The information seeking behaviors of caregivers in the management of childhood fever - A systematic literature review.

INTRODUCTION: Parents' and caregivers' non-evidence-based childhood fever management 'fever phobic' practices have remained relatively stable over more than 34 years despite successful educational interventions. This systematic review aimed to assess the information seeking behavior of caregivers managing fever in their children, as well as to compile the fever management practices undertaken by caregivers by investigating underlying factors influencing them. METHODS: The electronic databases Pubmed, CINAHL, Medline, and International Pharmaceutical Abstracts were searched using key terms including, fever, child, caregiver, and management. Studies were included if they were written in English, published between January 1980 and January 2021, explored generalized childhood fever management practices of caregivers, and factors which influence fever management. Data extracted included study year and design, location, dimensions of fever management explored (i.e., knowledge, beliefs, detection, and/or treatment of fever), factors influencing management, and information sources used by caregivers. RESULTS: In total, 36 studies were eligible for inclusion in the study. Twenty-nine of the studies were designed as a cross-sectional survey, six studies were interviews and the remainder were pre-post studies. The review of studies found that parents and caregivers sourced childhood fever management information most commonly from friends and family or their own personal experiences, however, participants most commonly sourced doctors/general practitioners as their first line of information when required. Over the years, trends showed that doctors as well as the internet were more frequently being used as a first line source of information by caregivers. CONCLUSIONS: Despite decades of research, education and development of evidence-based guidelines caregivers continue to exhibit 'fever phobia' when caring for febrile children. This is demonstrated by their continued use of non-evidence-based methods and increasing reliance on, and incorrect use of antipyretics, alternating antipyretics if fever is not sufficiently reduced or returns. There is an increasing need for the development of easy to access digital resources for caregiver as internet use is rising which mirrors best practice taught to professionals.

Exploring First Nations' and Cultural Safety Content of Pharmacy Curricula With Academics in Australia.

OBJECTIVE: This study aimed to explore academics' views on Aboriginal and/or Torres Strait Islander Health and Cultural Safety content in pharmacy school curricula to inform recommendations for future curricula. METHODS: All 18 Australian pharmacy schools were contacted, and interviews were conducted with consenting heads of school and/or their delegate(s). The interviews covered what the school was doing with respect to the First Nations theme in the revised accreditation standards and further ideas for improvement. Audio recordings of interviews were transcribed verbatim via an online transcription service. Transcripts were thematically analyzed and coded according to the framework approach and mapped to the Aboriginal and Torres Strait Islander Health Curriculum Framework. Coding was facilitated using NVivo software. RESULTS: All 18 schools consented to participate and a total of 22 interviews were conducted. The pharmacy accreditation standards were well known to most educators, however, the dissemination of the Aboriginal and Torres Strait Islander Health Curriculum Framework, introduced in 2014, appeared to be poor. Many interviewees (n = 14) expressed that the current content regarding Aboriginal health and cultural safety/competence was lacking and cited barriers that have led to a lack of development such as a lack of First Nations staff and expertize. CONCLUSION: While cultural safety/competency was taught in all Australian pharmacy schools, it is apparent that pharmacy schools are at various stages in their development of Aboriginal and Torres Strait Islander Health curriculum design and implementation. Future resources should be developed and made available.

Simulated psychosis care role-plays for pharmacy curricula: a qualitative exploration of student experiences.

PURPOSE: Mental Health First Aid (MHFA) training is embedded in various tertiary healthcare curricula. However, opportunities for students to practise their newly acquired MHFA skills before entering the clinical practice workforce are lacking. The purpose of this study was to explore pharmacy students' experiences of MHFA training and post-MHFA simulated psychosis care role-plays. METHODS: Final-year pharmacy students received MHFA training, after which they were invited to participate in simulated patient role-plays with trained actors, whilst being observed by peers, pharmacy tutors and mental health consumer educators (MHCEs). Immediately after each role-play, the role-playing student engaged in self-assessment, followed by performance feedback and debrief discussions with the tutor, MHCE and observing peers. All MHFA-trained students were invited to participate in audio-recorded focus groups to explore their experiences. Audio-recordings were transcribed verbatim and thematically analysed. RESULTS: MHFA training was delivered to 209 students, of which 86 participated in a simulated patient role-play as a role-player and the remaining students observed. Seven focus groups were conducted with 36 students (mean duration 40 min, SD 11 min). Five themes emerged: scenario reactions, realistic but not real, mental health confidence, MHFA skills application, feedback and self-reflection. CONCLUSION: Students enjoyed the post-MHFA simulated psychosis care role-plays, which provided opportunities to apply and reflect on their newly-acquired MHFA skills in a safe learning environment. These experiences enhanced students' confidence to support people in the community, experiencing mental health symptoms or crises, and could be an add-on to MHFA training in the future.

Perinatal depression screening in community pharmacy: Exploring pharmacists' roles, training and resource needs using content analysis.

BACKGROUND: Perinatal depression (PND) screening is often recommended in primary care settings, which includes the community pharmacy setting. However, there is limited research exploring pharmacists' perspectives on their roles in screening for perinatal mental illness. AIM: This study aimed to explore pharmacists' views of pharmacists' roles in PND screening, as well as training and resource needs for PND screening in community pharmacy settings. METHOD: A questionnaire including three open-ended questions focusing on pharmacists' perspectives of their role in PND screening, their training, and resource needs in this area, was disseminated to pharmacists across Australia via professional organisations and social media. Each open-ended question was separately analysed by inductive content analysis. Subcategories were deductively mapped to the Theoretical Framework of Acceptability. RESULTS: Responses (N = 149) from the first open-ended question about pharmacists' roles in PND screening resulted in three categories (PND screening in primary care settings will support the community, community pharmacy environment, and system and policy changes) and ten subcategories. Responses to question two on training needs (n = 148) were categorised as: training content, training length, and training delivery while responses about resource needs (n = 147) fell into three categories: adapting community pharmacy operating structures, pharmacist-specific resources, and consumer-specific resources. CONCLUSION: While some pharmacists were accepting of a role in PND screening due to pharmacists' accessibility and positive relationships with consumers, others had concerns regarding whether PND screening was within pharmacists' scope of practice. Further training and resources are needed to facilitate pharmacists' roles in PND screening, referral and care.

Co-designing psychosis simulated patient scenarios with mental health stakeholders for pharmacy curricula.

BACKGROUND: Pharmacists need knowledge and confidence to support people living with mental illness. Evidence-based educational materials for pharmacy students to provide psychosis care is limited. AIM: To co-design, content validate and pilot-test, with mental health stakeholders, simulated patient scenarios to educate and assess students in providing psychosis care. METHOD: Mental health consumers were invited to co-design three simulated patient scenarios (first-episode psychosis, carer of someone living with schizophrenia, non-adherence to antipsychotics), guided by published and psychometrically-tested materials. A panel of mental health stakeholders participated in two rounds of content validation (RAND/UCLA appropriateness model). Round 1 involved individual survey completion to calculate item content validity index (I-CVI) for relevance/clarity, content validity ratio for essentiality and overall scale content validity index (S-CVI/Ave and S-CVI/UA) scores for each scenario. Scores analyses and feedback comments informed revisions. Round 2 involved a panel meeting to discuss revisions and finalise content. The scenarios were then pilot-tested with pharmacy students. RESULTS: Two consumers participated in co-design, nine stakeholders in content validation. All items showed excellent content validity for relevance/clarity. Eleven items were revised for essentiality, discussed, then re-rated at the panel meeting for consensus. The scenarios were pilot-tested with pharmacy students (n = 15) and reported to be realistic and relevant to future practice, contributing to students' confidence in supporting people experiencing mental health symptoms or crises. CONCLUSION: Partnering with mental health stakeholders has enabled co-design of authentic, content valid educational materials for pharmacy students to provide psychosis care, in preparation for future provision of mental health support.

The Use of Mental Health Simulation in Pharmacy Practice and Education: A Systematic Review.

OBJECTIVES: To explore how mental health simulation has been used in the context of pharmacy practice and education, specifically what types of simulation techniques have been used, and which mental health-related content has been simulated. FINDINGS: A literature search retrieved 449 reports, from which 26 articles pertaining to 23 studies were eligible for inclusion. Most studies were conducted in Australia. The most common type of simulation utilized was live simulated/standardized patient, followed by pre-recorded scenarios, role-play, and auditory simulation. While many study interventions included content relating to multiple mental illnesses and included activities other than simulation, the most simulated mental health content was enacting a person living with depression (with or without suicidal thoughts), mental health communication, followed by stress-induced insomnia, then hallucinations. Key outcomes from included studies were significantly improved student outcomes such as mental health knowledge, attitudes, social distance, and empathy scores, as well as highlighting the potential to further improve the mental healthcare skills of community pharmacists. SUMMARY: This review demonstrates a varied use of techniques to simulate mental health in pharmacy practice and education. Future research is suggested to consider other simulation methods such as virtual reality and computer simulation, and to investigate how lesser-simulated mental health content such as psychosis could be incorporated. It is also recommended that future research provides greater detail on the development of the simulated content, such as involving people with lived experience of mental illness and mental health stakeholders in the development process to improve the authenticity of simulation training.

Accuracy of best possible medication histories by pharmacy students: an observational study.

BACKGROUND: Medication reconciliation is an effective strategy to prevent medication errors upon hospital admission and requires obtaining a patient's best possible mediation history (BPMH). However, obtaining a BPMH is time-consuming and pharmacy students may assist pharmacists in this task. AIM: To evaluate the proportion of patients who have an accurate BPMH from the pharmacy student-obtained BPMH compared to the pharmacist-obtained BPMH. METHOD: Twelve final-year pharmacy students were trained to obtain BPMHs upon admission at 2 tertiary hospitals and worked in pairs. Each student pair completed one 8-h shift each week for 8 weeks. Students obtained BPMHs for patients taking 5 or more medications. A pharmacist then independently obtained and checked the student BPMH from the same patient for accuracy. Deviations were determined between student-obtained and pharmacist-obtained BMPH. An accurate BPMH was defined as only having no-or-low risk medication deviations. RESULTS: The pharmacy students took BPMHs for 91 patients. Of these, 65 patients (71.4%) had an accurate BPMH. Of the 1170 medications included in patients' BPMH, 1118 (95.6%) were deemed accurate. For the student-obtained BPMHs, they were more likely to be accurate for patients who were older (OR 1.04; 95% CI 1.03-1.06; p < 0.001), had fewer medications (OR 0.85; 95% CI 0.75-0.97; p = 0.02), and if students used two source types (administration and supplier) to obtain the BPMH (OR 1.65; 95% CI 1.09-2.50; p = 0.02). CONCLUSION: It is suitable for final-year pharmacy students to be incorporated into the BPMHs process and for their BPMHs to be verified for accuracy by a pharmacist.

Perinatal Women's Views of Pharmacist-Delivered Perinatal Depression Screening: A Qualitative Study.

Internationally, 20% of women experience perinatal depression (PND). Healthcare providers including general practitioners and midwives are critical in providing PND screening and support; however, the current workforce is unable to meet growing demands for PND care. As accessible and trusted primary healthcare professionals, pharmacists could provide PND care to complement existing services, thereby contributing to early detection and intervention. This study aimed to explore perinatal women's views of community pharmacist-delivered PND screening and care, with a focus on their attitudes towards and acceptability of PND screening implementation in community pharmacy. Semi-structured interviews with women (n = 41) were undertaken, whereby interview data were transcribed verbatim and then inductively and thematically analysed. Five overarching themes emerged; "patient experience with existing PND support and screening services"; "familiarity with pharmacists' roles"; "pharmacist visibility in PND screening care"; "patient-pharmacist relationships" and "factors influencing service accessibility". Themes and subthemes were mapped to the Consolidated Framework for Implementation Research. Findings highlight participants' generally positive attitudes towards community pharmacist-delivered PND screening and care, and the potential acceptability of such services provided pharmacists are trained and referral pathways are established. Addressing perceived barriers and facilitators would allow community pharmacist-delivered PND screening and care to support existing PND care models.

The role of community pharmacists in delivering interventions for osteoporosis: A systematic review.

BACKGROUND: Osteoporosis is a major public health concern, given that disease prevalence is expected to substantially increase due to the aging population. Community pharmacists can play a key role in the identification and management of chronic diseases. OBJECTIVES: The purpose of this systematic review was to present an overview of the literature on the role of community pharmacists in providing osteoporosis interventions to patients. The secondary objective was to assess the impact of these interventions on patient outcomes. METHODS: A literature search was conducted in Embase, CINAHL, Scopus, MEDLINE, and Web of Science from database inception to March 2021. The search was limited to human studies in the English language. Primary studies were included if they described or assessed a patient-directed osteoporosis intervention conducted by community pharmacists. The following data were extracted and tabulated: citation, study location, study design, subject, number of participants, nature of intervention, classification of intervention, outcome measures, measurement methods, findings, and effect. Risk of bias was assessed using the Cochrane Risk of Bias tool for randomized trials (RoB 2) and Risk of Bias in Non-randomized Studies (ROBINS-I). RESULTS: Twenty-one studies were included in this review. The main interventions were education, screening, and medication management. Nineteen of these studies reported patient outcomes, all yielding positive outcomes. Outcomes included increased physician follow-up, risk factor reduction, increased osteoporosis knowledge, increased medication adherence, identification of medication-related problems, and positive patient-reported experience measures (PREMs). Three studies were considered to have a moderate risk of bias, whereas the remaining 18 studies had a high risk of bias. CONCLUSION: There is some evidence that pharmacist-led osteoporosis interventions have a positive impact on patient outcomes. More high-quality studies using objective outcome measures are needed to determine whether this translates into clinical outcomes such as decreased hospitalization and fractures.

Perinatal depression screening: a systematic review of recommendations from member countries of the Organisation for Economic Co-operation and Development (OECD).

Perinatal depression (PND) screening recommendations are made by national, state-based and professional organisations; however, there is disagreement regarding screening timing, provider responsible, screening setting, screening tool as well as the follow-up and referral pathways required post-screening. This systematic review aimed to identify, describe and compare PND screening recommendations from member countries of the Organisation for Economic Co-operation and Development (OECD). Publications were identified through systematically searching PubMed, Google and the Guidelines International Network (GIN). Recommendations regarding PND screening endorsement, timing, frequency, responsible provider, tools/assessments and follow-up and referral were extracted. Twenty-one publications, including guidelines, from five countries were included. Most made recommendations in support of PND screening using the Edinburgh Postnatal Depression Scale. Details differed regarding terminology used, as well as frequency of screening, follow-up mechanisms and referral pathways. A broad range of health providers were considered to be responsible for screening. This is the first review to identify and compare PND screening recommendations from OECD member countries; however, only online publications published in English, from five countries were included. Heterogeneity of publication types and inconsistency in definitions rendered quality assessment inappropriate. While most publications generally endorsed PND screening, there are exceptions and the associated details pertaining to the actual conduct of screening vary between and within countries. Developing clear, standardised recommendations based on current evidence is necessary to ensure clarity amongst healthcare providers and a comprehensive approach for the early detection of PND.

Assessing the comparative effectiveness of implementation strategies for professional services to community pharmacy: A systematic review.

BACKGROUND: Despite the growth of research in how professional services are implemented in the community pharmacy setting, there is limited evidence for which implementation strategy is more effective. OBJECTIVE: The aim of this review was to assess the evidence for the comparative effectiveness of implementation strategies for pharmacist delivered professional services in the community pharmacy. METHODS: Studies comparing implementation strategies published in the last 13 years in English were extracted via four databases, combining the topics of 'pharmacy', 'pharmacy services' and 'implementation'. Experimental studies with quantitative evaluation of two or more implementation strategies were included. Selected studies were screened through three internationally recognised tools, two focusing on implementation: quality of evidence (Cochrane Qualitative & Implementation Methods Group), reporting standards (Standards for Reporting Implementation Studies - StaRI), and one assessing the risk of bias (The Risk of Bias in Non-randomised Studies of Interventions). RESULTS: Six studies were identified, assessing the implementation of services improving use of medicines (n = 2), primary care and public health services (n = 3), and one study evaluating the implementation of services in both categories. Some form of staff training was demonstrated to be more effective (n = 4). The risk of bias ranged from moderate to critical. With respect to reporting on StaRI tool items, the mention of these was, in the majority, indirect. Items such as harms and published protocols and economic evaluation were not reported in any of the studies included in the final review, highlighting opportunities for improvement. CONCLUSIONS: Training may be superior for implementation of professional services to community pharmacies, although this finding is limited by a moderate to critical risk of bias. A recommendation to researchers is for the greater use of comparative implementation study designs that reflect recognised reporting, quality and validity tools. REGISTRATION: None.

Clinical yarning with Aboriginal and/or Torres Strait Islander peoples-a systematic scoping review of its use and impacts.

OBJECTIVES: To explore how clinical yarning has been utilised as a health intervention for Aboriginal and/or Torres Strait Islander peoples and if there are any reported impacts yarning might have on health outcomes. STUDY DESIGN: Systematic scoping review of published literature. DATA SOURCES: A one-word search term "yarning" was applied in Scopus, EMBASE, CINAHL, MEDLINE, International Pharmaceutical Abstracts, Australian Public Affairs Information Service-Health, and the Aboriginal and/or Torres Strait Islander Health Bibliography databases. Databases were searched from inception to May 20, 2020. STUDY SELECTION: Studies were included where clinical yarning had been used as a health intervention. Inclusion and exclusion criteria were developed and applied according to PRISMA systematic and scoping review reporting methods. DATA SYNTHESIS: A total of 375 manuscripts were found from the initial data search. After removal of duplicates and removal of manuscripts based on abstract review, a total of 61 studies underwent full-text review. Of these, only five met the inclusion criteria of utilising yarning as a clinical intervention. Four of these studies described consumer self-reported health outcomes, with only one study looking at improvements in objective physiological health outcomes. CONCLUSIONS: Whilst clinical yarning may be a culturally appropriate intervention in healthcare, there are limited studies that have measured the impact of this intervention. Further research may be needed to ascertain the true benefits of this intervention.

Exploring the impact of suicide care experiences and post-intervention supports sought among community pharmacists: a cross-sectional survey.

BACKGROUND: There is a need to appropriately train, support and remunerate pharmacists for their expanding roles in mental healthcare. Pharmacists often care for people experiencing mental health crises, including suicidal thoughts and behaviours, but little is known about pharmacists' suicide care experiences. AIM: This cross-sectional study aimed to explore the impact of professional experiences with people at risk of suicide and support accessed, among community pharmacists. METHOD: A survey exploring pharmacists' experiences with people at risk of suicide and post-intervention support-seeking was disseminated through Australian and Canadian professional associations, conferences and social media (June 2016-May 2017). Quantitative data were analysed using Chi-squared, Fisher's exact and independent t-tests, where appropriate. Qualitative data exploring the impact of these experiences were thematically analysed, and reasons for not seeking help post-intervention were identified. RESULTS: Among 378 respondents, 84% had encountered patients at risk of suicide and 28% had lost patients to suicide. Some were negatively affected personally and/or professionally (11%), of which 88% did not seek professional support, mainly due to uncertainty about available services. Pharmacists were significantly more negatively affected if they had a personal mental health diagnosis (p = 0.017) and previous suicide care experiences (p = 0.001). Qualitative themes included: expanding knowledge and skills, role limitation and emotional impact and response. CONCLUSION: A large proportion of pharmacists have interacted with suicidal patients and are impacted by these experiences, yet few seek help due to lack of awareness and access. There is a need to recognize pharmacists' roles in suicide care, and develop pharmacist-specific post-intervention support.

Australian care givers' knowledge of and attitudes towards paediatric fever management.

AIM: Non-evidence-based practice and inappropriate paediatric fever management by care givers is common. The aim of this study was to survey a large sample of Australian parents and care givers utilising a validated Fever Management Tool, to determine the current knowledge, beliefs and attitudes of Australian care givers regarding fever management. METHODS: This study employed a cross-sectional survey conducted via a third-party market research company. Univariate analysis of demographic factors and their influence on knowledge scores were tested. A multivariate linear regression model was specified using all available independent univariate predicators to determine the demographic factors influencing care givers fever knowledge. RESULTS: Data from 1000 questionnaires were analysed. The participants' total knowledge scores were evenly distributed with a mean score of 15.4/29 correct answers in the True/False questionnaire, a median score of 16 and a standard deviation of 4.27. It highlighted that Australian care givers had poor knowledge in questions related to 'teething', 'physical cooling methods' and 'medication dosing'. In the multivariate analysis, 28.9% of the total variance was explained (R2 value = 0.289, P < 0.001) with 5 of 11 factors contributing. CONCLUSION: Overall, this cross-sectional survey has provided a strong understanding of the current knowledge, attitude and beliefs of Australian care givers in regards to fever management in their children. Total knowledge of fever management was generally poor in Australia with many participants harbouring misconceptions and non-evidence-based practices. Future interventions improving fever management practices should be tailored to the specific weaknesses faced by Australian care givers in order to promote long term change.

A systematic review of patient interactions with student pharmacists in educational settings.

BACKGROUND: Patients may contribute to various aspects of student pharmacists' education within clinical, experiential and educational settings. There is an emerging body of literature describing and evaluating the contribution of patients to health care education; however, little is known about patients' contribution to pharmacy education specifically within educational settings. OBJECTIVE: To explore the evidence relating to the involvement of patients in the education of student pharmacists, in terms of the nature, extent, and outcomes of their contribution. METHODS: A systematic literature search was undertaken within Embase, MEDLINE, Education Resources Information Center, International Pharmaceutical Abstracts, PubMed, PsycINFO, CINAHL, and Scopus databases from inception to April 10, 2020. Inclusion criteria included primary research studies reporting on the active involvement of patients in pharmacy education, within an educational setting. Quality assessment appraisal for the included studies was conducted using the Mixed Methods Appraisal Tool. RESULTS: Twelve studies were eligible for inclusion in this systematic review. Nine studies explored the use of patients as educators providing valuable insight about their lived experience. Six studies involved patients in question-and-answer sessions, providing students with opportunities to inquire about their lived experience in relation to medicines, health care, and medical conditions. Studies that reported on students' learning outcomes demonstrated improvements in communication skills, deeper understanding of patients' lived experience particularly relating to mental illness, and increased confidence in providing care for patients. Among patients, participation in the educational process led to greater satisfaction, empowerment, and knowledge from sharing personal experiences. There were no clinical outcomes measured among patients participating in the included studies. The 5 nonrandomized quantitative studies ranged from low to moderate levels of quality, the 4 mixed-methods studies were of low quality, and the 3 qualitative studies were of high quality. CONCLUSION: The involvement of patients in the education of student pharmacists was found to benefit both patients and students. Student-specific outcomes included development of communication skills and new insights about patients' lived experience. Further research is needed to better understand the long-term impact of patient involvement in pharmacy education, in terms of students' learning outcomes and clinical outcomes among patients.

The simulated patient method: Design and application in health services research.

The simulated patient method is becoming increasingly popular in health services research to observe the behaviour of healthcare practitioners in a naturalistic setting. This method involves sending a trained individual (simulated patient among other names), who is indistinguishable from a regular consumer, into a healthcare setting with a standardised scripted request. This paper provides an overview of the method, a brief history of its use in health services research, comparisons with other methods, ethical considerations, and considerations for the development of studies using the simulated patient method in health services research, with examples from pharmacy and other fields. Methods of analysis, mixed-methods, and the use of simulated patients with feedback are also discussed.

Factors Associated with Medication-Related Burden Quality of Life (MRB-QoL) in Community-Dwelling Adults with Long-Term Conditions: An Exploratory Study.

BACKGROUND: The Medication-Related Burden Quality of Life (MRB-QoL) tool has been developed to measure the burden of medications on functioning and wellbeing from a patient perspective. However, predictors of MRB-QoL were not reported in greater detail in the validation study. This study aimed to explore factors associated with MRB-QoL to see whether there is any new information that calls for further research. METHODS: Analysis of data from the MRB-QoL validation study was undertaken. Outcome variables were domains of the MRB-QoL (Routine and Regimen Complexity, Psychological Burden, Functional and Role Limitation, Therapeutic Relationship, and Social Burden). Explanatory variables were patient age; disease-related factors; and medication-related factors, such as number of medications, complexity of medication regimen (measured by the Medication Regimen Complexity Index [MRCI]), and exposure to medications with anticholinergic and sedative effects (measured by the Drug Burden Index [DBI]). Linear regression analyses were used to identify factors associated with the MRB-QoL. RESULTS: The study included 367 participants (52.1% male), with a median age of 64 years. In multivariable regression analyses, an increase in the DBI was significantly associated with poorer Psychological wellbeing (ß=-0.15, p<0.001) and Functional and Role Limitation (ß=-1.79, p<0.001). Living with three or more medical conditions was significantly associated with poorer Psychological wellbeing (ß=-0.21, p<0.001). Age was significantly associated with all domains of the MRB-QoL (ß=0.28 to 0.55). Polypharmacy and MRCI were not associated with any of the MRB-QoL domains. CONCLUSION: In this sample of community-dwelling adults with multiple medications, the DBI was independently associated with the Psychological Burden and Functional and Role Limitation domains of the MRB-QoL. This study provides preliminary evidence on factors affecting medication-related quality of life outcomes from a patient perspective. Future longitudinal studies, along with further psychometric testing of the MRB-QoL measure, are warranted to better understand predictors of MRB-QoL.

Simulated Patient Role-Plays with Consumers with Lived Experience of Mental Illness Post-Mental Health First Aid Training: Interrater and Test Re-Test Reliability of an Observed Behavioral Assessment Rubric.

Mental Health First Aid (MHFA) training teaches participants how to assist people experiencing mental health problems and crises. Observed behavioral assessments, post-training, are lacking, and the literature largely focuses on self-reported measurement of behaviors and confidence. This study explores the reliability of an observed behavioral assessment rubric used to assess pharmacy students during simulated patient (SP) role-play assessments with mental health consumers. Post-MHFA training, pharmacy students (n = 528) participated in SP role-play assessments (n = 96) of six mental health cases enacted by consumers with lived experience of mental illness. Each assessment was marked by the tutor, participating student, and consumer (three raters). Non-parametric tests were used to compare raters' means scores and pass/fail categories. Interrater reliability analyses were conducted for overall scores, as well as pass/fail categories using intra-class correlation coefficient (ICC) and Fleiss' Kappa, respectively. Test re-test reliability analyses were conducted using Pearson's correlation. For interrater reliability analyses, the intra-class correlation coefficient varied from poor-to-good to moderate-to-excellent for individual cases but was moderate-to-excellent for combined cases (0.70; CI 0.58-0.80). Fleiss' Kappa varied across cases but was fair-to-good for combined cases (0.57, p < 0.001). For test re-test reliability analyses, Pearson's correlation was strong for individual and combined cases (0.87; p < 0.001). Recommended modifications to the rubric, including the addition of barrier items, scoring guides, and specific examples, as well as the creation of new case-specific rubric versions, may improve reliability. The rubric can be used to facilitate the measurement of actual, observed behaviors post-MHFA training in pharmacy and other health care curricula.

Development and validation of a Fever Management Questionnaire aimed at parents and care givers.

AIM: The symptoms of childhood fever are often inappropriately managed by care givers resulting in overuse of health resources and medication errors. Understanding care giver's knowledge, attitudes and beliefs about fever management using a validated questionnaire is warranted. The aim of this study was to develop and validate a comprehensive Fever Management Questionnaire. METHODS: The questionnaire items were developed through a content analysis of the literature and current fever management guidelines. For the knowledge component, a multidisciplinary panel of 12 experts assessed content validity of items (n = 35) through a one-round Delphi process. The construct validity of the attitudes and belief items (19 items) were assessed using principal components analysis utilising response data collected from 149 Australian parents and care givers. RESULTS: Based on the responses from the panel of experts, six items were removed, six items required substantive modification, 13 items required minor modification with the remaining eight items retained in original form. For the Attitudes and Beliefs items, a parsimonious solution with three principal components resulted after removal of six cross-loading items. The factor loadings of each item displayed a strong correlation to one of three components with scores ranging from 0.791 down to 0.541. The resulting Cronbach's α for the tool was 0.729. CONCLUSION: Psychometric testing of this two-part Fever Management Questionnaire has resulted in a tool with acceptable validity and reliability. This tool should now be used to gather the knowledge and attitudes of care givers surrounding fever management to further understand factors that lead to inappropriate fever management.

Measurement of the reliability of pharmacy staff and simulated patient reports of non-prescription medicine requests in community pharmacies.

BACKGROUND: The use of simulated patients (SPs) in pharmacy practice research has become an established method to observe practice. The reliability of data reported using this method in comparison to pharmacy staff self-reported behaviour has yet to be ascertained. OBJECTIVE: To compare the inter-rater agreement of pharmacy staff and SP-reported data to researcher-reported data from audio recordings of SP encounters. METHODS: A dataset of 352 audio-recorded SP encounters was generated in March-October 2015 by 61 undergraduate pharmacy students completing SP visits to 36 community pharmacies in Sydney, Australia. Post-visit scores were recorded on data collection forms by SPs. Staff completed self-assessments on identical forms immediately after the encounter. Two-hundred-and-seventy visits were randomly selected as the sample for this study, where the researcher independently scored encounters via audio recordings. Inter-rater agreement was calculated through intra-class correlation (ICC) and weighted kappa analyses. RESULTS: Analysis of staff scores returned ICC values of 0.48 (95% CI:0.38-0.56; p < 0.001) for information gathering and 0.63 (95% CI:0.55-0.70; p < 0.001) for total score. Weighted kappa for information rating was 0.30 (95% CI:0.21-0.38; p < 0.001) and 0.43 (95% CI:0.34-0.51; p < 0.001) for overall outcome. ICC values for SPs were 0.91 (95% CI:0.88-0.93; p < 0.001) and 0.90 (95% CI:0.87-0.92; p < 0.001) for information gathering and total scores respectively. Weighted kappa values were 0.44 (95% CI:0.37-0.52; p < 0.001) for information rating and 0.63 (95% CI:0.55-0.70; p < 0.001) for overall outcome. CONCLUSION: Pharmacy staff self-reported their behaviour with a poor degree of reliability. Conversely, SPs had a high level of agreement with the researcher scoring from audio recordings. Disagreement for both groups of raters was most apparent in rating the information provided and overall appropriateness of outcome. Future research should investigate this discrepancy between staff-reported behaviour and actual behaviour and consider the implications of this discrepancy in the interpretation of self-reported data.