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Community pharmacy advanced adherence services for children and young people with long-term conditions: A cross-sectional survey study.

ABSTRACT: Objective:The aim of this study was to investigate the provision of community pharmacy services to children and young people with a focus on advanced services such as medicines use review. Perceptions and experiences of community pharmacists, pharmacy staff, young people and their parents or carers on the provision of such services were also explored. Methods:Four different cross-sectional, self-administered questionnaires were distributed in parallel to pharmacists, pharmacy staff members, children and young people and parents in the United Kingdom. Results:An outline of pharmacist's current involvement with children and young people was provided by 92 pharmacists. A different group of 38 community pharmacists and 40 non-pharmacist members of pharmacy staff from a total of 46 pharmacies provided information and views on the conduct of Medicines use review with children and young people. Experiences of advanced pharmacy service provision were collected from 51 children and young people and 18 parents. Most pharmacists offered public health advice to children and young people (73/92; 79.3%) and even more (83/92; 90.2%) reported that they often interacted with children and young people with long-term condition. Despite their high levels of interaction, and a majority opinion that medicines use reviews could benefit children (35/38; 92.1%), the number of pharmacies reporting to have conducted medicines use reviews with children was low (5/41). Pharmacists perceived the main barriers to recruitment as consent (17/29; 58.6%), guideline ambiguity (14/29; 48.3%) and training (13/29; 44.8%). A considerable proportion pharmacists (12/29; 41.4%) and other personnel (14/33; 42.4%) working in community pharmacies were unaware that children were potentially eligible for medicines use reviews. Only 29.4% of the 51 children and young people participants had received advice about their long-term condition from a pharmacist and the majority (46/51; 90.2%) had not taken part in an advanced service focused on adherence. Conclusions:While general engagement with children and young people appears high from the pharmacist's perspective, advice specific to children and young people with long-term conditions and the provision of advanced services in this group remains a challenge.

SUBMITTER: Alsairafi Z

PROVIDER: S-EPMC7104799 | biostudies-literature | 2020 Jan-Mar

REPOSITORIES: biostudies-literature

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Community pharmacy advanced adherence services for children and young people with long-term conditions: A cross-sectional survey study.

Alsairafi Zahra Z Mason Julie J Davies Natasha N Dennis Molly M Pilgrim Gabrielle G Goel Neera N Yahyouche Asma A Jalal Zahraa Z

Pharmacy practice 20200101 1

<h4>Objective</h4>The aim of this study was to investigate the provision of community pharmacy services to children and young people with a focus on advanced services such as medicines use review. Perceptions and experiences of community pharmacists, pharmacy staff, young people and their parents or carers on the provision of such services were also explored.<h4>Methods</h4>Four different cross-sectional, self-administered questionnaires were distributed in parallel to pharmacists, pharmacy staf ...[more]

PMID: 32256895

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Project description:OBJECTIVES:The primary objective was to assess the accuracy (calibration and validation status) of digital blood pressure (BP) monitors used within community pharmacy in England and the secondary objectives were to assess the overall quality of the BP service by assessing service prevalence, service utilisation and other in-service considerations. DESIGN:A cross-sectional survey. SETTING:Primary-care retail-pharmacies. PARTICIPANTS:500 pharmacies that contribute to government dispensing-data were invited by post to complete the survey. Private contractors were excluded. INTERVENTIONS:We conducted a questionnaire survey with a follow-up (September 2018 to December 2018). RESULTS:109 responses were received. 61% (n=66) of responding pharmacies provided a free BP check to their patients. 40 (61%) pharmacies used recommended validated clinical metres, 6 (9%) had failed validation and 20 (30%) provided too little information to enable us to determine their monitor's status. CONCLUSIONS:Responding pharmacies were able to provide useful BP monitoring services to their patients, though quality enhancements need to be implemented. Majority of pharmacies use validated BP monitors, however, there was a lack of range of cuff sizes, variation in replacement and calibration of monitors and apparent absence of such practice in a minority of pharmacies alongside variation in training standards. We noted higher frequency of BP screening in the most deprived postcodes.We recommend in-service redesign and delivery improvements, and suggest professional bodies and researchers work together to create clearer frameworks for front-line practitioners, creating appropriate incentives to facilitate this service redesign.Funders and policy setters should consider the value added to the National Health Service and other healthcare agencies of such screening by pharmacy providers both nationally and internationally. It has the potential to reduce complications of undiagnosed hypertension and the medicines burden that it creates. Future work should examine the impact of pharmacist-led BP screening on patients.

Project description:OBJECTIVE:UK policy initiatives aiming to extend community pharmacy services to moderate patient demands and to reduce general practitioners' (GPs) workload have had limited success. This study used marketing theory to identify factors that could influence patients to make better use of community pharmacies within the primary care pathway. DESIGN:Cross-sectional postal survey design applying the '7Ps marketing mix' ('product', 'price', 'place', 'promotion', 'people', 'process' and 'physical evidence'). SETTING:Greater Manchester, England. PARTICIPANTS:Patients with asthma or chronic obstructive pulmonary disease registered at two GP practices. PRIMARY OUTCOME:Patient preference for community pharmacy services. RESULTS:The response rate was 29% (289/1003). Most respondents preferred to use GP practices for invasive/diagnostic services (product) while preferring using community pharmacy for medicines supply and minor ailments (place). Stronger preference for using GP practices over community pharmacy was significantly associated with gender (male>female), age group (≥65 years) and healthcare services previously accessed at the pharmacy. Respondents perceived they would be more likely to use community pharmacy services if pharmacists offered them enough time to discuss any concerns (73.3%) (price), if community pharmacies had private/clean consultation rooms (70%-73%) (physical evidence) and if pharmacy staff had strong interpersonal skills (68%-70%) (people). Respondents were divided on likelihood of using community pharmacy services if pharmacists could access their whole medical record but wanted pharmacists to add information about their visit (59.6%) (process). Respondents would be encouraged to use community pharmacy for healthcare services if they were offered services by pharmacy staff or recommended/referred to services by their GP (44%) (promotion). CONCLUSIONS:Using the 7Ps marketing mix highlighted that community pharmacies having staff with strong interpersonal skills, good quality consultation rooms and integrated information systems could positively influence patients to use community pharmacies for management of long-term conditions. There are opportunities for community pharmacies to alleviate GP workload, but a whole system approach will be necessary.

Project description:BackgroundCommunity pharmacy represents an important setting to identify patients who may benefit from an adherence intervention, however it remains unclear whether it would be feasible to monitor antihypertensive adherence within the workflow of community pharmacy. The aim of this study was to identify facilitators and barriers to monitoring antihypertensive medication adherence of older adults at the point of repeat dispensing.MethodsWe undertook a factorial survey of Irish community pharmacists, guided by a conceptual model adapted from the Theory of Planned Behaviour (TPB). Respondents completed four sections, 1) five factorial vignettes (clinical scenario of repeat dispensing), 2) a medication monitoring attitude measure, 3) subjective norms and self-efficacy questions, and 4) demographic and workplace questions. Barriers and facilitators to adherence monitoring behaviour were identified in factorial vignette analysis using multivariate multilevel linear modelling, testing the effect of both contextual factors embedded within the vignettes (section 1), and respondent-level factors (sections 2-4) on likelihood to perform three adherence monitoring behaviours in response to the vignettes.ResultsSurvey invites (n = 1543) were sent via email and 258 completed online survey responses were received; two-thirds of respondents were women, and one-third were qualified pharmacists for at least 15 years. In factorial vignette analysis, pharmacists were more inclined to monitor antihypertensive medication adherence by examining refill-patterns from pharmacy records than asking patients questions about their adherence or medication beliefs. Pharmacists with more positive attitudes towards medication monitoring and normative beliefs that other pharmacists monitored adherence, were more likely to monitor adherence. Contextual factors also influenced pharmacists' likelihood to perform the three adherence monitoring behaviours, including time-pressures and the number of days late the patient collected their repeat prescription. Pharmacists' normative beliefs and the number of days late the patient collected their repeat prescription had the largest quantitative influence on responses.ConclusionsThis survey identified that positive pharmacist attitudes and normative beliefs can facilitate adherence monitoring within the current workflow; however contextual time-barriers may prevent adherence monitoring. Future research should consider these findings when designing a pharmacist-led adherence intervention to be integrated within current pharmacy workflow.

Project description:BackgroundPharmacists' knowledge about the clinical and legal aspects of antibiotic supply has an impact on appropriate dispensing practice. There are limited studies evaluating community pharmacists' knowledge of antibiotic dispensing in low and middle-income countries, including Sri Lanka. We aimed (i) to evaluate community pharmacy staff's self-reported knowledge about antibiotics and dispensing behaviour of antibiotics without a prescription, and (ii) to identify possible factors impacting their antibiotic dispensing behaviour.MethodsA cross-sectional survey was conducted among a random sample (n = 369) of community pharmacies across all nine provinces in Sri Lanka using a self-administered questionnaire on their antibiotic knowledge and dispensing practice. Data were analysed using descriptive and inferential statistics including; t-test, one-way ANOVA or chi-square test, and binary and multiple logistic regression.ResultsA total of 265 pharmacy staff (210 (79%) pharmacists and 55 (21%) assistants) responded. Overall mean antibiotic knowledge score was 26.1 (SD 3.9; range 1-33, max possible score 34). The overall mean knowledge score t(263) = 2.41, p = 0.017, specific knowledge about antibiotic resistance (ABR) t(262) = 4.98, p = 0.021 and legal aspects of antibiotic dispensing χ2(1, N = 265) = 8.55, p = 0.003) were significantly higher among pharmacists than assistants. One in every three pharmacy staff reported that they dispensed antibiotics without a prescription on patient request; however the proportion was close to half when the patient was known to them. About 30% of the staff reported to have supplied antibiotics for minor infections in the week prior to the survey. However, there was no significant difference in the supply between pharmacists and assistants except for acute sore throat (12% vs 23%, respectively; p = 0.040). Those pharmacists with higher ABR knowledge were less likely to give out antibiotics without a prescription for viral infections in adults (Adj. OR = 0.73, 95% CI: 0.55-0.96; p = 0.027) and children (Adj. OR = 0.55, 95% CI: 0.38-0.80; p = 0.002). Awareness of legal aspects of antibiotic supply reduced overall dispensing (Adj. OR = 0.47, 95% CI: 0.30-0.75; p = 0.001), and specifically for bacterial infections in adults (Adj. OR = 0.45, 95% CI: 0.20-0.99; p = 0.047). Knowledge about antibiotic use and misuse reduced the likelihood of illegal dispensing for common cold (Adj. OR = 0.75, 95% CI: 0.60-0.94; p = 0.011) and acute diarrhoea (Adj. OR = 0.76, 95% CI: 0.58-0.99; p = 0.048).ConclusionDespite the law prohibiting provision, antibiotic dispensing without a prescription continues in community pharmacies in Sri Lanka. Appropriate antibiotic dispensing was associated with high levels of pharmacists' legal and clinical knowledge about antibiotics. Strategies to change the current practice are urgently needed.

Project description:BackgroundPrimary health care is known to have positive effects on population health and may reduce at-risk behavior and health problems in adolescence. Yet little is known about the factors that are associated with adolescent and young adult utilization of family physician services. It is critical to determine the factors associated with utilization to inform effective primary health care policy. We address this gap in the primary health care literature by examining three issues concerning adolescent and young adult family physician use: inequity; the unique developmental stage of adolescence; and the distinction between utilization (users versus non-users) and intensity (high users versus low users).MethodsWe conducted nested logistic regressions for two outcomes: utilization and intensity of family physician services for early adolescence, middle adolescence, and young adulthood using the 2005 Canadian Community Health Survey.ResultsChronic conditions were associated with utilization in early and middle adolescence and intensity in all age groups. Respondents from Quebec had lower odds of utilization. Those without a regular medical doctor had much lower odds of being users. The factors associated with use in early and middle adolescence were in keeping with parental involvement while the factors in young adulthood show the emerging independence of this group.ConclusionsWe highlight key messages not known previously for adolescent and young adult use of family physician services. There is inequity concerning regional variation and for those who do not have a regular medical doctor. There is variation in factors associated with family physician services across the three age groups of adolescence. Health care and health care policies aimed at younger adolescents must consider that parents are still the primary decision-maker while older adolescents are more autonomous. There is variation in the factors associated with the two outcomes of utilization and intensity of services. Factors associated with utilization must be understood when considering the equitability of access to primary health care while factors associated with intensity must be understood when considering appropriate use of resources. The understanding gained from this study can inform health care policy that is responsive to the critical developmental stage of adolescence and young adulthood.

Dataset Information

Community pharmacy advanced adherence services for children and young people with long-term conditions: A cross-sectional survey study.

Publications

Community pharmacy advanced adherence services for children and young people with long-term conditions: A cross-sectional survey study.

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