ORCID Profile
0000-0002-5589-182X
Current Organisation
University of Tasmania
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Publisher: BMJ
Date: 04-2020
DOI: 10.1136/BMJOPEN-2019-032851
Abstract: Many medicines have adverse effects which are difficult to detect and frequently go unrecognised. Pharmacist monitoring of changes in signs and symptoms of these adverse effects, which we describe as medicine-induced deterioration, may reduce the risk of developing frailty. The aim of this trial is to determine the effectiveness of a 12-month pharmacist service compared with usual care in reducing medicine-induced deterioration, frailty and adverse reactions in older people living in aged-care facilities in Australia. The reducing medicine-induced deterioration and adverse reactions trial is a multicentre, open-label randomised controlled trial. Participants will be recruited from 39 facilities in South Australia and Tasmania. Residents will be included if they are using four or more medicines at the time of recruitment, or taking more than one medicine with anticholinergic or sedative properties. The intervention group will receive a pharmacist assessment which occurs every 8 weeks. The pharmacists will liaise with the participants’ general practitioners when medicine-induced deterioration is evident or adverse events are considered serious. The primary outcome is a reduction in medicine-induced deterioration from baseline to 6 and 12 months, as measured by change in frailty index. The secondary outcomes are changes in cognition scores, 24-hour movement behaviour, grip strength, weight, percentage robust, pre-frail and frail classification, rate of adverse medicine events, health-related quality of life and health resource use. The statistical analysis will use mixed-models adjusted for baseline to account for repeated outcome measures. A health economic evaluation will be conducted following trial completion using data collected during the trial. Ethics approvals have been obtained from the Human Research Ethics Committee of University of South Australia (ID:0000036440) and University of Tasmania (ID:H0017022). A copy of the final report will be provided to the Australian Government Department of Health. Australian and New Zealand Trials Registry ACTRN12618000766213.
Publisher: Oxford University Press (OUP)
Date: 02-02-2012
DOI: 10.1111/J.2042-7174.2012.00188.X
Abstract: Drug-related problems (DRPs) are associated with significant morbidity and mortality, with most DRPs thought to be preventable. Community pharmacists can detect and either prevent or resolve many of these DRPs. A survey-based clinical knowledge measurement tool was designed and validated to estimate a community pharmacist's clinical knowledge and ability to detect and appropriately resolve DRPs. Nine clinical cases with seven multiple-choice statements (63 statements in total) were constructed, based on scenarios that were found to occur frequently in Australian community pharmacies. The statements aimed to assess a pharmacist's ability to identify, gather relevant information about and make appropriate recommendations to resolve, a DRP. The survey was pilot tested with 18 academics at three Australian pharmacy schools, resulting in the removal of 23 statements. The survey was then administered to undergraduate pharmacy students (28 fourth-year, 41 third-year and 42 first-year students) and to 433 Australian community pharmacists who were participating in an intervention documentation trial. The pharmacists' resultant survey scores were correlated against their actual rate of documenting clinical interventions. The tool had relatively good internal consistency. Significant differences were seen between the three groups of students (P & 0.01). Community pharmacists with additional clinical qualifications had a significantly higher score than other participating pharmacists (P & 0.01). A moderate, but significant, correlation was seen between the pharmacists' survey score and their clinical intervention rate in practice during the trial (P & 0.01). The clinical knowledge measurement tool appeared to estimate a pharmacist's ability to detect and resolve DRPs within the community pharmacy environment.
Publisher: Oxford University Press (OUP)
Date: 04-2022
Abstract: To assess the effectiveness of a pharmacist-led intervention using validated tools to reduce medicine-induced deterioration and adverse reactions. Multicenter, open-label parallel randomised controlled trial involving 39 Australian aged-care facilities. Residents on ≥4 medicines or ≥1 anticholinergic or sedative medicine. Pharmacist-led intervention using validated tools to detect signs and symptoms of medicine-induced deterioration which occurred every 8 weeks over 12 months. Usual care (Residential Medication Management Review) provided by accredited pharmacists. Primary outcome was change in Frailty Index at 12 months. Secondary outcomes included changes in cognition, 24-hour movement behaviour by accelerometry, grip strength, weight, adverse events and quality of life. 248 persons (median age 87 years) completed the study 120 in the interventionand, 128 in control arms. In total 575 pharmacist, sessions were undertaken in the intervention arm. There was no statistically significant difference for change in frailty between groups (mean difference: 0.009, 95% CI: −0.028, 0.009, P = 0.320). A significant difference for cognition was observed, with a mean difference of 1.36 point change at 12 months (95% CI: 0.01, 2.72, P = 0.048). Changes in 24-hour movement behaviour, grip strength, adverse events and quality of life were not significantly different between groups. Point estimates favoured the intervention arm at 12 months for frailty, 24-hour movement behaviour and grip strength. The use of validated tools by pharmacists to detect signs of medicine-induced deterioration is a model of practice that requires further research, with promising results from this trial, particularly with regards to improved cognition.
Publisher: Springer Science and Business Media LLC
Date: 09-2016
DOI: 10.1007/S40266-016-0398-6
Abstract: It is currently recommended in Australia that nursing home residents are supplemented daily with 1000 IU vitamin D as they are at an increased risk of fractures. Historically, supplementation has been low, and current supplementation prevalence is not known. The aim of this study was to determine the prevalence of vitamin D supplementation amongst nursing home residents in Tasmania, Australia. Resident data, including demographics, medical conditions and medications (including vitamin D and calcium supplement use), exercise and sun exposure, were obtained from residents' files and staff in consenting nursing homes. Dietary calcium intake was estimated from the weekly menu of one nursing home and total calcium intake estimated from this and calcium supplement use. The prevalence of vitamin D supplementation was compared by resident characteristics and fracture risk factors. Of 811 residents, 409 (50 %) received daily vitamin D supplementation of at least 1000 IU. Residents receiving vitamin D supplementation were slightly younger (mean 83 vs. 85 years for supplemented and unsupplemented groups, respectively, p = 0.003) and more likely to have osteoporosis (29 vs. 22 % for supplemented and unsupplemented groups, respectively, p = 0.019). Only 43 % of residents with osteoporosis received vitamin D supplements. Most residents (86 %) did not have regular sunlight exposure. The median estimated total calcium intake of 800 ± 275 mg daily was below guideline recommendations of 1000-1300 mg daily. The prevalence of vitamin D supplementation in nursing home residents was relatively low, suggesting poor adherence to the relevant clinical guidelines. Additionally, most residents do not access sunlight. Interventions addressing this evidence-practice gap are needed.
Publisher: Elsevier BV
Date: 11-2022
DOI: 10.1016/J.CPTL.2022.09.024
Abstract: Although pharmacists are first and foremost medication specialists and suppliers, in Australia they are also ideally positioned within the healthcare setting to encourage and support positive lifestyle choices in the community. Little has been done to assess their nutrition knowledge in over 20 years. We aimed to explore pharmacists' nutrition knowledge and associated practice and to subsequently develop and evaluate a short course to fill identified gaps. The General Nutrition Knowledge Questionnaire was revised for testing nutrition knowledge in the pharmacy setting. Once validated, the questionnaire was distributed to pharmacists using social rofessional media advertising. A short course was then developed, and its effectiveness assessed on final-year pharmacy students. Pharmacists' (N = 258) mean score was 89.9 out of 121 (SD = 10.6) with significant variation. Nutrition education provision in practice was provided inconsistently and was associated with how strongly participants rated their own knowledge. Most pharmacists (95.7%) agreed they are well-placed to assist in disease burden reduction through nutrition education however, most (98.4%) felt their knowledge needed improvement. The short course was well received by participants, deemed to be appropriate in context, and resulted in a median improvement in matched scores of 14.7% (P < .001) with no significant decline in knowledge when reassessed three weeks later (P = .383). Pharmacists' nutrition knowledge and practice was variable. Further education can improve knowledge without significant time outlay and is likely to improve associated counselling practices.
Publisher: Springer Science and Business Media LLC
Date: 19-11-2012
DOI: 10.1007/S11096-011-9583-1
Abstract: Drug-related problems (DRPs) are a major burden on the Australian healthcare system. Community pharmacists are in an ideal position to detect, prevent, and resolve these DRPs. Objective To develop and validate an easy-to-use documentation system for pharmacists to classify and record DRPs, and to investigate the nature and frequency of clinical interventions undertaken by Australian community pharmacists to prevent or resolve them. Setting Australian community pharmacies. The DOCUMENT classification system was developed, validated and refined during two pilot studies. The system was then incorporated into software installed in 185 Australian pharmacies to record DRPs and clinical interventions undertaken by pharmacists during a 12-week trial. The number and nature of DRPs detected within Australian community pharmacies. A total of 5,948 DRPs and clinical interventions were documented from 2,013,923 prescriptions dispensed during the trial (intervention frequency 0.3%). Interventions were commonly related to Drug selection problems (30.7%) or Educational issues (23.7%). Pharmacists made an average of 1.6 recommendations per intervention, commonly relating to A change in therapy (40.1%) and Provision of information (34.7%). Almost half of interventions (42.6%) were classified by recording pharmacists as being at a higher level of clinical significance. The DOCUMENT system provided pharmacists with a useful and easy-to-use tool for recording DRPs and clinical interventions. Results from the trial have provided a better understanding of the frequency and nature of clinical interventions performed in Australian community pharmacies, and lead to a national implementation of the system.
Publisher: Springer Science and Business Media LLC
Date: 02-08-2018
Publisher: Elsevier BV
Date: 04-2018
DOI: 10.1016/J.PMN.2017.10.002
Abstract: Up to 80% of residents in aged care facilities (ACFs) experience pain, which is often suboptimally managed. The purpose of this study was to characterize pain management in ACFs and identify the barriers to optimal pain management. This exploratory descriptive qualitative study used semistructured interviews in five Southern Tasmania, Australian ACFs. Interviewees included 23 staff members (18 nurses and 5 facility managers) and were conducted from September to November 2015. Interviews included questions about how pain was measured or assessed, what happened if pain was identified, barriers to pain management, and potential ways to overcome these barriers. Interviewees noted that there were no formal requirements regarding pain assessment at the ACFs reviewed however, pain was often informally assessed. Staff noted the importance of adequate pain management for the residents' quality of life and employed both nonpharmacologic and pharmacologic techniques to reduce pain when identified. The barriers to optimal pain management included difficulty identifying and assessing pain, residents' resistance to reporting pain and/or taking medications, and communication barriers between the nursing staff and GPs. Staff interviewed were dedicated to managing residents' pain effectively however, actions in a number of areas could improve resident outcomes. These include a more consistent approach to documenting pain in residents' progress notes and improving nurse-GP communications to ensure that new or escalating pain is identified and expedient changes can be made to the resident's management. Additionally, resident, family, nurse, and carer education, conducted within the facilities on a regular basis, could help improve the pain management of residents.
Publisher: SAGE Publications
Date: 30-08-2201
DOI: 10.1345/APH.1Q138
Publisher: Royal College of General Practitioners
Date: 05-03-2019
DOI: 10.3399/BJGPOPEN18X101629
Abstract: The management of pain by GPs for residents of aged care facilities (ACFs) is very common. To measure the prevalence and assess the management of pain in ACF residents, particularly those with dementia. A retrospective review of ACF residents’ medical records was undertaken at five southern Tasmanian (Australia) ACFs. Data extracted included results of the most recent assessment of pain and its management, frequency and treatment of pain incidents in the previous 7 days, demographics, and medical and medication history. Univariate analysis was used to identify variables associated with increased frequency of pain episodes. The final analysis included 477 residents. At least one episode of pain in the preceding 7 days was documented in 25.6% ( n = 122) of residents' notes. Pain episodes were most commonly managed by analgesics (45.5%), massage (40.7%), and heatpacks (13.8%). Residents with dementia were not less likely to have pain identified during the past week (14% versus 20% P = 0.09), but they were much less likely to have pain identified on their most recent pain assessment ( P = 0.03). GPs should carefully consider the suitability of using ‘as required’ analgesics. Furthermore, on admission to an ACF, GPs need to ensure a patient’s medical history includes all pain or potentially pain-causing conditions, to ensure that a resident’s pain assessment is complete. This is especially necessary for those with dementia, to ensure that staff remain vigilant about the possibility of the resident experiencing pain.
Publisher: Wiley
Date: 11-04-2011
Publisher: Elsevier BV
Date: 06-2020
DOI: 10.1016/J.JGAR.2019.08.025
Abstract: Antimicrobial stewardship (AMS) programmes are well established in hospitals, yet such programmes have not been widely implemented in the community. Understanding current practices and perceptions of community pharmacists about AMS may provide insights into the implementation of AMS in community pharmacies. The aims of this study were to validate a questionnaire to measure community pharmacists' perceptions of AMS and to explore barriers and facilitators to their involvement in community-based AMS initiatives. A 44-item survey questionnaire comprising sections on demographics, AMS practices and perceptions of community pharmacists, and barriers and facilitators to AMS was hosted online. Community pharmacists were recruited through social media pages of community pharmacist groups across Australia. Cronbach's alpha and exploratory factor analysis were used to measure the reliability and validity of the survey tool, respectively. A total of 330 community pharmacists started the survey, with 255 of them completing at least one question. Pharmacists were more likely to intervene with general practitioners (GPs) (≥80% of the time) for allergies, dosing and drug interactions and were less likely to intervene if they felt the choice of antibiotic was inappropriate (45%). Major barriers limiting pharmacists' participation in AMS were lack of access both to patient data (82.6%) and to a standard guideline to implement AMS programmes (72.1%). Almost all pharmacists (98%) reported that better collaboration with GPs would improve their participation in AMS initiatives. Future studies utilising the knowledge gained from this study may provide a framework for AMS in community pharmacy settings.
No related grants have been discovered for Mackenzie Williams.