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Does an integrated information technology system provide support for community pharmacists undertaking Discharge Medicines Reviews? An exploratory study.

ABSTRACT: Objective:The aim of this study was to explore the views of community pharmacists participating in the pilot of a secure online platform in Wales, the Choose Pharmacy application (CPA), with particular interest in the electronic Discharge Advice Letters (e-DALs) and online Discharge Medicines Review (DMR) form. Materials and methods:A qualitative approach with semi-structured interviews was adopted. A gatekeeper from National Health Service Wales Informatics Service identified 35 pharmacies, of the 43 pharmacies where the CPA had been implemented, that had completed at least one DMR, and these were therefore invited to an interview. Results:A total of 17 pharmacists were interviewed. Overall, the results were positive and CPA and e-DAL were perceived to facilitate continuity of care between care settings. The design and usability were perceived as good as pharmacists could navigate the CPA without problems; many felt this was due to the level of training they had received. Many pharmacists were happy for other services to be included on the platform due to its ease of use and automatic reimbursement. Several pharmacists felt that communication between primary and secondary care can be further improved as the uptake of e-DAL increases. Conclusion:CPA was found to streamline the completion of online DMR improving continuity of care between primary and secondary sectors, which in turn should improve patient safety on discharge from hospital.

SUBMITTER: Mantzourani E

PROVIDER: S-EPMC5774314 | biostudies-literature | 2017

REPOSITORIES: biostudies-literature

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Does an integrated information technology system provide support for community pharmacists undertaking Discharge Medicines Reviews? An exploratory study.

Mantzourani Efthymia E Way Cheryl M CM Hodson Karen L KL

Integrated pharmacy research & practice 20170920

<h4>Objective</h4>The aim of this study was to explore the views of community pharmacists participating in the pilot of a secure online platform in Wales, the Choose Pharmacy application (CPA), with particular interest in the electronic Discharge Advice Letters (e-DALs) and online Discharge Medicines Review (DMR) form.<h4>Materials and methods</h4>A qualitative approach with semi-structured interviews was adopted. A gatekeeper from National Health Service Wales Informatics Service identified 35 ...[more]

PMID: 29354561

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Project description:BackgroundIn Australia, polypharmacy and medication-related problems are prevalent in the community. Therefore, medicines safety initiatives such as the Home Medicines Review (HMR) service are critical to health care provision. While the evidence continues to expand around HMR service, little is known of accredited pharmacists' experiences of HMR time investment.ObjectiveThis study aimed to explore accredited pharmacists' experiences of HMR practice regarding time investment in the study's defined HMR Stages: 1 (initial paper-based assessment and review), 2 (in-home patient-accredited pharmacist consultation), and 3 (HMR report collation, generation, completion, and provision to the patient's General Practitioner, including any liaison time).MethodsAn electronic survey was developed and piloted by a panel of reviewers. Convenience sampling was used to distribute the final anonymous survey nationally via professional pharmacy organisations. Data were analyzed for frequency distributions and a chi-square test of independence was performed to evaluate any association between demographic variables relating to HMR time investment.ResultsThere was a total of 255 survey respondents, representing approximately 10% of national accredited pharmacist membership. The majority were experienced accredited pharmacists who had completed >100 HMRs (73%), were female (71%), and aged >40 years (60%). Regarding time investment for a typical instance of HMR, most spent: <30 minutes performing Stage 1 (46.7%), and 30-60 minutes performing Stage 2 (70.2%). In Stage 3, 40.0% invested 1-2 hours, and 27.1% invested 2-3 hours in HMR report collation and completion. Quantitative analysis revealed statistically significant (p=0.03) gender findings where females performed longer patient consultations than males (Stage 2). More HMR career experience resulted in statistically significant (p=0.01) less time performing Stage 1 (initial paper-based assessment and review); with a trend to less time performing Stage 3 (HMR report writing).ConclusionsAccredited pharmacists invest significant time in performing comprehensive HMRs, especially during in-home patient consultations and during HMR report collation and completion. Their significant HMR time investment as medicines experts provides insight for program and workforce considerations and warrants further research to better understand their work processes for optimizing medicines use and improving health.

Project description:This study aimed to identify the knowledge, skills and attitudes of Brazilian hospital pharmacists in the use of information technology and electronic tools to support clinical practice.A questionnaire was sent by email to clinical pharmacists working public and private hospitals in Brazil. The instrument was validated using the method of Polit and Beck to determine the content validity index. Data (n = 348) were analyzed using descriptive statistics, Pearson's Chi-square test and Gamma correlation tests.Pharmacists had 1-4 electronic devices for personal use, mainly smartphones (84.8%; n = 295) and laptops (81.6%; n = 284). At work, pharmacists had access to a computer (89.4%; n = 311), mostly connected to the internet (83.9%; n = 292). They felt competent (very capable/capable) searching for a web page/web site on a specific subject (100%; n = 348), downloading files (99.7%; n = 347), using spreadsheets (90.2%; n = 314), searching using MeSH terms in PubMed (97.4%; n = 339) and general searching for articles in bibliographic databases (such as Medline/PubMed: 93.4%; n = 325). Pharmacists did not feel competent in using statistical analysis software (somewhat capable/incapable: 78.4%; n = 273). Most pharmacists reported that they had not received formal education to perform most of these actions except searching using MeSH terms. Access to bibliographic databases was available in Brazilian hospitals, however, most pharmacists (78.7%; n = 274) reported daily use of a non-specific search engine such as Google. This result may reflect the lack of formal knowledge and training in the use of bibliographic databases and difficulty with the English language. The need to expand knowledge about information search tools was recognized by most pharmacists in clinical practice in Brazil, especially those with less time dedicated exclusively to clinical activity (Chi-square, p = 0.006).These results will assist in defining minimal competencies for the training of pharmacists in the field of information technology to support clinical practice. Knowledge and skill gaps are evident in the use of bibliographic databases, spreadsheets and statistical tools.

Project description:ObjectiveTo (1) characterize community pharmacists' and community pharmacy residents' decision making and unmet information needs when conducting comprehensive medication reviews (CMRs) as part of medication therapy management and (2) explore any differences between community pharmacists and community pharmacy residents in CMR decision making and unmet information needs.DesignThirty-to 60-minute semistructured interviews framed using a clinical decision-making model (CDMM) were conducted with community pharmacists and residents.Setting and participantsParticipants were recruited from practice-based research networks and researchers' professional networks. Eligible participants had completed or supported the completion of at least 2 CMRs in the last 30 days.Outcome measuresTwo researchers independently coded transcripts using a combination of inductive and deductive methods to identify themes pertaining to community pharmacists' and residents' decision making and unmet information needs in the provision of CMRs. Discrepancies among researchers' initial coding decisions were resolved through discussion.ResultsSixteen participants (8 pharmacists and 8 residents) were interviewed. Themes were mapped to 5 CDMM steps. Participants primarily used subjective information during "case familiarization"; objective information was secondary. Information used for "generating initial hypotheses" varied by medication therapy problem (MTP) type. During "case assessment," if information was not readily available, participants sought information from patients. Thus, patients' levels of self-management and health literacy influenced participants' ability to identify and resolve MTPs, as described under "identifying final hypotheses." Finally, participants described "decision-making barriers," including communication with prescribers to resolve MTPs. Although pharmacist and resident participants varied in the types of MTPs identified, both groups cited the use and need of similar information.ConclusionCommunity pharmacists and residents often rely primarily on patient-provided information for decision making during CMRs because of unmet information needs, specifically, objective information. Moreover, confidence in MTP identification and resolution is reduced by communication challenges with prescribers and limitations in patients' ability to convey accurate and necessary information.

Project description:Background Insufficient transfer of medicines information is a common challenge at discharge from hospital. Following discharge, home dwelling patients are expected to manage their medicines themselves and adequate counselling is an important prerequisite for patient empowerment and self-efficacy for medicines management. Objective The aim was to identify patients' needs for medicines information after discharge from hospital, including the patients' perception and appraisal of the information they received at discharge. Setting The study enrolled patients discharged from three medical wards at a secondary care hospital in Oslo, Norway. Method Patients were included at the hospital, at or close to the day of discharge and qualitative, semi-structured interviews were performed during the first 2 weeks after discharge. Eligible patients were receiving medicines treatment on admission and after discharge, were handling the medicines themselves, and discharged to their own home. Data were collected in 2017. Interviews were analysed with thematic analysis inspired by Systematic Text Condensation. Main outcome measure Patients' perceptions of medicines information. Results In total, 12 patients were interviewed. They were discharged in equal numbers from the three wards, representing both sexes and a broad age range. Patients perceive medicines information as a continuum and not limited to specific encounters, like the discharge conversation. They gain information in several ways; by receiving information from health care professionals, through observations, and by seeking it themselves. Some thought they could have been better informed about adverse reactions and how to manage life while being a medicines user. Others felt they did not want or need more information. Patients employ various strategies for coping with their use of medicines, influencing their self-efficacy towards medicine management. Conclusion Medicines information should focus on empowering the patients throughout the hospital stay and not solely at discharge, taking into account the individual patient's needs for information, preferences and prior knowledge.

Project description:ObjectiveThe aim with this study was to understand more about how general practitioners (GPs) and nurses in primary care experience their work with medication reviews in elderly patients.DesignThis qualitative study was nested within a cluster randomised trial and analysed narrative and unstructured diaries written by two pharmacists who performed academic detailing, i.e. educational outreach visits in primary care. The educational sessions dealt with potentially inappropriate medicines, and stimulated interprofessional dialogue in relation to medication reviews. The purpose of the diaries was to document and structure the pedagogical process of academic detailing and contained quotes from 194 GP and 113 nurse participants in the sessions, and the pharmacists' reflections. The data was explored using thematic analysis.SettingThirty-three primary care practices in Stockholm, Sweden.SubjectsGPs and nurses working in primary care.Main outcome measuresThematic descriptions of academic detailing by pharmacists.ResultsFive themes were identified: 1) Complexity in 3 'P': patients, pharmacotherapy, and primary care; 2) What, when, who? Clash between GPs' and nurses' experiences and guidelines; 3) Real-world problems and less-than-ideal solutions; 4) Eureka? Experiences with different steps during a medication review; and 5) Threats to GP autonomy.ConclusionGPs and nurses should participate in the construction and release of guidelines in order to increase their usability in clinical practice. Future research should analyse if alternative strategies such as condensed medical reviews and feedback on prescribing are easier to implement in primary care. Key points Complex medication reviews have been introduced on a large scale in Swedish primary care, but knowledge on GPs' and nurses' views on such reviews is lacking. In the context of primary care alternative strategies such as condensed medication reviews and feedback on prescribing may be more applicable than medication reviews according to guidelines. GPs and nurses should make contributions to the development of guidelines on medication reviews in order to increase their usability in clinical practice.

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Does an integrated information technology system provide support for community pharmacists undertaking Discharge Medicines Reviews? An exploratory study.

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Does an integrated information technology system provide support for community pharmacists undertaking Discharge Medicines Reviews? An exploratory study.

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