Pharmacy students can deliver services in general practices: a longitudinal work-based learning model for integrated clinical teaching

Introduction

Collaboration between healthcare providers and higher education institutions enable service delivery using the student workforce.(1) This is significant as access to an appropriately skilled workforce can broaden the delivery of pharmacy services.(1) Pharmacy students may have knowledge and communication skills to be able to contribute to service delivery.(2) However, models that integrate pharmacy students into pharmacy services in general practice are limited.

Aim

to explore a new model of work-based learning in general practice for pharmacy students.

Methods

A qualitative design is appropriate and was used for this exploratory study. Thirty-two students were recruited from third year of an MPharm programme at one University to provide services via a Pharmacy Hub for three general practices in England. Each student attended the Hub for one 3-hour session, each fortnight, for 12 weeks between September 2019 and February 2020. Students completed ‘tasks’ using read-only access to patient records on SystmOne and recorded their activity on clinical worksheets. Students and stakeholders from the Hub were invited to take part in an interview covering what students did and what the long-term impact of the initiative might be via email. A convenience sample of fifteen students, four general practitioners, two pharmacists, two pharmacy technicians, one general practice manager, and two receptionists, completed semi-structured interviews. Data was also extracted from a convenience sample of 51/105 clinical worksheets to identify the types of tasks completed by students. Content analysis of transcribed interview data and extracted clinical data was completed by both authors until theoretical data saturation was reached. Institutional ethics approval was received for this study.

Results

Four themes were identified which included i) what activities students completed, ii) impact of working in general practice on student learning iii) impact on recruitment to general practice and iv) concerns. Concerns had three sub-themes relating to indemnity cover for students, a lack of face-to-face patient contact and repetition of simple tasks. See Table 1 for extracts of data. Clinical worksheets indicated students reviewed repeat medication requests (76%, n= 39) and acute medication requests (12%, n=6), for a wide range of products, such as analgesia, antifungal treatment, statin therapy and H.pylori eradication. Students also answered medication-related queries (12%, n=6) such as identifying the porcine content of medications and how to switch from insulin glargine to insulin levemir.

Conclusion

Findings suggest pharmacy students can contribute to service delivery in general practice by providing supporting roles. However, models must ensure students have access to progressively more complex tasks to facilitate learning. These findings should prompt further research evaluating the role of the pharmacy student workforce to establish key activities students can be trusted to complete. A strength of the study is the combination of data from qualitative interviews and clinical worksheets which provide rich, contextual data. A weakness of the study is that participant validation was not used to confirm the study findings.

References

1. Bates I, John C, Seegobin P, al. e. An analysis of the global pharmacy workforce capacity treands from 2006 to 2012. Hum Resour Health. 2018;16.

2. Bullen. K, Davison K, Hardisty J. Community pharmacy as an effective teaching and learning environment: student perspecives from a UK Mpharm programme. Currents in Pharmacy Teaching and Learning. 2019;11(9):902–8.

A systematic review and thematic synthesis of patients' experience of medicines adherence

BACKGROUND

Medicines non-adherence continues to be problematic in health care practice. After decades of research, few interventions have a robust evidence-based demonstrating their applicability to improve adherence. Phenomenology has a place within the health care research environment.

OBJECTIVE

To explore patients' lived experiences of medicines adherence reported in the phenomenonologic literature.

METHODS

A systematic literature search was conducted to identify peer-reviewed and published phenomenological investigations in adults that aimed to investigate patients' lived experiences of medicines adherence. Studies were appraised using the Critical Appraisal Skills Programme (CASP) Qualitative Research Tool. Thematic synthesis was conducted using a combination of manual coding and NVivo10 [QSR International, Melbourne] coding to aid data management.

RESULTS

Descriptive themes identified included i) dislike for medicines, ii) survival, iii) perceived need, including a) symptoms and side-effects and b) cost, and iv) routine. Analytic themes identified were i) identity and ii) interaction.

CONCLUSIONS

This work describes adherence as a social interaction between the identity of patients and medicines, mediated by interaction with family, friends, health care professionals, the media and the medicine, itself. Health care professionals and policy makers should seek to re-locate adherence as a social phenomenon, directing the development of interventions to exploit patient interaction with wider society, such that patients 'get to know' their medicines, and how they can be taken, throughout the life of the patient and the prescription.