Dataset Information

Specialist Clinicians' Management of Dependence on Non-Prescription Medicines and Barriers to Treatment Provision: An Exploratory Mixed Methods Study Using Behavioural Theory.

ABSTRACT: The aim of the study was to establish how non-prescription medicine (NPM) dependence is treated by doctors in specialist substance misuse treatment services and to identify perceived barriers to providing treatment. An online survey was conducted to establish current practice and whether changes to service provision are needed to facilitate treatment (n = 83). Semi-structured interviews, based on the Theoretical Domains Framework, were conducted to derive a detailed exploration of suggested changes (n = 11). Most survey respondents had encountered cases of NPM dependence. Analgesics containing codeine were the most frequently NPMs of dependence mentioned by respondents. Most respondents were unaware of specific guidelines for the treatment of NPM dependence. The most frequently identified barriers to providing treatment identified by interviewees were limited resources or capacity and the challenges presented by this client group. There was a perception that this client group could be difficult to treat due to comorbidities, and these this client group perceived themselves to be different from people dependent on alcohol or illicit drugs. This study identified a clear need for specific clinical guidelines for the treatment of NPM dependence. Such guidance should be appropriate for specialist and generalist clinicians as the current pressure on resources may force more treatment into general practice. Appropriate care pathways need to be established and defined, and sufficient resources allocated to accommodate this client group.

SUBMITTER: Fingleton N

PROVIDER: S-EPMC6473901 | biostudies-literature | 2019 Mar

REPOSITORIES: biostudies-literature

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Specialist Clinicians' Management of Dependence on Non-Prescription Medicines and Barriers to Treatment Provision: An Exploratory Mixed Methods Study Using Behavioural Theory.

Fingleton Niamh N Duncan Eilidh E Watson Margaret M Matheson Catriona C

Pharmacy (Basel, Switzerland) 20190305 1

The aim of the study was to establish how non-prescription medicine (NPM) dependence is treated by doctors in specialist substance misuse treatment services and to identify perceived barriers to providing treatment. An online survey was conducted to establish current practice and whether changes to service provision are needed to facilitate treatment (n = 83). Semi-structured interviews, based on the Theoretical Domains Framework, were conducted to derive a detailed exploration of suggested chan ...[more]

PMID: 30841493

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Project description:Pharmaceutical care (PC) services reduce medication errors, improve the use of medicines, and optimize the cost of treatment. It can detect medication-related problems and improve patient medication adherence. However, PC services are not commonly provided in hospital pharmacies in Nepal. Therefore, the present study was done to determine the situation of PC in hospital pharmacies and explore the perception, practice, and barriers (and their determinants) encountered by hospital pharmacists while providing PC. A descriptive online cross-sectional study was conducted from 25th March to 25th October 2021 among pharmacists with a bachelor's degree and above working in hospital pharmacies using non-probability quota sampling. The questionnaire in English addressed perception and practice regarding PC, and barriers encountered and were validated by experts and pre-tested among 23 pharmacists. Descriptive statistics were used to describe the data. Kendall's correlation was used to explore the correlations among various perception and practice constructs. The scores were also compared among subgroups of respondents using the Mann-Whitney test for subgroups with two categories and Kruskal-Wallis test for greater than two categories. A total of 144 pharmacists participated in the study. Majority of the participants were male, between 22 and 31 years of age, and had work experience between 10 and 20 years. Over 50% had received no training in PC. The perception scores were higher among those with more work experience and the practice scores among those who had received PC training. Participants agreed that there were significant barriers to providing PC, including lack of support from other professionals, lack of demand from patients, absence of guidelines, inadequate training, lack of skills in communication, lack of compensation, problems with access to the patient medical record, lack of remuneration, and problems with accessing objective medicine information sources. A correlation was noted between certain perceptions and practice-related constructs. Hospital pharmacists who participated had a positive perception and practice providing PC. However, PC was not commonly practised in hospital pharmacies. Significant barriers were identified in providing PC. Further studies, especially in the eastern and western provinces, are required. Similar studies may be considered in community pharmacies.

Project description:Background: The need for palliative care among patients living with cancer is increasing globally. This need is far greater in resource-constrained settings like Ghana where there is a high unmet need for palliative care services. Consequently, there are lapses in the current palliative care regime, thus, resulting in suboptimal utilization. Objective: The study aims to explore patients living with cancer’s expectations of palliative care services and examine the barriers that impede palliative care utilization. Design: Descriptive exploratory qualitative design. Methods: A total of 15 patients living with cancer and receiving treatment in a tertiary health facility were purposively sampled to participate in this study. Semi-structured interviews were conducted. The data were transcribed and inductively analysed following Collaizi’s qualitative analysis framework. Results: From the analysis, the findings were grouped under two main categories: perceived expectations and barriers to utilizing palliative care. The participants expected to receive meaningful communication about their condition and prognosis; they also expected to be actively involved in palliative care decision-making. Regarding the barriers, the following themes emerged: financial constraints, unfavourable health appointment schedules, problems with the distance to the health facility, poor referral and follow-up from oncology specialists and being unaware of the availability of palliative care services. Conclusion: In conclusion, there is a need to actively involve patients and their families in all decision-making along the continuum of palliative care service delivery. The study underscores the need for Ghana to implement an integration of palliative care services in primary healthcare facilities to avert the challenges that distance to tertiary healthcare facilities poses to palliative care utilization. Service providers must implement awareness programmes to enable patients to better comprehend palliative care services.

Project description:Switching or reclassifying medicines with established safety profiles from prescription to non-prescription aims to increase timely consumer access to medicines, reduce under-treatment and enhance self-management. However, risks include suboptimal therapy and adverse effects. With a long-standing government policy supporting switching or reclassifying medicines from prescription to non-prescription, the United Kingdom is believed to lead the world in switch, but evidence for this is inconclusive. Interest in switching medicines for certain long-term conditions has arisen in the United Kingdom, United States, and Europe, but such switches have been contentious. The objective of this study was then to provide a comprehensive comparison of progress in switch for medicines across six developed countries: the United States; the United Kingdom; Australia; Japan; the Netherlands; and New Zealand.A list of prescription-to-non-prescription medicine switches was systematically compiled. Three measures were used to compare switch activity across the countries: "progressive" switches from 2003 to 2013 (indicating incremental consumer benefit over current non-prescription medicines); "first-in-world" switches from 2003 to 2013; and switch date comparisons for selected medicines.New Zealand was the most active in progressive switches from 2003 to 2013, with the United Kingdom and Japan not far behind. The United States, Australia and the Netherlands showed the least activity in this period. Few medicines for long-term conditions were switched, even in the United Kingdom and New Zealand where first-in-world switches were most likely. Switch of certain medicines took considerably longer in some countries than others. For example, a consumer in the United Kingdom could self-medicate with a non-sedating antihistamine 19 years earlier than a consumer in the United States.Proactivity in medicines switching, most notably in New Zealand and the United Kingdom, questions missed opportunities to enhance consumers' self-management in countries such as the United States.

Project description:BackgroundCommunication serves several functions in pediatric oncology, but communication deficiencies persist. Little is known about the broad spectrum of barriers contributing to these deficiencies. Identifying these barriers will support new strategies to improve communication.MethodsThe authors performed 10 focus groups on perceived communication barriers with nurses, nurse practitioners, physicians, and psychosocial professionals across 2 academic institutions. They analyzed transcripts by adapting a multilevel framework from organizational psychology.ResultsThe authors identified 6 levels of barriers to communication from the clinicians' perspectives: individual, team, organization, collaborating hospital, community, and policy. Individual barriers were subdivided into clinician characteristics, family characteristics, or characteristics of the clinician-family interaction. Within each level and sublevel, several manifestations of barriers were identified. Some barriers, such as a lack of comfort with difficult topics (individual), cultural differences (individual), a lack of a shared team mental model (team), and time pressure (organization), manifested similarly across professions and institutions. Other barriers, such as a need for boundaries (individual), intimidation or embarrassment of family (individual), unclear roles and authority (team), and excessive logistical requirements (policy), manifested differently across professions. With the exception of collaborating hospitals, participants from all professions identified barriers from each level. Physicians did not discuss collaborating hospital barriers.ConclusionsNurses, nurse practitioners, physicians, and psychosocial professionals experience communication barriers at multiple levels, which range from individual- to policy-level barriers. Yet their unique clinical roles and duties can lead to different manifestations of some barriers. This multilevel framework might help clinicians and researchers to identify targets for interventions to improve communication experiences for families in pediatric oncology.Lay summaryClinicians and families experience many barriers to communication in pediatric oncology. The authors performed 10 focus groups with 59 clinicians who cared for children with cancer. In these focus groups, barriers to effective communication were discussed. In this article, the authors report on an analysis of the responses. Six levels of barriers to communication were found: individual, team, organization, collaborating hospital, community, and policy. With an understanding of these barriers, interventions can be developed to target these barriers in hopes of improving communication for parents and patients in pediatric oncology.

Project description:BackgroundThere is a growing interest in high income countries to control expenditure on medicines by improving the rationale for their selection. However, in middle income countries with differing priorities and needs, little attention has been paid to this issue. In this paper we explore the policies and processes for the selection and use of medicines in a group of hospitals in Chile, a middle income country which has recently joined the OECD.MethodsA combination of qualitative and quantitative methods was used. A national survey questionnaire was distributed to investigate the role and operation of PTCs (Pharmacy and Therapeutics Committees). Interviews were conducted with key actors in the selection of medicines in large urban public hospitals.ResultsThe national survey had an overall response rate of 42% (83 out of 196), whilst 7 out of 14 hospitals participated in the qualitative study. High complexity hospitals are large urban hospitals; all of which claim to have a working PTC. The pharmacy offices are mainly involved in dispensing medicines with little involvement in clinical duties.The interviews conducted suggest that the formulary of all the hospitals visited is no more than a stock list. PTCs are unable to influence the prescribing practices of doctors. Members do not feel prepared to challenge the opinions of specialists requesting a certain drug, and decisions are based primarily on costs. The inclusion of medicines in the clinical practice of hospitals is as a result of doctors bypassing the PTC and requesting the purchase of exceptional items, some of which are included in the formulary if they are widely used.ConclusionsThere is an urgent need to develop medicine policies in hospitals in Chile. The procedures used to purchase medicines need to be revised. Central guidance for PTCs could help ensure a more rational use of medicines. PTCs need to be empowered to design formularies which cover all the clinical needs of doctors, training members in the analysis of scientific evidence beyond their own specialities. An influential PTC can take the appropriate measures and design workable policies to enforce a cost effective-use of resources.

Dataset Information

Specialist Clinicians' Management of Dependence on Non-Prescription Medicines and Barriers to Treatment Provision: An Exploratory Mixed Methods Study Using Behavioural Theory.

Publications

Specialist Clinicians' Management of Dependence on Non-Prescription Medicines and Barriers to Treatment Provision: An Exploratory Mixed Methods Study Using Behavioural Theory.

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