ORCID Profile
0000-0002-9507-5050
Current Organisation
University of Sydney
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Publisher: Wiley
Date: 05-10-2020
DOI: 10.1002/JPPR.1675
Publisher: Elsevier BV
Date: 06-2019
DOI: 10.1016/J.SAPHARM.2018.08.009
Abstract: In Australia, the Home Medicines Review (HMR) is a nationally-funded program, led by pharmacists to optimize medication use for older people. A Medicines Conversation Guide was developed for pharmacists to use in the context of a HMR. The Guide aims to increase patient involvement and support discussions about: general health understanding, decision-making and information preferences, health priorities related to medicines, patient goals and fears, views on important activities and trade-offs. This study describes the development and feasibility testing of a Medicines Conversation Guide in HMRs with pharmacists and older patients. The Guide was developed using a systematic and iterative process, followed by testing in clinical practice with 11 pharmacists, 17 patients (aged 65+) and their companions. A researcher observed HMRs, surveyed and qualitatively interviewed patients and pharmacists to discuss feasibility. Transcribed recordings of the interviews were thematically coded and a Framework Analysis method used. Pharmacists found the Guide to be an acceptable and useful component to the HMR, especially among patients with limited knowledge of their medicines. The Guide seemed most effective when integrated with the HMR and tailored to suit the in idual patient. Some questions were difficult for patients to grasp (e.g. trade-offs) or sounded formal. Most patients found the Guide focused the HMR on their perspective and encouraged a more holistic approach to the HMR. From the quantitative survey, pharmacists found the Guide easy to implement, balanced and understandable. Pharmacists and patients reported the Guide fits with the HMR encounter relatively easily and promoted communication about goals and preferences in relation to medications. This study highlighted some key challenges for communication about medicines and how the Guide may help support the process of involving patients more in the HMR.
Publisher: SLACK, Inc.
Date: 10-2017
DOI: 10.3928/24748307-20170724-01
Abstract: Asking patients to “Teach-Back” information during a health care consultation is widely recommended, yet little is known about patient and provider experiences using this method. Teach-Back has not previously been evaluated in a consumer telephone health service, a situation in which low health literacy can be especially difficult to identify. This study sought to explore telenurse experiences using Teach-Back at a maternal and child health helpline, supplemented with caller experiences. After training maternal and child health nurses to use Teach-Back ( n = 15), we interviewed nurses and callers to the helpline service. We used semi-structured guides to conduct focus groups and telephone interviews and analyzed transcripts of nurse and caller data using the Framework method. This qualitative study forms part of a randomized controlled trial of Teach-Back involving 637 callers. Nurses ( n = 13) reported Teach-Back was helpful to invite questions from callers, summarize information, review action plans, and close calls. Some found it helpful to empower and calm (anxious) callers. Nurses reported they did not always use Teach-Back, either because it was not appropriate or they felt uncomfortable with phrasing. Comfort with using Teach-Back tended to improve with practice. Perceived effect on call duration was mixed. We report s le Teach-Back strategies used by nurses, including the lead-in phrase “just before you go…,” which was considered helpful for initiating Teach-Back at close of a call. Caller reports of Teach-Back were limited ( n = 8) but mostly positive. Teach-Back is a simple communication technique that can be used in a consumer telehealth service to confirm caller understanding and actions to take, and in some cases it may also reduce caller anxiety. Further research on caller experiences and objective impact on call duration is needed. [ Health Literacy Research and Practice . 2017 (4):e173–e181.] Low health literacy can be difficult to identify, especially over the telephone. Asking callers to summarize important information and agreed actions (known as Teach-Back) could help telehealth providers confirm understanding. We interviewed nurses operating a maternal and child health helpline and callers about their experiences with Teach-Back. Findings support Teach-Back for telehealth and suggest Teach-Back can also reduce caller anxiety.
Publisher: Springer Science and Business Media LLC
Date: 30-11-2022
Publisher: CSIRO Publishing
Date: 2020
DOI: 10.1071/PY19072
Abstract: This qualitative study explored GPs’ experiences with pharmacist-led home medicines reviews (HMRs) and the barriers and facilitators to GPs using HMRs to optimise medicines for older people. Semi-structured interviews were conducted with 32 GPs Australia-wide. Purposeful s ling was undertaken to obtain a representative group in terms of age, gender and location. Data were analysed using framework analysis. Overall, GPs found HMRs useful for educating patients about their medicines, improving adherence and understanding the patient’s home environment. Barriers to effective use of HMRs included patient resistance to having medicines reviewed and limited access to HMRs in regional or rural areas. GPs differed in the extent and way they use HMRs. One group found HMRs very useful, wanted more access to HMRs and reported frequent interactions with pharmacists. A second group was ambivalent, and perceived HMRs could be useful but had limitations in what they can achieve. A third group was sceptical, and reported HMRs rarely provide new insights, and recommendations were not clinically relevant to patients. Understanding GPs’ expectations and preferences through interprofessional communication and partnerships are ways to address these barriers. Future improvements to the HMR program may include incentives and resources that promote collaboration between GPs and pharmacists.
Publisher: Springer Science and Business Media LLC
Date: 10-09-2020
DOI: 10.1038/S41746-020-00325-Z
Abstract: Digital health applications (apps) have the potential to improve health behaviors and outcomes. We aimed to examine the effectiveness of a consumer web-based app linked to primary care electronic health records (EHRs). CONNECT was a multicenter randomized controlled trial involving patients with or at risk of cardiovascular disease (CVD) recruited from primary care (Clinical Trial registration ACTRN12613000715774). Intervention participants received an interactive app which was pre-populated and refreshed with EHR risk factor data, diagnoses and, medications. Interactive risk calculators, motivational messages and lifestyle goal tracking were also included. Control group received usual health care. Primary outcome was adherence to guideline-recommended medications (≥80% of days covered for blood pressure (BP) and statin medications). Secondary outcomes included attainment of risk factor targets and eHealth literacy. In total, 934 patients were recruited mean age 67.6 (±8.1) years. At 12 months, the proportion with % days covered with recommended medicines was low overall and there was no difference between the groups (32.8% vs. 29.9% relative risk [RR] 1.07 [95% CI, 0.88–1.20] p = 0.49). There was borderline improvement in the proportion meeting BP and LDL targets in intervention vs. control (17.1% vs. 12.1% RR 1.40 [95% CI, 0.97–2.03] p = 0.07). The intervention was associated with increased attainment of physical activity targets (87.0% intervention vs. 79.7% control, p = 0.02) and e-health literacy scores (72.6% intervention vs. 64.0% control, p = 0.02). In conclusion, a consumer app integrated with primary health care EHRs was not effective in increasing medication adherence. Borderline improvements in risk factors and modest behavior changes were observed.
Publisher: Elsevier BV
Date: 03-2022
DOI: 10.1016/J.PEC.2021.06.021
Abstract: To examine older adults' perceptions and identify barriers and enablers to initiating a conversation about stopping medication(s) with their healthcare provider. We conducted one focus group (n = 3) and in-depth, face-to-face, in idual interviews (n = 6) using an interview guide. Older adults aged ≥65 years in a retirement community who were taking ≥5 medications were recruited. Focus groups and interviews were audio-recorded and transcribed verbatim. Both a deductive analysis, informed by the Theoretical Domains Framework, and an inductive analysis were conducted. Five themes and fourteen sub-themes were identified. Theme 1, 'older adult-related barriers', discusses limited or varying self-efficacy, past unsuccessful deprescribing experiences and limited familiarity with medications/deprescribing. Theme 2, 'provider-related barriers', discusses trust, short office visits, lack of communication and multiple providers. Theme 3, 'environmental/social-related barriers', involves limited availability of resources and access to telehealth/internet. The remaining themes (Themes 4-5) identified enablers including strategies to promote older adults' self-efficacy and improved healthcare communication. Consumer-centric tools could improve older adults' self-efficacy to initiate deprescribing conversations. Removing barriers and implementing enablers may empower older adults to initiate deprescribing conversations with providers to take fewer medications. Ultimately, this could be a catalyst for increased translation of deprescribing in practice.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-05-2022
DOI: 10.1097/J.PAIN.0000000000002340
Abstract: Deprescribing is the systematic process of discontinuing drugs when harms outweigh the benefits. We conducted semistructured telephone interviews with 22 general practitioners (GPs) who had prescribed or deprescribed opioids in patients with chronic noncancer pain within the past 6 months to investigate the barriers and facilitators to deprescribing opioid analgesics in patients with chronic noncancer pain. We also explored GPs' perspectives on the available resources to assist them with opioid deprescribing. Interviews were audio-recorded, transcribed verbatim, and then coded using an iterative process until data saturation reached. The thematic analysis process identified themes, first as concepts, and then refined to overarching themes after the merging of similar subthemes. Themes exploring barriers to deprescribing highlighted the difficulties GPs face while considering patient factors and varying prescribing practices within the confines of the health system. Patient motivation and doctor–patient rapport were central factors to facilitate deprescribing and GPs considered the most important deprescribing resource to be a multidisciplinary network of clinicians to support themselves and their patients. Therefore, although GPs emphasised the importance of deprescribing opioid analgesics, they also expressed many barriers relating to managing complex pain conditions, patient factors, and varying prescribing practices between clinicians. Some of these barriers could be mitigated by GPs having time and resources to educate and build rapport with their patients. This suggests the need for further development of multimodal resources and improved support through the public health system to enable GPs to prioritise patient-centred care.
Publisher: Oxford University Press (OUP)
Date: 22-11-2022
DOI: 10.1093/IJPP/RIAC088
Publisher: Springer Science and Business Media LLC
Date: 08-01-2021
DOI: 10.1186/S12875-020-01347-Y
Abstract: To optimise medication use in older people, it is recommended that clinicians evaluate evidence on potential benefits and harms of medicines in light of the patients’ overall health, values and goals. This suggests general practitioners (GPs) should attempt to facilitate patient involvement in decision-making. In practice this is often challenging. In this qualitative study, we explored GPs’ perspectives on the importance of discussing patients’ goals and preferences, and the role patient preferences play in medicines management and prioritisation. Semi-structured interviews were conducted with GPs from Australia ( n = 32). Participants were purposively s led to recruit GPs with variation in experience level and geographic location. Transcribed audio-recordings of interviews were coded using Framework Analysis. The results showed that most GPs recognised some value in understanding older patients’ goals and preferences regarding their medicines. Most reported some discussions of goals and preferences with patients, but often this was initiated by the patient. Practical barriers were reported such as limited time during busy consultations to discuss issues beyond acute problems. GPs differed on the following main themes: 1) definition and perception of patients’ goals, 2) relationship with the patient, 3) approach to medicines management and prioritisation. We observed that GPs preferred one of three different practice patterns in their approach to patients’ goals in medicines decisions: 1) goals and preferences considered lower priority – ‘Directive’ 2) goals seen as central – ‘Goal-oriented’ 3) goals and preferences considered but not explicitly elicited – ‘Tacit’. This study explores how GPs differ in their approach to eliciting patients’ goals and preferences, and how these differences are operationalised in the context of older adults taking multiple medicines. Although there are challenges in providing care that aligns with patients’ goals and preferences, this study shows how complex decisions are made between GPs and their older patients in clinical practice. This work may inform future research that investigates how GPs can best incorporate the priorities of older people in decision-making around medicines. Developing practical support strategies may assist clinicians to involve patients in discussions about their medicines.
Publisher: Springer Science and Business Media LLC
Date: 14-11-2022
Publisher: Oxford University Press (OUP)
Date: 28-11-2017
Abstract: Polypharmacy in the older population is increasing-and can be harmful. It can be safe to reduce or carefully cease medicines (deprescribing) but a collaborative approach between patient and doctor is required. This study explores decision-making about polypharmacy with older adults and their companions. Semi-structured interviews were conducted with 30 older people (aged 75+ years, taking multiple medicines) and 15 companions. Framework analysis was used to identify qualitative themes. Participants varied considerably in attitudes towards medicines, preferences for involvement in decision-making, and openness to deprescribing. Three types were identified. Type 1 held positive attitudes towards medicines, and preferred to leave decisions to their doctor. Type 2 voiced ambivalent attitudes towards medicines, preferred a proactive role, and were open to deprescribing. Type 3 were frail, perceived they lacked knowledge about medicines, and deferred most decisions to their doctor or companion. This study provides a novel typology to describe differences between older people who are happy to take multiple medicines, and those who are open to deprescribing. To enable shared decision-making, prescribers need to adapt their communication about polypharmacy based on their patients' attitudes to medicines and preferences for involvement in decisions.
Publisher: Wiley
Date: 23-03-2023
DOI: 10.1111/BCPT.13857
Publisher: Wiley
Date: 03-07-2023
DOI: 10.1111/BCPT.13911
Publisher: Springer Science and Business Media LLC
Date: 07-03-2018
Publisher: Public Library of Science (PLoS)
Date: 31-10-2018
Publisher: Elsevier BV
Date: 02-2022
Publisher: AMPCo
Date: 03-2016
DOI: 10.5694/MJA15.01153
Abstract: Our aim was to compare surgical treatment rates and survival rates for Aboriginal and non-Aboriginal people in New South Wales with colorectal cancer, and to describe the medical treatment received by a s le of Aboriginal people with colorectal cancer. All people diagnosed with colorectal cancer in NSW during 2001-2007 were identified and their cancer registry records linked to hospital admissions data and death records. A medical records audit of a s le of Aboriginal people diagnosed with colorectal cancer during 2000-2011 was also conducted. Cause-specific survival, odds of surgical treatment, and the proportions of people receiving adjuvant treatments. Of 29 777 eligible colorectal cancer cases, 278 (0.9%) involved Aboriginal people. Similar proportions of Aboriginal (76%) and non-Aboriginal (79%) people had undergone surgical treatment. Colorectal cancer-specific survival was similar for Aboriginal and non-Aboriginal people up to 18 months after diagnosis, but 5 years post-diagnosis the risk of death for Aboriginal people who had had surgical treatment was 68% higher than for non-Aboriginal people (adjusted hazards ratio, 1.68 95% CI, 1.32-2.09). Of 145 Aboriginal people with colorectal cancer identified by the medical records audit, 117 (81%) had undergone surgery, and 56 (48%) had also received adjuvant chemotherapy and/or radiotherapy. Aboriginal people with colorectal cancer had poorer survival rates than non-Aboriginal people, although rates of surgical treatment, complications and follow-up colonoscopy were similar. More work is needed to identify and understand why outcomes for Aboriginal people with colorectal cancer are different from those of other New South Wales residents.
Publisher: SAGE Publications
Date: 10-09-2019
Abstract: Conducting a medication review is one way to optimize medications and support older people to reduce the burden of polypharmacy. In Australia, a service called a Home Medicines Review (HMR) is conducted by pharmacists as part of a nationally funded program. HMRs aim to identify and resolve problems associated with polypharmacy and improve collaboration between patient, pharmacist and general practitioner. The aim of this study was to explore the benefits of and barriers to HMRs from the perspective of older patients and pharmacists. This qualitative study involved observations of HMRs ( n = 12) and telephone interviews with 32 participants including 11 accredited pharmacists, 17 older adults aged 65 years and above, with 4 of their companions, in Australia. The researcher observing took notes during the HMR and added more detail and reflections afterwards. Transcribed audio-recordings and observational notes were thematically coded using framework analysis. Older patients and their companions found the HMR useful and they appreciated the opportunity to learn more about their medicines. However, many did not understand the purpose of the HMR, had limited understanding about their medicines and some did not want to know more. Pharmacists found HMRs useful for identifying medication errors and improving adherence. They also reported barriers to effective HMRs relating to patients (resistance to the evaluation of their medicines, misunderstanding about the aim of the HMR) and GPs (limited information upon referral, and limited follow-up afterwards). Older patients and pharmacists reported a range of benefits for HMRs in terms of optimizing medicines use. Barriers to effective HMR use need to be addressed, including gaps in inter-professional communication and factors related to patient involvement, such as limited medicines understanding and health literacy.
Publisher: Elsevier BV
Date: 12-2022
DOI: 10.1016/J.SAPHARM.2022.07.043
Abstract: Deprescribing is the systematic process of discontinuing medications when the harms outweigh the benefits. This study aimed to identify barriers and facilitators in people with chronic non-cancer pain when deprescribing opioid analgesics, and their views on resources that assist with deprescribing. A purposive s ling strategy was used to recruit 19 adults with chronic non-cancer pain from the community who were, or had been, on long-term opioid therapy. Recruitment continued until thematic saturation was achieved. Semi-structured telephone interviews were conducted. A five-step framework and thematic analysis method identified themes for each study aim. Themes identifying barriers to opioid deprescribing raised challenges of a lack of available alternatives, managing opioid dependency and withdrawal symptoms or inability to function without opioids when in extreme pain. Facilitating themes described the value of support networks, including a trusting doctor-patient relationship and finding in idual coping strategies to address deprescribing barriers. We explored a variety of resources from electronic forms such as websites and apps to paper-based or face to face. Participants expressed that whatever the form, resources need to be educational but also simple and engaging. Most people suffering from chronic non-cancer pain expressed dissatisfaction with being on opioids but most were still unwilling to deprescribe due to insufficient alternatives, a lack of support from their doctors and lack of information about the deprescribing process. Deprescribing can be facilitated by improving supportive networks and strategies and providing simple and positive educational resources.
Publisher: Elsevier BV
Date: 05-2021
Publisher: Wiley
Date: 08-09-2023
DOI: 10.1111/BCPT.13938
Publisher: Elsevier BV
Date: 12-2023
Publisher: Elsevier BV
Date: 2020
DOI: 10.2139/SSRN.3556692
Publisher: American Medical Association (AMA)
Date: 11-10-2023
Publisher: Wiley
Date: 07-05-2019
DOI: 10.1111/BCP.13912
Publisher: Authorea, Inc.
Date: 20-02-2023
No related grants have been discovered for Kristie Weir.