: Utilising skill mix in general practice is proposed as a solution to the demand-supply issue. Pharmacists can play an important role in this context, leading to an increase in training and funding for independent prescriber roles. A role for pharmacists in general practice was funded, piloted, and evaluated by NHS England (NHSE) from 2015. AIM: To answer the following question: what is the patient perspective of pharmacists in patient-facing roles in general practice in the UK? DESIGN & SETTING: Focus group interviews exploring patient perspectives on the pharmacist role in the UK. METHOD: Thirty-four patients were interviewed in five focus group (January-December 2016). Data were iteratively analysed using the one sheet of paper technique. RESULTS: While the public were aware of the primary care crisis, they were less well informed about potential solutions. Data showed patients primarily sought access to a clinician over expressing a preference for any type of clinician. Low awareness was shown about the pharmacist role and there was initial confusion about it. Acceptability levels were high. It was found that pharmacists added value and provided an expert medication-focused service, which had a positive impact on medicines use. Patients reported benefit from longer appointments, feeling they were not rushed, and that all their conditions were being considered holistically. They trusted pharmacists as experts in medication and trust was consolidated over time. Regular coaching from a pharmacist could lead to improved patient self-monitoring and self-care. CONCLUSION: Pharmacists can add value to the general practice team and this is recognised by patients.
RESUMO
BACKGROUND: The safe provision of medicines administration is a fundamental challenge faced in long-term care facilities (LTCFs). Many residents of LTCFs are frail older persons with multiple morbidities, and in addition to polypharmacy, are particularly at risk of harm due to concomitant disease and disability. One potential method to optimise medication safety and facilitate medicines administration within LTCFs is the introduction of technology. OBJECTIVE: This paper explores the barriers to long-term sustainability concerning the use of an electronic administration system (eMAR) in LTCFs. METHODS: Fifteen in depth, semi-structured interviews were conducted with LTCF staff (9), eMAR service commissioners (2), members of the implementation team (2) and care home strategy managers (2) across three LTCF sites. The study participants were purposefully sampled and each interview audio-recorded, transcribed verbatim and analysed using Nvivo 11. In addition to interviews, observational notes were taken by the lead researcher from visits to the LCTFs as a form of data collection. The analysis process consisted of a two-stage process of thematic analysis then theoretical mapping. RESULTS: Barriers identified were split into four main overarching areas: structural, implementation team, system user and operational barriers. The adoption of eMAR within this setting was welcomed by top-level stakeholders, however, LTCF staff displayed concerns over its usability. The lack of co-development and on-going training need highlighted barriers to its sustainability, in addition to risks associated with current legislation. The themes identified throughout the framework highlight challenges faced when exploring the sustainability of eMAR in LTCF. CONCLUSIONS: The use of technology in health care is evolving. Awareness of actors relating to its introduction can have significant impact on success and service sustainability.
