ORCID Profile
0000-0003-4189-8403
Current Organisations
Great Lakes Environmental Research Laboratory
,
University of Sydney
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Publisher: Springer Science and Business Media LLC
Date: 20-11-2013
DOI: 10.1007/S00127-012-0625-3
Abstract: Non-adherence to antidepressant medications is a significant barrier to the successful treatment of depression. The purpose of this study was to explore the perspectives of health care providers on antidepressant medication non-adherence in clinical practice. In idual semi-structured interviews were conducted with a purposive s le of 31 health care providers from a range of disciplines and settings in the state of New South Wales, Australia. Interviews focused on medication adherence issues in depression and participants' strategies in addressing them. Interviews were audio recorded, transcribed verbatim and thematically content analyzed using a constant comparison approach. Participants acknowledged medication non-adherence to be a complex problem in depression, and attributed this problem to patient, medication and environmental-specific issues. Five approaches in addressing non-adherence were reported: patient education, building partnerships with patients, pharmacological management, developing behavioural skills and building supportive networks. Challenges to the management of non-adherence were lack of time and skills, assessment of medication adherence, transition period immediately post-discharge and conflicts in views between providers. Participants were able to identify issues and strategies in addressing antidepressant non-adherence however, barriers were also identified that could impact on providers' ability to address this issue effectively. More research is needed to develop effective multidisciplinary strategies that take into account providers' perspectives in improving adherence to antidepressant medications.
Publisher: Springer Science and Business Media LLC
Date: 15-10-2009
DOI: 10.1007/S00127-009-0148-8
Abstract: Few studies have investigated strategies to identify and resolve drug-related problems among clients of community mental health teams (CMHTs). The objective of this study was to evaluate the clinical impact and appropriateness of comprehensive medication reviews for clients of CMHTs. Trained pharmacists conducted interviews (30-45 min each) with clients of CMHTs to identify actual and potential drug-related problems. The pharmacists prepared medication review reports that detailed their findings and recommendations to optimize drug therapy. An expert panel comprising a psychiatrist, general medical practitioner, mental health pharmacist and medication review pharmacist evaluated reviews for 48 clients of 5 CMHTs. Panelists independently assessed review findings, review recommendations, likelihood of recommendation implementation and the overall expected clinical impact. Two hundred and nine medication review findings and 208 medication review recommendations were evaluated. Panelists agreed with 76% of findings and considered that 81% of recommendations were appropriate. Collectively, 69% of recommendations were considered likely to be implemented. Thirty-seven (77%) reviews were deemed potentially to have a positive clinical impact. The agreement between panelists was statistically significant (P < 0.01) for the assessment of the findings, recommendations and likelihood of recommendation implementation. Pharmacists' findings and recommendations to optimize drug therapy were considered appropriate and likely to result in improved clinical outcomes. Comprehensive medication reviews may be a valuable strategy to identify and resolve drug-related problems among clients of CMHTs.
Publisher: Wiley
Date: 06-06-2013
DOI: 10.1111/HEX.12092
Publisher: Elsevier BV
Date: 12-2015
DOI: 10.1016/J.JAD.2015.06.015
Abstract: Perinatal depression (PND) affects approximately 10-15% of women, worldwide. PND screening, using screening tools, has been undertaken by a broad range of healthcare professionals in different settings. Our objective was to explore the acceptability of PND screening and how acceptability was being assessed. A systematic literature review of studies that explored the acceptability of PND screening was carried out throughout MEDLINE, PsycINFO, PubMed, CINAHL, Embase, Maternity and Infant Care and Joanna Briggs Institute databases. Twenty-eight out of twenty-nine publications reported PND screening to be acceptable to most participants. A wide range of terms, questions and statements was used to infer, assess or report on acceptability. There was no uniform, psychometrically tested tool used to measure acceptability across the studies. Broad inclusion criteria and methodological differences limited comparisons, but are overcome by the comprehensiveness of the data and the lack of uniformity across studies. Even though PND screening appears acceptable, it is difficult to draw conclusions about PND screening acceptability as studies used different methods to infer, assess or report on acceptability. The lack of a uniform, psychometrically tested tool to measure acceptability is not unique to PND. Nonetheless, the majority of perinatal women and healthcare professionals reported positive attitudes towards PND screening using different tools in different settings, indicating that it may be the responsibility of all healthcare professionals who come into contact with perinatal women.
Publisher: Informa UK Limited
Date: 07-2018
DOI: 10.2147/PPA.S167396
Publisher: Elsevier BV
Date: 02-2019
DOI: 10.1016/J.SAPHARM.2018.03.066
Abstract: The assessment of content validity is a critical and complex step in the development process of instruments which are frequently used to measure complex constructs in social and administrative pharmacy research. The aims of this study were to investigate the elements of content validity to describe a practical approach for assessing content validity and to discuss existing content validity indices. This is a narrative review of the assessment and quantification of content validity. It describes the key stages of conducting the content validation study and discusses the quantification and evaluation of the content validity estimates. Content validity provides evidence about the degree to which elements of an assessment instrument are relevant to and representative of the targeted construct for a particular assessment purpose. The assessment of content validity relies on using a panel of experts to evaluate instrument elements and rate them based on their relevance and representativeness to the content domain. It is a three-stage process that includes the development stage, judgment and quantifying stage, and revising and reconstruction stage. To quantify the expert judgments, several indices have been discussed in this paper such as the content validity ratio (CVR), content validity index (CVI), modified-Kappa, and some agreement indices. A practical guide describes the process of content validity evaluation is provided. In summary, content validation processes and content validity indices are essential factors in the instrument development process, should be treated and reported as important as other types of construct validation. Determining item CVI and reporting an overall CVI are important components necessary to instruments especially when the instrument is used to measure health outcomes or to guide a clinical decision making. Content validity deserves a rigorous assessment process as the obtained information from this process are invaluable for the quality of the newly developed instrument.
Publisher: Springer Science and Business Media LLC
Date: 04-05-2007
DOI: 10.1007/S11096-007-9130-2
Abstract: In medication review involving community pharmacists and physicians, there is an underlying assumption that if community pharmacists provide evidence based pharmacotherapeutic recommendations, physicians, in turn, will implement these recommendations. However, although in general medication review has been shown to improve the quality of medicine use, medication management plans arising from the medication review process are not always implemented. There is a need for better understanding of the factors that influence outcomes in medication review. The current paper will address some cultural and procedural factors that may assist in understanding outcomes in medication review using research into collaboration from areas outside the healthcare as a framework.
Publisher: Springer Science and Business Media LLC
Date: 09-11-2022
DOI: 10.1007/S11096-021-01340-0
Abstract: Background Opioid prescribing has escalated, particularly long-term in chronic noncancer pain. Innovative models of care have been recommended to augment regulatory and harm-minimisation strategies and to review the safety and benefits of opioids for the in idual patient. Medication stewardship and pharmacist integration are evolving approaches for general practice. Aim To explore enablers, barriers, and outcomes of a pharmacist-led intervention to improve opioid management in general practice, from the perspectives of general practitioners (GPs) and practice personnel. Method The study was part of a mixed-methods investigation into a general practice pharmacist pilot. Qualitative data relevant to opioids were analysed. Data from 13 semi-structured interviews were coded, analysed iteratively and thematically, and interpreted conceptually through the framework of Opioid Stewardship fundamentals proposed by the National Quality Forum. Results Seven themes and 14 subthemes aligned with stewardship fundamentals. Participants considered organisational policy, supported by leadership and education, fostered collaboration and consistency and improved practice safety. Patient engagement with in idualised resources, 'agreements' and 'having the conversation' with the pharmacist enabled person-centred opioid review and weaning. GPs reported greater accountability and reflection in their practices, in the broader context of opioid prescribing and dilemmas in managing patients transitioning through care. Receiving feedback on practice deprescribing outcomes encouraged participants' ongoing commitment. Patient communication was deemed an early barrier however, learnings were applied when transferring the model to other high-risk medicines. Conclusion Improved opioid management was enabled through implementing pharmacist-led coordinated stewardship. The findings offer a practical application of guideline advice to in idualise opioid deprescribing.
Publisher: Wiley
Date: 2003
DOI: 10.1046/J.1440-1584.2003.00468.X
Abstract: A pharmacist-delivered health promotion and screening service for cardiovascular risk factors in rural community pharmacy was implemented in the Upper Hunter Valley, New South Wales (NSW). We describe the development of the service and profile 204 participants at their initial screening. A standardised clinical protocol guided the pharmacist through delivery of the service. The mean age of participants was 44 years (SD +/- 13). Over half (54%) had a Body Mass Index (BMI) > 25, 54% had cholesterol > 5.0 mmol L-1 and 18% a systolic BP> or = 140 mmHg and/or diastolic BP >or = 90 mmHg. Most (80%) received lifestyle information (dietary, exercise or smoking cessation). One third required referral to a general practitioner. Provision of the service through community pharmacy increased the community's access to screening, 28% reported that they had never had their cholesterol measured. Since this new service was able to identify, educate and refer people at risk of cardiovascular disease in a rural community, we recommend a broader adoption through rural pharmacies.
Publisher: JMIR Publications Inc.
Date: 13-10-2017
DOI: 10.2196/JMIR.7656
Publisher: Springer Science and Business Media LLC
Date: 12-2017
Publisher: Wiley
Date: 12-02-2016
Publisher: John Wiley & Sons, Ltd
Date: 28-02-2013
Publisher: Springer Science and Business Media LLC
Date: 07-06-2012
DOI: 10.1007/S11096-012-9661-Z
Abstract: Patients at risk of experiencing medicine-related problems do not always appear willing to participate in collaborative medication management services. Little is known about the psycho-social factors which motivate patients to participate in these services. The theory of motivated information management (TMIM) suggests that patients' willingness to participate may be motivated by their uncertainty and worry about their medicines. The objective of this study was to investigate factors which may motivate patients to participate in a collaborative medication management program. Fourteen semi-structured focus group interviews held throughout Australia provided the data for the study. Eighty participants were recruited by community pharmacists. Participants were recruited into the study if they had experienced Australia's Home Medicines Review (HMR) program or would be eligible to participate in the program because they were at risk of experiencing medicine-related problems. Methods An interview guide was developed which was informed by TMIM. Focus group data were audio-recorded, transcribed and where necessary, translated into English. Qualitative data were thematically analysed to identify participants' expectations about the outcomes of HMR and the factors which may influence these expectations. Participants' most salient outcome expectancies of HMR were that it was a medication-information source which would assist them to manage their medicines. Recipients of the program held overall positive outcome expectancies, whereas nonrecipients' expectancies varied widely. Consistent with theory, participants who expressed some worry about their medicines, generally held positive outcome expectancies and were willing to participate in HMR. Compared with younger participants, older participants (those aged >74 years) tended to engage less in their thoughts about being at risk, and consequently did not experience worry. Worry about medicines is a key factor in motivating participants to engage in medicines information-seeking. Older persons who rely heavily on heuristics appeared less likely to worry about their medicines and willing to participate in medication management services. Age-related reduction in the motivation to participate may have important implications for medication safety. Further examination of this effect is warranted because older persons are at greatest risk of medicine related problems.
Publisher: Springer Science and Business Media LLC
Date: 08-08-2016
Publisher: Elsevier BV
Date: 03-2019
DOI: 10.1016/J.SAPHARM.2018.04.034
Abstract: Persistent medicine shortages have highlighted that global access to essential medicines remain problematic. Existing supply chain vulnerabilities impact health systems and risk consumer safety. This study aimed to examine how different key stakeholders' roles facilitate access to essential medicines. In depth interviews were conducted with 47 participants across seven stakeholder groups globally. Stakeholders included government, academics, consumer groups, non-profit organizations, hospital healthcare providers, manufacturers, and wholesaler/distributors. An inductive approach to data analysis was undertaken. A pragmatic Grounded Theory "approach" was adopted, using tools such as open, axial, and selective coding. Thematic content analysis was applied to the comprehensive theory of collaboration to provide a contextual management framework to interpret themes. Results were displayed in Ishikawa fishbone diagrams for decision making and the logistics process. Findings showed that logistics management and therapeutic decision making were managed separately by stakeholders. Interestingly, hospital pharmacists had overlapping roles in patient care decisions and supply chain logistics, highlighting their importance as supply chain managers. Furthermore, despite the significant role that wholesalers/distributors had in managing supply disruptions and shortages, they were not involved in the decision-making process and did not participate in therapeutic selection committees. Additionally, sometimes stakeholders' intended control mechanisms contributed to increasing the complexity of the supply chain. There is a need for improved and innovative stakeholder engagement. Expanding the role of pharmacy to include hospital formulary pharmacists and including wholesaler/distributors in therapeutic selection committee decisions could improve these collaborations, may help to align the selection and procurement of medicines processes.
Publisher: Wiley
Date: 18-06-2015
DOI: 10.1002/PSP4.56
Publisher: SAGE Publications
Date: 22-01-2015
Abstract: Background: More than 20 different types of classification systems for drug-related problems (DRPs) and their causes have been developed. Classification is necessary to describe and assess clinical, organizational, and economic impacts of DRPs through documentation of collected data. However, many researchers have judged classification systems incomplete when describing their data, and have modified them or developed their own. This variability between systems has made study comparisons difficult. Objectives: To perform a category-by-category comparison of the content of selected DRP classification systems to construct an aggregated cause-of-DRP classification system containing the content of all systems. Method: DRP classification systems were identified after a literature review, with 7 chosen based on their use in varied health care settings, geographical ersity, frequency of use, and method of development. These systems were critically analyzed, and the content of each category was compared and aggregated where appropriate. A hierarchy of categories was constructed to include all content from all systems. Any modifications that previous studies may have made to the 7 systems were also cross-referenced to ensure that no concepts were missing from the newly aggregated system. Clinical ex les to optimize application, and instructions for when or when not to use categories, were developed. Interrater agreement for classification of the causes of DRPs from 10 medication reviews was performed between 3 clinical pharmacists and the authors’ gold standard. Results: We found variation in developmental methods, category descriptions, number and types of categories, and validation methods between the 7 selected systems, together with intermingling of categories identified as causes of DRPs with DRPs themselves. A hierarchical classification system was constructed consisting of 9 cause-of-DRP categories, 33 subcategories, and 58 sub-subcategories, for which interrater agreements were 82.5%, 74.6%, and 58.8%, respectively. Conclusion: An aggregated classification system was constructed through a unique and transparent developmental process that may provide the most comprehensive description of causes of DRPs to date. This may facilitate teaching of pharmaceutical care, comparisons of clinical practice, and measurement of the effectiveness of pharmaceutical care interventions.
Publisher: Springer Science and Business Media LLC
Date: 2003
Abstract: The past decade has seen a notable shift in the practice of pharmacy, with a strong focus on the provision of cognitive pharmaceutical services (CPS) by community pharmacists. The benefits of these services have been well documented, yet their uptake appears to be slow. Various strategies have been developed to overcome barriers to the implementation of CPS, with varying degrees of success, and little is known about the sustainability of the practice changes they produce. Furthermore, the strategies developed are often specific to in idual programs or services, and their applicability to other CPS has not been explored. There seems to be a need for a flexible change management model for the implementation and dissemination of a range of CPS, but before it can be developed, a better understanding of the change process is required. This paper describes the development of a qualitative research instrument that may be utilised to investigate practice change in community pharmacy. Specific objectives included gaining knowledge about the circumstances surrounding attempts to implement CPS, and understanding relationships that are important to the change process. Organisational theory provided the conceptual framework for development of the qualitative research instrument, within which two theories were used to give insight into the change process: Borum's theory of organisational change, which categorizes change strategies as rational, natural, political or open and Social Network Theory, which helps identify and explain the relationships between key people involved in the change process. A semi-structured affecting practice change found in the literature that warranted further investigation with the theoretical perspectives of organisational change and social networks. To address the research objectives, the instrument covered four broad themes: roles, experiences, strategies and networks. The qualitative research instrument developed in this study provides a starting point for future research to lead to a description and understanding of practice change in community pharmacy, and subsequent development of models for the sustainable implementation of CPS.
Publisher: BMJ
Date: 12-2015
Publisher: Elsevier BV
Date: 03-2018
DOI: 10.5688/AJPE6110
Publisher: Elsevier BV
Date: 12-2007
DOI: 10.1016/J.SAPHARM.2006.10.005
Abstract: People living with bipolar mood disorder and psychotic illnesses in Australia primarily access public-sector mental health care through community mental health teams (CMHTs). Adverse drug events are common among clients of CMHTs taking psychotropic medications. The study aimed to investigate and describe a potential role for pharmacists as members of CMHTs. Five study pharmacists were employed 1 day per week to work with 5 mental health teams over a 24-week period. The pharmacists conducted both client and team specific activities designed to optimize the use of medications. The pharmacists recorded their professional activities in diaries. Audiotaped focus groups were conducted with the pharmacists (n=1) and mental health team staff (n=3) at the conclusion of the study. Pharmacists' diaries and the transcripts of focus groups were thematically content analyzed. Study pharmacists were perceived as valuable sources of unbiased and evidence-based drug information for both mental health team staff and their clients and caregivers. Mental health team staff particularly appreciated the provision of information about nonpsychotropic medications. Pharmacists' participation in clinical team meetings was used as an opportunity to present medication review findings and recommendations. Liaising between medication prescribers and dispensers working in primary and secondary care settings was deemed an important additional role however, participating only 1 day per week was considered to delay rapport building and the establishment of collaborative working relationships with mental health team staff. Including pharmacists as members of CMHTs addressed an unmet need for pharmaceutical services among clients and staff of CMHTs. Pharmacists' contributions were welcomed by mental health team staff. The study raised the issue of whether pharmacists should be considered as essential and legitimate members of interdisciplinary CMHTs.
Publisher: American Psychiatric Association Publishing
Date: 03-2020
DOI: 10.1176/APPI.PS.201900244
Abstract: The study's objective was to examine Canadian and Australian community pharmacists' experiences with people at risk of suicide. A survey was developed and administered online. Countries were compared by Fisher's exact and t tests. Multivariable logistic-regression analysis was used to identify variables associated with preparedness to help someone in a suicidal crisis. The survey was completed by 235 Canadian and 161 Australian pharmacists. Most (85%) interacted with someone at risk of suicide at least once, and 66% experienced voluntary patient disclosure of suicidal thoughts. More Australians than Canadians had mental health crisis training (p<0.001). Preparedness to help in a suicidal crisis was negatively associated with being Canadian, having a patient who died by suicide, lacking training and confidence, and permissive attitudes toward suicide. Several perceived barriers impede pharmacists' abilities to help patients who voluntarily disclose suicidal thoughts. Gatekeeper and related suicide prevention strategy training for community pharmacists is warranted.
Publisher: Springer Science and Business Media LLC
Date: 10-08-2014
DOI: 10.1007/S11096-014-9997-7
Abstract: Drug-related problems (DRPs) cause significant morbidity and mortality in healthcare. Clinical pharmacists have shown to reduce DRPs in the inpatient setting. In mental health the effects of clinical pharmacists on DRPs is relatively unknown. To explore the clinical role of inpatient mental health pharmacists and the factors affecting their role. Australian hospitals. Mixed methods. As the profile of the hospital mental health pharmacy workforce is unknown, surveys were distributed to all Australian hospitals with a pharmacy department. DRPs and recommendations were classified using an adaptation of the DOCUMENT system. In-depth semi-structured interviews were undertaken with members of the Society of Hospital Pharmacists Australia's Mental Health Committee of Specialty Practice. Types of DRPs identified by mental health pharmacists, the recommendations made to address them and the rate at which these recommendations were implemented. As well as mental health pharmacists' views on the factors which affect their clinical role. 277 clinical interventions were reported by 47 mental health pharmacists, with 332 DRPs identified and 355 recommendations made. Drug interactions were the most commonly identified DRP (13.9 %). DRPs ranged in severity and likelihood of occurring. Changes to therapy accounted for the vast majority of recommendations (60.8 %), with the most common being change of drug (29.9 %). In total 91.8 % of recommendations were implemented. On average pharmacists estimated 56.1 % of their clinical interventions focused on psychotropic medication issues. Sixteen pharmacists were interviewed. Their relationship with the medical officers, time constraints and a gap in the evidence base to guide practice were identified as the major factors affecting their role. Pharmacists play an important role in ensuring the quality use of medicines in inpatient mental health. However, significant factors need to be addressed to further expand clinical pharmacy services in inpatient mental healthcare in Australia.
Publisher: Elsevier BV
Date: 11-2010
DOI: 10.5688/AJ7409167
Publisher: Springer Science and Business Media LLC
Date: 04-05-2016
Publisher: Oxford University Press (OUP)
Date: 12-10-2023
DOI: 10.1093/IJPP/RIAD061
Publisher: Oxford University Press (OUP)
Date: 03-09-2010
Abstract: Dyslipidaemia is a major risk factor for coronary heart disease. A key issue in management is adherence to therapy. Pharmacists are ideally situated to provide a service to increase medication adherence and optimize health outcomes. This study aimed to evaluate the impact of a community pharmacist-delivered adherence support service on patients' adherence and total cholesterol levels. A repeated measures [baseline (t = 1), post-intervention at 3-monthly intervals (t = 2,3,4)], randomized-controlled study in community pharmacies, with patients on chronic lipid-lowering therapy was conducted. Measures used were Brief Medication Questionnaire, Medication Adherence Report Scale, total cholesterol and pharmacist intervention data sheets. A baseline t-test of cholesterol levels between groups was conducted followed by a repeated-measures analysis of variance. Seventeen pharmacists recruited 142 patients (97 completions: 49 control, 48 intervention). Most patients missed either the third or last visit, thus data at t = 3 and 4 were combined. Although the intervention group started with a higher cholesterol level (5.1 vs. 4.8 mmol/l), a difference was observed in the drop in cholesterol levels of the intervention group between t = 2 and 3 (F(1,95) = 8.85, P < 0.01), and between the two groups over the study period (F(2,190) = 4.89, P < 0.05). No changes in medicine adherence scores were observed though there was an improvement in participants' exercise and eating habits. Patients significantly lowered their cholesterol levels probably as a result of the service delivered by their pharmacists within the short study time frame of ~9 months.
Publisher: SAGE Publications
Date: 27-10-2009
Abstract: Background: Healthcare professionals commonly exhibit negative attitudes toward people with mental disorders. Few international studies have sought to investigate the determinants of stigma. Objective: To conduct an international comparison of pharmacy students’ stigma towards people with schizophrenia, and to determine whether stigma is consistently associated with stereotypical attributes of people with schizophrenia. Method: Students ( n = 649) at eight universities in Australia, Belgium, India, Finland, Estonia and Latvia completed a seven-item Social Distance Scale (SDS) and six items related to stereotypical attributes of people with schizophrenia. Results: Mean SDS scores were 19.65 (± 3.97) in Australia, 19.61 (± 2.92) in Belgium, 18.75 (± 3.57) in India, 18.05 (± 3.12) in Finland, and 20.90 (± 4.04) in Estonia and Latvia. Unpredictability was most strongly associated with having a high social distance in Australia (β = —1.285), the perception that people will never recover in India (β = — 0.881), dangerousness in Finland (β = —1.473) and the perception of being difficult to talk to in Estonia and Latvia (β = —2.076). Unpredictability was associated with lower social distance in Belgium (β = 0.839). Conclusion: The extent to which students held stigmatizing attitudes was similar in each country, however, the determinants of stigma were different. Pharmacy education may need to be tailored to address the determinants of stigma in each country.
Publisher: SAGE Publications
Date: 10-2006
DOI: 10.1345/APH.1H163
Abstract: People with mental illness have been recognized as key stakeholders in the development of mental health education. However, few studies have evaluated the impact of people with mental illness as participants in education programs for students studying to become health professionals. To assess the impact of education provided by mental health consumer–educators on the attitudes of pharmacy students toward people with mental illness. The study used a 2 group, nonrandomized, clustered, comparative design, with 4 tutorial classes allocated to receive standard pharmacist-led instruction (comparison group), and 5 tutorial classes to receive standard pharmacist-led instruction plus additional input from mental health consumer–educators (intervention group). All pharmacy students (N = 229) enrolled in the third year of a 4 year pharmacy degree program were invited to participate. Consumer–educators receiving ongoing treatment for illnesses including schizophrenia, bipolar disorder, and major depression participated in small-group work, case-study discussions, and role plays with pharmacy students in the intervention group. Pharmacy students' attitudes were assessed using a 39 item survey instrument derived from previously published instruments evaluating social distance, attribution, provision of pharmaceutical services, and stigmatization of people with schizophrenia and severe depression. Paired baseline and follow-up responses were obtained from 117 students in the intervention group and 94 students in the comparison group. Students who received the consumer intervention had decreased social distance scores (F (1209) = 5.30 p = 0.02). Students in the intervention group more strongly disagreed with 26 of 27 nonsocial distance statements that demonstrated a negative attitude toward people with mental illness (F (1209) = 13.58 p 0.001) and more strongly agreed with all 4 nonsocial distance statements that demonstrated a positive attitude (F (1209) = 7.56 p = 0.014). Consumer participation in mental health education for pharmacy students improves students' attitudes toward people with mental illness.
Publisher: Springer Science and Business Media LLC
Date: 04-2022
DOI: 10.1007/S11096-022-01375-X
Abstract: Background Polypharmacy is associated with an increased risk of adverse drug events in older people. Although national guidance on geriatric pharmacotherapy exists in Japan, tools to routinely monitor the quality of care provided by community pharmacists are lacking. Aim To develop a set of quality indicators (QIs) to measure the quality of care provided by community pharmacists in improving geriatric pharmacotherapy in primary care in Japan, using a modified Delphi study. Method The development of QIs for the Japanese community pharmacy context followed a two–step process: national guidance review and consensus testing using a modified Delphi study. The latter involved two rounds of rating with a face–to–face meeting between the rounds. Ten experts in geriatric pharmacotherapy in primary care were recruited for the panel discussion. QIs were mapped to three key taxonomies and frameworks: the Anatomical Therapeutic Chemical (ATC) classification system, problems and causes of drug–related problems (DRPs) taxonomy and Donabedian’s framework. Results A total of 134 QIs for geriatric pharmacotherapy were developed. This QI set included 111 medicine specific indicators, covering medicines in 243 third–level ATC classifications. QIs were classified into the problem of treatment safety (80%) and causes of drug selection (38%) based on validated classification for DRPs. In Donabedian's framework, most QIs (82%) were process indicators. There were no structure indicators. Conclusion A set of 134 QIs for geriatric pharmacotherapy was rigorously developed. Measurement properties of these QIs will be evaluated for feasibility, applicability, room for improvement, sensitivity to change, predictive validity, acceptability and implementation issues in a subsequent study.
Publisher: MDPI AG
Date: 05-12-2022
Abstract: 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.
Publisher: AMPCo
Date: 03-2015
DOI: 10.5694/MJA14.01486
Publisher: SAGE Publications
Date: 18-06-2019
Publisher: Elsevier BV
Date: 07-2013
Publisher: Wiley
Date: 05-2019
DOI: 10.1002/NOP2.294
Publisher: Public Library of Science (PLoS)
Date: 09-12-2015
Publisher: Elsevier BV
Date: 07-2020
DOI: 10.1016/J.SAPHARM.2019.10.010
Abstract: Convention states that it is inappropriate to use tools that have not undergone validity and reliability testing in order to form conclusions on the topic they are assessing. The use of content analysis to aid in the profiling and retrieval of measurement tools may be useful to inform tool design. These analysis methods can be applied effectively to any topic area to streamline questionnaire development. The aim of this review was to demonstrate that the utilisation of a content analysis of instruments found in literature may be helpful to aid in the profiling and development of a measurement tool in fever. MEDLINE, EMBASE, CINAHL, PubMED, PsycINFO and International Pharmaceutical Abstracts were searched in accordance with PRISMA guidelines. Studies were included if they contained a structured or semi-structured measurement tool and a focus on fever management, knowledge or participant attitudes, beliefs or behaviours of fever. All items extracted were imputed into NVivo11 and a thematic content analyses based on themes and style of question were undertaken. A total of 99 manuscripts were reviewed containing 82 unique measurement tools. A total of 1525 items were content analysed in 3 separate content analyses including the fever 'theme', the style of question and whether the question was based on knowledge, attitudes, beliefs or behaviours. A large proportion of manuscripts (41/99) had no reported form of validity or reliability testing undertaken on the tool utilised in the study. The majority of items (n = 778) were attitude/belief questions, and the most common question types were Likert-Type Scale(n = 380) items. Through the methodology of undertaking content analyses of literature, it is possible to streamline the tool development process by incorporating previously established data and circumventing the creation of items from the ground up. This was apparent in this content analysis of fever management tools.
Publisher: Springer Science and Business Media LLC
Date: 14-07-2012
DOI: 10.1007/S00127-011-0413-5
Abstract: Contact with mental health consumers has shown to be a promising strategy to address mental health stigma, particularly in the context of pharmacy education. This research aimed to compare the effectiveness of a direct (face-to-face) contact intervention with an indirect (film based) contact intervention in reducing the mental health stigma of pharmacy students. A two-group, non-randomized, comparative study was conducted with third year pharmacy students (n = 198) allocated to the direct contact arm and fourth year pharmacy students (n = 278) allocated to the indirect contact arm. Baseline and immediate post-intervention data were collected using a validated 39 item survey instrument to assess the impact of the interventions on mental health stigma as well as attitudes towards providing mental health pharmaceutical services. Participants in the direct contact group showed a significant improvement in 37 out of 39 survey items and participants in the indirect contact group showed a significant improvement in 27 out of 39 items (P < 0.05). While direct contact had a stronger impact than indirect contact for 22 items (P < 0.05), for numerous key measures of mental health stigma the impact of the two contact interventions was equivalent. Both indirect and direct contact may positively impact mental health stigma. While the strength of the stigma-change process may be heightened by face-to-face interactions, the largely positive impact of indirect contact suggests that stigma reduction may depend less on the medium of contact but more on the transcendent messages contributed by the consumers facilitating the contact experience.
Publisher: Informa UK Limited
Date: 09-2014
DOI: 10.2147/CIA.S66660
Publisher: Springer Science and Business Media LLC
Date: 30-08-2023
DOI: 10.1007/S11096-023-01631-8
Abstract: Over the past 40 years, the tasks of pharmacists have shifted from logistic services to pharmaceutical care (PhC). Despite the increasing importance of measuring quality of care, there is no general definition of Quality Indicators (QIs) to measure PhC. Recognising this, a working group in a European association of PhC researchers, the Pharmaceutical Care Network Europe (PCNE), was established in 2020. This research aimed to review existing definitions of QIs and develop a definition of QIs for PhC. A two-step procedure was applied. Firstly, a systematic literature review was conducted to identify existing QI definitions that were summarised. Secondly, an expert panel, comprised of 17 international experts from 14 countries, participated in two surveys and a discussion using a modified Delphi technique to develop the definition of QIs for PhC. A total of 182 QI definitions were identified from 174 articles. Of these, 63 QI definitions (35%) cited one of five references as the source. Sixteen aspects that construct QI definitions were derived from the identified definitions. As a result of the Delphi study, the panel reached an agreement on a one-sentence definition of QIs for PhC: “quality indicators for pharmaceutical care are validated measurement tools to monitor structures, processes or outcomes in the context of care provided by pharmacists”. Building upon existing definition of QIs, an international expert panel developed the PCNE definition of QIs for PhC. This definition is intended for universal use amongst researchers and healthcare providers in PhC.
Publisher: Elsevier BV
Date: 05-2015
DOI: 10.1016/J.SAPHARM.2013.04.006
Abstract: Pharmacists' provision of medication counseling and medication review has been shown to improve adherence and resolve drug-related problems. Lack of knowledge of mental health conditions and negative beliefs may act as a barrier to the provision of pharmacy services. It is unclear how pharmacists' knowledge and attitudes impact their provision of pharmacy services. To explore the relationship between pharmacists' level of mental health stigma, mental health literacy and behavioral intentions in relation to providing pharmacy services for consumers with schizophrenia. A survey instrument containing a measure of mental health literacy, the 7-item social distance scale, and 16 items relating to the provision of pharmacy services for consumers with schizophrenia compared to cardiovascular disease, was mailed to a random s le of 1000 pharmacists registered with the Pharmacy Board of New South Wales in November 2009. Multiple linear regression models were used to assess the relationship between stigma, knowledge and behavior. Responses were received from 188 pharmacists. Pharmacists were significantly more confident and comfortable to provide services to consumers with a cardiovascular illness than a mental illness. Social distance, β = -0.11 (95% CI: -0.22, -0.01, P = 0.03), and schizophrenia literacy scores, β = 1.02, (95% CI: 0.54, 1.50, P < 0.001), were strongly associated with willingness to provide medication counseling. Schizophrenia literacy was also a predictor of identifying drug-related problems, β = 1.09 (95% CI: 0.39, 1.79, P = 0.002). Low levels of mental health stigma and high levels of schizophrenia literacy were associated with pharmacists being more willing to provide medication counseling and identify drug-related problems for consumers with schizophrenia. This demonstrates the importance of improving knowledge and stigma surrounding schizophrenia to improve service delivery for consumers taking medications for schizophrenia.
Publisher: BMJ
Date: 2012
Publisher: Elsevier BV
Date: 11-2016
DOI: 10.1016/J.SAPHARM.2015.11.002
Abstract: The Drug Burden Index (DBI) is a pharmacological risk assessment tool that measures the total exposure to anticholinergic and sedative medicines, which may impair function in older adults. A computerized clinical decision support system (CCDSS) for DBI has not been previously developed or evaluated. (a) Develop a CCDSS that calculates and generates reports on DBI (b) validate the CCDSS for accuracy and (c) evaluate the CCDSS for use in clinical practice. The DBI Calculator© application, based on the published formula and Australian registered prescribing information was built and designed using Microsoft Access 2010. Accuracy testing involved the comparison of DBI scores computed manually (gold standard) with those computed using The DBI Calculator© for 25 published medication review case studies. Agreement was measured using Cohen's Kappa statistic. To evaluate the CCDSS application in practice, ten pharmacists completed a performance test and usability survey. Participants were timed performing a DBI calculation with the application for a fictitious patient case. The interface, functionality, clinical applications and user satisfaction of the application were rated using 5-point, Likert-type scales. Excellent agreement between the manual and CCDSS application was observed (Cohen's Kappa 0.95). In the evaluation phase, the average time (mins:sec ± SD) for participants to complete the task was 7:20 ± 1:45 and the DBI Calculator© was considered useful by 80% of pharmacists for recognizing sedative and anticholinergic medicines in practice. A reliable CCDSS has been developed to report DBI of older patients taking multiple medications. Future studies should test the utility of The DBI Calculator© in clinical practice.
Publisher: Elsevier BV
Date: 12-2005
DOI: 10.1016/J.SAPHARM.2005.09.003
Abstract: Much of the research on cognitive pharmaceutical services has focused on understanding or changing community pharmacist behaviour, with few studies focusing on the pharmacy as the unit of analysis or considering the whole profession as an organisation. To investigate practice change and identify facilitators of this process in community pharmacy, with specific focus on the implementation of cognitive pharmaceutical services (CPS) and related programs. Thirty-six in-depth, semistructured interviews were conducted with participants from 2 groups, community pharmacies and pharmacy "strategists," in Australia. The interview guide was based on a framework of organizational theory, with 5 subject areas: roles and goals of participants in relation to practice change experiences with CPS change strategies used networks important to the change process and business impacts of CPS. Interviews were transcribed verbatim and thematically content analyzed, using NVivo software for data management. Five key themes relating to the change process were derived from the interviews: change strategies (process- and behaviorally oriented) social networks (within and beyond the pharmacy) drivers of change (eg, government policy) motivators (eg, professional satisfaction) and facilitators of practice change (remuneration for implementation or service delivery, communication and teamwork, leadership, task delegation, external support or assistance, and reorganization of structure and function). The use of an organizational perspective yielded rich data from which an understanding of the practice change process in relation to CPS implementation was gained. Current programs for the implementation and delivery of CPS have not taken into account all of the factors that have the ability to facilitate change in community pharmacy. Not only do future programs need to be underpinned by these elements, but policy makers must include them when planning remuneration and dissemination strategies.
Publisher: Springer Science and Business Media LLC
Date: 2006
Publisher: Informa UK Limited
Date: 03-2021
DOI: 10.2147/PROM.S245534
Publisher: Elsevier BV
Date: 03-2018
DOI: 10.1016/J.PEC.2017.08.015
Abstract: Patients are increasingly accessing online health information and have become more participatory in their engagement with the advent of social media (SM). This study explored how patients' use of SM impacted their interactions with healthcare professionals (HCPs). Focus groups (n=5) were conducted with 36 patients with chronic conditions and on medication who used SM for health-related purposes. The discussions lasted 60-90min, were audio-recorded, transcribed verbatim, and thematically analysed. Participants did not interact with HCPs on SM and were not expecting to do so as they used SM exclusively for peer interactions. Most reported improvement in the patient-HCP relationship due to increased knowledge, better communication, and empowerment. Participants supplemented HCP-provided information with peer interactions on SM, and prepared themselves for consultations. They shared online health information with HCPs, during consultations, to validate it and to actively participate in the decision-making. Although some participants reported HCP support for their online activities, most perceived overt or tacit opposition. Participants perceived that their SM use positively impacted relationships with HCPs. They felt empowered and were more assertive in participating in decision-making. HCPs should be aware of patients' activities and expectations, and support them in their online activities.
Publisher: Wiley
Date: 02-11-2021
DOI: 10.1111/BCP.14557
Publisher: Springer Science and Business Media LLC
Date: 23-08-2019
DOI: 10.1007/S11096-019-00889-1
Abstract: Background Shortages of essential medicines impact patient safety and raise the costs of medicines to consumers and governments. Ongoing medicine shortages have become a critical issue that threaten global access to medicines. Objective The aim of this study was to explore key stakeholders' perspectives on the challenges surrounding management and supply of essential medicines. Setting Western Pacific, Asia, Europe, North America, and Africa. Methods In-depth, semi-structured interviews with 47 participants were conducted across seven stakeholder groups globally. Stakeholders included government, academics, consumer groups, non-profit organisations, hospital healthcare providers, manufacturers, and wholesaler/distributors. A grounded theory approach was applied to qualitative analysis. Main outcome measure Stakeholders' perspectives on the challenges surrounding management and supply of essential medicines. Results This study showed that supporting consumer demand for a wide range of therapeutic products required increased resources and coordination. Four main themes were identified: (1) consumer demand for a wide range of in idual therapeutic needs cannot be sustained by the supply chain (2) there lacked a coordinated approach to manage medicine shortages throughout the supply chain (3) there were gaps in communication throughout the continuum of the supply chain and (4) both international and local disruptions contributed to vulnerabilities in the supply chain. Conclusion Prioritisation of supply, logistics, and budget decisions around essential medicines need to be clearly coordinated between stakeholders to mitigate medicine shortages. Financial structures should include resilience planning to support fair and equitable access to medicines that meet consumer needs.
Publisher: Hindawi Limited
Date: 16-08-2011
DOI: 10.1111/J.1742-1241.2011.02746.X
Abstract: Non-adherence to antidepressant medications is a significant barrier to the successful treatment of depression in clinical practice. This review aims to systematically assess the effectiveness of interventions for improving antidepressant medication adherence among patients with unipolar depression, and to evaluate the effect of these interventions on depression clinical outcomes. MEDLINE, PsycINFO and EMBASE databases were searched for English-language randomised controlled trials published between January 1990 and December 2010 on interventions to improve antidepressant adherence. The impact of interventions on antidepressant medication adherence (compliance and persistence) and depression clinical outcomes was evaluated. Data concerning the quality of the included studies were also extracted. Twenty-six studies met the inclusion criteria. Interventions were classified as educational, behavioural and multifaceted interventions. A total of 28 interventions were tested, as two studies investigated two interventions each. Sixteen (57%) of the 28 interventions showed significant effects on antidepressant adherence outcomes, whereas 12 (43%) interventions demonstrated significant effects on both antidepressant adherence and depression outcomes. The interventions which showed significant improvement in outcomes were primarily multifaceted and complex, with proactive care management and involvement of mental health specialists. The most commonly used elements of multifaceted interventions included patient educational strategies, telephone follow-up to monitor patients' progress, as well as providing medication support and feedback to primary care providers. Overall, educational interventions alone were ineffective in improving antidepressant medication adherence. In conclusion, improving adherence to antidepressants requires a complex behavioural change and there is some evidence to support behavioural and multifaceted interventions as the most effective in improving antidepressant medication adherence and depression outcomes. More carefully designed and well-conducted studies are needed to clarify the effect of interventions in different patient populations and treatment settings.
Publisher: Oxford University Press (OUP)
Date: 08-11-2011
DOI: 10.1111/J.2042-7174.2011.00180.X
Abstract: There is a lack of knowledge regarding recipients' experiences with, perceptions of, and willingness to reuse the Home Medicines Review (HMR) programme in Australia. In addition, little is known about eligible non-recipients' awareness of and willingness to use the HMR service. The aim of the study was therefore to explore perceptions of, and willingness to use, HMRs. A cross-sectional questionnaire was conducted with recipients and eligible non-recipients of HMRs. Eligible non-recipients were defined as those who had not had an HMR and were at risk of medication misadventure. The questionnaire was distributed by 264 practising pharmacists throughout Australia. A total of 595 out of 1893 (31%) HMR recipients and 293 out of 1829 (16%) eligible non-recipients completed the questionnaires. Overall, 91% of recipients were satisfied with the service. Compared with eligible non-recipients, recipients were more willing to have an HMR if their general practitioner (GP) suggested it (91% versus 71%, P & 0.001) and more willing to ask for an HMR if they were having concerns about their medicines (82% versus 63%, P & 0.001). Among eligible non-recipients, 23% were aware of HMRs. Predominantly pharmacists (68%) and GPs (36%) provided awareness of HMRs, which was associated with increased willingness to have an HMR if their GP suggested it (83% versus 67%, P & 0.014). An overwhelming majority of patients were satisfied with the HMR programme. Experience with HMR, and to a lesser extent, prior awareness, increased willingness to use HMR. Therefore, pharmacists and GPs who introduce HMR to eligible non-recipients may increase their willingness to use this service.
Publisher: Springer Science and Business Media LLC
Date: 22-06-2008
Publisher: Wiley
Date: 05-2010
DOI: 10.1002/GPS.2359
Abstract: To investigate determinants of antipsychotic medication use among older people living in aged care homes in Australia. Retrospective study of a random s le of de-identified medication reports using cross-sectional data gathered between 1 January 2008 and 30 June 2008 in Australia. The mean (SD) age of the residents was 84.0 (9.0) years. Seventy-five per cent were females. Resident demographics, clinical characteristics, medical diagnoses and prescribed medication were systematically recorded. Logistic regression (LR) models were used to determine predictors for any antipsychotic, atypical and conventional antipsychotic use. Twenty-three per cent of the residents were prescribed one or more antipsychotics. In the LR model, factors for predicting the odds ratio and 95% confidence interval (CI) for any antipsychotic medication use were agitation (7.11, 95% CI 3.15-16.03), challenging behaviours (7.47, 95% CI 2.53-22.10), dementia (2.35, 95% CI 1.36-4.06), dementia with mood disorder (0.39, 95% CI 0.16-0.92), paranoia (6.70, 95% CI 1.08-41.55), psychosis (14.79, 95% CI 3.64-60.00) and any psychiatric diagnosis (3.30, 95% CI 1.82-6.00). Use of atypical antipsychotic medication was significant for agitation (4.58, 95% CI 2.05-10.23), aggression (2.25, 95% CI 1.05-4.78), challenging behaviours (8.01, 95% CI 2.76-23.24), dementia (3.64, 95% CI 1.99-6.67), dementia with mood disorder (0.16, 95% CI 0.06-0.43), psychosis (16.51, 95% CI 4.28-63.66) and any psychiatric diagnosis (4.44, 95% CI 2.33-8.46). Psychiatric diagnosis, psychosis and dementia were associated with significantly greater odds for the use of antipsychotic medications. Older people suffering from dementia and comorbid mood disorders treated with antidepressants were less likely to be prescribed atypical antipsychotics.
Publisher: JMIR Publications Inc.
Date: 23-11-2015
DOI: 10.2196/JMIR.4161
Publisher: Wiley
Date: 16-12-2018
DOI: 10.1111/GGI.13562
Abstract: In Japan, home pharmaceutical care (HPC) has recently been provided to home-bound older adults who have difficulties in accessing a community pharmacy, for regular medicine supplies and medication management. Although the number of HPC services provided has increased, HPC is not always carried out by clinically well-trained pharmacists, causing differences in the quality of HPC provided. The aim of the present study was to establish the quality dimensions of HPC (i.e. components that impact the quality of HPC) from the perspectives of home healthcare professionals. Semistructured interviews and focus groups were carried out with nine home healthcare teams, comprising 61 multidisciplinary professionals including pharmacists, doctors, nurses, care managers, home helpers, medical social workers and other relevant stakeholders involved in home healthcare. Participants' responses were analyzed using thematic analysis. Identified themes were then categorized using Donabedian's framework (structure, process and outcome). Nine themes and 27 subthemes emerged, including: structure (pharmacist factors, pharmacy factors and external factors), process (before HPC, during HPC, after HPC and outside of HPC) and outcome (impact on patients and impact on other healthcare professionals). This study has identified quality dimensions of HPC from multidisciplinary home healthcare professionals' perspectives. These findings might be used to inform aspects of HPC that require improvement. In order to evaluate the quality of HPC, a set of indicators based on the identified quality dimensions could be developed. Geriatr Gerontol Int 2019 19: 35-43.
Publisher: Wiley
Date: 24-09-2007
Publisher: Elsevier BV
Date: 06-2019
DOI: 10.1016/J.SAPHARM.2019.08.035
Abstract: Psychotropic medication use in the elderly population is associated with significant adverse effects. Robust evidence for the efficacy of psychotropic medications for behavioural and psychological symptoms of dementia is lacking. Despite national bodies, governments, and policymakers employing interventions to optimise the use of psychotropic medicines in this population, there is little research on their overall impact. To identify and categorise system level strategies that have been implemented internationally and assess their impact on psychotropic medicine use in aged care facilities. A systematic search of health-related databases including Medline, Embase, CINAHL, Web of Science and Scopus was performed. Empirical studies published in English prior to March 2019 that reported on the impact of system level strategies on psychotropic medicine use in aged care facilities were included. Studies were mapped to the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework to measure impact and were assessed for risk of bias. This review identified 36 studies which examined mandatory (n = 22) and non-mandatory (n = 14) system level strategies. The impact of strategies was highly dependent on implementation as well as organisational and patient factors. Mandatory strategies had greater evidence of impact on drug utilisation patterns compared to non-mandatory strategies which primarily focussed on adoption and implementation, rather than outcomes. The Omnibus Budget Reconciliation Act 1987 (OBRA-87) in the United States of America had the greatest reach and implementation of the interventions examined, with an observed reduction in psychotropic medicine use post-implementation. There was no substantive body of evidence reporting on the sustainability of strategies or the influence of cost on outcomes. Despite the implementation of system level strategies, psychotropic medicine use in aged care facilities remains problematic. There is a need for revised or novel system level strategies which consider sustainability, economic influences and patient outcomes in their design and implementation.
Publisher: SAGE Publications
Date: 28-09-2018
Abstract: Prior to implementing perinatal depression (PND) screening, health-care professionals’ acceptability of screening and their attitudes toward PND should be explored. We aimed to develop and psychometrically evaluate a questionnaire measuring PND attitudes and screening acceptability. A 31-item questionnaire was developed based on published questionnaires and a systematic review on PND screening acceptability. Principal components analysis with direct oblimin rotation was used to determine construct validity. Reliability of the resulting components was explored using Cronbach’s α. Pharmacists ( N = 153) were recruited from the Australian Association of Consultant Pharmacy. The scree plot and parallel analysis indicated a six-component solution. Due to cross-loadings ( .2 difference) and low loadings ( .445), it was necessary to delete 7 items. The six components explored PND screening acceptability, screening readiness, stigma, attitudes toward treatment efficacy, medication counseling responsibility, and the effect PND has on others. The six components explained 59.8% of the variance. Item loadings ranged from .445 to .880. Cronbach’s α for each component ranged from .45 to .86. The construct validity and internal consistency reliability of the PND attitudes and screening acceptability questionnaire have been explored. Future measurements of these constructs using uniform, psychometrically sound scales may facilitate comparisons across studies.
Publisher: Springer Science and Business Media LLC
Date: 10-2023
Publisher: Springer Science and Business Media LLC
Date: 06-04-2016
DOI: 10.1007/S11096-016-0289-2
Abstract: Synthesis of qualitative studies is an emerging area that has been gaining more interest as an important source of evidence for improving health care policy and practice. In the last decade there have been numerous attempts to develop methods of aggregating and synthesizing qualitative data. Although numerous empirical qualitative studies have been published about different aspects of health care research, to date, the aggregation and syntheses of these data has not been commonly reported, particularly in pharmacy practice related research. This paper describes different methods of conducting meta-synthesis and provides an overview of selected common methods. The paper also emphasizes the challenges and opportunities associated with conducting meta-synthesis and highlights the importance of meta-synthesis in informing practice, policy and research.
Publisher: SAGE Publications
Date: 12-2010
DOI: 10.3109/00048674.2010.512864
Abstract: Objectives: To assess the beliefs of pharmacists about the helpfulness of interventions for schizophrenia and depression. Methods: A survey instrument containing a measure of mental health literacy was mailed to a random s le of 2000 pharmacists registered with the Pharmacy Board of New South Wales in November 2009. Vignettes of a person with either depression or psychosis were presented, followed by questions related to the recognition of the disorder, the helpfulness of various interventions, prognosis with and without professional help, the person's long-term functioning in various social roles and the likelihood of the person being discriminated against. Results: A total of 391 responses were received (response rate 19.5%). The majority of pharmacists correctly identified depression (92%) with fewer recognizing schizophrenia (79%). Pharmacists rated medicine use highly for both schizophrenia and depression but were also positive about the use of psychological therapies and lifestyle interventions. Pharmacists had negative views about admission to a psychiatric ward and the use of electroconvulsive therapy (ECT). However, younger pharmacists had significantly more positive views on the use of ECT (p = 0.001). The majority of pharmacists (74%) thought discrimination by the community was highly likely and rated long-term prognosis as poor without appropriate professional help. Their views on the likelihood of specific negative outcomes were mixed, with many pharmacists not recognizing the risk of suicide in schizophrenia and depression. However, both female (p = 0.002) and younger pharmacists (p 0.001) were significantly more inclined to rate the likelihood of suicide as more likely in a person with schizophrenia or depression. Conclusions: The majority of pharmacists had a high degree of mental health literacy as indicated by the correct identification of, and support for evidence-based interventions for mental illnesses. Pharmacists should be aware that their attitudes and stigma towards mental illness may impact on the patient care they provide.
Publisher: Springer Science and Business Media LLC
Date: 04-2005
Publisher: SAGE Publications
Date: 22-04-2008
DOI: 10.1345/APH.1K617
Abstract: There has been an increasing international trend toward the delivery of cognitive pharmaceutical services (CPS) in community pharmacy. CPS have been developed and disseminated in idually, without a framework underpinning their implementation and with limited knowledge of factors that might assist practice change. The implementation process is complex, involving a range of internal and external factors. To quantify facilitators of practice change in Australian community pharmacies. We employed a literature review and qualitative study to facilitate the design of a 43-item “facilitators of practice change” scale as part of a quantitative survey instrument, using a framework of organizational theory. The questionnaire was pilot-tested (n = 100), then mailed to a random s le of 2000 community pharmacies, with a copy each for the pharmacy owner, employed pharmacist, and pharmacy assistant. The construct validity and reliability of the scale were established using exploratory factor analysis and Cronbach's α, respectively. A total of 735 (37%) pharmacies responded, with 1303 in idual questionnaires. Factor analysis of the scale yielded 7 factors, explaining 48.8% of the total variance. The factors were: relationship with physicians (item loading range 0.59–0.85 Cronbach's α 0.90), remuneration (0.52–0.74 0.82), pharmacy layout (0.52–0.79 0.81), patient expectation (0.52–0.85 0.82), manpower/staff (0.49–0.66 0.80), communication and teamwork (0.37–0.65 0.77), and external support/assistance (0.47–0.69 0.74). All of the factors demonstrated good reliability and construct validity and explained approximately half of the variance. Implementing CPS requires support not only with the clinical aspects of service delivery, but also for the process of implementation itself, and remuneration models must reflect this. The identified facilitators should be used in a multilevel strategy to integrate professional services into the community pharmacy business, engaging pharmacists and their staff, policy makers, educators, and researchers. Further research is required to determine additional factors impacting the capacity of community pharmacies to implement change.
Publisher: Springer Science and Business Media LLC
Date: 2008
DOI: 10.2165/00002512-200825090-00004
Abstract: Evidence-practice gaps, adverse medication-related incidents and unplanned medical admissions to hospital are common in elderly Australians. Many prescribing indicator tools designed to address some of these problems have been reported in the literature, the most common of which is the Beers list of inappropriate medications in the elderly. However, many of these tools are not appropriate for the Australian healthcare environment without modification and validation, and there appears to be a need for a tool based on Australian data. To develop a list of prescribing indicators for elderly (aged >65 years) Australians based on the most frequent medications prescribed to Australians, and the most frequent medical conditions for which elderly Australians consult medical practitioners. The most common reasons for elderly Australians to seek or receive healthcare were cross-referenced with the 50 highest-volume Pharmaceutical Benefits Scheme medications prescribed to Australians in 2006 to develop prescribing indicators in the elderly using Australian medication and medical condition information resources. Forty-eight prescribing indicators were identified, consisting mainly of optimum as well as inappropriate medication choices for a large number of common medical conditions in the elderly. A prescribing indicators tool was developed. This tool is envisaged as forming an important part of the medication review process, which is aimed at addressing the common problem of adverse medication-related events in elderly Australians.
Publisher: Cambridge University Press (CUP)
Date: 27-02-2012
DOI: 10.1017/S1041610212000117
Abstract: Background: Antipsychotics are associated with adverse events and mortality among older adults with dementia. The objective of this study was to evaluate the risk of death associated with antipsychotic use among community-dwelling older adults with a range of comorbidities. Methods: This was a population-based cohort study of all 2,224 residents of Leppävirta, Finland, aged ≥65 years on 1 January 2000. Records of all reimbursed drug purchases were extracted from the Finnish National Prescription Register and diagnostic data were obtained from the Special Reimbursement Register. All-cause mortality was evaluated over a nine-year follow-up period. Time-dependent Cox proportional hazard models were used to compute unadjusted and adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of mortality of antipsychotic use compared to non-use. Results: In total, 332 residents used antipsychotics between 2000 and 2008. The unadjusted HR for risk of death associated with antipsychotic use was 2.71 (95% CI = 2.3–3.2). After adjusting for baseline age, sex, antidepressant use, and diagnostic confounders, the HR was 2.07 (95% CI = 1.73–2.47). The adjusted HR was the highest among antipsychotic users with baseline respiratory disease (HR = 2.21, 95% CI = 1.30–3.76). Conclusions: The increased risk of death associated with antipsychotic use was similar across diagnostic categories, the highest being among those with baseline respiratory disease. However, the results should be interpreted with caution, as the overall s le size of antipsychotic users was small. As in other observational studies, residual confounding may account for the higher mortality observed among antipsychotic users. Further research is needed to confirm these findings.
Publisher: Wiley
Date: 27-01-2023
Abstract: Students from a range of health disciplines need to learn from people with lived experience of mental distress and recovery to develop recovery capabilities for mental health practice. The aims of this study are to describe the co‐design of a teaching resource, to explore the experience of people with lived experience during the resource development, and to evaluate the outcome of the resource on student recovery capabilities. Using a sequential mixed method, a project group consisting of six people with lived experience and 10 academics from five health disciplines was convened to co‐develop teaching resources. People with lived experience met independently without researchers on several occasions to decide on the key topics and met with the research team monthly. The teaching resource was used in mental health subjects for two health professional programmes, and the Capabilities for Recovery‐Oriented Practice Questionnaire (CROP‐Q) was used before and after to measure any change in student recovery capabilities. Scores were compared using the Wilcoxon signed rank test. The people with lived experience were also interviewed about their experience of being involved in constructing the teaching resources. Interviews were audiotaped, transcribed, and analysed thematically. The finished resource consisted of 28 short videos and suggested teaching plans. Occupational therapy and nursing student scores on the CROP‐Q prior to using the educational resource ( n = 33) were 68 (median) and post scores ( n = 28) were 74 (median), indicating a statistically significant improvement in recovery capability ( P = 0.04). Lived experience interview themes were (i) the importance of lived experience in education (ii) personal benefits of participating (iii) co‐design experience and (iv) creating the resource. Co‐design of teaching resources with people with lived experience was pivotal to the success and quality of the final product, and people with lived experience described personal benefits of participating in resource development. More evidence to demonstrate the use of the CROP‐Q in teaching and practice is needed.
Publisher: Springer Science and Business Media LLC
Date: 07-03-2016
Publisher: Elsevier BV
Date: 07-2013
DOI: 10.1016/J.SAPHARM.2012.07.001
Abstract: Some consumers at risk of experiencing medication-related problems have chosen not to use pharmacist-provided medication management services. Previous research has shown that consumers' willingness to use the Australian Home Medicines Review (HMR) service depends on the extent to which they believe that they will receive medication information to assist them with self-management. The aim of this study was to develop and test a model of willingness to use HMR among consumers who were eligible to receive the service but have not yet experienced it. Specifically, this study aimed to determine the effects of consumers' medication-related worry and the social influence of the consumer's general practitioner (GP) over willingness. A cross-sectional postal survey was conducted among 1600 members of Council on the Ageing (NSW, Australia). Respondents were included in the study if they had not experienced an HMR and were taking more than 5 medicines daily or more than 12 doses daily. Measurement scales were developed or were based on previous research. Confirmatory factor analysis was used to test the reliability and validity of the multi-item scales. Multiple regression analysis and structural equation modeling (SEM) were used to test the model. Surveys received from 390 respondents (24.3%) were analyzed. Respondents held overall low-to-neutral positive outcome expectancy (POE). The SEM analysis revealed that worry had a direct effect on POE (β=0.35, P<.05) and an indirect effect on willingness (β=0.22, P<.05). Subjective norms had a direct effect on willingness (β=0.27, P<.05) but not POE. Worry was higher among those who had experienced a change in the medication regimen within the past 3 months (β=0.19, P<.001). Those consumers who were worried about their medicines were more willing to use HMR. The consumer's GP appeared to exert a significant positive social influence over willingness to use this medication management service.
Publisher: Springer Science and Business Media LLC
Date: 10-12-2019
DOI: 10.1007/S00228-019-02796-W
Abstract: This study aims to systematically review studies describing screening tools that assess the risk for drug-related problems (DRPs) in older adults (≥ 60 years). The focus of the review is to compare DRP risks listed in different tools and describe their development methods and validation. The systematic search was conducted using evidence-based medicine, Medline Ovid, Scopus, and Web of Science databases from January 1, 1985, to April 7, 2016. Publications describing general DRP risk assessment tools for older adults written in English were included. Disease, therapy, and drug-specific tools were excluded. Outcome measures included an assessment tool’s content, development methods, and validation assessment. The search produced 15 publications describing 11 DRP risk assessment tools. Three major categories of risks for DRPs included (1) patient or caregiver related risks (2) pharmacotherapy-related risks and (3) medication use process-related risks. Of all the risks included in the tools only 8 criteria appeared in at least 4 of the tools, problems remembering to take the medication being the most common (n=7). Validation assessments varied and content validation was the most commonly conducted ( n = 9). Reliability assessment was conducted for 6 tools, most commonly by calculating internal consistency ( n = 3) and inter-rater reliability ( n = 2). The considerable variety between the contents of the tools indicates that there is no consensus on the risk factors for DRPs that should be screened in older adults taking multiple medicines. Further research is needed to improve the accuracy and timeliness of the DRP risk assessment tools.
Publisher: JCFCorp SG PTE LTD
Date: 11-09-2021
DOI: 10.18549/PHARMPRACT.2021.3.2545
Abstract: Mental illnesses cause significant disease burden globally, with medicines being a major modality of treatment for most mental illnesses. Pharmacists are accessible and trusted healthcare professionals who have an important role in supporting people living with mental illness. This commentary discusses the role of pharmacists in mental healthcare, as part of multidisciplinary teams, the current evidence to support these roles, and the training, remuneration and policy changes needed to recognize these roles and embed pharmacists as core members of the mental healthcare team.
Publisher: Elsevier BV
Date: 12-2020
Publisher: Oxford University Press (OUP)
Date: 10-03-2015
DOI: 10.1111/IJPP.12130
Publisher: Springer Science and Business Media LLC
Date: 14-12-2021
Publisher: Elsevier BV
Date: 03-2018
DOI: 10.5688/AJPE6222
Publisher: Elsevier BV
Date: 05-2013
DOI: 10.1016/J.PSYNEUEN.2012.11.019
Abstract: A series of studies have reported on the salubrious effects of oxytocin nasal spray on social cognition and behavior in humans, across physiology (e.g., eye gaze, heart rate variability), social cognition (e.g., attention, memory, and appraisal), and behavior (e.g., trust, generosity). Findings suggest the potential of oxytocin nasal spray as a treatment for various psychopathologies, including autism and schizophrenia. There are, however, increasing reports of variability of response to oxytocin nasal spray between experiments and in iduals. In this review, we provide a summary of factors that influence transmucosal nasal drug delivery, deposition, and their impact on bioavailability. These include variations in anatomy and resultant airflow dynamic, vascularisation, status of blood vessels, mode of spray application, gallenic formulation (including presence of uptake enhancers, control release formulation), and amount and method of administration. These key variables are generally poorly described and controlled in scientific reports, in spite of their potential to alter the course of treatment outcome studies. Based on this review, it should be of no surprise that differences emerge across in iduals and experiments when nasal drug delivery methods are employed. We present recommendations for researchers to use when developing and administering the spray, and guidelines for reporting on peptide nasal spray studies in humans. We hope that these recommendations assist in establishing a scientific standard that can improve the rigor and subsequent reliability of reported effects of oxytocin nasal spray in humans.
Publisher: Informa UK Limited
Date: 27-11-2018
DOI: 10.1080/03630242.2018.1539431
Abstract: Perinatal depression (PND) screening is encouraged in healthcare settings. We aimed to develop and content validate a basic PND knowledge questionnaire for use among pharmacists and potentially other primary healthcare professionals (HCPs). A six-item questionnaire was developed. Twenty-five perinatal mental health experts were invited to participate in content validation by completing the questionnaire and assessing its content validity. A content validity index (CVI) score above 0.8 was indicative of content validity. Expert comments may inform items' deletion or revision. Between November 2016 and February 2017, ten experts participated. For five out of six items, the CVI score was 0.9 or 1.0. Two experts selected "I think none are correct" for one item regarding the onset of postpartum depression. Comments reflected the lack of consensus in the literature surrounding onset periods and prevalence rates and informed minor modifications to three of six questions and seven of 24 response options. The CVI for the questionnaire was 0.83.Content validation of a questionnaire measuring basic PND knowledge resulted in modifications. Comments about PND onset and prevalence indicated the need for consistency when defining and measuring these constructs. This questionnaire may be used among pharmacists and other HCPs.
Publisher: Springer Science and Business Media LLC
Date: 11-10-2021
Publisher: SAGE Publications
Date: 28-07-2016
Abstract: To describe the perceived experiences of stigma and discrimination among people living with severe and persistent mental illness in assertive community treatment (ACT teams) settings in New South Wales (NSW), Australia. The Discrimination and Stigma Scale (DISC) was used in this cross-sectional study with people living with severe and persistent mental illness. The DISC is a reliable and valid, quantitative and qualitative instrument used to explore and measure levels of negative, anticipated and positive discrimination. Relevant clinical history and socio-demographic information were also collected. A total of 50 clients participated, with 40 (80%) reporting experienced negative discrimination in at least one life area. Negative discrimination was most commonly experienced in being avoided or shunned ( n=25, 50%), by neighbours ( n=24, 48%) and family ( n=23, 46%). Anticipated discrimination was common, with half of participants ( n=25, 50%) feeling the need to conceal their mental health diagnosis. Discrimination was highly prevalent in everyday aspects of life. While healthcare professionals often tend to increase perceived stigma and discrimination, this was only experienced in interactions with general health professionals, while interactions with ACT team members decreased perceived stigma and increased positive discrimination. This indicates that healthcare professionals potentially have a significant role in reducing stigma and discrimination in mental health and that such an effect may be optimised in an ACT team setting.
Publisher: SAGE Publications
Date: 26-05-2009
DOI: 10.1345/APH.1L700
Abstract: To review the currently available literature on the impact of interventions by pharmacists on suboptimal prescribing in the elderly. MEDLINE, EMBASE, and International Pharmaceutical Abstracts databases were searched for studies published between January 1992 and December 2008. Key words included medication review, drug regimen review, pharmaceutical services, pharmaceutical care, pharmacists, medications, appropriateness, suboptimal, underuse, aged, elderly, randomized controlled trial, inappropriate, prescribing, and intervention. To be included in the review, studies must have been conducted in patients 65 years or older, published in English, randomized and controlled, and must have included an intervention delivered by a pharmacist or had a pharmacist as a member of the intervention team. From each relevant study, the following data were extracted: study duration, country, number of patients, year of publication, objective, type and impact of the intervention, method used to assess suboptimal prescribing, and data concerning the quality of the study. A total of 38 articles were identified, of which 12 matched our inclusion criteria. Seven articles included interventions initiated by pharmacists, and the remaining 5 described interventions in which the pharmacist was a part of the multidisciplinary team. A broad range of tools was used to measure prescribing appropriateness we found that a consensus on the best approach has not been reached. Most of the studies involving pharmacists showed significant improvement in suboptimal prescribing at one or more time points. However, most of these interventions were directed toward reducing the overuse or misuse of medications. Pharmacy services to reduce suboptimal prescribing have shown promising and noteworthy improvements. More research is needed to address the underutilization of medications in the elderly and healthcare impact of reducing suboptimal prescribing.
Publisher: SAGE Publications
Date: 08-2013
Publisher: Wiley
Date: 10-2009
Abstract: This study sought to determine whether the presence of in vitro anticholinergic activity (AA) among different drugs is associated with reporting of neuropsychiatric adverse events (NPAEs) and whether age affects this relationship. Retrospective case/noncase analyses using Australia's spontaneous Adverse Drug Reaction System (ADRS) database containing 150 475 reports determined crude and adjusted reporting odds ratios (RORs) for NPAEs for 23 drugs with various reported in vitro AA. Covariates were age (treated as a dichotomous variable [> or =65 years]), gender, and concomitant use of antipsychotics, benzodiazepines, tricyclic antidepressants, and drugs with recognized inherent anticholinergic properties (anticholinergic drugs). The interaction effect between these covariates and each drug exposure category was examined. Age (> or =65 years) has a significant association with greater odds relative to younger age for reporting NPAEs. Drugs with reported significant AA in vitro were not always associated with RORs greater than 1 for reporting NPAEs, highlighting a dissonance between the in vitro AA index and ADRS observations. Significant interactions were observed between age (> or =65 years) and exposure to cimetidine, anticholinergic drugs, antipsychotics, and tricyclic antidepressants in modifying odds for reporting NPAEs, reinforcing the need for cautious use and monitoring of drugs with AA in older people.
Publisher: Oxford University Press (OUP)
Date: 06-2006
Abstract: To investigate models and frameworks for the implementation of cognitive pharmaceutical services (CPS) in community pharmacy. Relevant literature published in English was identified through searches of online databases (no date limits), texts, conference proceedings, and bibliographies of identified literature. Literature that involved a discussion of models or frameworks for community pharmacy practice change in relation to the implementation of CPS was selected for review. Many of the identified studies were conceptual in nature, and although they were selected in the same way as the empirical research papers, were not able to be critically reviewed in an equivalent manner. A narrative, rather than systematic review, was considered more appropriate. Many of the identified models focused on specific services, seeming to overlook the complexity of the implementation process. Many relied on behavioural theories, with an assumption that changing pharmacists' knowledge, skills or attitude will automatically result in successful change, often ignoring organisational aspects of change. Models that included business aspects remain largely untested, and where testing occurred s le sizes were generally small and populations conveniently or purposively s led, limiting the generalisability of the findings. The factors affecting change are more than just those confined to the in idual pharmacist who is providing a service, and the implementation process is more complex, involving a range of organisational factors. Research is needed to identify the key elements of a framework for how new CPS should be implemented and delivered.
Publisher: Elsevier BV
Date: 2018
DOI: 10.1016/J.JAD.2017.08.060
Abstract: Consensus on a tool for depression screening among adults in primary healthcare (PHC) settings is lacking. This systematic review aimed to explore the psychometric properties of depression screening tools. A systematic literature search composed of four terms (screening AND psychometric AND depression AND primary healthcare) was conducted in PubMed, EMBASE, PsycINFO and MEDLINE, between January 1995 through October 2015. Studies that aimed to psychometrically test a depression screening tool among the general adult population in a PHC setting were included. Studies exploring the diagnostic properties of depression screening tools among specific populations were excluded. Sixty publications, evaluating the psychometric properties of 55 tools or adaptations, were included. Studies were conducted in 24 countries and 18 languages on 48234 adults. The Patient Health Questionnaire-9 was the most evaluated tool with 14 studies evaluating its psychometric properties. Fifty-four studies reported on at least one measure of receiver operating characteristics. Sensitivity and specificity values ranged from 28% to 100% and 43% to 100%, respectively. Cronbach alpha values ranged from 0.56 to 0.94. Other forms of reliability and validity testing were less consistently and commonly reported. The inclusion of studies regardless of methodological quality or design may have limited generalizability, but allowed for a comprehensive and detailed overview of the current literature. Depression screening tools vary in their psychometric properties. The PHQ-9 was the most extensively psychometrically tested tool. This systematic review may aid PHC professionals in choosing a depression screening tool for universal use as it provides a comprehensive overview of their psychometric properties.
Publisher: Elsevier BV
Date: 09-2019
DOI: 10.1016/J.CBI.2019.108747
Abstract: Pathological scarring is an intractable problem for both patients and clinicians. A major obstacle for the development of scar remediation therapies is the paucity of suitable in vivo and in vitro models. The "Scar-in-a-jar" model was previously established by our colleagues based on the principle of "Macromolecular crowding". This has been demonstrated to be an extracellular matrix-rich in vitro model offering a novel tool for studies related to the extracellular matrix. In the study reported herein, we have optimised this approach to model human dermal fibroblasts derived from hypertrophic tissues. This optimised in vitro model has been found to hold similar properties, such as increased collagen I, interleukins and transforming growth factor beta-1 expression, compared to that observed in hypertrophic scar tissue in vivo. In addition, Shikonin has been previously demonstrated to hold potential as a novel hypertrophic scar treatment due to its apoptosis-inducing property on hypertrophic scar fibroblasts. Other Shikonin analogues have also been reported to hold apoptosis-inducing properties in various cancer cell lines, however, the effects of these analogues on hypertrophic scar-related cells are unknown. We therefore evaluated the effects of Shikonin and its analogues on hypertrophic scar-derived human fibroblasts using the optimised "Macromolecular crowding" model. Our data indicates that Shikonin and Naphthazarin are the most effective molecules compared to related naphthoquinones. The data generated from the study offers a novel in vitro collagen-rich model of hypertrophic scar tissue. It also provides further evidences supporting the use of Shikonin and Naphthazarin as potential treatments for hypertrophic scars.
Publisher: Wiley
Date: 02-05-2018
DOI: 10.1111/JGS.15349
Publisher: Elsevier BV
Date: 04-2021
Publisher: Springer Science and Business Media LLC
Date: 19-05-2023
DOI: 10.1186/S13063-023-07361-6
Abstract: The evidence for the clinical utility of pharmacogenomic (PGx) testing is growing, and guidelines exist for the use of PGx testing to inform prescribing of 13 antidepressants. Although previous randomised controlled trials of PGx testing for antidepressant prescribing have shown an association with remission of depression in clinical psychiatric settings, few trials have focused on the primary care setting, where most antidepressant prescribing occurs. The PRESIDE Trial is a stratified double-blinded randomised controlled superiority trial that aims to evaluate the impact of a PGx-informed antidepressant prescribing report (compared with standard prescribing using the Australian Therapeutic Guidelines) on depressive symptoms after 12 weeks, when delivered in primary care. Six hundred seventy-two patients aged 18–65 years of general practitioners (GPs) in Victoria with moderate to severe depressive symptoms, measured using the Patient Health Questionnaire-9 (PHQ-9), will be randomly allocated 1:1 to each arm using a computer-generated sequence. Participants and GPs will be blinded to the study arm. The primary outcome is a difference between arms in the change of depressive symptoms, measured using the PHQ-9 after 12 weeks. Secondary outcomes include a difference between the arms in change in PHQ-9 score at 4, 8 and 26 weeks, proportion in remission at 12 weeks, a change in side effect profile of antidepressant medications, adherence to antidepressant medications, change in quality of life and cost-effectiveness of the intervention. This trial will provide evidence as to whether PGx-informed antidepressant prescribing is clinically efficacious and cost-effective. It will inform national and international policy and guidelines about the use of PGx to select antidepressants for people with moderate to severe depressive symptoms presenting in primary care. Australian and New Zealand Clinical Trial Registry ACTRN12621000181808. Registered on 22 February 2021.
Publisher: Wiley
Date: 10-2006
DOI: 10.1111/J.1440-1584.2006.00812.X
Abstract: To explore factors affecting recruitment and retention of pharmacists in rural/remote areas of New South Wales (NSW). Qualitative semistructured in-depth interviews. Primary care--rural/remote community pharmacies. Purposive s le of 12 community pharmacists. Factors affecting recruitment and retention of pharmacists in rural/remote areas of NSW. Respondents reported a variety of personal and professional reasons for taking up rural practice, including previous rural experience and a preference for working in rural over metropolitan areas. The main factor affecting retention in rural areas was the high level of professional satisfaction and interprofessional rapport. Perceived reasons for the current under-supply of pharmacists to rural/remote areas of NSW included changing demographics of the pharmacy undergraduate degree programs and pharmacy workforce, and negative perceptions of rural pharmacy practice and rural lifestyle. This study identified factors believed to affect recruitment and retention of pharmacists in rural/remote areas. There appears to be considerable overlap between the factors, with different weightings of importance for different in iduals. The lack of consensus for a proposed method of resolving this problem highlights its complexity and the need for further studies in this area.
Publisher: Wiley
Date: 14-11-2020
DOI: 10.1002/PDS.4906
Abstract: Various strategies have been studied in the literature to address the significant underreporting of adverse drug reactions (ADRs) in healthcare systems worldwide. We conducted a systematic review of the literature that assessed the impact of various strategies to improve ADR reporting published in the last decade and compared this with the strategies identified in a previous systematic review. MEDLINE and EMBASE databases were used to retrieve papers published from 01 July 2010 to 17 June 2019. We included papers in the English language that investigated the quantitative impact of strategies used to improve ADR reporting. A total of 10,021 articles were retrieved using our search criteria, of which 13 met the inclusion criteria. Multifaceted strategies resulted in a point estimate increase in ADR reporting of 9.26-fold (-2.21-17.11, 95% CI) versus 7.19-fold (-5.29-32.68, 95% CI) for single interventions. Using electronic reporting tools was more commonly identified as an interventional strategy with a point estimate increase of 13.69-fold (-5.29-32.68, 95%CI) versus 4.42-fold (0.66-8.19, 95% CI) for traditional educational methods. The quality of the majority of publications included in this review was low. Developments in digital technology in the last decade has led to the increased use of electronic reporting tools to improve ADR reporting. Higher quality studies investigating the impact of these electronic methods are needed to fully explore its role in improving ADR reporting.
Publisher: Springer Science and Business Media LLC
Date: 03-2016
DOI: 10.1007/S40266-016-0357-2
Abstract: Older people are often prescribed multiple medicines and have a high prevalence of polypharmacy. Polypharmacy is associated with an increased risk of inappropriate use of medicines and drug-related problems. As experts in pharmacotherapy, pharmacists are well placed to review complex medication regimens and identify causes of drug-related problems and recommend solutions to prevent or resolve them. Involvement in medication review services represents a major philosophical shift and paradigm change in the way pharmacists practice, in that the focus is shifted away from the dispensing of prescription medicines to the provision of a professional service for a patient, in collaboration with their general practitioner (GP). In Australia, there are two established medication review programs: Home Medicines Review (HMR) and Residential Medication Management Review (RMMR). The objectives of this article were to describe the process of government-funded medication review services in Australia and to evaluate the contribution of pharmacists to HMR and RMMR, using evidence-based measures, such as the Drug Burden Index (DBI) and the Medication Appropriateness Index (MAI). This review found that there is good evidence to support the role of pharmacists in delivering medication review services across different settings. Although the positive impact of such services has been demonstrated using a variety of validated measures (DBI, MAI), there remains a need to also evaluate actual clinical outcomes and/or patient-reported outcomes.
Publisher: BMJ
Date: 09-2015
Publisher: JMIR Publications Inc.
Date: 23-09-2016
DOI: 10.2196/JMIR.5702
Publisher: Springer Science and Business Media LLC
Date: 04-12-2013
DOI: 10.1007/S11096-013-9900-Y
Abstract: The importance of pharmacists in mental healthcare is starting to be recognised around the world. However few studies have focused on the evidence supporting pharmacist involvement in the inpatient mental healthcare setting. Evaluate types of outcomes achieved and level of evidence supporting clinical pharmacy services in inpatient mental health settings. Medline, PyscINFO and International Pharmaceutical Abstracts databases were searched from January 1990 to March 31 2013. Studies were included if in an inpatient setting, published in English, and reported an intervention provided by a pharmacist or involving a pharmacist with a pivotal role in an intervention team. Data were extracted according to s le population and size, study design and outline, country, role of the pharmacist in the study, and the main results of the study. The level of evidence for each study was assessed using Australia's National Health and Medical Research Council's hierarchy of clinical evidence and results were categorised as having economic, clinical and/or humanistic outcomes. Eighteen articles met the inclusion criteria. A range of pharmaceutical services provided by pharmacists in inpatient mental healthcare were identified. These services highlight the role of pharmacists as reviewers of medication charts, laboratory results and medication prescribing and as educators of patients and other health care professionals. Six studies included a control or comparison group and had pre and post intervention measures. These comprised of three randomised control trials, one historical control study and two case series post and pre-post tests, corresponding to evidence levels of II, III-3 and IV respectively. Seven studies reported clinical outcomes, two economical and one humanistic outcomes. One study reported both clinical and economical outcomes. Seven studies focused on impact evaluation measures. Pharmacists provide a variety of services and play a significant role in inpatient mental healthcare. However, the level of evidence supporting these services is limited and the type of outcomes achieved is narrow.
Publisher: American Geophysical Union (AGU)
Date: 06-2021
DOI: 10.1029/2021JG006247
Abstract: Among its many impacts, climate warming is leading to increasing winter air temperatures, decreasing ice cover extent, and changing winter precipitation patterns over the Laurentian Great Lakes and their watershed. Understanding and predicting the consequences of these changes is impeded by a shortage of winter‐period studies on most aspects of Great Lake limnology. In this review, we summarize what is known about the Great Lakes during their 3–6 months of winter and identify key open questions about the physics, chemistry, and biology of the Laurentian Great Lakes and other large, seasonally frozen lakes. Existing studies show that winter conditions have important effects on physical, biogeochemical, and biological processes, not only during winter but in subsequent seasons as well. Ice cover, the extent of which fluctuates dramatically among years and the five lakes, emerges as a key variable that controls many aspects of the functioning of the Great Lakes ecosystem. Studies on the properties and formation of Great Lakes ice, its effect on vertical and horizontal mixing, light conditions, and biota, along with winter measurements of fundamental state and rate parameters in the lakes and their watersheds are needed to close the winter knowledge gap. Overcoming the formidable logistical challenges of winter research on these large and dynamic ecosystems may require investment in new, specialized research infrastructure. Perhaps more importantly, it will demand broader recognition of the value of such work and collaboration between physicists, geochemists, and biologists working on the world's seasonally freezing lakes and seas.
Publisher: Wiley
Date: 21-08-2014
DOI: 10.1111/BCP.12359
Publisher: Springer Science and Business Media LLC
Date: 08-03-2011
DOI: 10.1007/S00127-011-0364-X
Abstract: The purpose of this study was to explore the self-reported effect of consumer and caregiver-led education for pharmacy students and to explore the goals, challenges and benefits of mental health consumer educators providing education to health professional students. Five focus groups (mean duration 46 min, SD 22 min) were held with 23 participants (11 undergraduate pharmacy students, 12 mental health consumer educators) using semi-structured interview guides. The focus groups were digitally audio-recorded, transcribed verbatim and thematically content analyzed using a constant comparison approach. Three major themes emerged from the data raising awareness about mental health, impact on professional practice and impact on mental health consumers. The students reported decreased stigma, improved attitudes toward mental illness and behavior changes in their professional practice. The primary reason for becoming an educator was to raise awareness and reduce mental health stigma. However, educators also benefited personally through empowerment, improved confidence and social skills. Providing students the opportunity to have contact with consumers with a mental illness in a safe, educational setting led to decreases in stigma, the fostering of empathy and self-reported behavior changes in practice. Sharing personal stories about mental illness is a powerful tool to decrease mental health stigma and may be an important aspect of a person's recovery from mental illness. Contact with mental health consumers in an educational setting is recommended, particularly for future health care professionals. Appropriate training and support of consumers is crucial to ensure the experience is positive for all involved.
Publisher: SAGE Publications
Date: 12-07-2016
Abstract: Objective: To evaluate the impact of pharmaceutical care (PC) interventions on health-related quality of life (HRQoL) and determine sensitivity of HRQoL measures to PC services. Data Sources: MEDLINE, EMBASE, International Pharmaceutical Abstracts, PubMed, Global Health, PsychINFO, CINAHL, and Web of Science (January 2005 to September 2015) were searched. Study Selection and Data Extraction: Original English-language articles were included if PC impact on HRQoL was evaluated and reported using validated HRQoL measures. Data Synthesis: A total of 31 randomized controlled trials, 9 nonrandomized studies with comparison groups, and 8 before-after studies were included. PC interventions resulted in significant improvement in 1 domain and ≥3 domains of HRQoL measures in 66.7% and 27.1% of the studies, respectively. There was a significant improvement in at least 1 domain in 18 of 32 studies using generic and 16 of 21 studies using disease-specific measures. When the Short Form 36 Items Health Survey (SF-36) measure was used, PC interventions had a moderate impact on social functioning (standardized mean difference [SMD] = 0.59 95% CI = 0.14, 1.04), general health (SMD = 0.36 95% CI = 0.12, 0.59), and physical functioning (SMD = 0.30 95% CI = 0.11, 0.48). The pooled data on heart failure–specific (SMD = −0.17 95% CI = −0.43, 0.09), asthma-specific (SMD = 0.17 95% CI = −0.03, 0.36), and chronic obstructive pulmonary disease–specific (SMD = −0.09 95% CI = −0.37, 0.19) measures indicated no significant impact of PC on HRQoL. Conclusions: PC interventions can significantly improve at least 1 domain of HRQoL. Existing measures may have minimal to moderate sensitivity to PC interventions, with evidence pointing more toward social functioning, general health, and physical functioning of the SF-36 measure. However, evidence generated from current non–PC-specific HRQoL measures is insufficient to judge the impact of PC interventions on HRQoL. The development of a suitable HRQoL measure for PC interventions may help generate better evidence for the contribution of pharmacist services to improving HRQoL.
Publisher: Elsevier BV
Date: 06-2019
DOI: 10.1016/J.SAPHARM.2018.08.015
Abstract: Psychotropic medicines are often prescribed in nursing homes to manage behavioral and psychological symptoms of dementia despite marginal clinical effects alongside harmful adverse events. Organizational culture has been identified as a key factor that contributes to the high-level prescribing of psychotropic medicines in nursing homes. There are gaps in existing tools used to link organizational culture to the use of psychotropic medicines. The aim of this research was to develop and content validate a tool that evaluates organizational culture specific to the use of psychotropic medicines, named the Psychotropic medicines use in Residents And Culture: Influencing Clinical Excellence (PRACTICE) tool Schein's theory of organizational culture was used to guide the development and content validation of the PRACTICE tool Across the two rounds, the PRACTICE tool The PRACTICE tool
Publisher: Springer Science and Business Media LLC
Date: 04-06-2016
Publisher: Oxford University Press (OUP)
Date: 06-09-2019
DOI: 10.1111/IJPP.12501
Publisher: BMJ
Date: 2018
DOI: 10.1136/BMJOPEN-2017-018880
Abstract: Medication-related burden (MRB) is a negative experience with medicine, which may impact on psychological, social, physical and financial well-being of an in idual. This study describes the development and initial validation of an instrument specifically designed to measure MRB on functioning and well-being—the Medication-Related Burden Quality of Life (MRB-QoL) tool. An initial pool of 76-items for MRB-QoL was generated. The link to MRB-QoL survey was sent to a s le of consumers living with at least one chronic medical condition and taking ≥3 prescription medicines on a regular basis. Exploratory factor analysis (EFA) was used to determine the underlining factor structure. Internal consistency (Cronbach’s α) and construct validity were examined. The latter was examined through correlation with Medication Regimen Complexity Index (MRCI), Drug Burden Index (DBI) and Charlson’s Comorbidity Index (CCI). 367 consumers completed the survey (51.2% male). EFA resulted in a 31-item, five-factor solution explaining 72% of the total variance. The five subscales were labelled as ‘Routine and Regimen Complexity’ (11 items), ‘Psychological Burden’ (six items), ‘Functional and Role Limitation’ (seven items), ‘Therapeutic Relationship’ (three items) and ‘Social Burden’ (four items). All subscales showed good internal consistency (Cronbach’s α 0.87 to 0.95). Discriminant validity of MRB-QoL was demonstrated via its correlations with MRCI (Spearman’s r −0.16 to 0.08), DBI (r 0.12 to 0.28) and CCI (r −0.23 to −0.15). Correlation between DBI and ‘Functional and Role Limitation’ subscale (r 0.36) indicated some evidence of convergent validity. Patients with polypharmacy, multiple morbidity and DBI had higher median scores of MRB-QoL providing evidence for known group validity. The MRB-QoL V.1 has good construct validity and internal consistency. The MRB-QoL may be a useful humanistic measure for evaluating the impact of pharmaceutical care interventions on patients’ quality of life. Future research is warranted to further examine additional psychometric properties of MRB-QoL V.1 and its utility in patient care.
Publisher: Springer Science and Business Media LLC
Date: 29-03-2023
DOI: 10.1186/S12877-023-03921-2
Abstract: Polypharmacy and potentially inappropriate medicine use is common in older people, resulting in harm increased by lack of patient-centred care. Hospital clinical pharmacy services may reduce such harm, particularly prevalent at transitions of care. An implementation program to achieve such services can be a complex long-term process. To describe an implementation program and discuss its application in the development of a patient-centred discharge medicine review service to assess service impact on older patients and their caregivers. An implementation program was begun in 2006. To assess program effectiveness, 100 patients were recruited for follow-up after discharge from a private hospital between July 2019 and March 2020. There were no exclusion criteria other than age less than 65 years. Medicine review and education were provided for each patient/caregiver by a clinical pharmacist, including recommendations for future management, written in lay language. Patients were asked to consult their general practitioner to discuss those recommendations important to them. Patients were followed-up after discharge. Of 368 recommendations made, 351 (95%) were actioned by patients, resulting in 284 (77% of those actioned) being implemented, and 206 regularly taken medicines (19.7 % of all regular medicines) deprescribed. Implementation of a patient-centred medicine review discharge service resulted in patient-reported reduction in potentially inappropriate medicine use and hospital funding of this service. This study was registered retrospectively on 12 th July 2022 with the ISRCTN registry, ISRCTN21156862, www.isrctn.com/ISRCTN21156862 .
Publisher: Elsevier BV
Date: 05-2015
DOI: 10.1016/J.SAPHARM.2014.08.013
Abstract: Depression is one of the largest causes of disease burden globally but can routinely go undetected in primary care. Screening for depression is an effective way to increase early recognition, and there is an opportunity to utilize pharmacists' skills and accessibility to do this. The overall aim of this study was to determine the feasibility of Australian community pharmacists performing screening and risk assessment services for depression. The specific objectives were to: (1) develop a depression screening training program to aid pharmacists in the screening and risk assessment of depression in community pharmacy, (2) assess the feasibility of pharmacists using a screening tool for depression, (3) assess pharmacists' perspectives on the ease of use of different screening tools in the community pharmacy setting and (4) investigate the barriers and facilitators to pharmacists performing screening and risk assessment services for depression in community pharmacy. Twenty pharmacists from 12 community pharmacies were recruited. A training program on depression was developed and delivered to the pharmacists, followed by an eight week data collection period during which pharmacists conducted patient screenings for depression. Semi-structured interviews were conducted at the end of the data collection period to gather pharmacists' reflections on the intervention and to explore the barriers and facilitators to depression screening and risk assessment. Forty-one screening and risk assessments were conducted from 75 consumers who were approached. The majority of consumers screened were female, less than 40 years old and previously known to the pharmacy. More than 70% of consumers were referred on to a GP or psychologist for assessment. Barriers to implementation of the service included time, stigma and a lack of awareness of the pharmacists' role. Facilitators to the service included the accessibility of the pharmacist, having a private consultation area in the pharmacy, awareness c aigns and mental health resources on display. Pharmacists are capable of performing screening and risk assessment services for depression and making referrals to appropriate health care professionals when required. Pharmacy based depression screening programs have the potential to increase the early detection of depression which may lead to early intervention, and potentially contribute to easing the enormous disease burden associated with depression.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2014
Publisher: Elsevier BV
Date: 08-2009
DOI: 10.1016/J.AMJOPHARM.2009.07.001
Abstract: Depression is underrecognized and poorly treated among older people living in aged care homes worldwide. Depression has been associated with higher rates of recurrence, disability, and death in older people. The primary objective of this study was to assess the determinants of antidepressant medication prescribing among older people living in aged care homes in Australia. A further objective was to investigate the anti-depressant medications in common use, doses of antidepressants, and concurrent pharmacotherapy among people receiving antidepressants. A random s le of 500 deidentified medication review reports was extracted from a database containing >165,000 Residential Medication Management Review reports. Residents' demographic and clinical characteristics, medical diagnoses, and prescribed medications were systematically extracted from these reports. Logistic regression models were used to determine factors associated with the prescribing of any antidepressant, including tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), and "other" antidepressants (eg, mianserin, mirtazapine, venlafaxine). The mean (SD) age of the residents was 84.0 (9.0) years. Seventy-five percent were female. The prevalence of antidepressant prescribing among these aged care home residents was 33.0%. SSRIs were more commonly prescribed than TCAs, monoamine oxidase inhibitors, and other antidepressants. Antidepressants were more likely to be prescribed in people treated for dementia with mood disorder (odds ratio [OR] = 9.70 95% CI, 5.26-17.88), depression (OR = 13.28 95% CI, 6.44-27.36), and Parkinson's disease (OR = 3.56 95% CI, 1.37-9.23). SSRI prescribing was associated with dementia with mood disorder (OR = 5.85 95% CI, 3.19-10.72) and depression (OR = 6.44 95% CI, 3.38-12.26). TCA prescribing was associated with depression (OR = 2.95 95% CI, 1.18-7.35) and concurrent benzodiazepine use (OR = 2.43 95% CI, 1.03-5.72). Other antidepressant prescribing was associated with dementia with mood disorder (OR = 6.53 95% CI, 3.15-13.50) and depression (OR = 5.00 95% CI, 2.23-11.19). There was preferential prescribing of SSRI antidepressants among these older aged care home residents with depression. Cognitive impairment alone was not significantly associated with antidepressant prescribing however, these aged care home residents with dementia and mood disorders had an increased likelihood of being treated with antidepressants. The prescribing of TCAs was significantly associated with concurrent benzodiazepine use.
Publisher: Oxford University Press (OUP)
Date: 15-07-2016
DOI: 10.2146/AJHP160425
Publisher: Springer Science and Business Media LLC
Date: 28-08-2018
DOI: 10.1007/S00127-018-1582-2
Abstract: Health care professionals, including pharmacists, have the potential to recognise and assist those at risk of suicide. The primary aim of this study was to assess the impact of utilising people with a lived experience of mental illness as simulated patients on final year pharmacy students' attitudes toward and confidence in caring for people at risk of suicide after first receiving Mental Health First Aid (MHFA) training. A parallel group repeated measures design was used. People with a lived experience of mental illness enacted patients experiencing a mental health crisis, including possible suicidal ideation. Following MHFA training, the first group directly participated in the simulation, the second group observed, and the final group had no exposure to the simulation. Validated surveys measuring student attitudes and confidence were conducted at three time points pre and post MHFA, and then at 2-4 weeks follow-up. Full datasets of survey responses were received from 34/40 direct participants (85%), 104/146 observers (71%) and 50/66 comparison students (76%). Mean confidence scores significantly improved for all groups post MHFA training (p < 0.05). At follow-up, all 8 confidence items for the direct participant and observer group maintained significance from baseline to post intervention (p < 0.05). Mixed results in relation to attitudes towards suicide were evident at each time point and among each participant group. Utilising people with a lived experience of mental illness as simulated patients has a positive effect on sustaining pharmacy student confidence in discussing suicidal behaviour post MHFA training. The inconsistency in attitudes towards suicide suggests that attitudes are complex in nature, involving multiple dynamic influences.
Publisher: Springer Science and Business Media LLC
Date: 23-03-2008
DOI: 10.1007/S11096-008-9211-X
Abstract: To compare and contrast the extent to which pharmacy students in Australia, Belgium, Finland, India, Estonia and Latvia hold stigmatising attitudes toward people with schizophrenia and severe depression. Data were collected as part of the International Pharmacy Students Health Survey, a census survey of third-year pharmacy students studying at eight universities in six countries. Respondents (n = 642) indicated how strongly they endorsed six stigmatising statements about patients with schizophrenia and severe depression. Coded data were analysed using the Statistical Package for the Social Sciences (Version 14.0). Between 52.5% (95% CI 46.2-58.9%) of students in Australia and 65.1% (95% CI 56.9-73.3) in Finland agreed that people with schizophrenia are a danger to others. Between 30.3% (95% CI 24.5-36.1%) of students in Australia and 60.0% (95% CI 48.5-71.5) in Estonia and Latvia agreed that people with schizophrenia are difficult to talk to. Between 9.8% (95% CI 4.0-15.6%) of students in Belgium and 43.8% (95% CI 35.3-52.3%) in Finland agreed that people with severe depression have themselves to blame. Sub-optimal attitudes toward people with schizophrenia and severe depression were common among pharmacy students in all countries. New models of pharmacy education are required to address the attitudes and misconceptions among pharmacy students.
Publisher: Elsevier BV
Date: 05-2017
DOI: 10.1016/J.SAPHARM.2016.05.044
Abstract: Social networking sites (SNS) are a new venue for communication, and health care professionals, like the general population, are using them extensively. However, their behavior on SNS may influence public perceptions about their professionalism. This study explored how pharmacists separate professional and personal information and activities on SNS, their perceptions of professional behavior on SNS, and opinions on guidelines in this area. In-depth, semi-structured interviews were conducted with international practising pharmacists (n = 31) recruited from a range of countries (n = 9). Initially, pharmacists known to the research team were invited, and thereafter, participants were recruited using a snowballing technique. The interviews lasted from 30 to 120 min. All interviews were recorded, transcribed verbatim, and thematically analyzed. A majority of participants mixed professional and personal information and activities on SNS, and about one third adopted a separation strategy where professional information and activities were clearly separated from personal ones (e.g. two different SNS accounts, or one particular SNS for professional use and another platform for personal purposes). Most participants expressed concern over how pharmacists present themselves and behave in SNS when they reported (un)professional behaviors of peers they had observed. Ex les of perceived unprofessional behaviors included revealing details of personal life and activities open complaints about the pharmacy sector, co-workers, physicians, and patients inappropriate description of pharmacists' roles and activities and breaches of patient confidentiality. Positive professional behaviors, such as expression of compassion for patients, ex les of effective patient management, promotion of pharmacists' role, and correction of misleading health information being spread online were also observed. There was no consensus on having professional social media guidelines. Some preferred SNS to be unregulated while most believed certain guidance was needed to maintain high professional standards in the online environment. A definitive strategy to separate professional and personal information and activities on SNS was not adopted by most pharmacists. E-professionalism issues could negatively impact on the standing of in idual practitioners and the profession. Most agreed that education about SNS use would be beneficial however, support for guidelines or regulations for pharmacists' use of SNS was not unanimous.
Publisher: Informa UK Limited
Date: 09-2018
DOI: 10.2147/PPA.S160728
Publisher: Oxford University Press (OUP)
Date: 08-11-2011
DOI: 10.1111/J.2042-7174.2011.00177.X
Abstract: Drug-related problems (DRPs) are common in older people, resulting in a disproportionate number of serious medication adverse events. Pharmacist-led interventions have been shown to be effective in identifying and reducing DRPs such as medication interactions, omission of recommended medications and use of ineffective medications. In 2008 we proposed a prescribing indicators tool to assist in identifying DRPs as part of the Australian medication review process. The objective was to apply the proposed prescribing indicators tool to a cohort of older Australians, to assess its use in detecting potential DRPs. The prescribing indicators tool was applied in a cross-sectional observational study to 126 older (aged ≥65 years) English-speaking Australians taking five or more medications, as they were being discharged from a small private hospital into the community. Indicators were unmet when prescribing did not adhere to indicator tool guidelines. We found a high incidence of under-treatment, and use of inappropriate medications. There were on average 18 applicable indicators per patient, with each patient having on average seven unmet indicators. The use of a prescribing indicators tool for commonly used medications and common medical conditions in older Australians may contribute to the efficient identification of DRPs.
Publisher: SAGE Publications
Date: 30-11-2010
DOI: 10.1345/APH.1P373
Abstract: Home Medicines Review (HMR), a community-based collaborative service provided by general practitioners (GPs) and accredited pharmacists in Australia, has demonstrated effectiveness in preventing, detecting, and resolving medication-related problems. The Medication Appropriateness Index (MAI) has been found to be a reliable, valid, standardized instrument for assessment of multiple elements of drug therapy prescribing. To retrospectively evaluate the impact of HMRs on the appropriateness of prescribing, using the MAI as a tool to categorize pharmacists' recommendations. A retrospective analysis was performed on a s le of 270 HMR cases pertaining to community-dwelling older people (≥65 years) in New South Wales, Australia. The HMRs were collected from 7 accredited pharmacists using purposive s ling. All HMRs were conducted between February 2006 and October 2009. MAI scores were retrospectively calculated at baseline, after the HMR service based on the pharmacist's recommendations to the GP, and following uptake of the pharmacist's recommendations by the GP. The mean ± SD age of the patients was 75.3 ± 7.4 years and 55% were female. Overall, almost all (99% n = 267) patients had at least 1 inappropriate rating at baseline and more than 50% (n = 154) of the patients had a cumulative MAI score . The mean MAI score at baseline was 18.6 ± 11.3, which decreased to 9.3 ± 7.5 after HMR. The number of patients with a cumulative MAI score ≥15 increased to 216 after the HMR service, compared to 116 at baseline. Pharmacists' recommendations documented in the HMR reports and uptake of these recommendations by the GP resulted in a statistically significant decrease in the MAI scores (both p 0.001). The study demonstrates that the provision of medication reviews by accredited pharmacists can improve the appropriateness of prescribing as demonstrated by the change in MAI score and, hence, has the potential to improve patient outcomes. Pharmacists who perform medication reviews could also consider including the systematic approach of applying the MAI to assist in optimizing prescribing in older people.
Publisher: Informa UK Limited
Date: 19-02-2013
DOI: 10.3109/13561820.2013.767225
Abstract: Shared decision-making is an essential element of patient-centered care in mental health. Since mental health services involve healthcare providers from different professions, a multiple perspective to shared decision-making may be valuable. The objective of this study was to explore the perceptions of different healthcare professionals on shared decision-making and current interprofessional collaboration in mental healthcare. Semi-structured interviews were conducted with 31 healthcare providers from a range of professions, which included medical practitioners (psychiatrists, general practitioners), pharmacists, nurses, occupational therapists, psychologists and social workers. Findings indicated that healthcare providers supported the notion of shared decision-making in mental health, but felt that it should be condition dependent. Medical practitioners advocated a more active participation from consumers in treatment decision-making whereas other providers (e.g. pharmacists, occupational therapists) focused more toward acknowledging consumers' needs in decisions, perceiving themselves to be in an advisory role in supporting consumers' decision-making. Although healthcare providers acknowledged the importance of interprofessional collaboration, only a minority discussed it within the context of shared decision-making. In conclusion, healthcare providers appeared to have differing perceptions on the level of consumer involvement in shared decision-making. Interprofessional roles to facilitate shared decision-making in mental health need to be acknowledged, understood and strengthened, before an interprofessional approach to shared decision-making in mental health can be effectively implemented.
Publisher: Cambridge University Press (CUP)
Date: 18-05-2016
DOI: 10.1017/S1041610216000715
Abstract: The influence of organizational culture on how psychotropic medicines are used in nursing homes has not been extensively studied. Schein's theory provides a framework for examining organizational culture which begins with the exploration of visible components of an organization such as behaviors, structures, and processes. This study aimed to identify key visible components related to the use of psychotropic medicines in nursing homes. A qualitative study was conducted in eight nursing homes in Sydney, Australia. Purposive s ling was used to conduct semi-structured interviews with 40 participants representing a broad range of health disciplines. Thematic analysis was used to derive concepts. Three visible components were related to psychotropic medicine use. These were drugs and therapeutics committee meetings, pharmacist led medication management reviews and formal and informal meetings with residents and their families. We found that only a few nursing homes utilized drugs and therapeutics committee meetings to address the overuse of psychotropic medicines. Pharmacist led medication management reviews provided a lever to minimize inappropriate psychotropic prescribing for a number of nursing homes however, in others it was used as a box-ticking exercise. We also found that some nursing homes used meetings with residents and their families to review the use of psychotropic medicines. This study was the first to illustrate that visible components of organizational culture do influence the use of psychotropic medicines and explains in detail what of the culture needs to be addressed to reduce inappropriate psychotropic prescribing.
Publisher: Springer Science and Business Media LLC
Date: 02-2010
DOI: 10.2165/11531560-000000000-00000
Abstract: A significant problem in older people (aged >or=65 years) is the use of potentially inappropriate medications (PIMs), including those with sedative and anticholinergic properties. However, effective intervention strategies have yet to be identified. The Drug Burden Index (DBI) is an evidence-based tool that measures a person's total exposure to medications with sedative and anticholinergic properties and has been shown to be independently associated with impairment in cognitive and physical function. The main aim of the study was to investigate whether Home Medicines Review (HMR) services by pharmacists for community-dwelling older people would lead to an improvement in the use of medications, as measured by a decrease in the DBI score. The study also aimed to investigate the (i) distribution of DBI scores and PIMs among older people living in the community, and (ii) impact of pharmacists' recommendations on DBI scores and PIMs. A retrospective analysis of medication reviews was performed for 372 community-dwelling older people (aged >or=65 years) who received an HMR service from the pharmacist. The main outcome measure was the total DBI score at baseline and post-HMR. The data were also examined to determine the extent of PIM use (2003 Beers' criteria), and the number and nature of pharmacists' recommendations. Overall, medications contributing to the DBI (i.e. medications with sedative or anticholinergic properties) and PIMs were identified in 60.5% (n = 225) and 39.8% (n = 148) of the patients, respectively. Following pharmacist recommendations during the HMR service, medications contributing to the DBI were identified in 51.6% (n = 192) of the patients. A statistically significant reduction in the sum total of DBI scores for all patients was observed following pharmacists' recommendations during the HMR service (206.9 vs 157.3, p < 0.001). Pharmacists' recommendations also led to a decrease in the use of PIMs, which were identified in 28.2% (n = 105) of the patients following the HMR service. When the DBI is used for evaluation, pharmacists' recommendations during HMR services, if acted upon, may effect changes in the prescribing of sedative and anticholinergic medications, thereby substantially reducing the patient's drug burden. Future studies should focus on whether such a decrease may translate into functional improvements. The study also showed a positive influence of HMR services on the prescribing of PIMs.
Publisher: Oxford University Press (OUP)
Date: 28-04-2015
DOI: 10.1111/IJPP.12115
Abstract: To explore the attitudes of Australian hospital pharmacists towards patient safety in their work settings. A safety climate questionnaire was administered to all 2347 active members of the Society of Hospital Pharmacists of Australia in 2010. Part of the survey elicited free-text comments about patient safety, error and incident reporting. The comments were subjected to thematic analysis to determine the attitudes held by respondents in relation to patient safety and its quality management in their work settings. Two hundred and ten (210) of 643 survey respondents provided comments on safety and quality issues related to their work settings. The responses contained a number of dominant themes including issues of workforce and working conditions, incident reporting systems, the response when errors occur, the presence or absence of a blame culture, hospital management support for safety initiatives, openness about errors and the value of teamwork. A number of pharmacists described the development of a mature patient-safety culture – one that is open about reporting errors and active in reducing their occurrence. Others described work settings in which a culture of blame persists, stifling error reporting and ultimately compromising patient safety. Australian hospital pharmacists hold a variety of attitudes that reflect erse workplace cultures towards patient safety, error and incident reporting. This study has provided an insight into these attitudes and the actions that are needed to improve the patient-safety culture within Australian hospital pharmacy work settings.
Publisher: Elsevier BV
Date: 2015
DOI: 10.1016/J.SAPHARM.2014.04.002
Abstract: Social media is becoming increasingly ubiquitous. It has significant potential as a health communication and educational tool, and may provide a medium for the delivery of health-related services. This systematic review aimed to investigate the use of social media in professional pharmacy practice and pharmacy education, and includes an evaluation of the research designs utilized. Medline, Embase, PubMed, IPA, and CINAHL databases were broadly searched for peer-reviewed research studies about pharmacy and social media (SM). The search was restricted to years 2000 to June 2013, with no other restrictions applied. Key words used were within three concept areas: "social media" and "pharmacist or student" and "pharmacy." Twenty-four studies met the inclusion criteria. SM was broadly addressed as a general concept in 3 of the 24 studies. The other 21 studies investigated/used specific SM tools. Fourteen of those addressed social networking sites (SNS), four wikis, two blogs, and one Twitter. The studies' foci were to describe SM use (n = 17 studies) by pharmacist, pharmacy educators, and pharmacy students and investigate usage related topics (such as e-professionalism and student-educator boundary issues) or the use of SM as an educational tool in pharmacy education (n = 7). Pharmacy students were the subject of 12 studies, pharmacists of six, and faculty members and administrators of four. Survey methods were used in 17 studies, alone or with an additional method focus groups were used in two interviews in one and direct observation of social media activity in seven. Results showed that SM in general and SNS in particular were used mainly for personal reasons. Wikis, Facebook, and Twitter were used as educational tools in pharmacy education with positive feedback from students. Research investigating the use of SM in the practice of pharmacy is growing however, it is predominantly descriptive in nature with no controlled studies identified. Although some studies have used SM to deliver and enhance pharmaceutical education, none have focused on the delivery of pharmacy services through SM.
Publisher: Informa UK Limited
Date: 16-05-2013
Publisher: Springer Science and Business Media LLC
Date: 12-02-2020
DOI: 10.1186/S12877-020-1442-2
Abstract: Older people living in the community have a high prevalence of polypharmacy and are vulnerable to adverse drug events. Home Medicines Review (HMR) is a collaborative medication review service involving general practitioners (GPs), accredited clinical pharmacists (ACPs) and patients, which aims to prevent medication-related problems. This study aims to evaluate the implementation of a Computerised Clinical Decision Support System (CCDSS) called G-MEDSS© (Goal-directed Medication Review Electronic Decision Support System) in HMRs to deprescribe anticholinergic and sedative medications, and to assess the effect of deprescribing on clinical outcomes. This study consists of 2 stages: Stage I – a two-arm parallel-group cluster-randomised clinical trial, and Stage II – process evaluation of the CCDSS intervention in HMR. Community-dwelling older adults living with and without dementia who are referred for HMR by their GP and recruited by ACPs will be included in this study. G-MEDSS is a CCDSS designed to provide clinical decision support for healthcare practitioners when completing a medication review, to tailor care to meet the patients’ goals and preferences. The G-MEDSS contains three tools: The Goals of Care Management Tool, The Drug Burden Index (DBI) Calculator©, and The revised Patients’ Attitudes Towards Deprescribing (rPATD) questionnaire. The G-MEDSS produces patient-specific deprescribing reports, to be included as part of the ACPs communication with the patient’s GP, and patient-specific reports for the patient (or carer). ACPs randomised to the intervention arm of the study will use G-MEDSS to create deprescribing reports for the referring GP and for their patient (or carer) when submitting the HMR report. ACPs in the comparison arm will provide the usual care HMR service (without the G-MEDSS). The primary outcome is reduction in DBI exposure 3 months after HMR ± G-MEDSS intervention between comparison and intervention groups. The secondary outcomes include changes in clinical outcomes (physical and cognitive function, falls, institutionalisation, GP visits, medication adherence and mortality) 3-months after HMR. This study is expected to add to the evidence that the combination of CCDSS supporting medication review can improve prescribing and clinical outcomes in older adults. The trial was registered on the Australian New Zealand Clinical Trials Registry ACTRN12617000895381 on 19th June 2017.
Publisher: MDPI AG
Date: 21-10-2014
Publisher: Springer Science and Business Media LLC
Date: 12-2005
Abstract: The objective of this systematic review was to evaluate the impact of pharmacist delivered community-based services to optimise the use of medications for mental illness. Twenty-two controlled (randomised and non-randomised) studies of pharmacists' interventions in community and residential aged care settings identified in international scientific literature were included for review. Papers were assessed for study design, service recipient, country of origin, intervention type, number of participating pharmacists, methodological quality and outcome measurement. Three studies showed that pharmacists' medication counselling and treatment monitoring can improve adherence to antidepressant medications among those commencing treatment when calculated using an intention-to-treat analysis. Four trials demonstrated that pharmacist conducted medication reviews may reduce the number of potentially inappropriate medications prescribed to those at high risk of medication misadventure. The results of this review provide some evidence that pharmacists can contribute to optimising the use of medications for mental illness in the community setting. However, more well designed studies are needed to assess the impact of pharmacists as members of community mental health teams and as providers of comprehensive medicines information to people with schizophrenia and bipolar disorder
Publisher: BMJ
Date: 20-08-2009
DOI: 10.1136/BMJ.B3282
Publisher: Wiley
Date: 02-09-2010
DOI: 10.1111/J.1365-2753.2010.01374.X
Abstract: Drug-related problems (DRPs) in Australian aged care homes have been studied previously. However, little is known about the acceptance and implementation of pharmacists' recommendations by general practitioners (GPs) to resolve DRPs. The primary objective of this study was to investigate the number and nature of DRPs identified by accredited clinical pharmacists. The secondary objective was to study the GP acceptance and implementation of pharmacist recommendations to resolve DRPs. This was a retrospective study of 500 randomly selected, de-identified medication reviews performed by 10 accredited clinical pharmacists over 6 months across 62 aged care homes. The DRPs identified by pharmacists were subsequently classified by the drugs involved, types of problem (indication, effectiveness and safety) and medical diagnoses of the patient. GP written feedback on the medication review reports determined implementation of pharmacists' recommendations to resolve the DRPs. A total of 1433 DRPs were identified in 480 of the 500 residents. Potential DRPs were frequently classified as risk of adverse drug reactions, need for additional monitoring and inappropriate choice of a drug. Alimentary, cardiovascular, central nervous system and respiratory drugs were most frequently implicated, accounting for more than 75% of the DRPs. GPs' acceptance and implementation of pharmacists recommendations were 72.5% (95% CI 70.2, 74.8) and 58.1% (95% CI 55.5, 60.6), respectively. Over 96% of the residents had potential DRPs identified by pharmacists. GP acceptance of pharmacists' recommendations was independent of the drug category, but not independent of the disease category.
Publisher: Wiley
Date: 08-06-2021
DOI: 10.1111/BCP.14924
Abstract: Most research into medication safety has been conducted in hospital settings with less known about primary care. The aim of this study was to characterise the nature and causes of medication incidents (MIs) in the community using a pharmacy incident reporting programme. Thirty community pharmacies participated in an anonymous or confidential MI spontaneous reporting programme in Sydney, Australia. The Advanced Incident Management System was used to record and classify incident characteristics, contributing factors, severity and frequency ratings. In total, 1013 incidents were reported over 30 months, 831 of which were near misses while 165 reports involved patient harm. The largest proportion of cases pertained to patients aged years (35.7%). Most incidents involved errors during the prescribing stage (61.1%), followed by dispensing (25.7%) and administration (23.5%), while some errors occurred at multiple stages (17.9%). Systemic antibacterials (12.2%), analgesics (11.8%) and renin–angiotensin medicines (11.7%) formed the majority of implicated classes. Participants identified erse and interrelating contributing factors: those concerning healthcare providers included violations to procedures/guidelines (75.6%), rule‐based mistakes (55.6%) and communication (50.6%) those concerning patients included cognitive factors (31.9%), communication (25.5%) and behaviour (6.1%). Organisational safety culture and inadequate risk management processes were rated as suboptimal. An MI reporting programme can capture and characterise medication safety problems in the community and identify the human and system factors that contribute to errors. Since medicine use is ubiquitous in the community, morbidity and mortality from MIs may be reduced by addressing the prioritised risks and contributing factors identified in this study.
Publisher: Elsevier BV
Date: 10-2014
Publisher: Springer Science and Business Media LLC
Date: 10-01-2018
DOI: 10.1007/S11096-017-0582-8
Abstract: Background Several measures of Health-Related Quality of Life (HRQoL) have been used to evaluate Pharmaceutical Care (PC) interventions in the past decades. However, their suitability for evaluation of PC services has not been comprehensively evaluated. Aim of the review The aim of this review was to perform content analysis of HRQoL measures used in PC studies to gain an insight into their suitability for evaluation of PC services. Method PC studies evaluating HRQoL as a primary or secondary outcomes were retrieved based on a literature search of articles published from 1990 to 2015, on Medline, Embase, International Pharmaceutical Abstracts, Global Health, PsycInfo, Web of Science, Cinahl, HealthStar, Cochrane Library, AUSThealth, Australian Medical Index, and Current content. Measures of HRQoL used in the studies were identified and relevant information was extracted. A conceptual model of a patient reported Medication-Related Burden Quality of Life was used to guide the analysis. Results 117 studies were retrieved. Thirty-seven: 10 generic, 27 condition-specific HRQoL measures with a total of 1019 items about physical functioning (n = 430), psychological wellbeing (n = 288), social wellbeing (n = 119), physical burden (n = 69) and others (n = 113) were used in the studies. Only 34 of 1019 items were specifically related to medicines. Of these, the majority of items focused on other aspects of medicine such as adherence, rather than the burden imposed by medicine on quality of life. Conclusion A holistic analysis of HRQoL measures used in PC studies published over two and half decades provided a better insight into sensitivity and specificity of the measures to PC services. This review found that HRQoL measures used in PC studies provide a very limited coverage of themes related to the burden of medicine on quality of life. Therefore, may have limited potential for use as a sole humanistic measure when evaluating PC interventions. There is a scope for future research in the development of an alternative measure suitable for evaluation of the burden of medicine and the impact of PC interventions on quality of life outcomes.
Publisher: Elsevier BV
Date: 12-2017
Publisher: SAGE Publications
Date: 07-2011
DOI: 10.3109/00048674.2011.585454
Abstract: Objective: The aim of this study was to assess the impact of delivering Mental Health First Aid (MHFA) training for pharmacy students on their mental health literacy and stigma towards mental illness. Methods: A non-randomized controlled design was used, with all third year pharmacy students at the University of Sydney (n = 272) in 2009 invited to participate in one of two MHFA training courses, each of 12 hours duration. Of these, 174 students applied for MHFA training, of whom 60 were randomly selected and offered MHFA training. Outcome measures that were completed by all participants in the MHFA and non-MHFA groups before and after the MHFA training included an evaluation of mental health literacy, the 7-item social distance scale, and 16 items related to self-reported behaviour. Results: The survey instrument was completed by 258 participants at baseline (59 MHFA and 199 non-MHFA) and 223 participants at follow up (53 MHFA and 170 non-MHFA). The MHFA training improved the participants’ ability to correctly identify a mental illness (p = 0.004). There was a significant mean decrease in total social distance of 2.18 (SD 3.35) p .001 for the MHFA group, indicating less stigmatizing attitudes. There were improvements in recognition of helpful interventions with participants’ views becoming more concordant with health professional views about treatments for depression (p = 0.009) and schizophrenia (p = 0.08), and participants were significantly more confident (p 0.01) to provide pharmaceutical services to consumers with a mental illness following the training. Conclusion: This study demonstrated that MHFA training can reduce pharmacy students’ mental health stigma, improve recognition of mental disorders and improve confidence in providing services to consumers with a mental illness in the pharmacy setting.
Publisher: Elsevier BV
Date: 05-2013
DOI: 10.1016/J.SAPHARM.2012.04.004
Abstract: Evaluations of interrater agreement and interrater reliability can be applied to a number of different contexts and are frequently encountered in social and administrative pharmacy research. The objectives of this study were to highlight key differences between interrater agreement and interrater reliability describe the key concepts and approaches to evaluating interrater agreement and interrater reliability and provide ex les of their applications to research in the field of social and administrative pharmacy. This is a descriptive review of interrater agreement and interrater reliability indices. It outlines the practical applications and interpretation of these indices in social and administrative pharmacy research. Interrater agreement indices assess the extent to which the responses of 2 or more independent raters are concordant. Interrater reliability indices assess the extent to which raters consistently distinguish between different responses. A number of indices exist, and some common ex les include Kappa, the Kendall coefficient of concordance, Bland-Altman plots, and the intraclass correlation coefficient. Guidance on the selection of an appropriate index is provided. In conclusion, selection of an appropriate index to evaluate interrater agreement or interrater reliability is dependent on a number of factors including the context in which the study is being undertaken, the type of variable under consideration, and the number of raters making assessments.
Publisher: Elsevier BV
Date: 04-2018
DOI: 10.1016/J.SOCSCIMED.2018.02.010
Abstract: Psychotropic medicines have limited efficacy in the management of behavioural and psychological disturbances, yet they are commonly used in nursing homes. Organisational culture is an important consideration influencing use of psychotropic medicines. Schein's theory elucidates that organisational culture is underpinned by basic assumptions, which are the taken for granted beliefs driving organisational members' behaviour and practices. By exploring the basic assumptions of culture we are able to find explanations for why psychotropic medicines are prescribed contrary to standards. A qualitative study guided by Schein's theory was conducted using semi-structured interviews with 40 staff representing a broad range of roles from eight nursing homes. Findings from the study suggest two basic assumptions influenced the use of psychotropic medicines: locus of control and necessity for efficiency or comprehensiveness. Locus of control pertained to whether staff believed they could control decisions when facing negative work experiences. Necessity for efficiency or comprehensiveness concerned how much time and effort was spent on a given task. Participants' arrived at decisions to use psychotropic medicines that were inconsistent with ideal standards when they believed they were helpless to do the right thing by the resident and it was necessary to restrict time on a given task. Basic assumptions tended to provide the rationale for staff to use psychotropic medicines when it was not compatible with standards. Organisational culture is an important factor that should be addressed to optimise psychotropic medicine use.
Publisher: Elsevier BV
Date: 03-2020
DOI: 10.1016/J.HEALTHPOL.2020.01.003
Abstract: This paper explores how organisational structure, policies and practices in healthcare can inadvertently disadvantage marginalised populations (e.g. in iduals from ethnic minority backgrounds) and reinforce health inequalities. We draw upon three erse UK healthcare settings (long term care institutions, high security hospitals and community pharmacies) to illustrate how systemic injustices negatively impact on access to care, treatment and health outcomes. The first case study considers the care of older people within nursing homes specifically the disempowering effects of this service structure and impacts of choice reduction upon health and their access to health provision. The second case study explores the impact of security restrictions upon patients within high security hospitals, focusing particularly on the maintenance of relationships and support networks outside of the hospital. The third and final case study, draws upon a national community pharmacy medicine management service to illustrate ways in which policies and guidelines inadvertently obstruct patients' engagement with the service within a community setting. We draw upon these settings to highlight inequalities within different contexts and to illustrate the ways in which well intended services can inadvertently disadvantage marginalised communities in multiple ways.
Publisher: Elsevier BV
Date: 05-2013
Publisher: Springer Science and Business Media LLC
Date: 03-2018
DOI: 10.1007/S40266-018-0527-5
Abstract: Psychotropic medicines are commonly used in nursing homes, despite marginal clinical benefits and association with harm in the elderly. Organizational culture is proposed as a factor explaining the high-level use of psychotropic medicines. Schein describes three levels of culture: artifacts, espoused values, and basic assumptions. This integrative review aimed to investigate the facets and role of organizational culture in the use of psychotropic medicines in nursing homes. Five databases were searched for qualitative, quantitative, and mixed method empirical studies up to 13 February 2017. Articles were included if they examined an aspect of organizational culture according to Schein's theory and the use of psychotropic medicines in nursing homes for the management of behavioral and sleep disturbances in residents. Article screening and data extraction were performed independently by one reviewer and checked by the research team. The integrative review method, an approach similar to the method of constant comparison analysis was utilized for data analysis. Twenty-four studies met the inclusion criteria: 13 used quantitative methods, 9 used qualitative methods, 1 was quasi-qualitative, and 1 used mixed methods. Included studies were found to only address two aspects of organizational culture in relation to the use of psychotropic medicines: artifacts and espoused values. No studies addressed the basic assumptions, the unsaid taken-for-granted beliefs, which provide explanations for in/consistencies between the ideal use of psychotropic medicines and the actual use of psychotropic medicines. Previous studies suggest that organizational culture influences the use of psychotropic medicines in nursing homes however, what is known is descriptive of culture only at the surface level, that is the artifacts and espoused values. Hence, future research that explains the impact of the basic assumptions of culture on the use of psychotropic medicines is important.
Publisher: Elsevier BV
Date: 2019
DOI: 10.1016/J.SAPHARM.2018.02.008
Abstract: To identify and evaluate the range of adherence measures used to assess different phases of medication adherence (initiation, implementation, and discontinuation) to antidepressants, including the psychometric properties of the measures. This systematic review followed the PRISMA statement. Medline, Embase, International Pharmaceutical Abstracts, CINAHL and PsychINFO were searched (1994-2015) for articles which reviewed or reported the psychometric properties of adherence measures in adults with unipolar depression without co-morbidity. Included articles were reviewed for the reliability and validity of their adherence measures. 26 studies met the inclusion criteria. Most assessed medication adherence at implementation and/or discontinuation phases. Self-report measures were the most frequently used, followed by electronic lid devices and pharmacy records. Standardized self-report measures such as Morisky, Green, and Levine Self-Reported Medication Taking Scale (MGLS) and Antidepressant Adherence Scale (AAS) demonstrated acceptable reliability and validity, while medication claims data showed good reliability as a long-term measure. Although the psychometric properties of various measures have been evaluated across the three phases of adherence, a standout measure with strong reliability and validity was not apparent. No single measure demonstrated reliability and validity throughout the adherence process. A range of different subjective and objective adherence measures is recommended to assess medication adherence across the different phases.
Publisher: Springer Science and Business Media LLC
Date: 15-03-2017
DOI: 10.1007/S11096-017-0444-4
Abstract: Background Social media are frequently used by consumers and healthcare professionals. However, it is not clear how pharmacists use social media as part of their daily professional practice. Objective This study investigated the role social media play in pharmacy practice, particularly in patient care and how pharmacists interact online with patients and laypeople. Setting Face-to-face, telephone, or Skype interviews with practising pharmacists (n = 31) from nine countries. Method In-depth semi-structured interviews audio-recorded, transcribed verbatim, and thematically analysed. Main outcome measure Two themes related to the use of social media for patient care: social media and pharmacy practice, and pharmacists' online interactions with customers and the public. Results Most participants were community pharmacists. They did not provide in idualized services to consumers via social media, despite most of them working in a pharmacy with a Facebook page. No participant "friended" consumers on Facebook as it was perceived to blur the boundary between professional and personal relationships. However, they occasionally provided advice and general health information on social media to friends and followers, and more commonly corrected misleading health information spread on Facebook. Short YouTube videos were used to support patient counselling in community pharmacy. Conclusions Participants recognized the potential social media has for health. However, its use to support patient care and deliver pharmacy services was very incipient. Pharmacists as medicine experts are well equipped to contribute to improvements in social media medicines-related information, learn from consumers' online activities, and design new ways of delivering care to communities and in iduals.
Publisher: SAGE Publications
Date: 27-08-2010
Abstract: Evidence-based therapies (EBTs) for the prevention of cardiovascular disease (CVD) are reportedly underutilized in older people. The primary purpose of this study was to evaluate the use of EBTs for the prevention of CVD events in older people and secondarily whether a Home Medicines Review (HMR) service by pharmacists’ predicts the use of these medicines. A retrospective cross-sectional audit of HMR reports pertaining to 608 community-dwelling older people (≥65 years) was conducted. EBTs considered for this audit included four guideline-recommended therapies for CVD: antithrombotic therapy (warfarin ± antiplatelet therapy), β-blockers, statins, and angiotensin agents (angiotensin-converting enzyme inhibitors [ACEI] ± angiotensin II receptor blockers [ARBs]). The prevalence of EBT use among the older people, mean age (SD) 75.6 (7.5) years, was: 73% for antithrombotic therapy, 75% for statins, 74% for angiotensin therapy, and 35% for β-blockers. CVD risk factors warranting treatment with these EBTs were frequently associated with use of EBTs. EBTs were least likely to be used in those with coronary interventions like coronary artery bypass grafting (CABG)/stent insertion (all EBTs except angiotensin agents) and angiotensin agents in those with a history of myocardial infarction or chronic heart failure. A pharmacist-led HMR service was significantly associated with the prescribing of all 4 EBTs. The results from this study show good adherence to evidence-based guidelines in general, although there is still room for improvement to further optimize clinical outcomes in these complex patients. The study also adds to the available literature on the effectiveness of pharmacists’ collaborative contribution to the care of these high-risk patients.
Publisher: BMJ
Date: 22-06-2016
DOI: 10.1136/BMJSTEL-2016-000111
Abstract: Despite peer-led teaching demonstrating benefits in patient safety education, few studies have evaluated these programmes from the perspective of peer leaders. To evaluate the impact of peer leader participation in a patient safety education workshop in improving their patient safety attitudes. 34 final year pharmacy student peer leaders. An interactive peer-led patient safety workshop was delivered to 249 first year pharmacy students. Peer leaders' attitudes were assessed 2 months prior to and immediately after peer leader training and immediately after and 1 month following the workshop. Using a validated patient safety attitudinal survey, repeated measures analysis of variance and pairwise comparisons were used to evaluate changes in four key attitudes over time: being quality improvement focused internalising errors questioning more senior healthcare professionals' behaviours and attitudes towards the open disclosure of errors. Compared to baseline, peer leaders' attitudes towards open disclosure significantly improved immediately following the workshop (p=0.010) and were sustained after 1 month (p=0.028). Attitudes towards being quality improvement focused also improved significantly 1 month after the workshop (p=0.003). Participation in a peer-led patient safety education programme benefits both students and peer leaders, enabling further mastery of concepts and enhancing generational change in patient safety practices.
Publisher: Springer Science and Business Media LLC
Date: 03-05-2023
DOI: 10.1007/S00127-022-02280-4
Abstract: People with mental illness are a vulnerable and stigmatised group with poor health outcomes including greater premature mortality. This study aimed to investigate trends and rates of change in unintentional drug-related deaths for people with mental illness, describe types of medicines involved, and identify populations at risk in a cohort from New South Wales, Australia. Features of unintentional drug-related deaths for people with mental illness between 2012 and 2016 were identified in a retrospective review of data from the National Coronial Information System. A total of 495 unintentional drug-related deaths were identified (1.6 deaths/100,000 population), showing an upward trend ( p 0.01). The most common substance involved was diazepam in both genders (males 135/319, 42%, female 76/176, 43%) and more than one contributory drug was included in 80% of cases. Between 2012 and 2016, hetamine-related deaths showed the highest increase (3.2-fold), followed by codeine (2.5-fold) and quetiapine (2.5-fold). Males (RR 1.8, 95% CI 1.5–2.2) and people aged 35–44 (RR 1.7, CI 1.3–2.2) were more likely to die from unintentional drug-related deaths compared with the reference (females and people aged 25–34). This study found that the drugs commonly involved in deaths are also the drugs commonly used by and prescribed to people with mental illness. There were also significant differences between gender, age group, and marital status in the trend and rate of unintentional drug-related deaths for people with mental illness. A multifaceted approach encompassing both pharmaceutical prescribing and targeted public health messaging is required to inform intervention and prevention strategies.
Publisher: Elsevier BV
Date: 03-2014
DOI: 10.1016/J.SAPHARM.2013.05.006
Abstract: Effective communication between community pharmacists and patients, particularly with a patient-centered approach, is important to address patients' concerns relating to antidepressant medication use. However, few studies have investigated community pharmacists' communication behaviors in depression care. To characterize community pharmacist-patient interactions during consultations involving use of antidepressants. Twenty community pharmacists received 3 simulated patient visits involving issues related to the use of antidepressants: 1) patient receiving a first-time antidepressant prescription 2) patient perceiving lack of efficacy of antidepressants after 2 weeks of treatment, and 3) patient intending to discontinue treatment prematurely. All 60 encounters were audio-recorded and analyzed using the Roter Interaction Analysis System (RIAS), a quantitative coding system that characterizes communication behaviors through discrete categories. A patient-centeredness score was calculated for each encounter. The majority of pharmacist communication was biomedical in nature (50.7%), and focused on providing therapeutic information and advice on the antidepressant regimen. In contrast, only 5.4% of pharmacist communication was related to lifestyle sychosocial exchanges. There were also few instances of emotional rapport-building behaviors (8.6%) or information gathering (6.6%). Patient-centered scores were highest in the scenario involving a first-time antidepressant user, as compared to other scenarios involving issues with continued therapy. Community pharmacists appeared to adopt a "medication-centered" approach when counseling on antidepressant issues. There is scope for improvement in patient-centered communication behaviors, particularly lifestyle sychosocial discussions, facilitating patient participation, and emotional rapport-building. The RIAS appears suited to characterize brief consultations in community pharmacies and can provide a framework in guiding communication training efforts. Further research is needed to assess the impact of pharmacist communication behaviors on patient care outcomes.
Publisher: BMJ
Date: 07-2018
DOI: 10.1136/BMJOPEN-2017-020437
Abstract: All healthcare systems require valid ways to evaluate service delivery. The objective of this study was to identify existing content validated quality indicators (QIs) for responsible use of medicines (RUM) and classify them using multiple frameworks to identify gaps in current quality measurements. Systematic review without meta-analysis. All care settings. CINAHL, Embase, Global Health, International Pharmaceutical Abstract, MEDLINE, PubMed and Web of Science databases were searched up to April 2018. An internet search was also conducted. Articles were included if they described medication-related QIs developed using consensus methods. Government agency websites listing QIs for RUM were also included. Several multidimensional frameworks were selected to assess the scope of QI coverage. These included Donabedian’s framework (structure, process and outcome), the Anatomical Therapeutic Chemical (ATC) classification system and a validated classification for causes of drug-related problems (c-DRPs drug selection, drug form, dose selection, treatment duration, drug use process, logistics, monitoring, adverse drug reactions and others). 2431 content validated QIs were identified from 131 articles and 5 websites. Using Donabedian’s framework, the majority of QIs were process indicators. Based on the ATC code, the largest number of QIs pertained to medicines for nervous system (ATC code: N), followed by anti-infectives for systemic use (J) and cardiovascular system (C). The most common c-DRPs pertained to ‘drug selection’, followed by ‘monitoring’ and ‘drug use process’. This study was the first systematic review classifying QIs for RUM using multiple frameworks. The list of the identified QIs can be used as a database for evaluating the achievement of RUM. Although many QIs were identified, this approach allowed for the identification of gaps in quality measurement of RUM. In order to more effectively evaluate the extent to which RUM has been achieved, further development of QIs may be required.
Publisher: Elsevier BV
Date: 05-2016
DOI: 10.5688/AJPE80463
Publisher: Elsevier BV
Date: 07-2017
DOI: 10.1016/J.SAPHARM.2016.10.001
Abstract: Safety climate evaluation is increasingly used by hospitals as part of quality improvement initiatives. Consequently, it is necessary to have validated tools to measure changes. To evaluate the construct validity and internal consistency of a survey tool to measure Australian hospital pharmacy patient safety climate. A 42 item cross-sectional survey was used to evaluate the patient safety climate of 607 Australian hospital pharmacy staff. Survey responses were initially mapped to the factor structure previously identified in European community pharmacy. However, as the data did not adequately fit the community pharmacy model, participants were randomly split into two groups with exploratory factor analysis performed on the first group (n = 302) and confirmatory factor analyses performed on the second group (n = 305). Following exploratory factor analysis (59.3% variance explained) and confirmatory factor analysis, a 6-factor model containing 28 items was obtained with satisfactory model fit (χ This study has demonstrated the validity of a survey to evaluate patient safety climate of Australian hospital pharmacy staff. Importantly, this validated factor structure may be used to evaluate changes in safety climate over time.
Publisher: Wiley
Date: 13-06-2021
DOI: 10.1111/BCP.14915
Abstract: To undertake a scoping review of pharmacist activities in opioid medicines management in primary care settings, including those developed or led by pharmacists, or in which pharmacists were members of broader multidisciplinary teams, and to collate the activities, models of care and settings, and reported outcomes. The bibliographic databases MEDLINE, EMBASE, International Pharmaceutical Abstracts, CINAHL, SCOPUS and Web of Science were searched. Studies with quantitative evaluation and published in English were eligible. Participants were patients with any pain category or an opioid use disorder, and healthcare providers. Studies originating in hospitals or involving supply functions were not included. Screening of literature and data charting of results were undertaken by two researchers. The 51 studies included in the scoping review occurred in primary care settings collated into four categories: general practice or primary care clinics, healthcare organisations, community pharmacies and outreach services. Studies were primarily of opioid use in chronic, noncancer pain. Other indications were opioid use disorder, cancer and dental pain. Pharmacist activities targeted risk mitigation, patient and provider education and broader, strategic approaches. Patient‐related outcomes included reduced opioid load, improved functionality and symptom management, enhanced access to services and medication‐assisted treatments, and engagement in risk‐mitigation strategies. Behaviour change of providers was demonstrated. The review has identified the significant contribution that pharmacists working in primary care settings can make to minimise harm from opioids. Strategies implemented in isolation have the potential to further reduce adverse clinical outcomes with greater collaboration and coordination, such as opioid stewardship.
Publisher: Springer Science and Business Media LLC
Date: 02-07-2014
Publisher: Elsevier BV
Date: 11-2012
DOI: 10.1016/J.SAPHARM.2012.01.002
Abstract: Previous research has demonstrated that some patients who are at risk of experiencing medication-related problems express a lack of willingness to use pharmacist-provided medication management services. Little is known about the factors that influence willingness to use these services among patients who have not yet experienced the service. The aim of this study was to test a model of willingness to use the Australian Home Medicines Review (HMR) service. Specifically, this study aimed to determine the influence of positive and negative outcome expectancies and communication efficacy over willingness among patients who were eligible to receive the service but have not yet experienced it. A cross-sectional survey was conducted with patients who were recruited by 264 community pharmacists throughout Australia. Patients were included in the study if they had not yet experienced HMR but were taking more than 5 medicines daily or more than 12 doses daily. Measurement scales were developed using exploratory and confirmatory factor analyses. Structural equation modeling was used to test the model. Questionnaires received from 286 patients (15.6%) were analyzed. Multi-item measurement scales were observed to have acceptable construct reliabilities (range, 0.69-0.94). Importantly, respondents held overall neutral expectations about the personal benefits of HMR (positive outcome expectancies) but high communication efficacy. Structural equation modeling revealed that positive outcome expectancies (β=0.56, P<.001) and communication efficacy (β=0.25, P<.05) influenced willingness to use, whereas negative outcome expectancies had no significant effect. The extent to which patients believe that HMR would provide them with increased medicines knowledge, improve their medicines management capability, and reduce their medicine concerns had a significant influence over willingness to use the service. Because these expectancies are relatively low, there appears to be significant scope for increasing patient demand for these services. Patient-directed material about medication management services should highlight the provision of medication information.
Publisher: SAGE Publications
Date: 05-06-2015
Publisher: SAGE Publications
Date: 06-2016
Abstract: Background: Anticholinergic and sedative (ACh-Sed) medications are commonly prescribed for older adults and are associated with adverse events. Objectives: (1) To investigate perspectives of health care practitioners (HCPs) surrounding deprescribing (withdrawal) of ACh-Sed medications in older adults (2) to assess HCPs’ perspectives on the design and implementation of a report on a patient’s exposure to ACh-Sed medications using the Drug Burden Index (DBI) pharmacological tool. Methods: This was a qualitative study using focus groups with purposive s les of accredited pharmacists (APs), general practitioners (GPs), and specialist physicians (SPs). Participants were also asked to comment on a s le DBI report of a hypothetical patient and its potential role in practice. The discussions were audiorecorded, transcribed verbatim, and thematically analyzed to derive conceptual domains. QSR NVivo Version 10 was used for data management. Results: Several barriers and enablers to deprescribing ACh-Sed medications in older adults were identified. The most noteworthy barrier to deprescribing related to devolving responsibility. Predominantly, APs expressed frustration surrounding disregard by GPs of their recommendations to deprescribe medications. GPs expressed that deprescribing should be conducted by SPs and vice versa. The DBI report supported and addressed some of the identified barriers to deprescribing ACh-Sed medications in older adults. The HCPs also identified several opportunities and considerations for implementing the DBI report in practice, mainly highlighting that ACh-Sed medications are not the only high-risk medications for older people. Conclusions: Although HCPs recognize the harms associated with ACh-Sed medication use, they devolve prescribing and management responsibility to other groups of HCPs.
Publisher: Cambridge University Press (CUP)
Date: 27-03-2019
DOI: 10.1017/S0714980819000084
Abstract: La réduction des médicaments potentiellement inappropriés (MPI) chez les personnes âgées est un enjeu important selon de nombreux cliniciens et chercheurs à travers le monde, car ces médicaments accroissent significativement la morbidité et la mortalité dans la population plus âgée. La prévalence des MPI est un problème répandu malgré l’existence de plusieurs critères explicites et implicites de réduction des MPI chez les personnes âgées, les plus courants étant les critères de Beers, les critères STOPP/START et plusieurs critères nationaux spécifiques. Cette revue non systématique visait à examiner les critères de référence pour la réduction des MPI et à clarifier le rôle de certaines mesures, dont la déprescription, pour optimiser la prescription des médicaments chez les personnes âgées. Des recherches par mots-clés et termes MeSH ont été menées dans des bases de données électroniques. Les nombreux critères disponibles ont chacun leurs avantages et inconvénients. La déprescription, qui vise à réduire l’utilisation des MPI, a considérablement gagné en importance dans les initiatives associées à l’amélioration des pratiques de prescription. La déprescription est une approche méthodique qui implique l’arrêt graduel, éclairé et in idualisé des médicaments inappropriés, avec un suivi rigoureux des patients pour assurer la détection d’événements indésirables ou de symptômes de rebond. Une approche combinée centrée sur le patient et le soignant favorise la collaboration entre les prescripteurs et les pharmaciens afin de réduire le nombre de MPI chez les personnes âgées.
Publisher: Elsevier BV
Date: 05-2019
DOI: 10.1016/J.SAPHARM.2018.07.015
Abstract: Post-market surveillance of medical devices relies on compulsory and voluntary reports. Although direct consumer reporting of medical device-related adverse events (AEs) is available in Australia, the proportion of consumer reports has remained low. Limited qualitative research has previously explored consumer insights on AEs associated with medical devices and in particular, AE reporting. To explore consumer opinions on AEs related to medical devices, and their knowledge of, experiences with, and views on, the reporting of medical device-related AEs. Focus groups (n = 4 total of 29 participants) were conducted in metropolitan Sydney, Australia. Focus group discussions of approximately 1.5 h in length centred on consumers' understanding of AEs, opinions on AEs and their previous experiences, views on medical device benefits and harms, and actions taken (or potential actions) in response to AEs. With participant consent, discussions were audio-recorded, transcribed verbatim, and thematically analysed. Participants regarded medical device-related side effects to be unexpected AEs associated with their use. Where there was a clear need for the medical device itself, potential improvement in quality of life took precedence over potential harms. Most participants had not experienced negative issues with their medical device(s). There was poor awareness among participants of an existing direct consumer AE reporting system for medical devices. Despite this, the value of reporting was acknowledged. Severity of the AE was a key motivator for potential AE reporting. Further efforts are necessary to improve consumer awareness of available AE reporting systems to better support post-market surveillance and safe medical device use.
Publisher: Elsevier BV
Date: 08-2008
Publisher: Springer Science and Business Media LLC
Date: 12-10-2016
Publisher: Elsevier BV
Date: 03-2007
DOI: 10.1016/J.SAPHARM.2006.05.005
Abstract: Case conferences are multidisciplinary meetings of health professionals to plan treatment for specific people with chronic and complex care needs. The value of multidisciplinary teamwork in mental health care is well recognized. This study aimed to explore the process of decision making in mental health case conferences involving community pharmacists and primary care physicians. Case conferences were conducted for 44 people receiving one or more medicines for a mental illness. Before participating in the case conferences, pharmacists conducted home visits and produced written reports that detailed Home Medicines Review findings and recommendations. The case conferences were audio taped and transcribed verbatim. A framework, based on the 3 components of decision making (derived from the Model of Shared Decision Making), was used to code statements made at the case conferences. These components were (1) information exchange, (2) deliberation, and (3) decision making. Pharmacists and physicians exchanged personal and medical information. Pharmacists presented their treatment findings and recommendations, and generally a brief discussion about treatment options followed (deliberation). The responsibility for deciding which treatments to implement (decision) typically remained with the physicians. The case conferences provided an opportunity for pharmacists and physicians to share information and discuss treatment options. Responsibility for deciding which treatment to implement generally remained with the primary care physicians.
Publisher: Springer Science and Business Media LLC
Date: 26-06-2010
DOI: 10.1007/S11096-010-9406-9
Abstract: To reconcile patients' medicines and to classify drug related problems identified during medication review conducted after discharge from hospital. Patients were discharged from the cardiology unit of Westmead Hospital after recruitment into the Westmead Medicines Project which ran from 2004 to 2007. This retrospective study involved an analysis of drugs, diseases and drug related problems in medication review reports available for 76 out of 85 patients who received a Home Medicines Review (HMR). Data sources for medication reconciliation and analyses also included hospital discharge summaries (n = 70) and GP referrals for HMR (n = 44). Comprehensive clinical profiles were constructed for the 76 subjects whose drug related problems were identified, coded, and then classified from their HMR reports. Number, type, distribution and international classification of drugs, diseases and drug-related problems. Patients were prescribed drugs for a broad range of cardiovascular, circulatory, endocrine, respiratory and digestive system diseases. Mean number of drugs per patient in discharge summaries: 8.7 ± SD 3.3 (range 3-19) in GP referrals: 8.9 ± SD 4.3 (range 2-23) and in HMR reports: 10.8 ± SD 4.0 (range 3-24). Mean number of diseases per patient in discharge summaries: 4.1 ± SD 2.9 (range 1-11) and in HMR reports: 4.7 ± SD 2.6 (range 1-12). A total of 398 drug related problems were identified for 71 (93.3%) patients with mean 5.6 ± SD 4.3 problems (range 1-21). The most frequently recorded problems were the patients' uncertainty about drug aim: n = 128 (32.0%) potential interactions n = 89 (22.4%) and adverse reactions n = 60 (15.1%). This study showed that patients recently discharged from a tertiary care hospital had a significant number of drug related problems. Classification of drugs and diseases revealed a broad range of non-cardiovascular medicines and conditions in the patients from an acute care cardiology unit. We found that home medicines review provided continuity of care and an opportunity for medication reconciliation which revealed marked differences in number of drugs, between hospital discharge and medicines review. The patients' uncertainly about their drugs and their erse range of co-morbidities indicated the need for timely counselling by pharmacists in the community.
Publisher: Oxford University Press (OUP)
Date: 09-2006
Abstract: To investigate facilitators of change in community pharmacy and their use in the implementation of cognitive pharmaceutical services (CPS). Relevant literature published in English was identified through searches of online databases (no date limits), texts, conference proceedings, and bibliographies of identified literature. Literature that involved a discussion of facilitators of community pharmacy practice change in relation to the implementation and/or delivery of CPS was selected for review. Some of the identified studies were conceptual in nature, and although they were selected in the same way as the empirical research papers, were not able to be critically reviewed in an equivalent manner. A narrative, rather than systematic review, was considered more appropriate. The identified facilitators exist at two levels: the in idual (e.g. knowledge) and the organisation (e.g. pharmacy layout). Few studies identified or measured facilitators drawn from experience, with many based on the views of researchers or participants in the studies, in reaction to identified barriers to CPS implementation. Purposive s ling was common in the reviewed studies, limiting the generalisability of the findings. Although a number of facilitators have been identified in the literature, it appears that little consideration has been given to how they can best be used in practice to accelerate CPS implementation. Identifying facilitators at both in idual and organisational levels is important, and future research should focus not only on their identification in representative populations, but on how they should be incorporated into programmes for CPS delivery.
Publisher: Springer Science and Business Media LLC
Date: 08-2009
DOI: 10.2165/11316440-000000000-00000
Abstract: The Drug Burden Index (DBI) is an evidence-based tool that associates medication exposure with functional outcomes in older people. Accredited clinical pharmacists performing medication reviews could consider including the DBI in their medication reviews to optimize prescribing in older people. To examine the impact of residential medication management reviews (RMMRs) performed by accredited clinical pharmacists on DBI in older people living in aged-care homes. A retrospective analysis was performed of a random s le of 500 de-identified RMMR reports from residents aged (mean +/- SD) 84 +/- 9.0 years who had medication reviews conducted by ten accredited clinical pharmacists from 1 January 2008 through 30 June 2008. The data on medication use were collected over 8 months across 62 aged-care homes. DBI scores were calculated at baseline, after the recommendations had been made by the pharmacist and after uptake of pharmacist recommendations by the general practitioner (GP). A statistically significant decrease (p < 0.001) in median DBI score was observed as a result of uptake of pharmacist recommendations by the GP. GPs were more likely to take up recommendations made by pharmacists that resulted in a decrease in DBI score than recommendations that resulted in an increase in DBI score (60.7% vs 34.6%, respectively). The mean decrease in DBI as a result of pharmacist recommendations was 0.12 (95% CI 0.09, 0.14) representing a 20% decrease in mean baseline DBI for residents. When GPs implemented pharmacists' recommendations, DBI decreased by a mean of 12% from baseline (mean decrease 0.07 95% CI 0.05, 0.08). Most of the recommendations proposed by the pharmacists involved withdrawing benzodiazepines or reducing antipsychotic drug dosage. This is the first study in which DBI has been used as a tool to evaluate the impact of RMMRs conducted by accredited clinical pharmacists. The study demonstrates that pharmacist-conducted medication reviews can reduce prescribing of sedative and anticholinergic drugs in older people, resulting in a significant decrease in the DBI score.
Publisher: Informa UK Limited
Date: 08-2013
DOI: 10.2147/PPA.S48486
Publisher: BMJ
Date: 03-2023
DOI: 10.1136/BMJOPEN-2022-066665
Abstract: To assess measurement properties of 121 face and content validated quality indicators (QIs) for medication safety in geriatric pharmacotherapy in primary care. A mixed methods study: a 6-month observational study in primary care (July–December 2020) and in-depth semistructured online interviews with participants (February–March 2021). Sixty community pharmacies in Japan. Patients aged 75 years and older who were regularly taking six or more prescription medicines for ˃4 weeks were eligible. The observational study included 457 patients. The interviews were undertaken with 26 community pharmacists, including pharmacy managers and owners. Five measurement properties of QIs (applicability, improvement potential, acceptability, implementation issues and sensitivity to change) were evaluated. A web application was developed for data reporting and data visualisation. This study showed that 53 QIs met the measurement properties of applicability, improvement potential, acceptability and implementation issues. Of 53 QIs, 17 also had a high sensitivity to change. Interviews identified eight themes (indicator characteristics, web application, policy, patient, time, competence, pharmacy administration and collaboration) in relation to the consequence of implementation of QIs. A set of 121 QIs for geriatric pharmacotherapy was field tested for their five measurement properties. This QI set can be used to identify patients who may benefit from clinician reviews of their medicines. These QIs may be applied at different levels within the healthcare system: patient, pharmacy, regional and national levels. Further mechanisms to automatically collect and report data should be established to facilitate sustainable quality improvement initiatives.
Publisher: Hindawi Limited
Date: 22-12-2013
DOI: 10.1111/IJCP.12276
Abstract: Community treatment orders (CTOs) are legal orders which require in iduals with mental illness to accept treatment in the community. Previous studies report that long-acting injectable (LAI) antipsychotics are associated with CTOs, however, little is known about the specific treatment plans prescribed in CTOs. The objective of this study was to describe the patterns of psychotropic drugs prescribed to in iduals issued a CTO, focusing on LAI antipsychotics, antipsychotic polypharmacy and high-dose antipsychotics. This was a retrospective cross-sectional study of 378 in iduals randomly selected from a s le of 1317 in iduals with a CTO expiry date up to and including 30 April 2010, taken from all 2856 in iduals issued a CTO by the New South Wales Mental Health Review Tribunal, Australia, in 2009. De-identified information relating to in iduals' treatment plans, demographic and clinical details were systematically extracted. A total of 377 (99.7%) in iduals were prescribed at least one antipsychotic. Of these, 310 (82%) were prescribed a LAI antipsychotic, either alone (45%), or in combination with, an oral antipsychotic (37%). Risperidone was the most prevalent antipsychotic, prescribed to 164 (43%) in iduals. Antipsychotic polypharmacy was prescribed to 121 (32%) in iduals and between 20% and 27% of in iduals were prescribed high-dose antipsychotics. Antipsychotic polypharmacy accounted for 74-80% of in iduals prescribed high-dose antipsychotics. The results from this study confirm that LAI antipsychotics are commonly prescribed in CTOs. Antipsychotic polypharmacy was also common, and accounted for the majority of in iduals prescribed high-dose antipsychotics. Further research is needed to determine the potential outcomes and implications of the patterns observed.
Publisher: Elsevier BV
Date: 03-2015
DOI: 10.1016/J.SAPHARM.2014.07.002
Abstract: Research has shown that consumers prefer a pharmacist who is skilled in communication and pays particular attention to friendliness, empathy and attentiveness. Medication management interviews tend to be more time consuming than other patient-pharmacist interactions. The extra time for these interviews provides patients with an opportunity to evaluate the quality of interpersonal care provided by the pharmacist. Patient evaluations of pharmacists may influence their intentions to use medication management services. In previous studies, a conceptual model based on information-seeking theory was developed and used to explain a significant amount of the variation in consumers' and caregivers' willingness to use Australia's Home Medicines Review (HMR) service. The aim of this paper was to extend the conceptual model to include the influence of patients' evaluation of interpersonal care provided. We aimed to test the hypothesis that patients' perceptions of how well the pharmacist listened to them during their most recent HMR interview (Listening) would increase their willingness to re-use HMR (Willingness). Patients (N = 595) who had experienced Australia's Home Medicines Review (HMR) within the previous 6 months completed questionnaires. Exploratory and confirmatory factor analyzes were used to validate the measurement scales. Structural equation modeling was used to test the model. The structural model provided a reasonable fit to the data and explained 53% of the variation in Willingness. The structural model revealed that Listening increased patients' perceptions that the HMR provided positive outcomes (Outcomes) (β = 0.37, P < 0.05) and directly and indirectly increased Willingness (β = 0.61, P < 0.05). These results suggest that patients' willingness to use a medication management service in the future is strongly influenced by their perceptions of how well the pharmacist listened to them during their last medication review interview. Improving pharmacist listening skills may be explored as a strategy for improving patient engagement with pharmacy services.
Publisher: Elsevier BV
Date: 02-2020
DOI: 10.1016/J.SAPHARM.2019.04.005
Abstract: Medication discrepancies directly impact patient safety and can adversely impact quality of care and resource utilization at transitions of care. To develop a common nomenclature and taxonomy for classifying and reporting medication discrepancies and to assess the content validity and reliability of the taxonomy. The taxonomy was developed following a multi-stage process. The content of the taxonomy was then assessed using expert opinion through a two-round modified Delphi process. The expert panel comprised 10 experts who were selected based on pre-defined selection criteria. Six experienced pharmacists were then invited to classify medication discrepancies from a number of fictitious cases (adapted from authentic cases) using the taxonomy. The medication discrepancy taxonomy (MedTax) comprises 12 main types and 28 sub-types of discrepancies. A set of operational instructions and definitions to aid the use of the taxonomy was formulated. The overall Average content validity index (Ave-CVI) was 0.93 and interrater reliability was 0.67 (multirater κfree), indicating substantial agreement. An excellent internal consistency of the taxonomy was established (Kuder-Richardson Formula 20 (KR-20) = 0.92). A content valid and reliable taxonomy for classifying medication discrepancies was developed. The MedTax may be used to classify medication discrepancies identified following medication reconciliation services. The clear and consistent reporting of medication discrepancies arising from medication reconciliation services may be of value to policy makers, healthcare professionals and researchers, when evaluating such services. The MedTax was designed to fill an essential void in global endeavors to reinforce standardization of medication reconciliation practices and to improve medication safety across transitions of care.
Publisher: Springer Science and Business Media LLC
Date: 02-05-2014
DOI: 10.1007/S00228-014-1686-X
Abstract: For over 20 years, researchers wanting to record, discuss and compare drug-related problems (DRPs) have had the task of choosing between a multiplicity of classification systems offering a variable number of categories identified as causes of DRPs and DRPs. To characterise studies which have reported DRPs through the use of a DRP classification system to determine types of classification systems chosen, factors influencing their choice, and methodological issues that may have affected their application. A systematic search of MEDLINE, CINAHL, International Pharmaceutical Abstracts (Ovid), EMBASE and PubMed was performed. All English language studies reporting DRPs through the use of a classification system published between January 2000 and July 2013 were reviewed, with no limitation on the type of study. Of 2,774 articles screened, 268 met our inclusion criteria. We identified the use of 20 different types of DRP classification systems. Three quarters of studies modified an existing classification system or developed their own. Few studies stated reasons for choice of system. We identified issues such as variability in skills of data collectors, selective choice of patients and missing data, affecting application of classification systems and limiting quality, analysis and comparison of studies. There appeared to be no consensus on preference or structure of classification systems. Future studies should consider addressing or acknowledging the methodological issues identified. Through identification and discussion of these problems, recommendations for future studies and for practice have been made.
Publisher: Wiley
Date: 11-2020
DOI: 10.1111/BCP.14587
Abstract: Quality indicators (QIs) are an important mechanism by which health services can be evaluated. We aimed to develop a set of QIs for pharmacist home visit services and assess their measurement properties. A three‐step procedure was applied: (1) Selection of existing content‐validated QIs from the international literature and the development of QIs based on national guidelines and home healthcare professionals' opinions (2) Expert panel consensus of a preliminary set of QIs using the RAND/UCLA Appropriateness Method (3) Field testing to evaluate their measurement properties (feasibility, applicability, improvement potential, discriminatory capacity, sensitivity to change, acceptability and implementation issues) followed by exploratory semistructured interviews in Japan. Fifty‐two preliminary QIs were prepared and 45 were judged as “appropriate”by the expert panel. Sixty‐one community pharmacies were recruited to this study with 41 contributing QI data monthly over the 6‐month period. Field testing showed that 20 QIs met six measurement properties (ie, feasibility, applicability, improvement potential, discriminatory capacity, acceptability and implementation issues). Nine of these QIs also had high sensitivity to change. Additionally, interviews identified that the main positive impact on practice of using QIs was the early detection of causes of drug‐related problems but a negative impact was decrease of pharmacists' motivation. Auto extraction of QIs was seen as a major facilitator, given the time taken to manually extract QI data. A set of QIs for pharmacist home visit services was rigorously developed and tested. This QI set may be useful in evaluating the quality of such services.
Publisher: Wiley
Date: 29-06-2016
DOI: 10.1111/BCP.13017
Publisher: Mary Ann Liebert Inc
Date: 04-2010
Abstract: The aim of this study was to analyze changes in the prevalence and incidence of antidepressant use among children and adolescents in Finland post October, 2003. The s le comprised all children and adolescents in Finland aged < or =19.0 years (n = 27,676) who collected one or more reimbursed prescriptions for an antidepressant in noninstitutional and nonhospital settings between January, 1998, and December, 2005. Time-series models were used to compare antidepressant use 60 months before and 24 months after the health advisory issued by the Food and Drug Administration (FDA) in October, 2003. The annual prevalence (users/1,000 youths) of antidepressant use increased from 5.24 in 2002 to 5.93 in 2005. There was an increase in the monthly incidence (users = 1,000 youths) of selective serotonin reuptake inhibitors (SSRIs) use (+0.02498), fluoxetine use (+0.00691), and sertraline use (+0.00727) post October, 2003. When considering preadvisory trends in antidepressant use, only fluoxetine use was higher than the predicted post October 2003, use (<0.001). The use of all other SSRIs was significantly lower than predicted. In contrast to many other countries, the use of antidepressants continued to increase among children and adolescents in Finland post October, 2003. While the rate of fluoxetine use increased, there was a decline in the rate at which all other SSRIs were used.
Publisher: Springer Science and Business Media LLC
Date: 22-08-2015
DOI: 10.1007/S11096-015-0186-0
Abstract: Older people are at increased risk of drug-related problems (DRPs) caused by inappropriate use or underuse of medications which may be increased during care transitions. To examine the effects of applying a validated prescribing appropriateness criteria-set during medication review in a cohort of older (≥65 years) Australians at the time of discharge from hospital. Private hospital and homes of older patients in Sydney, Australia. Cognitively well English speaking patients aged 65 years or over taking five or more medications were recruited. A prescribing appropriateness criteria-set and SF-36 health-related quality of life health (HRQoL) survey were applied to all patients at discharge. Patients were then randomly assigned to receive either usual care (control, n = 91) or discharge medication counselling and a medication review by a clinical pharmacist (intervention, n = 92). Medication review recommendations were sent to the general practitioners of intervention group patients. All patients were followed up at 3 months post discharge, where the prescribing appropriateness criteria-set was reapplied and HRQoL survey repeated. MAIN OUTCOME MEASURES change in the number of prescribing appropriateness criteria met change in HRQoL number and causes of DRPS identified by medication review intervention patient medication recommendation implementation rates. There was no significant difference in the number of criteria applicable and met in intervention patients, compared to control patients, between follow-up and discharge (0.09 ≤ p ≤ 0.97). While the difference between groups was positive at follow-up for SF-36 scores, the only domain that reached statistical significance was that for vitality (p = 0.04). Eighty-eight intervention patient medication reviews identified 750 causes of DRPs (8.5 ± 2.7 per patient). No causes of DRPs were identified in four patients. Of these causes, 76.4 % (573/750) were identified by application of the prescribing appropriateness criteria-set. GPs implemented a relatively low number (42.4 %, 318/750) of recommendations. Application of a prescribing appropriateness criteria-set during medication review in intervention patients did not increase the number of criteria met, nor result in a significant improvement in HRQoL. Higher recommendation implementation rates may require additional facilitators, including a higher quality of collaboration.
Publisher: Springer Science and Business Media LLC
Date: 2006
DOI: 10.2165/00044011-200626070-00003
Abstract: Adverse drug events are a leading cause of morbidity in Australia and internationally. People taking psychotropic drugs for mental illnesses may be particularly susceptible. This study aimed to classify and describe pharmacists' Home Medicines Review (HMR) findings and recommendations for people with mental illnesses. This was a descriptive study conducted from March to November 2003. General practitioners and community pharmacists practising in two regions of metropolitan Sydney were invited to participate. General practitioners recruited and referred community-dwelling people with mental illnesses to receive HMRs conducted by accredited pharmacists. Reviewing pharmacists interviewed 49 people in their homes. During the interviews the pharmacists provided drug information, assessed drug knowledge and beliefs, and assessed drug adherence. Pharmacists then produced written referenced reports that outlined drug-, patient- and prescriber-related findings and recommendations. These findings and recommendations were presented to the referring general practitioners at follow-up case conferences. Drugs were classified using the Anatomical Therapeutic Chemical Classification System. Pharmacists' findings and recommendations were classified using the Clinical Pharmacy Activity Classification System. The most common types of nervous system drugs taken by people who received a HMR were antidepressants (n = 39.33%), analgesics (n = 29.24%) and antipsychotics (n = 17.14%). Pharmacists reported 403 findings and made 360 recommendations for 49 people, with 90% of recommendations being accepted by the referring general practitioners. The most common findings related to potential adverse drug reactions (n = 53, for 47% of people), suspected adverse drug reactions (n = 48, for 55% of people), potential interactions (n = 30, for 37% of people), and people taking additional drugs unbeknown to their referring general practitioner (n = 26, for 25% of people). The most common recommendations were to switch a drug (n = 37, for 49% of people), suggest a non-drug treatment (n = 29, for 41% of people) and to suggest a new drug (n = 27, for 49% of people). At the time of referral, general practitioners documented people to be taking 7.8 +/- 4.4 (mean +/- SD) drugs each (range 1-18). Following home interviews, pharmacists determined people to be taking 9.1 +/- 4.8 drugs (range 1-20). This difference was statistically significant (p < 0.001). Pharmacists identified a high incidence of drug-related problems among people receiving treatment for mental illnesses. Pharmacists also identified a higher incidence of overall drug use than documented by the referring general practitioners. HMRs and case conferences, undertaken collaboratively by general practitioners and pharmacists, may be a useful strategy to identify drug-related problems among people with mental illnesses.
Publisher: SAGE Publications
Date: 07-09-2019
Abstract: Consumers are increasingly using social media to interact with other consumers about health conditions and treatment options. This study aimed to investigate the advantages and disadvantages of using social media for health-related purposes from the consumers’ perspectives. Five focus groups with 36 Australian adults with a chronic condition and on medication were conducted, audio-recorded, transcribed verbatim, and thematically analysed. Consumers reported that social media was very convenient, for accessing health-related information and for peer engagement user-friendly improved their health knowledge empowered them and provided social and emotional support. The disadvantages included information overload, wasting time negative feelings doubts about online information credibility and issues related to online interactions. Despite some disadvantages, health-related use of social media led consumers to feel supported, knowledgeable, and empowered. Consumers’ motivation to keep accessing social media for health-related purposes opens up avenues for the delivery of services via social media.
Publisher: Wiley
Date: 15-08-2010
DOI: 10.1111/J.1365-2753.2010.01375.X
Abstract: Over the past decade medication review services have been implemented in many countries, including Australia, UK and USA. Although, the attitudes and barriers to the implementation of evidence-based medicine have been investigated, the extent to which medication review recommendations are evidence-based is not known. To determine (1) the extent to which pharmacist's recommendations during medication review services were consistent with the evidence-based guides at the time of the review and (2) the nature and extent of drug-related problems (DRPs) and the actions recommended by pharmacists to resolve DRPs. A retrospective review of Home Medicines Review cases performed on 224 community-dwelling older people (65 years or older). The chi-squared test for categorical variables was used to compare the proportion of recommendations that were evidence-based and recommendations for which no evidence could be identified in the most common Australian information sources. DRPs and the actions recommended to resolve the DRPs were classified according to previously employed criteria. Pharmacists made a total of 1114 therapeutic recommendations to general practitioners, of which 964 required supporting pharmacotherapeutic evidence. The majority (94%) of the pharmacists' recommendations were in accordance with the evidence-based guides, as compared with the recommendations for which no evidence could be identified (P < 0.001). Pharmacists reported that 98% of the patients had at least one problem with use of their medication detected. The majority of the actions recommended by pharmacists during the medication review process were consistent with the literature embedded in key Australian information sources. Medication management in older people is complex and challenging, as highlighted by the DRPs identified in 98% of our patients. A suitably trained pharmacist, with full access to the patient, medical record and supporting resources, can help to improve the quality use of medicines in this at-risk population.
Publisher: BMJ
Date: 02-2016
Publisher: SAGE Publications
Date: 31-03-2009
DOI: 10.1345/APH.1L505
Abstract: Continuity of care is important for the delivery of quality health care. Despite the abundance of research on this concept in the medical and nursing literature, there is a lack of consensus on its definition. As pharmacists have moved beyond their historical product-centered practice, a source of patient-centered research on continuity of care for practice application is required. To determine the scope of research in which pharmacists were directly involved in patients' continuity of care and to examine how the phrase continuity of care was defined and applied in practice. A working definition of continuity of care and a tool for relevance quality assessment of search articles were developed. MEDLINE, International Pharmaceutical Abstracts, EMBASE, and the Cochrane Collaboration evidence-based medicine reviews and bibliographies were searched (1996–March 2008). Reporting clarity was assessed by the Consolidated Standards of Reporting Trials checklist and outcomes were grouped by economic, clinical, and/or humanistic classification. The search yielded 21 clinical and randomized controlled trials, including 11 pharmacist-only and 10 multidisciplinary studies. A broad range of research topics was identified and detailed analysis provided ready reference for considerations of research replication or practice application. Studies revealed a range of research aims, settings, subject characteristics, attrition rates and group sizes, interventions, measurement tools, outcomes, and definitions of continuity of care. Research focused on patients with depression (n = 4), cardiovascular disease {n = 4), diabetes (n = 2), and dyslipidemia (n = 1) specific drugs included non–tricyclic antidepressants, cardiovascular drugs, and benzodiazepines. From the proposed endpoints of economic cost (n = 6) and clinical (n = 14) and humanistic (n = 16) outcomes, 15 studies reported statistically significant results. Medication management at primary, secondary, and tertiary levels of care indicated an expanded role and collaboration of pharmacists in continuity of care. However, the exclusion of disadvantaged patients in 19 studies is at odds with continuity of care for these patients, who may have been the most in need for the same reason that they were excluded.
Publisher: Elsevier BV
Date: 05-2017
DOI: 10.1016/J.SAPHARM.2016.06.012
Abstract: Research concerning the overprescribing of psychotropic medicines in nursing homes suggests that organizational climate plays a significant role in the use of psychotropic medicines. Organizational climate refers to how members of the organization perceive their work environment as well as interactions with each other or outsiders. This study aimed to explore the key dimensions of organizational climate and their subsequent influence on the use of psychotropic medicines. Semi-structured interviews were conducted with 40 on-site and visiting staff from eight nursing homes in Sydney, Australia. Purposive s ling was used to recruit participants representing a broad range of health disciplines and roles. Transcripts were content coded for participants' perceptions related to the work environment and descriptions of psychotropic medicines use. Thematic analysis was used to derive key concepts. Three salient dimensions of organizational climate were linked to the use of psychotropic medicines in nursing homes: staffing, managerial expectations and teamwork among visiting and on-site staff. Inadequate staffing levels were perceived to influence on-site staff requests for initiation of psychotropic medicines to cope with high workload. Participants reported managers that prioritized the non-pharmacological management of behavioral disturbances led other on-site staff to have a reduced preference for psychotropic medicines. In addition, trust and open communication among on-site and visiting staff facilitated the cessation of psychotropic medicines. This study illustrates that organizational climate is an important factor influencing the use of psychotropic medicines. Furthermore, the study highlights what aspects of organizational climate need to be addressed to reduce the inappropriate prescribing of psychotropic medicines.
Location: United States of America
No related grants have been discovered for Timothy Chen.