1
|
Jamil N, Zainal ZA, Alias SH, Chong LY, Hashim R. A systematic review of behaviour change techniques in pharmacist-delivered self-management interventions towards patients with chronic obstructive pulmonary disease. Res Social Adm Pharm 2023:S1551-7411(23)00256-5. [PMID: 37202279 DOI: 10.1016/j.sapharm.2023.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 04/11/2023] [Accepted: 05/08/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Self-management interventions often employ behaviour change techniques in order to produce desired target behaviours that are necessary for day-to-day living with a chronic disease. Despite the large number of self-management interventions for patients with chronic obstructive pulmonary disease (COPD), previously reported interventions have been typically delivered by healthcare providers other than the pharmacist. OBJECTIVE This systematic review examined the components of pharmacists-delivered COPD self-management interventions according to an established taxonomy of behaviour change techniques (BCTs). METHODS A systematic search was conducted on PubMed, ScienceDirect, OVID, and Google Scholar from January 2011 to December 2021 for studies of pharmacist-delivered self-management interventions in COPD patients. RESULTS A total of seventeen studies of intervention were eligible for inclusion in the narrative review. Interventions were educational and were delivered individually and face-to-face for the first session. Across studies, pharmacists spent an average of 35 min on the first meeting and had an average of 6 follow-up sessions. Recurrent BCTs in pharmacist interventions were "Information on the health consequence", "Feedback on behaviour", "Instruction on how to perform a behaviour", "Demonstration of the behaviour" and "Behavioural practice/rehearsal". CONCLUSIONS Pharmacists have provided interventions towards improving health behaviours, especially on adherence and usage of inhaler devices for patients with COPD. Future self-management interventions should be designed using the identified BCTs for the improvement of COPD self-management and disease outcomes.
Collapse
Affiliation(s)
- Nurdiana Jamil
- Faculty of Pharmacy, University of Cyberjaya, Persiaran Bestari, 63000, Cyberjaya, Selangor, Malaysia.
| | - Zainol Akbar Zainal
- Faculty of Pharmacy, University of Cyberjaya, Persiaran Bestari, 63000, Cyberjaya, Selangor, Malaysia.
| | - Siti Hazlina Alias
- Faculty of Psychology and Social Sciences, University of Cyberjaya, Persiaran Bestari, 63000, Cyberjaya, Selangor, Malaysia.
| | - Li Yin Chong
- Serdang Hospital, Ministry of Health Malaysia, Jalan Puchong, 43000, Kajang, Selangor, Malaysia.
| | - Rosnani Hashim
- Faculty of Pharmacy, University of Cyberjaya, Persiaran Bestari, 63000, Cyberjaya, Selangor, Malaysia.
| |
Collapse
|
2
|
Forsyth P, Radley A, Rushworth GF, Marra F, Roberts S, O'Hare R, Duggan C, Maguire B. The Collaborative Care Model: Realizing healthcare values and increasing responsiveness in the pharmacy workforce. Res Social Adm Pharm 2022; 19:110-122. [DOI: 10.1016/j.sapharm.2022.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/18/2022] [Accepted: 08/21/2022] [Indexed: 10/14/2022]
|
3
|
Abu Fadaleh SM, Charrois TL, Makhinova T, Eurich DT, Rahman S, Sadowski CA. The effect of home medication review in community-dwelling older adults: a systematic review. J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-020-01447-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
4
|
Johnson CF, Maskrey M, MacBride-Stewart S, Lees A, Macdonald H, Thompson A. New ways of working releasing general practitioner capacity with pharmacy prescribing support: a cost-consequence analysis. Fam Pract 2022; 39:648-655. [PMID: 35016210 DOI: 10.1093/fampra/cmab175] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND General practice in the United Kingdom is experiencing a workforce crisis. Greater multidisciplinary working, including more general practice pharmacists, is seen as part of the solution. However, it is unknown what impact and cost-consequences that pharmacists may have in freeing general practitioner (GP) capacity. OBJECTIVE To evaluate the cost-consequences of additional pharmacists in releasing GP capacity. METHODS This cost-consequences evaluation of a prospective observational cohort study in 15 urban practices involving 69 GPs in 1 locality serving a population of 82,000 people. GPs recorded the time they spent addressing key targeted prescribing activities during 5 distinct 2-week audit periods. Pharmacists performed these key prescribing activities to release GP capacity. An additional 225 h of pharmacists' time per week was committed to the locality. Standardized staff costings were used to estimate the financial impact. Prescribing indicator performance was assessed against the other 7 localities within the health board. RESULTS When compared with employing extra nonsalaried GPs this required an estimated additional investment of £16.73 (range £5.97-20.87) per h to free GP capacity. This achieved a sustainable 47% (73 h per week, F(4,56) = 16.05, P < 0.001) reduction in GP time spent on key prescribing activities; equating to 4.9 h (95% confidence interval 3.1-6.7) per practice per week. No significant step changes in locality safety and quality prescribing measures, and no negative effects on locality-level prescribing cost-efficiency work were observed. CONCLUSION Appropriately resourced general practice pharmacy teams delivered prescribing cost-efficiencies as well as sustainably freeing GP capacity by performing key prescribing activities.
Collapse
Affiliation(s)
- Chris F Johnson
- Pharmacy Services, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - Margaret Maskrey
- Inverclyde Health and Social Care Partnership NHS Greater Glasgow and Clyde, Port Glasgow, United Kingdom
| | | | - Ann Lees
- Planning, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - Hector Macdonald
- Inverclyde Health and Social Care Partnership NHS Greater Glasgow and Clyde, Port Glasgow, United Kingdom
| | - Audrey Thompson
- Pharmacy Services, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| |
Collapse
|
5
|
The role of the clinical pharmacist in mental health hospital-in-the-home: A scoping review. Res Social Adm Pharm 2022; 18:3724-3735. [DOI: 10.1016/j.sapharm.2022.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 04/11/2022] [Accepted: 04/14/2022] [Indexed: 11/20/2022]
|
6
|
The standards of practice for delivery of polypharmacy and chronic disease medication reviews by general practice clinical pharmacists: a consensus study. Int J Clin Pharm 2022; 44:663-672. [PMID: 35320485 PMCID: PMC8941365 DOI: 10.1007/s11096-022-01387-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 02/15/2022] [Indexed: 01/05/2023]
Abstract
Background General practice in the UK is experiencing a crisis. Greater multidisciplinary working is a potential solution. The new general practice contract in Scotland encourages this and includes a new pharmacotherapy service to be delivered by General Practice Clinical Pharmacists (GPCPs). Consensus is lacking for the standards of practice for delivery of pharmacotherapy medication reviews (which are polypharmacy and chronic medication reviews) as part of this service. Aim To identify and validate standards of practice for polypharmacy and chronic disease medication (pharmacotherapy level 3) reviews conducted by GPCPs. Method A two-phased mixed-methods consensus methodology was used. Phase 1: An expert group of GPCPs (n = 4) and clinical pharmacist managers (n = 2) responsible for delivering the pharmacotherapy service used a Modified Nominal Group Technique to generate potential standards. Phase 2: Two-round Delphi survey involving GPCPs with ≥ 1 year of experience of working in general practice (n = 159). Results The expert group identified 44 potential standards of practice for polypharmacy and chronic disease reviews. Practicing GPCPs indicated during the Delphi phase that the 44 standards were applicable to practice. The standards of practice covered seven main categories: skills, environment, qualifications, qualities and behaviours, knowledge, process and experience. Conclusion Practicing GPCPs indicated that the standards identified by the expert group are acceptable and valid for current practice and the delivery of polypharmacy and chronic medication reviews. The application of these standards to practice may help GPCPs and general practices to ensure equitable delivery of patient care.
Collapse
|
7
|
Farag M, Hoti K, Hughes J, Chalmers L. Impact of a clinical pharmacist on medication safety in mental health Hospital-in-the-Home: a retrospective analysis. Int J Clin Pharm 2022; 44:947-955. [PMID: 35438472 PMCID: PMC9016122 DOI: 10.1007/s11096-022-01409-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 03/28/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Integration of clinical pharmacists into multidisciplinary Mental Health Hospital-in-the-Home teams is increasing but little is known about the medication safety contribution these pharmacists make. AIM To evaluate whether clinical pharmacist involvement in a Mental Health Hospital-in-the-Home service improved medication safety key performance indicators. METHOD Medical records were retrospectively reviewed of all patients admitted to 2 Western Australian Mental Health Hospital-in-the-Home services from September to November 2015. SITE 1: was a 16-bed service incorporating a clinical pharmacist as part of its multidisciplinary team. SITE 2: was a similarly structured 18-bed service but without clinical pharmacist involvement. The primary outcome measure was completion of medication safety key performance indicators obtained from the Western Australian Government Pharmaceutical Review Policy and mental health-specific best practice guidelines. RESULTS Key performance indicators from Site 1 (n = 75 records), which incorporated a clinical pharmacist, demonstrated significantly (p < 0.001) higher rates of completion of medication reconciliation [65 (87%) versus 17 (29%)], accurate adverse drug reaction list [73 (97%) versus 34 (58%)], accurate discharge medication list [51 (74%) versus 18 (45%)], accurate medication profile [74 (99%) versus 40 (68%)] and medication chart review [74 (99%) versus 0 (0%)] than Site 2 (n = 59). CONCLUSION Integrating a clinical pharmacist into a Mental Health Hospital-in-the-Home program significantly improved achievement of medication safety key performance indicators.
Collapse
Affiliation(s)
- Mechaiel Farag
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Kent Street, Bentley, WA, 6102, Australia. .,North Metropolitan Health Service-Mental Health Pharmacy, Brockway Road, Mount Claremont, WA, 6010, Australia.
| | - Kreshnik Hoti
- grid.1032.00000 0004 0375 4078Curtin Medical School, Faculty of Health Sciences, Curtin University, Kent Street, Bentley, WA 6102 Australia ,grid.449627.a0000 0000 9804 9646Division of Pharmacy, Faculty of Medicine, University of Prishtina, Prishtina, Kosovo
| | - Jeff Hughes
- grid.1032.00000 0004 0375 4078Curtin Medical School, Faculty of Health Sciences, Curtin University, Kent Street, Bentley, WA 6102 Australia
| | - Leanne Chalmers
- grid.1032.00000 0004 0375 4078Curtin Medical School, Faculty of Health Sciences, Curtin University, Kent Street, Bentley, WA 6102 Australia
| |
Collapse
|
8
|
Nduaguba S, Barner JC, Makhinova T, Roberson K. Medication Therapy Management for Texas MediCAID Patients With Asthma and Chronic Obstructive Pulmonary Disease-A Pilot Study. J Pharm Pract 2021; 35:528-535. [PMID: 33648367 DOI: 10.1177/0897190021997032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pharmacists can play an important role in providing medication therapy management (MTM) services, which focus on appropriate medication use. This pilot study aimed to describe pharmacists' MTM service provision, results/outcomes of pharmacists' recommendations and resolution/acceptance rate among patients with high-risk asthma and/or chronic obstructive pulmonary disease (COPD). METHODS This was a prospective descriptive study of MTM services provided by community pharmacists to Texas Medicaid patients (5-63 years) with "high risk" asthma or COPD. Patients received in-person and telephone consultations that included medication review, asthma control test assessment, and education on adherence and proper medication/device use. Data extracted from MTM software was used to describe: reasons for MTM services, type of pharmacists' interventions, outcomes of pharmacists' recommendations and acceptance rate. RESULTS Twenty-eight pharmacists provided 139 MTM interventions with 63 patients (2.2 interventions per patient). The most frequent intervention reason was complex drug therapy (53.2%), underuse of medication (8.6%), need for drug therapy (8.6%), new or changed prescription therapy (6.5%), and administration technique (5.0%). The resolution rate was 77.7%. Patient and prescriber, respectively, refused recommendation in 12% and 6% of the interventions. Outcomes included comprehensive medication review (46.7%), improved adherence (6.5%), therapeutic success (6.5%), improved administration technique (5.0%), and initiation of new therapy (5.0%). CONCLUSION Through the provision of MTM, pharmacists were able to identify and intervene with medication-related problems. These interventions are instrumental in helping patients better manage their asthma/COPD. The high resolution rate was encouraging. Larger scale studies are needed to assess clinical and economic outcomes.
Collapse
Affiliation(s)
- Sabina Nduaguba
- Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, Gainesville, FL, USA
| | - Jamie C Barner
- Health Outcomes Division, The University of Texas at Austin College of Pharmacy, Austin, TX, USA
| | - Tatiana Makhinova
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Kim Roberson
- Former Director of Professional Affairs, Texas Pharmacy Association, Austin, TX, USA
| |
Collapse
|
9
|
Lowrie R, Stock K, Lucey S, Knapp M, Williamson A, Montgomery M, Lombard C, Maguire D, Allan R, Blair R, Paudyal V, Mair FS. Pharmacist led homeless outreach engagement and non-medical independent prescribing (Rx) (PHOENIx) intervention for people experiencing homelessness: a non- randomised feasibility study. Int J Equity Health 2021; 20:19. [PMID: 33413396 PMCID: PMC7789612 DOI: 10.1186/s12939-020-01337-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 11/26/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Homelessness and associated mortality and multimorbidity rates are increasing. Systematic reviews have demonstrated a lack of complex interventions that decrease unscheduled emergency health services utilisation or increase scheduled care. Better evidence is needed to inform policy responses. We examined the feasibility of a complex intervention (PHOENIx: Pharmacist led Homeless Outreach Engagement Nonmedical Independent prescribing (Rx)) to inform a subsequent pilot randomised controlled trial (RCT). METHODS Non-randomised trial with Usual Care (UC) comparator group set in Greater Glasgow and Clyde Health Board, Scotland. Participants were adult inpatients experiencing homelessness in a city centre Glasgow hospital, referred to the PHOENIx team at the point of hospital discharge, from 19th March 2018 until 6th April 2019. The follow up period for each patient started on the day the patient was first seen (Intervention group) or first referred (UC), until 24th August 2019, the censor date for all patients. All patients were offered and agreed to receive serial consultations with the PHOENIx team (NHS Pharmacist prescriber working with Simon Community Scotland (third sector homeless charity worker)). Patients who could not be reached by the PHOENIx team were allocated to the UC group. The PHOENIx intervention included assessment of physical/mental health, addictions, housing, benefits and social activities followed by pharmacist prescribing with referral to other health service specialities as necessary. All participants received primary (including specialist homelessness health service based general practitioner care, mental health and addictions services) and secondary care. Main outcome measures were rates of: recruitment; retention; uptake of the intervention; and completeness of collected data, from recruitment to censor date. RESULTS Twenty four patients were offered and agreed to participate; 12 were reached and received the intervention as planned with a median 7.5 consultations (IQR3.0-14.2) per patient. The pharmacist prescribed a median of 2 new (IQR0.3-3.8) and 2 repeat (1.3-7.0) prescriptions per patient; 10(83%) received support for benefits, housing or advocacy. Twelve patients were not subsequently contactable after leaving hospital, despite agreeing to participate, and were assigned to UC. Two patients in the UC group died of drug/alcohol overdose during follow up; no patients in the Intervention group died. All 24 patients were retained in the intervention or UC group until death or censor date and all patient records were accessible at follow up: 11(92%) visited ED in both groups, with 11(92%) hospitalisations in intervention group, 9(75%) UC. Eight (67%) intervention group patients and 3(25%) UC patients attended scheduled out patient appointments. CONCLUSIONS Feasibility testing of the PHOENIx intervention suggests merit in a subsequent pilot RCT.
Collapse
Affiliation(s)
- Richard Lowrie
- Homeless Health, Pharmacy Services, Clarkston Court, NHS Greater Glasgow & Clyde, 56 Busby Road, Clarkston, Glasgow, G76 7AT, UK.
| | - Kate Stock
- Homeless Health, Pharmacy Services, Clarkston Court, NHS Greater Glasgow & Clyde, 56 Busby Road, Clarkston, Glasgow, G76 7AT, UK
| | | | | | - Andrea Williamson
- Department of General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Margaret Montgomery
- Homeless Health, Pharmacy Services, Clarkston Court, NHS Greater Glasgow & Clyde, 56 Busby Road, Clarkston, Glasgow, G76 7AT, UK
| | - Cian Lombard
- Acute Homeless Liaison Team, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Donogh Maguire
- Emergency Department, Glasgow Royal Infirmary, NHS Greater Glasgow & Clyde, Glasgow, UK
| | | | - Rebecca Blair
- Homeless Health, Pharmacy Services, Clarkston Court, NHS Greater Glasgow & Clyde, 56 Busby Road, Clarkston, Glasgow, G76 7AT, UK
| | | | - Frances S Mair
- Department of General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| |
Collapse
|
10
|
Hu Y, Yao D, Ung COL, Hu H. Promoting Community Pharmacy Practice for Chronic Obstructive Pulmonary Disease (COPD) Management: A Systematic Review and Logic Model. Int J Chron Obstruct Pulmon Dis 2020; 15:1863-1875. [PMID: 32821091 PMCID: PMC7425088 DOI: 10.2147/copd.s254477] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 07/03/2020] [Indexed: 12/25/2022] Open
Abstract
Purpose This study aimed 1) to identify and analyse the professional services provided by community pharmacists for chronic obstructive pulmonary disease (COPD) management; and 2) to develop a logic model for community pharmacy practice for COPD management. Methods A systematic review with a logic model was applied. English-language databases (PubMed, Web of Science, Embase, and Scopus) and a Chinese database (CNKI) were searched for articles published between January 2009 and June 2019. Studies concerning pharmacists and COPD were identified to screen for studies that focused on professional services provided at a community pharmacy level. Evidence on economic, clinical, and humanistic outcomes of interventions was summarized. Results Twenty-five articles were included in this study. Four categories of COPD-related interventions by community pharmacists were identified: 1) primary prevention; 2) early detection; 3) therapy management; and 4) long-term health management. The most common outputs examined were improvement in inhaler technique, medication adherence, and rate of smoking cessation. The clinical (improved quality of life, reduced frequency and severity of symptoms and exacerbation), humanistic (patient satisfaction), and economic (overall healthcare costs) outcomes were tested for some interventions through clinical studies. Contextual factors concerning pharmacists, healthcare providers, patients, facilities, clinic context, and socio-economic aspects were also identified. Conclusion Studies in the literature have proposed and examined different components of professional services provided by community pharmacists for COPD management. However, relationships among outcomes, comprehensive professional services of community pharmacists, and contextual factors have not been systematically tested. More well-designed, rigorous studies with more sensitive and specific outcomes measures need to be conducted to assess the effect of community pharmacy practice for COPD management.
Collapse
Affiliation(s)
- Yuqi Hu
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macau, People's Republic of China
| | - Dongning Yao
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macau, People's Republic of China
| | - Carolina Oi Lam Ung
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macau, People's Republic of China
| | - Hao Hu
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macau, People's Republic of China
| |
Collapse
|