ORCID Profile
0000-0002-3499-1514
Current Organisation
University of Sydney
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Research Topics
In Research Link Australia (RLA), "Research Topics" refer to ANZSRC FOR and SEO codes. These topics are either sourced from ANZSRC FOR and SEO codes listed in researchers' related grants or generated by a large language model (LLM) based on their publications.
Top 5 Research Topics
ANZSRC Field of Research (FoR)
Studies in Human Society not elsewhere classified | Public Health and Health Services | Specialist Studies in Education | Health, Clinical And Counselling Psychology | Developmental Psychology And Ageing | Sociology | Sociology not elsewhere classified | Public Health and Health Services not elsewhere classified | Health Counselling | Educational Psychology |
ANZSRC Socio-Economic Objective (SEO)
Expanding Knowledge through Studies of Human Society | Behaviour and Health | Social Structure and Health | Health Education and Promotion | Health education and promotion | Child health | Behaviour and health
Related Links
Publications
Experiences of community pharmacists involved in the delivery of a specialist asthma service in Australia
Publisher: Springer Science and Business Media LLC
Date: 18-06-2012
Inhaler reminders improve adherence with controller treatment in primary care patients with asthma
Publisher: Elsevier BV
Date: 12-2014
DOI: 10.1016/J.JACI.2014.05.041
Abstract: Poor adherence contributes to uncontrolled asthma. Pragmatic adherence interventions for primary care settings are lacking. To test the effectiveness of 2 brief general practitioner (GP)-delivered interventions for improving adherence and asthma control. In a 6-month cluster randomized 2 × 2 factorial controlled trial, with GP as unit of cluster, we compared inhaler reminders and feedback (IRF) and/or personalized adherence discussions (PADs) with active usual care alone all GPs received action plan and inhaler technique training. GPs enrolled patients prescribed combination controller inhalers, with suboptimal Asthma Control Test (ACT) scores (ACT score ≤19). Inhaler monitors recorded fluticasone propionate/salmeterol adherence (covertly for non-IRF groups) and, in IRF groups, provided twice-daily reminders for missed doses, and adherence feedback. PAD GPs received communication training regarding adherence. Outcomes collected every 2 months included ACT scores (primary outcome) and severe exacerbations. Intention-to-treat mixed-model analysis incorporated cluster effect and repeated measures. A total of 43 GPs enrolled 143 patients with moderate-severe asthma (mean age, 40.3 ± 15.2 years ACT score, 14.6 ± 3.8 fluticasone propionate dose, 718 ± 470 μg). Over 6 months, adherence was significantly higher in the IRF group than in non-IRF groups (73% ± 26% vs 46% ± 28% of prescribed daily doses P < .0001), but not between PAD and non-PAD groups. Asthma control improved overall (mean change in ACT score, 4.5 ± 4.9 P < .0001), with no significant difference among groups (P = .14). Severe exacerbations were experienced by 11% of the patients in IRF groups and 28% of the patients in non-IRF groups (P = .013 after adjustment for exacerbation history P = .06). Inhaler reminders offer an effective strategy for improving adherence in primary care compared with a behavioral intervention or usual care, although this may not be reflected in differences in day-to-day asthma control.
Consumer perspectives of medication-related problems following discharge from hospital in Australia: a quantitative study
Publisher: Oxford University Press (OUP)
Date: 26-04-2016
Abstract: The aim of this study was to investigate the consumer's perspectives and experiences regarding medication related problems (MRPs) following discharge from hospital. A cross-sectional study was conducted using an online 80-question survey. Survey participants were recruited through an online market research company. Five hundred and six participants completed the survey. Participants were included if they were aged 50 years or older, taking 5 or more prescription medicines, had been admitted to hospital with a minimum stay of 24 h, admitted to hospital within the last 4 months and discharged from hospital within the last 1 month. The survey comprised questions measuring: health literacy, health status, medication safety (measured by reported MRPs), missed dose(s), role of health professionals, health services and cost, and socio-demographic status. Descriptive and univariate statistics and logistic regression analysis was performed to examine the predictors of experiencing MRPs. Four main risk factors of MRPs emerged as significant: health literacy (P < 0.05), health status (P < 0.05), consumer engagement (P < 0.05) and cost of medicines (P = 0.001). Participants reporting a lack of perceived control over their medicines (OR 6.3 95% CI: 3.4-11.8) or those who played less of a role in follow-up discussions with their healthcare professionals (OR 7.6 95% CI: 1.3-45.7) were more likely to experience a self-reported MRP. This study provides insight into consumers' experiences and perceptions of self-reported MRPs following hospital discharge. Results highlight novel findings demonstrating the importance of consumer engagement in developing processes to ensure medication safety on patient discharge.
Does personality influence how people with asthma manage their condition?
Publisher: Informa UK Limited
Date: 14-05-2014
DOI: 10.3109/02770903.2014.910220
Abstract: Personality traits have been found to be associated with the management of chronic disease, however, there is limited research on these relationships with respect to asthma. Asthma management and asthma control are often suboptimal, representing a barrier to patients achieving good health outcomes. This explorative study aimed to investigate the relationship between correlates of asthma management and personality traits. Participants completed a postal survey comprising validated self-report questionnaires measuring personality traits (neuroticism, extraversion, openness to experiences, agreeableness, conscientiousness), asthma medication adherence, asthma control and perceived control of asthma. Relationships between asthma management factors and personality traits were examined using correlations and regression procedures. A total of 77 surveys were returned from 94 enrolled participants. Significant relationships were found between personality traits and (i) adherence to asthma medications, and (ii) perceived control of asthma. Participants who scored high on the conscientiousness dimension of personality demonstrated higher adherence to their asthma medications. Women who scored low on the agreeableness dimension of personality and high on the neuroticism dimension had significantly lower perceived confidence and ability to manage their asthma. No statistically significant associations were found between asthma control and personality traits. Three of the five personality traits were found to be related to asthma management. Future research into the role of personality traits and asthma management will assist in the appropriate tailoring of interventional strategies to optimize the health of patients with asthma.
Application of Australian clinical management guidelines: The current state of play in a sample of young people living with Type 1 diabetes in the state of New South Wales and the Australian Capital Territory
Publisher: Elsevier BV
Date: 09-2011
DOI: 10.1016/J.DIABRES.2011.04.017
Abstract: To describe care provided to a s le of young Australians with Type 1 diabetes, and benchmark this against national guidelines. 158 children and adolescents with Type 1 diabetes, aged 8-19 years, were recruited independent of their source of care as part of a three-year longitudinal study. Data were gathered annually regarding type of health-care services attended, demographic, health-care and self-care information. Participants were also telephoned quarterly to ascertain planned and actual attendance to diabetes services, and current diabetes management. A capillary s le was collected annually for HbA1c determination. The mean HbA1c of participants was significantly higher than recommended levels. The annual number of visits to diabetes clinics also fell short of the stipulated 3-4 visits a year and less than 25% of participants received care from all recommended multidisciplinary team members. While the majority of care was provided through the publicly funded system, there was an increasing reliance on privately funded psychologists. Standards of care received by this group of young Australians and levels of glycaemic control fall short of treatment guidelines, highlighting the need to identify ways to ensure equitable access to specialist multidisciplinary care for all young people affected by diabetes.
General practitioner-delivered adherence counseling in asthma: Feasibility and usefulness of skills, training and support tools
Publisher: Informa UK Limited
Date: 30-10-2016
DOI: 10.3109/02770903.2015.1091473
Abstract: Poor medication adherence contributes to uncontrolled asthma in primary care. Good doctor-patient communication around adherence increases patients' medication taking but general practitioners (GPs) often feel poorly equipped to provide effective adherence counseling. This study aimed to assess the feasibility and usefulness of adherence counseling training, skills and support tools for GPs. Twenty-five GPs enrolled in a 6-month cluster randomized-controlled trial of adherence interventions for asthma were randomized to an intervention delivering personalized adherence discussions. They received 2 hours training in delivering brief, motivational-interviewing-based adherence counseling and were provided with asthma-specific counseling support tools. At baseline, post-training and study end, GPs rated the training, reported confidence/frequency of using counseling skills and satisfaction with their consultations, and commented on support tools. Patients reported their barriers to adherence and rated their GPs empathy at baseline and at 6-months. 96% of GPs rated adherence counseling training as very/extremely useful. At the end of the study (17 ± 4 months) GPs' confidence in using counseling skills increased, as did the frequency they applied the skills and their satisfaction with consultations. GPs were positive about counseling support tools, stating that they were easy to use and facilitated covering more ground within single consultations. Half the GPs expressed some difficulty implementing counseling due to time constraints. Patients reported good GP empathy and no significant change in adherence barriers. GPs valued counseling training and support tools. Although implementation was sometimes challenging, GPs reported increased frequency of use and confidence in applying adherence counseling skills, which persisted for 17 months.
Healthcare professionals' perspectives on the use of medicinal cannabis to manage chronic pain: A systematic search and narrative review.
Publisher: Wiley
Date: 10-09-2022
DOI: 10.1111/PAPR.13161
Abstract: Chronic pain is a global public health problem that negatively impacts in iduals' quality of life and imposes a substantial economic burden on societies. The use of medicinal cannabis (MC) is often considered by patients to help manage chronic pain as an alternative or supplement to more conventional treatments, given enabling legalization in a number of countries. However, healthcare professionals involved in providing guidance for patients related to MC are often doing so in the absence of strong evidence and clinical guidelines. Therefore, it is crucial to understand their perspectives regarding the clinical use and relevance of MC for chronic pain. As little is known about attitudes of HCPs with regard to MC use for chronic pain specifically, the aim of this review was to identify and synthesize the published evidence on this topic. A systematic search was conducted across six databases: MEDLINE, EMBASE, CINAHL, Scopus, Web of Science, and PubMed from 2001 to March 26, 2021. Three authors independently performed the study selection and data extraction. Thematic analysis was undertaken to identify key themes. A total of 26 studies were included, involving the United States, Israel, Canada, Australia, Ireland, and Norway, and the perspectives of physicians, nurses, and pharmacists. Seven key themes were identified: MC as a treatment option for chronic pain, and perceived indicated uses willingness to prescribe MC legal issues low perceived knowledge and the need for education comparative safety of MC versus opioids addiction and abuse and perceived adverse effects CONCLUSION: To support best practice in the use of MC for chronic pain, healthcare professionals require education and training, as well as clinical guidelines that provide evidence-based information about efficacy, safety, and appropriate dosage of products for this indication. Until these gaps are addressed, healthcare professionals will be limited in their capacity to make treatment recommendations about MC for people atients with chronic pain.
The role of non-clinicians in a goal setting model for the management of allergic rhinitis in community pharmacy settings
Publisher: Elsevier BV
Date: 11-2011
DOI: 10.1016/J.PEC.2010.10.003
Abstract: To test the relative effects of a clinician versus non-clinician delivered goal setting intervention to assist patients presenting with Intermittent Allergic Rhinitis (IAR) in community pharmacies. A 10-day mixed-method, parallel group repeated measures study was conducted in Sydney. Clinicians (pharmacists) and non-clinicians (pharmacy assistants) recruited patients suffering IAR. Intervention group pharmacy staff delivered a brief structured goal setting intervention to support IAR patient self-management whilst the control group delivered standard care. One hundred and fifty participants (N=77 intervention N=73 control) were recruited at 20 community pharmacies. Both groups significantly improved on all outcome measures when assisted by either clinicians or non-clinicians. The intervention group patients supported by non-clinicians made significant improvements in self-efficacy and quality of life compared to the control group supported by non-clinicians. Strategies devised to control IAR triggers reflected practical actions whereas adherence and dose information strategies addressed IAR symptoms. Adherence did not impact significantly on self-reported symptom severity. Both clinicians and non-clinicians can deliver this service. There is a need for a detailed and practical approach to assist patients towards a goal-directed and autonomous management of IAR. With training non-clinicians can support patients with IAR, reducing the time constraints and workload for clinicians.
An International Comparison Study of Pharmacy Students’ Achievement Goals and their Relationship to Assessment Type and Scores
Publisher: Elsevier BV
Date: 04-2015
DOI: 10.5688/AJPE79335
Using drawings to explore patients' perceptions of their illness: a scoping review
Publisher: Informa UK Limited
Date: 11-2016
DOI: 10.2147/JMDH.S120300
Role of community pharmacists in asthma - Australian research highlighting pathways for future primary care models
Publisher: OMICS Publishing Group
Date: 30-04-2011
DOI: 10.4066/AMJ.2011.790
Personality, Attentional Biases towards Emotional Faces and Symptoms of Mental Disorders in an Adolescent Sample
Publisher: Public Library of Science (PLoS)
Date: 05-06-2015
Students' Goals, Self-Efficacy, Self-Handicapping, and Negative Affective Responses: An Australian Senior School Student Study
Publisher: Elsevier BV
Date: 07-2002
Healthcare professional versus patient goal setting in intermittent allergic rhinitis
Publisher: Elsevier BV
Date: 2008
DOI: 10.1016/J.PEC.2007.09.004
Abstract: To examine the impact of healthcare professional versus patient goal setting for the self-management of intermittent allergic rhinitis (AR) on symptom severity and quality of life. This was a 6 week, parallel group study. Group A participants, with pharmacist facilitation, nominated personally relevant goals and strategies relating to their AR. Group B participants had their goals and strategies set by the pharmacist. The main outcome measures used included perceived symptom severity and quality of life. In addition, goals and strategies data from participants of both groups were collected and analysed. Both groups demonstrated significant improvements in symptom severity and quality of life scores however Group B symptom severity scores improved more. Group B set a greater number of goals and strategies which were better structured and more task specific. This is the first study to investigate the impact of goal setting on patient behaviour in a chronic yet episodic illness. Our results suggest that self-management goals set by the healthcare professional which are clinically indicated but tailored to the patient's nominated symptoms yields better outcomes than goals nominated by the patient. A brief, structured intervention, tailored to patient symptoms, can enhance self-management of intermittent allergic rhinitis.
Severe asthma: Current management, targeted therapies and future directionsA roundtable report
Publisher: Wiley
Date: 30-11-2017
DOI: 10.1111/RESP.12957
Abstract: Asthma is a chronic respiratory disease characterized by respiratory symptoms, airway inflammation, airway obstruction and airway hyper-responsiveness. Asthma is common and directly affects 10% of Australians, 1-5% of adults in Asia and 300 million people worldwide. It is a heterogeneous disorder with many clinical, molecular, biological and pathophysiological phenotypes. Current management strategies successfully treat the majority of patients with asthma who have access to them. However, there is a subset of an estimated 5-10% of patients with asthma who have severe disease and are disproportionately impacted by symptoms, exacerbations and overall illness burden. The care required for this relatively small proportion of patients is also significant and has a major impact on the healthcare system. A number of new therapies that hold promise for severe asthma are currently in clinical trials or are entering the Australian and international market. However, recognition of severe asthma in clinical practice is variable, and there is little consensus on the best models of care or how to integrate emerging and often costly therapies into current practice. In this article, we report on roundtable discussions held with severe asthma experts from around Australia, and make recommendations about approaches for better patient diagnosis and assessment. We assess current models of care for patient management and discuss how approaches may be optimized to improve patient outcomes. Finally, we propose mechanisms to assess new therapies and how to best integrate these approaches into future treatment.
Asthma disease management-Australian pharmacists' interventions improve patients' asthma knowledge and this is sustained
Publisher: Elsevier BV
Date: 06-2011
DOI: 10.1016/J.PEC.2011.05.001
Abstract: To assess any improvements in knowledge of asthma patients after a tailored education program delivered by pharmacists and measure the sustainability of any improvements. To ascertain patients' perceptions about any changes in their knowledge. Ninety-six specially trained pharmacists recruited patients based on their risk of poor asthma control. A tailored intervention was delivered to patients based on in idual needs and goals, and was conducted at three or four time points over six months. Asthma knowledge was assessed at the beginning and end of the service, and six and 12 months after it had ended. Patients' perceptions of the impact of the service on their knowledge were explored qualitatively in interviews. The 96 pharmacists recruited 570 patients, 398 (70%) finished. Asthma knowledge significantly improved as a result of the service (7.65 ± 2.36, n=561, to 8.78 ± 2.14, n=393). This improvement was retained for at least 12 months after the service. Patients reported how the knowledge and skills gained had led to a change in the way they managed their asthma. Improvements in knowledge are achievable and sustainable if pharmacists used targeted educational interventions. Pharmacist educational interventions are an efficient way to improve asthma knowledge in the community.
Treating asthma with a self-management model of illness behaviour in an Australian community pharmacy setting
Publisher: Elsevier BV
Date: 04-2007
DOI: 10.1016/J.SOCSCIMED.2006.11.006
Abstract: Asthma affects a considerable proportion of the population worldwide and presents a significant health problem in Australia. Given its chronic nature, effective asthma self-management approaches are important. However, despite research and interventions targeting its treatment, the management of asthma remains problematic. This study aimed to develop, from a theoretical basis, an asthma self-management model and implement it in an Australian community pharmacy setting in metropolitan Sydney, using a controlled, parallel-groups repeated-measures design. Trained pharmacists delivered a structured, step-wise, patient-focused asthma self-management program to adult participants over a 9-month period focusing on identification of asthma problems, goal setting and strategy development. Data on process- clinical- and psychosocial-outcome measures were gathered. Results showed that participants set an average of four new goals and six repeated goals over the course of the intervention. Most common goal-related themes included asthma triggers, asthma control and medications. An average of nine strategies per participant was developed to achieve the set goals. Common strategies involved visiting a medical practitioner for review of medications, improving adherence to medications and using medications before exercise. Clinical and psychosocial outcomes indicated significant improvements over time in asthma symptom control, asthma-related self-efficacy and quality of life, and negative affect. These results suggest that an asthma self-management model of illness behaviour has the potential to provide patients with a range of process skills for self-management, and deliver improvements in clinical and psychosocial indicators of asthma control. The results also indicate the capacity for the effective delivery of such an intervention by pharmacists in Australian community pharmacy settings.
Student experience and tertiary expectations: factors predicting academic literacy amongst first‐year pharmacy students
Publisher: Informa UK Limited
Date: 14-03-2008
“I have nine specialists. They need to swap notes!” Australian patients’ perspectives of medication‐related problems following discharge from hospital
Publisher: Wiley
Date: 17-03-2017
DOI: 10.1111/HEX.12556
Self-Monitoring of Blood Glucose
Publisher: Mary Ann Liebert Inc
Date: 02-2015
Abstract: This article highlights the need and the value of SMBG in type 2 diabetes. More importantly, the article brings out its role for long-term complications of type 2 diabetes if glucose patterns are evaluated and necessary action is taken for therapeutic changes in time.
Glycemic control and type 1 diabetes: The differential impact of model of care and income
Publisher: Hindawi Limited
Date: 24-02-2011
DOI: 10.1111/J.1399-5448.2010.00670.X
Abstract: To examine the effect of model of care (specialist care vs. shared care), and income, on glycemic control in a s le of young people with type 1 diabetes. A total of 158 children and young people with type 1 diabetes, aged 8-19 yr, and their families, were recruited independent of their source of care as part of a longitudinal, cross-sectional exploratory study. At enrollment, participants completed a series of questionnaires and underwent a structured interview to gather data regarding the type of specialist and healthcare services attended, as well as demographic, healthcare, and self-care information. Capillary s le was taken for HbA1c determination. The mean HbA1c for the group as a whole was 8.6 ± 1.4%. There was no effect for model of care on glycemic control. However, young people living in households with a family income of less than AUS$83,000 (US$73,500) per year had a significantly higher mean HbA1c than their counterparts reporting a higher household income (8.8 ± 1.4% vs. 8.3 ± 1.1% p = 0.019). Although no differences were found with respect to the short-term impact of specialist vs. shared care, it is evident that more support is required to improve glycemic control in this s le of young people where the mean level of HbA1c was significantly higher than target. Further research is also indicated to determine the relationship between glycemic control and socioeconomic status.
Understanding patient perspectives on the use of gamification and incentives in mHealth applications to improve medication adherence: Qualitative Study (Preprint)
Publisher: JMIR Publications Inc.
Date: 14-07-2023
Abstract: edication non-adherence remains a significant health and economic burden in many developed countries. Emerging smartphone interventions have started to utilize features such as gamification and financial incentives with varying degrees of effectiveness on medication adherence and health outcomes. A more consistent approach to applying these features, informed by patient perspectives, may result in more predictable and beneficial results from this type of intervention. his qualitative study aims to identify patient perspectives on the use of gamification and financial incentives in mHealth apps for medication adherence, in Australian patients taking medication for chronic conditions. total of 19 participants were included in iterative semi-structured online focus groups conducted between May and December 2022. The facilitator used exploratory prompts relating to mHealth apps, gamification, and financial incentives, along with concepts raised from previous focus groups. Transcriptions were independently coded to develop a set of themes. hree themes were identified: (1) purpose-driven design, (2) trust-based standards, and (3) personal choice. All participants acknowledged gamification and financial incentives as potentially effective features in mHealth apps for medication adherence. However, they also indicated that the effectiveness heavily depended on implementation and execution. Main concerns relating to gamification and financial incentives were perceived trivialization and potential for abuse, respectively. he study’s findings provide a foundation for developers seeking to apply these novel features in an app intervention for a general cohort of patients. However, the study highlights the need for standards for mHealth apps for medication adherence, with particular attention to the use of gamification and financial incentives. Future research with patients and stakeholders across the mHealth app ecosystem should be explored to formalize and validate a set of standards or framework.
Young People’s Preferences for an Asthma Self-Management App Highlight Psychological Needs: A Participatory Study
Publisher: JMIR Publications Inc.
Date: 11-04-2017
DOI: 10.2196/JMIR.6994
Diabetes Medication Assistance Service Stage 1: impact and sustainability of glycaemic and lipids control in patients with Type 2 diabetes
Publisher: Wiley
Date: 13-07-2011
DOI: 10.1111/J.1464-5491.2011.03296.X
Abstract: To investigate (i) optimal intensity (four visits vs. six visits) and duration (6 vs. 12 months) of the Diabetes Medication Assistance Service in community pharmacy and (ii) sustainability of improvements in patients' diabetes control associated with differing intensities of intervention. A national quota s le of 90 community pharmacies in Australia were randomly assigned into group 1 (6-month Diabetes Medication Assistance Service) or group 2 (12-month Diabetes Medication Assistance Service) and subsequently recruited a total of 524 patients. A wide range of clinical (HbA(1c) , blood pressure, lipids) and quality-of-life outcome measures were assessed. The 6- and 12-month Diabetes Medication Assistance Service resulted in significant and similar reductions in HbA(1c) (-0.9 mmol/mol 95% CI -0.7 to -1.1) -, total cholesterol (-0.3 mmol/l 95% CI -0.1 to -0.4) and triglycerides (-0.3 mmol/l 95% CI -0.1 to -0.5). There was also a significant reduction in the number of patients who were at risk of having a cardiovascular event in the next 10 years. For the subset of patients for whom data were available at baseline, completion and 18 months, improvements in HbA(1c) and total cholesterol were sustained at 18 months and triglycerides showed a further improvement at 18 months. The Diabetes Medication Assistance Service resulted in significant improvements in diabetes control that were independent of intensity and duration of the service and showed evidence of being sustained at 18 months. The extent and sustainability of clinical improvements achieved by the Diabetes Medication Assistance Service, together with the resulting reduction in cardiovascular risk, should translate into future cost savings to healthcare systems by delaying and reducing diabetes-related complications.
The Use of Gamification and Incentives in Mobile Health Apps to Improve Medication Adherence: Scoping Review
Publisher: JMIR Publications Inc.
Date: 21-02-2022
DOI: 10.2196/30671
Abstract: Emerging health care strategies addressing medication adherence include the use of direct-to-patient incentives or elements adapted from computer games. However, there is currently no published evidence synthesis on the use of gamification or financial incentives in mobile apps to improve medication adherence. The aim of this scoping review is to synthesize and appraise the literature pertaining to the use of mobile apps containing gamification or financial incentives for medication adherence. There were two objectives: to explore the reported effectiveness of these features and to describe and appraise the design and development process, including patient involvement. The following databases were searched for relevant articles published in English from database inception to September 24, 2020: Embase, MEDLINE, PsycINFO, CINAHL, and Web of Science. The framework by Arksey and O’Malley and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist guided this scoping review. Using a systematic screening process, studies were included if incentives or game features were used within mobile apps to specifically address medication adherence. An appraisal using risk of bias tools was also applied to their respective study design. A total of 11 studies from the initial 691 retrieved articles were included in this review. Across the studies, gamification alone (9/11, 82%) was used more than financial incentives (1/11, 9%) alone or a combination of the two (1/11, 9%). The studies generally reported improved or sustained optimal medication adherence outcomes however, there was significant heterogeneity in the patient population, methodology such as outcome measures, and reporting of these studies. There was considerable variability in the development process and evaluation of the apps, with authors opting for either the waterfall or agile methodology. App development was often guided by a theory, but across the reviewed studies, there were no common theories used. Patient involvement was not commonly evident in predevelopment phases but were generally reserved for evaluations of feasibility, acceptance, and effectiveness. Patient perspectives on gamified app features indicated a potential to motivate positive health behaviors such as medication adherence along with critical themes of repetitiveness and irrelevance of certain features. The appraisal indicated a low risk of bias in most studies, although concerns were identified in potential confounding. To effectively address medication adherence via gamified and incentivized mobile apps, an evidence-based co-design approach and agile methodology should be used. This review indicates some adoption of an agile approach in app development however, patient involvement is lacking in earlier stages. Further research in a generalized cohort of patients living with chronic conditions would facilitate the identification of barriers, potential opportunities, and the justification for the use of gamification and financial incentives in mobile apps for medication adherence.
Community Pharmacy, Disease State Management, and Adherence to Medication
Publisher: Springer Science and Business Media LLC
Date: 2008
Glycemic control and blood glucose monitoring over time in a sample of young australians with type 1 diabetes: The role of personality
Publisher: American Diabetes Association
Date: 14-09-2013
DOI: 10.2337/DC12-1743
Abstract: To determine whether personality traits (conscientiousness, agreeableness, emotional regulation, extraversion, and openness to experience) are associated with glycemic control and blood glucose monitoring behavior, and change or stability of these outcomes over time, in young people with type 1 diabetes. A 3-year longitudinal study was conducted using data from 142 in iduals with type 1 diabetes, 8–19 years of age. Personality was assessed at baseline using the Five-Factor Personality Inventory for Children. Data relating to glycemic control (HbA1c) and frequency of blood glucose monitoring (based on meter memory) were collected annually. Relationships between personality traits and HbA1c and monitoring frequency were examined using regression models and mixed-design ANOVA. Three of the Five-Factor domains were independently associated with glycemic control. In iduals high in conscientiousness and agreeableness had a lower and more stable HbA1c across the 3-year study period. In contrast, the HbA1c of in iduals scoring low on these traits was either consistently worse or deteriorated over time. Low or high emotional regulation scores were also associated with worse glycemic control. By the third year, these domains, together with initial HbA1c, accounted for 39% of HbA1c variance. Conscientiousness was the only personality factor associated with blood glucose monitoring behavior. Results of this study underline the importance of personality in contributing to diabetes outcomes. Attention to a young person’s personality, and appropriate tailoring of diabetes management to ensure an in idualized approach, may help to optimize diabetes outcomes.
'Help for Hay Fever', a goal-focused intervention for people with intermittent allergic rhinitis, delivered in Scottish community pharmacies: Study protocol for a pilot cluster randomized controlled trial
Publisher: Springer Science and Business Media LLC
Date: 15-07-2013
Abstract: Despite the availability of evidence-based guidelines for managing allergic rhinitis in primary care, management of the condition in the United Kingdom (UK) remains sub-optimal. Its high prevalence and negative effects on quality of life, school performance, productivity and co-morbid respiratory conditions (in particular, asthma), and high health and societal costs, make this a priority for developing novel models of care. Recent Australian research demonstrated the potential of a community pharmacy-based ‘goal-focused’ intervention to help people with intermittent allergic rhinitis to self-manage their condition better, reduce symptom severity and improve quality of life. In this pilot study we will assess the transferability of the goal-focused intervention to a UK context, the suitability of the intervention materials, procedures and outcome measures and collect data to inform a future definitive UK randomized controlled trial (RCT). A pilot cluster RCT with associated preliminary economic analysis and embedded qualitative evaluation. The pilot trial will take place in two Scottish Health Board areas: Gr ian and Greater Glasgow & Clyde. Twelve community pharmacies will be randomly assigned to intervention or usual care group. Each will recruit 12 customers seeking advice or treatment for intermittent allergic rhinitis. Pharmacy staff in intervention pharmacies will support recruited customers in developing strategies for setting and achieving goals that aim to avoid/minimize triggers for, and eliminate/minimize symptoms of allergic rhinitis. Customers recruited in non-intervention pharmacies will receive usual care. The co-primary outcome measures, selected to inform a s le size calculation for a future RCT, are: community pharmacy and customer recruitment and completion rates and effect size of change in the validated mini-Rhinoconjunctivitis Quality of Life Questionnaire between baseline, one-week and six-weeks post-intervention. Secondary outcome measures relate to changes in symptom severity, productivity, medication adherence and self-efficacy. Quantitative data about accrual, retention and economic measures, and qualitative data about participants’ experiences during the trial will be collected to inform the future RCT. This work will lay the foundations for a definitive RCT of a community pharmacy-based ‘goal-focused’ self-management intervention for people with intermittent allergic rhinitis. Results of the pilot trial are expected to be available in April 2013. Current Controlled Trials ISRCTN43606442
Feasibility and Effectiveness of an Evidence-Based Asthma Service in Australian Community Pharmacies: A Pragmatic Cluster Randomized Trial
Publisher: Informa UK Limited
Date: 28-12-2013
DOI: 10.3109/02770903.2012.754463
Abstract: To test the feasibility, effectiveness, and sustainability of a pharmacy asthma service in primary care. A pragmatic cluster randomized trial in community pharmacies in four Australian states/territories in 2009. Specially trained pharmacists were randomized to deliver an asthma service in two groups, providing three versus four consultations over 6 months. People with poorly controlled asthma or no recent asthma review were included. Follow-up for 12 months after service completion occurred in 30% of randomly selected completing patients. Outcomes included change in asthma control (poor and fair/good) and Asthma Control Questionnaire (ACQ) score, inhaler technique, quality of life, perceived control, adherence, asthma knowledge, and asthma action plan ownership. Ninety-six pharmacists enrolled 570 patients, with 398 (70%) completing. Asthma control significantly improved with both the three- and four-visit service, with no significant difference between groups (good/fair control 29% and 21% at baseline, 61% and 59% at end, p = .791). Significant improvements were also evident in the ACQ (mean change 0.56), inhaler technique (17-33% correct baseline, 57-72% end), asthma action plan ownership (19% baseline, 56% end), quality of life, adherence, perceived control, and asthma knowledge, with no significant difference between groups for any variable. Outcomes were sustained at 12 months post-service. The pharmacy asthma service delivered clinically important improvements in both a three-visit and four-visit service. Pharmacists were able to recruit and deliver the service with minimal intervention, suggesting it is practical to implement in practice. The three-visit service would be feasible and effective to implement, with a review at 12 months.
When baby's chronic illness and disability interfere with breastfeeding: Women's emotional adjustment
Publisher: Elsevier BV
Date: 07-2013
DOI: 10.1016/J.MIDW.2012.07.011
Abstract: to explore the emotional adjustments that women make when their baby's chronic illness or disability threatens breastfeeding. qualitative descriptive study and exploratory secondary analysis of narratives from five breastfeeding women in the UK whose babies experienced a chronic condition. three key themes were discerned: (1) 'Overwhelmed'--feelings of shock and helplessness. Engagement in the practical issues of breastfeeding, relying on others and receiving emotional support from them helped. (2) 'Under acknowledged'--women spoke of not being listened to or taken seriously. Focus on the medical condition de-valued the contribution of breastfeeding. (3) 'Striving for normality'--reframing the situation and readjusting goals and expectations helped adjustment to a 'normal' life. varying levels of emotional adjustment were experienced by the women, and a process or path reflected their efforts to cope. Adjustments are discussed in terms of practical issues of coping and biographical disruption, thereby raising awareness of challenging aspects. Breastfeeding provided a sense of control and purpose. Understanding issues around breastfeeding an ill or disabled child can help health-care providers offer more appropriate care to women who wish to breast feed in spite of chronic illness.
<b><i>Schistosoma</i></b> Antigens Downmodulate the in vitro Inflammatory Response in Individuals Infected with Human T Cell Lymphotropic Virus Type 1
Publisher: S. Karger AG
Date: 2013
DOI: 10.1159/000348700
Abstract: Human T cell lymphotropic virus type 1 (HTLV-1) is the causal agent of HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). While the immune response to HTLV-1 infection is polarized to the Th1-type, chronic helminth infections drive the Th2- and T regulatory-type, and are able to downregulate the inflammatory response in some autoimmune diseases. b i Objective: /i /b To evaluate whether i Schistosoma /i spp. antigens alter the in vitro cytokine response in HTLV-1 infection. b i Methods: /i /b The recombinant i Schistosoma /i antigens Sm29 and ShTSP2 (tetraspanin) and PIII, a fraction of i the Schistosoma mansoni /i adult worm antigen were added to peripheral blood mononuclear cell (PBMC) cultures of HTLV-1-infected in iduals and the levels of interferon (IFN)-& #947 and interleukin (IL)-10 in the supernatants were measured using the ELISA sandwich technique. b i Results: /i /b Compared to the levels of cytokine in nonstimulated cultures, the levels of IFN-& #947 were reduced in 50, 47 and 50% of patients by the presence of Sm29, ShTsp2 and PIII, respectively. The downregulation of IFN-& #947 production in the presence of Sm29 antigen was observed mainly in subjects who had lower basal levels of this cytokine. The levels of IL-10, however, increased by the addition of the three antigens in the cultures in 74, 62 and 44% of in iduals, respectively. In addition, there was a decrease in the ratio of IFN-& #947 /IL-10 levels in cultures stimulated with Sm29 and ShTSP2 when compared to nonstimulated ones. b i Conclusions: /i /b The i Schistosoma /i spp. antigens used in this study were able to downmodulate IFN-& #947 production in vitro in HTLV-1 infection. This may be associated with the increased levels of IL-10 induced by the antigens.
A consumer designed smartphone app for young people with asthma: pilot of engagement and acceptability
Publisher: Informa UK Limited
Date: 06-11-2019
The reliability and utility of spirometry performed on people with asthma in community pharmacies
Publisher: Informa UK Limited
Date: 06-2015
DOI: 10.3109/02770903.2015.1004684
Abstract: To investigate the reliability and the utility of spirometry generated by community pharmacists participating in two large asthma intervention trials of 892 people. The Pharmacy Asthma Care Program (PACP) and the Pharmacy Asthma Management Service (PAMS) involved up to four visits to the pharmacy over 6 months for counseling and goal setting. Pharmacists performed spirometry according to ATS/ERS guidelines to inform management. The proportion of A-E, F quality tests, as per EasyOne QC grades, were recorded. Lung function results between visits and for participants referred/not referred to their general practitioner on the basis of spirometry were compared. Complete data from 2593 spirometry sessions were recorded, 68.5% of spirometry sessions achieved three acceptable tests with between-test repeatability of 150 ml or less (A or B quality), 96% of spirometry sessions included at least one test that met ATS/ERS acceptability criteria. About 39.1% of participants had FEV1/FVC values below the lower limit of normal (LNN), indicating a respiratory obstruction. As a result of the service, there was a significant increase in FEV1 and FEV1/FVC and asthma control. Lung function values were significantly poorer for participants referred to their general practitioner, compared with those not referred, on the basis of spirometry. Community pharmacists are able to reliably achieve spirometry results meeting ATS/ERS guidelines in people with asthma. Significant improvements in airway obstruction were demonstrated with the pharmacy services. Pharmacists interpreted lung function results to identify airway obstruction for referral, making this a useful technique for review of people with asthma in the community.
Cost-effectiveness analysis of a pharmacy asthma care program in Australia
Publisher: Springer Science and Business Media LLC
Date: 2007
The Use of Gamification and Incentives in Mobile Health Apps to Improve Medication Adherence: Scoping Review (Preprint)
Publisher: JMIR Publications Inc.
Date: 24-05-2021
Abstract: merging health care strategies addressing medication adherence include the use of direct-to-patient incentives or elements adapted from computer games. However, there is currently no published evidence synthesis on the use of gamification or financial incentives in mobile apps to improve medication adherence. he aim of this scoping review is to synthesize and appraise the literature pertaining to the use of mobile apps containing gamification or financial incentives for medication adherence. There were two objectives: to explore the reported effectiveness of these features and to describe and appraise the design and development process, including patient involvement. he following databases were searched for relevant articles published in English from database inception to September 24, 2020: Embase, MEDLINE, PsycINFO, CINAHL, and Web of Science. The framework by Arksey and O’Malley and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist guided this scoping review. Using a systematic screening process, studies were included if incentives or game features were used within mobile apps to specifically address medication adherence. An appraisal using risk of bias tools was also applied to their respective study design. total of 11 studies from the initial 691 retrieved articles were included in this review. Across the studies, gamification alone (9/11, 82%) was used more than financial incentives (1/11, 9%) alone or a combination of the two (1/11, 9%). The studies generally reported improved or sustained optimal medication adherence outcomes however, there was significant heterogeneity in the patient population, methodology such as outcome measures, and reporting of these studies. There was considerable variability in the development process and evaluation of the apps, with authors opting for either the waterfall or agile methodology. App development was often guided by a theory, but across the reviewed studies, there were no common theories used. Patient involvement was not commonly evident in predevelopment phases but were generally reserved for evaluations of feasibility, acceptance, and effectiveness. Patient perspectives on gamified app features indicated a potential to motivate positive health behaviors such as medication adherence along with critical themes of repetitiveness and irrelevance of certain features. The appraisal indicated a low risk of bias in most studies, although concerns were identified in potential confounding. o effectively address medication adherence via gamified and incentivized mobile apps, an evidence-based co-design approach and agile methodology should be used. This review indicates some adoption of an agile approach in app development however, patient involvement is lacking in earlier stages. Further research in a generalized cohort of patients living with chronic conditions would facilitate the identification of barriers, potential opportunities, and the justification for the use of gamification and financial incentives in mobile apps for medication adherence.
Developing Measures of Placement Quality in Allied Health, Dentistry, Medicine, and Pharmacy
Publisher: Coventry University, Lanchester Library
Date: 28-11-2018
DOI: 10.18552/IJPBLHSC.V6I2.493
Abstract: As placement numbers expand, there is a concern that the quality of student experience and learning may diminish. Furthermore, there is a paucity of evidence for evaluation and quality improvement in clinical health placements and there have been few studies undertaken to assess quality. Valid and reliable measures of placement quality are needed to provide an evidence-base to guide decisions about the most efficient and effective placement models in health. A two-phase mixed methods design, using a modified Delphi process, focus groups, and surveys, developed and tested items to measure placement quality. Thematic analysis, descriptive statistics, and exploratory factor analysis (EFA) were used to analyse the data. Twenty-three participants took part in the Phase 1 stakeholder focus groups, and 150 useable surveys were returned by 161 who took part in Phase 2 to test validity and reliability of the student survey items. Results show broad agreement on the features of a quality clinical placement across allied health dentistry, medicine, and pharmacy professions. The student survey was found to be a valid and reliable measure of placement quality, with the EFA showing one component accounting for 58.5% of the variance in the survey data. The findings offer a framework and approach that others can adopt to measure placement quality in their setting. The measures may be adaptable to contexts outside health.
Personal benefit, or benefiting others? Deciding whether to take part in clinical trials
Publisher: SAGE Publications
Date: 16-12-2011
Abstract: Background Participation in clinical trials is critical for the success of evidence-based healthcare. Much previous research suggests that people take part in clinical trials mostly for altruistic reasons, and that deriving personal benefit is a secondary consideration. Purpose To investigate patients’ reasons for deciding whether to take part in clinical trials and the extent to which personal benefit may be a motivating factor. Methods A qualitative study utilizing in-depth semi-structured interviews. Participants were 42 men and women who had been asked to participate in clinical trials testing a range of interventions in different conditions, including some who did not participate or withdrew. Trials were based in either primary or secondary care. Interviews were conducted at home. Results Reasons for taking part were complex and a wide variety of personal considerations were evident. Gaining some personal benefit emerged as an important primary motivation in this group of respondents, whereas altruistic considerations appeared to be largely subsidiary. People who decided not to take part were also mainly concerned about the balance of personal risk and benefit. Limitations Public dissemination of the results may have influenced participants’ responses. Conclusions Achieving target s le sizes for clinical trials may be enhanced by an understanding of what is likely to motivate patients to take part. In this study, respondents identified a range of attractive benefits, such as care in a specialist team with expert staff, active engagement in their health monitoring or care, more frequent or intensive monitoring, and information about the latest research into their condition.
Inhaler technique maintenance: Gaining an understanding from the patient's perspective
Publisher: Informa UK Limited
Date: 31-05-2011
DOI: 10.3109/02770903.2011.580032
Abstract: The aim of this study was to determine the patient-, education-, and device-related factors that predict inhaler technique maintenance. Thirty-one community pharmacists were trained to deliver inhaler technique education to people with asthma. Pharmacists evaluated (based on published checklists), and where appropriate, delivered inhaler technique education to patients (participants) in the community pharmacy at baseline (Visit 1) and 1 month later (Visit 2). Data were collected on participant demographics, asthma history, current asthma control, history of inhaler technique education, and a range of psychosocial aspects of disease management (including adherence to medication, motivation for correct technique, beliefs regarding the importance of maintaining correct technique, and necessity and concern beliefs regarding preventer therapy). Stepwise backward logistic regression was used to identify the predictors of inhaler technique maintenance at 1 month. In total 145 and 127 participants completed Visits 1 and 2, respectively. At baseline, 17% of patients (n = 24) demonstrated correct technique (score 11/11) which increased to 100% (n = 139) after remedial education by pharmacists. At follow-up, 61% (n = 77) of patients demonstrated correct technique. The predictors of inhaler technique maintenance based on the logistic regression model (X(2) (3, N = 125) = 16.22, p = .001) were use of a dry powder inhaler over a pressurized metered-dose inhaler (OR 2.6), having better asthma control at baseline (OR 2.3), and being more motivated to practice correct inhaler technique (OR 1.2). Contrary to what is typically recommended in previous research, correct inhaler technique maintenance may involve more than repetition of instructions. This study found that past technique education factors had no bearing on technique maintenance, whereas patient psychosocial factors (motivation) did.
Barriers and facilitators to patient recruitment to a cluster randomized controlled trial in primary care: Lessons for future trials
Publisher: Springer Science and Business Media LLC
Date: 12-03-2015
Learning styles and approaches: Can reflective strategies encourage deep learning?
Publisher: Elsevier BV
Date: 07-2015
The effect of reflective activities on reflective thinking ability in an undergraduate pharmacy curriculum
Publisher: Elsevier BV
Date: 05-2016
DOI: 10.5688/AJPE80465
Pharmacy Asthma Care Program (PACP) improves outcomes for patients in the community
Publisher: BMJ
Date: 06-2007
The contribution of goal specificity to goal achievement in collaborative goal setting for the management of asthma
Publisher: Elsevier BV
Date: 11-2201
DOI: 10.1016/J.SAPHARM.2013.02.002
Abstract: Goal setting was investigated as part of an implementation trial of an asthma management service (PAMS) conducted in 96 Australian community pharmacies. Patients and pharmacists identified asthma-related issues of concern to the patient and collaboratively set goals to address these. Although goal setting is commonly integrated into disease state management interventions, the nature of goals, and their contribution to goal attainment and health outcomes are not well understood. To identify and describe: 1) goals set collaboratively between adult patients with asthma and their pharmacist, 2) goal specificity and goal achievement, and 3) describe the relationships between specificity, achievement, asthma control and asthma-related quality of life. Measures of goal specificity, and goal achievement were developed and applied to patient data records. Goals set were thematically analyzed into goal domains. Proportions of goals set, goals achieved and their specificity were calculated. Correlational and regression analyses were undertaken to determine the relationships between goal specificity, goal achievement, asthma control and asthma-related quality of life. Data were drawn from 498 patient records. Findings showed that patients set a wide range and number of asthma-related goals (N = 1787) and the majority (93%) were either achieved or being working toward by the end of the study. Goal achievement was positively associated with specific and moderately specific goals, but not non-specific goals. However, on closer inspection, an inconsistent pattern of relationships emerged as a function of goal domain. Findings also showed that goal setting was associated with end-of-study asthma control but not to asthma-related quality of life. Pharmacists can help patients to set achievable and specific asthma management goals, and these have the potential to directly impact health outcomes such as asthma control. Goal specificity appears to be an important feature in the achievement of goals, but other factors may also play a role.
Experiences of depression, the role of social support and its impact on health outcomes
Publisher: Informa UK Limited
Date: 02-02-2015
DOI: 10.3109/09638237.2014.954693
Abstract: Little research has been conducted into the value of support from the perspective of the person experiencing depression, or the types of support that are valued. In this article we aim to identify the beneficial sources of social support, what form these took, and when and how these sources of support helped. Narrative interviews with a maximum variation s le of 42 Australians who had experienced depression. Interviews were audio and/or video recorded, transcribed verbatim and analysed using a coding framework and thematic analysis. Themes included "early warning system," "staying the course" and "striving for 'normality.'" Practical support made a difference to participants' health outcomes such as hospitalisation and access to therapy. Seemingly invisible sources of support were recognised and acknowledged by participants particularly when they were seeking to maintain wellness. Support varied according to the trajectory of the depression experience. Some forms of support can make a real difference to health outcomes. We propose an alternative interpretation to current understandings about the role of social support.
Personal experiences of taking part in clinical trials - A qualitative study
Publisher: Elsevier BV
Date: 09-2011
DOI: 10.1016/J.PEC.2011.06.002
Abstract: To investigate people's experiences of and attitudes to participation in clinical trials. 42 in-depth qualitative interviews, covering different types of trial and intervention, analysed thematically using a modified grounded theory approach. Many participants argued for a right to participate in research. This may be partly because personal benefit was a common primary motivation for taking part - but the benefits cited were not only personal health outcomes. Whilst most were satisfied with information received, some felt it was too complex. Gaps in understanding were evident, especially around randomisation, but trust in trial staff was high. Desire for feedback of trial results was common. Unintended consequences may arise from efforts to give full information and challenge therapeutic misconceptions. People wanted 'enough' information to help them decide, but their definition of 'enough', and the relative importance of written information versus discussion/advice from trusted professionals, varied by in idual. In seeking to minimise misunderstanding we stress uncertainty and risk but have perhaps lost sight of the value people derive from trial participation. Better information on trial availability, shorter trial leaflets and greater emphasis on face-to-face discussion are suggested. Recruitment literature could appeal to a wider range of benefits.
The Experience of Living with Severe Asthma, Depression and Anxiety: A Qualitative Art-Based Study
Publisher: Informa UK Limited
Date: 12-2021
DOI: 10.2147/JAA.S328104
Factors influencing Australian community pharmacists' willingness to participate in research projects - An exploratory study
Publisher: Oxford University Press (OUP)
Date: 09-2006
Abstract: To identify the factors influencing Australian community pharmacists' willingness to participate in research projects and their attitudes towards research. A mixed-method survey instrument comprising demographics, previous participation in research, and perceptions about participation in research was mailed to 267 community pharmacists in New South Wales and the Australian Capital Territory. An analysis of variance test was used to identify similarities and differences between research- and non-research-active respondents. Bivariate correlations and partial least squares (PLS) regression analyses were used to identify barriers and facilitators to research participation. The overall response rate to the survey was 40%. Of these, 70% were classified as previous research participants (PRP), and 30% were classified as non-previous research participants (NPRP). Both groups had mostly favourable attitudes towards research however, the results revealed several differences between the PRP and NPRP groups. Three items were identified as key facilitators to participation in research for both PRP and NPRP groups - having an interest in the research topic believing that the research will benefit the customer and a belief that community pharmacy research is important. Lack of time, either real or perceived, was identified as a key barrier to participation in research for both the PRP and NPRP groups. Researchers should take into account pharmacists' previous research experience when recruiting pharmacists into research projects. In the case of pharmacists with research experience, emphasis should be on promoting factors that facilitate participation. In the case of pharmacists with little research experience, emphasis should be on reducing barriers to participation.
Strategies for the management of intermittent allergic rhinitis: An Australian study
Publisher: Wiley
Date: 02-2014
Using the community pharmacy to identify patients at risk of poor asthma control and factors which contribute to this poor control
Publisher: Informa UK Limited
Date: 26-09-2011
DOI: 10.3109/02770903.2011.615431
Abstract: Although asthma can be well controlled by appropriate medication delivered in an appropriate way at an appropriate time, there is evidence that management is often suboptimal. This results in poor asthma control, poor quality of life, and significant morbidity. The objective of this study was to describe a population recruited in community pharmacy identified by trained community pharmacists as being at risk for poor asthma outcomes and to identify factors associated with poor asthma control. It used a cross-sectional design in 96 pharmacies in metropolitan and regional New South Wales, Victoria, Queensland, and Australian Capital Territory in Australia. Community pharmacists with specialized asthma training enrolled 570 patients aged ≥18 years with doctor-diagnosed asthma who were considered at risk of poor asthma outcomes and then conducted a comprehensive asthma assessment. In this assessment, asthma control was classified using a symptom and activity tool based on self-reported frequency of symptoms during the previous month and categorized as poor, fair, or good. Asthma history was discussed, and lung function and inhaler technique were also assessed by the pharmacist. Medication use/adherence was recorded from both pharmacy records and the Brief Medication Questionnaire (BMQ). The symptom and activity tool identified that 437 (77%) recruited patients had poor asthma control. Of the 570 patients, 117 (21%) smoked, 108 (19%) had an action plan, 372 (69%) used combination of inhaled corticosteroid (ICS)/long-acting β(2)-agonist (LABA) medications, and only 17-28% (depending on device) used their inhaler device correctly. In terms of adherence, 90% had their ICS or ICS/LABA dispensed <6 times in the previous 6 months, which is inconsistent with regular use this low adherence was confirmed from the BMQ scores. A logistic regression model showed that patients who smoked had incorrect inhaler technique or low adherence (assessed by either dispensing history or BMQ) and were more likely to have poor control. Community pharmacists were able to identify patients with asthma at risk of suboptimal control, and factors that contributed to this were elicited. This poorly controlled group that was identified may not be visible or accessible to other health-care professionals. There is an opportunity within pharmacies to target poorly controlled asthma and provide timely and tailored interventions.
Challenges to consumers travelling with multiple medicines
Publisher: Oxford University Press (OUP)
Date: 08-06-2015
DOI: 10.1111/JPHS.12097
Friendship, connectedness and (in)authenticity for those with chronic illness: Trading in one social gain for another
Publisher: Elsevier BV
Date: 06-2023
A systematic review - Biologically-based complementary medicine use by people living with cancer – is a more clearly defined role for the pharmacist required?
Publisher: Elsevier BV
Date: 11-2017
DOI: 10.1016/J.SAPHARM.2016.10.018
Abstract: Biologically-based complementary medicines (BB-CMs) including herbal, vitamin, mineral and nutritional supplements are frequently taken by people living with cancer. Pharmacists play an important and clearly defined role in the provision of standard cancer treatment. Due to the non-prescription status and easy access to BB-CMs, the role of the pharmacist in communicating to people living with cancer about their use is less clearly defined. To explore the role of the pharmacist in communicating to people living with cancer about their use of BB-CMs. Eligible studies were identified in PubMed, Medline, EmBase, International Pharmaceutical Abstracts and Google Scholar. Articles published between 2003 and 2016 were included searching for "Complementary OR Herbal medicine OR vitamin OR nutritional supplement" and "cancer OR oncology patient" and "pharmacist role OR attitude OR belief OR communication". BB-CM use is prevalent among people living with cancer for the management of side effects and are taken under the belief they are safe, natural and holistic. Fifty per cent of cancer patients do not disclose their BB-CM use to their physicians due to a perception that it will be discouraged and/or their physician will not be knowledgeable about BB-CMs. There are known drug-herb/nutrient interactions but interestingly pharmacists are the least consulted health care professional (HCP). With adequate knowledge about BB-CMs, pharmacists are well positioned as medication specialists to fill the current communication gap between people living with cancer and HCPs. Further research that informs the development of specific BB-CM guidelines for pharmacists in the management of cancer are required.
Diabetes Medication Assistance Service: The pharmacist's role in supporting patient self-management of type 2 diabetes (T2DM) in Australia
Publisher: Elsevier BV
Date: 06-2011
DOI: 10.1016/J.PEC.2011.04.027
Abstract: To evaluate the capacity and effectiveness of trained community pharmacists in delivering the Diabetes Medication Assistance Service (DMAS) via (1) number and types of self-management support interventions (SMSIs) (2) number of goals set and attained by patients and (3) patient outcomes (glycaemic control, medication adherence and satisfaction). Pharmacists (n=109) from 90 community pharmacies in Australia were trained and credentialed to deliver the DMAS. The training focused on developing pharmacists' knowledge and skills in supporting patients' diabetes self-management. A total of 387 patients completed the trial. The mean number of SMSIs per patient was 35 (SD ±31) and the majority (87%) had at least one documented goal that was fully or partially attained. There were significant health benefits for patients including improved glycaemic control and a reduced risk of non-adherence to medications. Over 90% of DMAS patients reported improvements in their knowledge about diabetes self-management. The DMAS provides self management support in the community pharmacy for people with T2DM which may result in improved clinical outcomes. Given appropriate training in diabetes care and behavior change strategies, community pharmacists can offer programs which provide self-management support to their patients with T2DM and improve their health outcomes.
The reliability and patient acceptability of the smarttrack device: A new electronic monitor and reminder device for metered dose inhalers
Publisher: Informa UK Limited
Date: 28-06-2012
DOI: 10.3109/02770903.2012.684253
Abstract: The SmartTrack (ST) is a new adherence monitoring device for pressurized metered-dose inhalers (pMDI), with remote upload and ringtone reminder capabilities. Our aim was to assess its reliability and patient acceptability. Baseline Quality Control (QC): Actuation log accuracy and device functionality tests were undertaken. Simulated Patient Use: Salmeterol/fluticasone inhalers with STs were actuated two times twice daily for 48 h. Accuracy of reminders, data logging, and uploads was tested. Patient Field Testing: Devices were quality tested before dispensing. Asthma patients each field-tested one ST for 7 days and recorded actuations in a diary. Uploaded data were compared to pMDI dose counter and patient diaries. Patient-reported ease of use for the ST was recorded. Baseline QC: 9/10 devices had 100% accuracy one had an electrical circuit failure. Simulated Patient Use: Accuracy was 99% (2/342 actuations duplicated). Patient Field Testing: One device failed pre-dispensing testing (electrical circuit failure). Eight devices were field-tested by asthma patients (mean age 45, 5 females). Mean actuation log accuracy was 97%. Reminders were 100% accurate. All devices successfully uploaded data. Average patient-rated difficulty of use was 6/100 (1 = extremely easy, 100 = extremely difficult). The ST has acceptable reliability and utility comparable to other electronic monitoring devices. Its remote data upload capability, reminder functions for missed doses, and graphical display of medication use for patient- and physician-feedback are useful additional features.
Exploring asthma in the workplace: A triangulation of perspectives from management, employees and people with asthma
Publisher: Informa UK Limited
Date: 20-10-2018
DOI: 10.1080/02770903.2017.1369991
Abstract: People with asthma spend a significant amount of time in the workplace but little is known about the current state of disease management in such contexts. The aim of the current study is to explore the experiences, attitudes and perceptions of asthma across different stakeholders in the workplace to help inform potential recommendations for workplace asthma policies. Using purposive and convenience s ling methods, in-depth semi-structured interviews were conducted in Australia with 5 human resource personnel, 10 employees with asthma and 10 employees without asthma. Interviews were guided by a schedule of questions focusing on attitudes and experiences of people with asthma in the workplace, which were audio recorded, transcribed verbatim and thematically analysed. Analysis of the qualitative dataset revealed three key themes: Beliefs and Attitudes about Asthma, Asthma Solutions in the Workplace and Workplace Obstacles. Findings suggest that employees with asthma experience problems managing their asthma at work and there is a lack of workplace support in relation to asthma emergency management. Key recommendations for workplace asthma policies have been made to provide better support for employees with asthma. However, further investigation into the experience of managing asthma is required in a wider variety of occupations and work experiences to inform the development of a workplace asthma policy.
Information needs of people with asthma.
Publisher: Oxford University Press (OUP)
Date: 13-08-2014
DOI: 10.1111/IJPP.12057
Abstract: To describe the information needs of a group of Australians with asthma and the extent to which their needs had been met. A self-administered survey was completed by people with asthma either presenting at community pharmacies or registered with a medical research institute database. The survey questions were developed based on a review of the literature, and included questions regarding participants’ information needs about their asthma, their sources of asthma information and the extent to which these information needs had been met. The responses concerning information needs were analysed thematically. Responses concerning sources of asthma information and the extent to which needs were met were analysed using descriptive and correlational statistics. Seventy-one people completed the survey. Key information needs that were identified included medications, management of asthma, asthma triggers, cure, aetiology of asthma and latest research. A third of participants reported having only ‘very little’, ‘a little’ or ‘some’ of their information needs met. The most common source of information was from a doctor (94% respondents), followed by a pharmacist or pharmacy assistant (56%). Insights into the information needs of people with asthma have been provided. In light of the level of unmet information needs of people with asthma, and the types of information sought, pharmacists are in an ideal position to close the information gap and promote optimal asthma self-management practices.
A pharmacy asthma service achieves a change in patient responses from increased awareness to taking responsibility for their asthma
Publisher: Oxford University Press (OUP)
Date: 04-07-2015
DOI: 10.1111/IJPP.12134
Abstract: If novel health services are to be implemented and sustained in practice, the perceptions and views of patients form a critical part of their evaluation. The aims of this study were to explore patient’s perceptions and experiences with a pharmacy asthma service and to investigate if there was a change over time. Interviews and focus groups were conducted with patients participating in the asthma service at three time points. Data were transcribed verbatim and thematically analyzed using a framework approach. The service led to an enhanced awareness and understanding of asthma, changes in participants’ beliefs and attitudes towards asthma management, changes in asthma-related health behaviours and improved self-efficacy. Participants were very positive about the service and the role of the pharmacist in asthma management. There was a shift in participant perceptions and views, from being at an abstract level in those who had completed just one visit of the service to a more experiential level in those who had experienced the entire comprehensive asthma service. A sustained experience/multiple visits in a service may lead to more concrete changes in patient perceptions of severity, beliefs, health behaviours and enhanced self-efficacy and control. The study highlights a need for such asthma services in the community.
Providing optimal service delivery for children and adolescents with type 1 diabetes: A systematic review
Publisher: Wiley
Date: 05-2009
DOI: 10.1002/PDI.1360
Identifying patient-specific beliefs and behaviours for conversations about adherence in asthma
Publisher: Wiley
Date: 06-2012
DOI: 10.1111/J.1445-5994.2011.02541.X
Abstract: Asthma guidelines advise addressing adherence at every visit, but no simple tools exist to assist clinicians in identifying key adherence-related beliefs or behaviours for in idual patients. To identify potentially modifiable beliefs and behaviours that predict electronically recorded adherence with controller therapy. Patients aged ≥ 14 years with doctor-diagnosed asthma who were prescribed inhaled corticosteroid/long-acting β(2)-agonist (ICS/LABA) completed questionnaires on medication beliefs/behaviours, side-effects, Morisky adherence behaviour score and Asthma Control Test (ACT), and recorded spirometry. Adherence with ICS/LABA was measured electronically over 8 weeks. Predictors of adherence were identified by univariate and multivariate analyses. 99/100 patients completed the study (57 female forced expiratory volume in 1 s mean ± standard deviation 83 ± 23% predicted ACT 19.9 ± 3.8). Mean electronically recorded adherence (n= 85) was 75% ± 25, and mean self-reported adherence was 85% ± 26%. Factor analysis of questionnaire items significantly associated with poor adherence identified seven themes: perceived necessity, safety concerns, acceptance of asthma chronicity/medication effectiveness, advice from friends/family, motivation/routine, ease of use and satisfaction with asthma management. Morisky score was moderately associated with actual adherence (r=-0.45, P < 0.0001). In regression analysis, 10 items independently predicted adherence (adjusted R(2) = 0.67 P < 0.001). Opinions of friends/family about the patient's medication use were strongly associated with poor adherence. Global concerns about ICS/LABA therapy were more predictive of poor adherence than were specific side-effects the one-third of patients who reported experiencing side-effects from their steroid inhaler had lower adherence than others (mean 62% vs 81% P= 0.015). This study identified several specific beliefs and behaviours which clinicians could use for initiating patient-centred conversations about medication adherence in asthma.
Reflective practice and its implications for pharmacy education
Publisher: Elsevier BV
Date: 02-2014
DOI: 10.5688/AJPE78118
The study, evaluation, and improvement of university student self-efficacy
Publisher: Informa UK Limited
Date: 03-02-2015
A model for assessing reflective practices in pharmacy education
Publisher: Elsevier BV
Date: 10-2015
DOI: 10.5688/AJPE798124
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