International Journal of Pharmacy Practice Abstracts

4 International Journal of Pharmacy Practice 2020; Supplement S1
studies evaluating a DT-based intervention for surgical

patients were included, specifically focusing on three
International Journal of elective specialties (bariatric, cancer, and orthopaedic
Pharmacy Practice surgeries) where pharmacists can play an enhanced role
in supporting and educating patients. Emergency/acute
IJPP 2020, Supplement S1: 4–43 surgeries were excluded, and no limit on publication
ªThe Authors. dates was applied. Joanna Briggs Critical Appraisal
IJPP ª 2020 Royal Pharmaceutical Society tools were used for quality/bias assessment.
Results: Seventeen studies from seven different countries,
published between 2011 and 2019, were included. They
Oral Presentations focused on adult surgical patients undergoing bariatric
(59%, n = 10), cancer (29%, n = 5), and orthopaedic sur-
Downloaded from https://academic.oup.com/ijpp/article/28/Supplement_1/4/6066791 by guest on 18 December 2021

Behaviour Change gery (12%, n = 2). We identified three key factors con-
tributing to DT effectiveness in supporting HBC in
elective surgical populations, specifically: intervention
The effectiveness of digital health delivery, implementation, and theoretical-underpinning.
technologies to support surgical patients e-Platforms demonstrated HBC (P ≤ 0.05) in 75% of
studies; however, this method may be superseded in the
in changing health behaviours: a near future with increasing prevalence of wearable tech-
systematic review and narrative synthesis nologies and apps. HBCs were found in 100% of studies
implementing DTs across the entire pre- and post-opera-
A. Robinson, A. Husband, B. Slight and tive period, compared to 40% and 62.5% of those target-
S. Slight ing only the pre-operative and post-operative periods,
respectively. Eight studies included HBC theories in their
Newcastle University, Newcastle, UK design: 75% (n = 6) produced HBC (P ≤ 0.05) relating to
reduced weight regain, increased PA and improved diet.
Introduction: Digital technologies (DTs) play an integral Conclusion: Findings demonstrate that DTs effectively
part in everyday life. Statistics estimate 78% of adults support HBC in elective surgical patients. Study size
own a smartphone, 90% of people regularly access the was a recognised limitation, where further research in
internet at home, and 20% use wearable technologies larger populations may strengthen conclusions. By
such as fitness trackers1. This uptake has been echoed in recognising factors contributing to DT effectiveness,
healthcare with successful shifts towards DT integration these findings can support recommendations for elective
to improve outcomes. DTs can aid diagnoses and surgical outcome improvement and further reiterate
improve clinician communication and information trans- HBC to improve population health.
fer across sectors2. For patients, DTs can enhance edu-
cation, improve communication with clinicians, and
References
empower shared decision-making and health behaviour
change (HBC).2 In surgical contexts, evidence has linked
better health behaviours and physical-preparedness prior 1. Smartphone usage among mobile phone users in the
to surgery, with improved post-operative outcomes.2 United Kingdom in 2018, Statista. 2018, Newcastle
Specifically, improvements in a patient’s weight, dietary University.
intake, and physical activity levels have been associated 2. Levett, D.Z., et al., Preparing the patient for surgery to
with better tolerance of post-surgical treatment and improve outcomes. Anaesthesiol, 2016. 30(2):p.145–57.
long-term prevention of ill health.2 At present, there are
variable amounts of support available for elective surgi- Developing a community pharmacy-
cal patients to make these beneficial HBCs. DTs (such
as activity trackers and smartphone applications) pre-
based reproductive health service for
sent an innovative opportunity to engage patients as women in receipt of opiate substitution
active partners in their care, whilst supporting HBC and therapy: a qualitative exploration of
potentially optimising surgical outcomes.2 pharmacists’ views using the COM-B
Aim: To conduct a systematic review and narrative synthesis
examining the effectiveness of DTs to support elective surgi- framework
cal patients in changing their health behaviours, specifically
focusing on physical activity, weight, and dietary intake. J. Scott1, H. Family2, N. Alhusein2, J. Neale3
Methods: This review was conducted according to Pre- and A. Chater4
ferred Reporting Items for Systematic Reviews and
Meta-Analyses (PRISMA) guidelines and registered with 1
University of Bath, Bath, UK 2University of Bristol, Bristol, UK 3King’s
PROSPERO: CRD42019127972. Medline, Embase, College London, London, UK and 4University of Bedfordshire,
CINAHL, PsycInfo, Web of Science, and Scopus data- Bedford, UK
bases were searched in March 2019. Experimental
ªThe Authors. IJPP ª 2020 Royal Pharmaceutical Society International Journal of Pharmacy Practice, 28 (Suppl. S1), pp. 4–43
Behaviour Change 5
Introduction: Women who experience addiction, particu- perceived to influence provision of reproductive health
larly to drugs such as heroin, with associated poor self- advice to women on OST. Most are not unique to OST
care and nutrition, can experience absence of menstrua- patients, with the exception of security, safety and use of
tion, and temporary reduction in fertility gives rise to the consultation room.
belief that they will not conceive. However, when sta- Conclusions: Community pharmacists could be well
bilised on opiate substitution treatment (OST), with placed to provide women receiving OST with reproduc-
associated improved lifestyle and diet, fertility often tive health advice and support. The COM-B system/
returns. As ovulation precedes menstruation, this can be TDF helped identify factors to inform design of the ser-
without knowledge of potential to conceive, creating vice and training, including barriers to be considered.
vulnerability to unintended pregnancies. Community This study is limited in that those who volunteered may
pharmacists undertake most daily supervision of OST have more positive views than others.
consumption, recommended in early treatment1. This

creates an opportunity to provide reproductive health
services and advice early on when needed, taking advan- References
tage of daily contact. This study was undertaken to
inform development of such an intervention. 1. Clinical Guidelines on Drug Misuse and Dependence
Aim: To investigate pharmacists’ perspectives on provid- Update 2017 Independent Expert Working Group
ing reproductive health services to women receiving OST. (2017) Drug misuse and dependence: UK guidelines
Methods: Semi-structured interviews using a schedule on clinical management. London: Department of
based on COM-B and Theoretical Domains Framework Health.
(TDF)2. Participants were recruited via head offices 2. A guide to using the Theoretical Domains Frame-
(multiples) and Local Pharmaceutical Committees. Inter- work of behaviour change to investigate implementa-
views were recorded and transcribed verbatim. Data tion problems. Atkins et al. Implementation Science
analysis included deductive coding using TDF, collapsed (2017) 12:77.
into COM-B domains. Second stage inductive analysis
comprised re-reading and reviewing deductive codes and
identifying inductive themes.
A consensus study to characterise the
Results: Twenty community pharmacists practising in behaviour change techniques of a
London and South West England participated. Five practitioner behaviour change
inductive themes were identified: (1) Pharmacists’ knowl- intervention for deprescribing in the
edge and experience of women’s RH needs. Many partici-
pants had seen their female OST patients getting hospital setting
pregnant, both planned and unplanned. Most described
not having enough knowledge about the relationship S. Scott1, A. Clark1, C. Farrow2, H. May2, M.
between OST and fertility. (2) The trigger, the need and Patel2, D. Wright1 and D. Bhattacharya1
a structure: pharmacists’ style of providing services. Data
1
illustrate differences in automatic and reflective motiva- University of East Anglia, Norwich, UK and 2Norfolk and Norwich
University Hospitals NHS Foundation Trust, Norwich, UK
tion of pharmacists, depending on whether participants
saw the service as one to provide proactively and oppor-
tunistically, or in response to a trigger. Participants Introduction: Deprescribing medicines where the poten-
described their need for “something to hook on” e.g. the tial for harm outweighs the benefits is not routine practice
patient initiating the subject, illustrated by participant 2: in hospital1. The hospital deprescribing implementation
‘a lot of the information we provide in the pharmacies is framework provides 44 behaviour change techniques
opportunistic it would be kind of where you have a patient (BCTs) to address the four barriers and one enabler
asking you or it might come up- a patient not sure, or when (Table 1) prioritised by geriatricians and pharmacists for
we do an emergency hormone contraception supply. . .”. hospital deprescribing interventions2. BCTs should be
Confidence and beliefs about capabilities were identified selected from the framework by the target audience to
as important. Emotions of the pharmacist and stigmatisa- develop an intervention according to contextual factors
tion of patients were also central influences. (3) Pharma- and the APEASE criteria (affordability, practicability,
cists’ perception of the relationship between them and the effectiveness, acceptability, safety and equitability).
women. Pharmacists believed that having a good rap- Aim: This study aimed to support geriatricians and
port/relationship with women on OST was key in deter- pharmacists to select BCTs from the hospital deprescrib-
mining whether individuals would engage in a pharmacy- ing implementation framework for an intervention in
based reproductive health intervention. (4) Social influ- the English hospital context.
ences. Participants said they probably wouldn’t approach Methods: A panel of geriatricians and pharmacists was
the subject of reproductive health when a woman is convened to participate in a consensus study comprising
accompanied e.g. by children or partners. Some felt pro- of the following two-stages: Stage 1: Initial voting round
viding or advertising such services may have a negative (online survey). Stage 2: Face-to-face nominal group tech-
effect on business. (5) Privacy and funding. This com- nique. The panel selected BCTs from the hospital depre-
prised environmental factors that influenced or were scribing implementation framework according to whether
they met the APEASE criteria for the English hospital The six characterised behaviour change techniques to
context in stage 1. A consensus threshold was set address the four barriers and one enabler prioritised for
of ≥ 80% agreement that a BCT met all of the APEASE deprescribing are presented in table 1.
criteria and a partial consensus threshold of ≥ 80% Conclusion: Selection of BCTs by the target audience
agreement across at least three of the criteria. Stage 2 for intervention development is feasible. Behaviour
involved the panel participating in one nominal group change interventions targeting geriatricians’ and phar-
technique cycle (silent generation, round robin, clarifica- macists’ deprescribing behaviour in the English hospital
tion, voting and discussion) per BCT that achieved partial context should include the six characterised BCTs. These
consensus from stage 1 in order to accept or reject. The provide an evidence-base for supporting routine depre-
panel was then asked to characterise all accepted BCTs scribing in hospital. The dose, frequency and mode of
from stages 1 and 2 in terms of how they may be opera- delivery of the BCTs will require modelling and feasibil-
tionalised in the English hospital context. ity testing prior to larger scale testing.

Results: Four geriatricians and five pharmacists were
recruited to the expert panel representing five English
hospitals. Three BCTs achieved consensus in stage 1 References
and were automatically accepted for the intervention. A
further three BCTs achieved partial consensus in stage 1. Scott S, Clark A, Farrow C, May H, Patel M,
1, of which two reached consensus at stage 2 and were Twigg MJ, et al. Deprescribing admission medica-
accepted for the intervention. The panel failed to reach tion at a UK teaching hospital; a report on quantity
consensus to include a BCT to address the enabler of and nature of activity. Int J Clin Pharm. 2018;
‘incentivising deprescribing’. Instead, the panel proposed 2. Scott S, Twigg MJ, Clark A, Farrow C, May H, Patel
addressing the enabler by “measuring, reporting and M, et al. Development of a hospital Deprescribing
sharing levels of deprescribing between wards or hospi- Implementation Framework: A focus group study
tals”, which aligns with the BCT ‘social comparison’. with geriatricians and Pharmacists. Age Ageing. 2019;
Table 1. Six Behaviour Change Techniques selected and characterised for operationalisation in a hospital deprescribing intervention
*Behaviour change technique achieved consensus to accept in the intervention at stage 1.

**Behaviour change technique achieved consensus to accept in the intervention at stage 2.
Innovation in Community Pharmacy 7
Innovation in Community Pharmacy structure of STTT reassured them about their condition.
Overall patient satisfaction was 99.2%. A total of 98.8%
of patients (n = 504) stated that next time they had a sore
Does an NHS test and treat service in throat they would return to the pharmacy instead of
communities pharmacy promote health- going to the GP, indicating a shift in health-seeking beha-
seeking behaviour change? A viour in relation sore throat symptoms.
Conclusion: A key factor in supporting the Welsh
quantitative study Government to deliver their vision for “A Healthier
Wales” is to work closely with community pharmacists
E. Mantzourani1,2, I. Hill1, A. Meudell1, C. and ensure that services in primary care are safely rebal-
Way2, E. Williams2, R. Deslandes1, anced to create capacity for GPs to manage more complex
L. Houldcroft1, B. Legay3, H. Ahmed1, conditions and patients that would otherwise would need

to be under hospital care1. This study evaluated patient
K. Hood1, R. Cannings-John1 and A. Evans4 acceptability with a service that was introduced in Wales
1
to support transfer of uncomplicated sore throat manage-
Cardiff University, Cardiff, UK 2NHS Wales Informatics Service,
Cardiff, UK 3Universite de Nantes, Nantes, France and 4Welsh ment to community pharmacies. Data from patient satis-
Government, Cardiff, UK faction surveys revealed high patient acceptability of the
pilot STTT service and evidence of a shift in health-seek-
Introduction: The first NHS funded Sore Throat “Test ing behaviour. These results, coupled with results from a
and Treat” (STTT) was introduced in selected commu- study exploring pharmacists’ acceptability of the service,
nity pharmacies in one nation in the United Kingdom suggest that potential benefits include providing an alter-
(UK) in November 2018. Patients ≥6 years old with native, preferred pathway for patients with sore throat2.
acute sore throat self-presenting to a participating phar- As the response rate was quite low, feedback obtained
macy could receive a clinical examination by a pharma- may not be representative of some patient subgroups.
cist who had completed extra training, an immediate
Point-of-Care Test (POCT) if the threshold clinical scor- References
ing criteria were met, and a supply of antibiotics under
a Patient Group Direction if the POCT was positive.
One of the main aims of the new service was to change 1. Welsh Government. Prudent Healthcare Securing
patient health-seeking behaviour towards visiting their Health and Well-being for Future Generations.
pharmacist instead of their GP, hence better utilising 2016. http://www.prudenthealthcare.org.uk/wp-content/
pharmacist skills and freeing up GP time for more com- uploads/2016/02/Securing-Health-and-Wellbeing-for-
plex and urgent medical issues, in line with principles of Future-Generations1.pdf
Prudent Healthcare. 2. Mantzourani E, Hicks R, Evans A, Williams E,
Aims: To determine patient satisfaction with the new Way C, Deslandes R. Community Pharmacist Views
STTT service and explore whether it influenced patient On The Early Stages Of Implementation Of A Path-
health-seeking behaviour. finder Sore Throat Test And Treat Service In Wales:
Method: A short, self-administered patient experience sur- An Exploratory Study. Integrated Pharmacy
vey was developed in collaboration with members of the Research and Practice. 2019 https://doi.org/10.2147/
public, including a mix of closed and open questions. The iprp.s225333
survey was distributed to all patients who had completed a
consultation, regardless of the outcome, between Novem- A qualitative exploration of young
ber 2018 and May 2019. A pre-paid envelope was supplied peoples’, pharmacists’ and contract
for return of the completed surveys and a link to online
submission was provided. All data from completed surveys managers’ perceptions of the
were entered in Jisc Online Surveys and exported to community pharmacy chlamydia
Excel for descriptive statistics. Free-text comments were screening service
imported in Word and deductive thematic analysis was
used in relation to access and future intentions. L. Ahmaro1, L. Lindsey1, S. Forrest2 and
Results: A total of 510 completed surveys were received
by the end of the data collection period (510/2750 consul- C. Whittlesea3
tations, response rate 18.5%). Of all patients, 67.3% 1
Newcastle University, Newcastle, UK 2Durham University, Durham, UK
(n = 343) tried to see a GP before going to the pharmacy. and 3University College London, London, UK
Deductive analysis of free-text comments revealed two
themes: convenience and accessibility, and perceived
Introduction: Chlamydia is the most common sexually
value of the service. Patients discussed accessibility of the
transmitted infection in the UK particularly among young
pharmacist, reduced waiting times in relation to attending
people. If not treated, it increases the risk of transmission
a GP appointment, increased understanding of the differ-
and serious health consequences including infertility in
ence between bacterial and viral infections, and how the
both sexes. To reduce these risks, many community
pharmacies provide free chlamydia screening for young pharmacies made them ideal for screening, but that the
people. In 2018, screening activity among this age group service required greater promotion.
was lower than previous years, and less than 1% were Conclusion: This is the first study to explore the percep-
screened in pharmacies compared to other settings1. The tions of all three stakeholders on the pharmacy chlamy-
reasons why uptake is low in pharmacies are unclear. dia screening service. However, the views of pharmacy
Aim: To investigate why community pharmacy screen- support staff about screening were not explored due to
ing activity is low, this study aims to understand the fac- time limitation. Findings and proposed recommenda-
tors that influence uptake of screening by exploring the tions will be disseminated to local decision-makers and
views of young people, pharmacists, and sexual health pharmacy committees to inform practice. Future work
contract managers. will involve designing a framework with policy makers
Methods: Semi-structured interviews were conducted to maximise service delivery.
with young people including service users, pharmacists,

and contract managers who assign the service to pharma-
cies. Information leaflets were provided to 40 youth club References
members aged 16–24. Participants were then recruited
using quota sampling (see Table 1) and interviewed at the 1. PHE Sexually transmitted infections and screening
clubs. The topic guide covered knowledge of chlamydia for chlamydia in England, 2018, published 7/06/19.
and associated risks and thoughts about the pharmacy 2. May C, Finch, T. Implementing, Embedding, and
screening method. Using thematic analysis, audio- Integrating Practices: An Outline of Normalization
recorded responses were transcribed and coded in NVivo Process Theory. Sociology. 2009;43(3):535–554.
Ver11 to produce themes, then re-coded under constructs
of the Health Belief Model and findings compared.
GP2Pharmacy: a quantitative evaluation
Table 1. The sample variables for interviewing young of a novel locally commissioned
people.
community pharmacy referral service in
Sample size: n = 30
Ages: 16–24
South Tyneside
Sample variables At least 20% of men and 20% A. Moore, M. Conway, A. Sturrock and
of women have been
previously tested for an STI
K. Bullen
At least 20% of men and 20%
University of Sunderland, Sunderland, UK
of women have used a
pharmacy sexual health
service including chlamydia Introduction: General practice is seeing increased demand
testing for rapid access appointments and higher patient expecta-
At least two participants tions. The NHS Long Term Plan suggests a need to better
representing each age from utilise the skills, experience and knowledge of community
16–24 interviewed pharmacists in order to relieve some of the pressure on
prescribers in primary care.1 GP2Pharmacy is an innova-
There were 102 pharmacists and 2 contract managers tive service, which utilises PGDs (including antibiotics for
invited to take part in the study by post. Stratified sam- urinary tract infections and tonsillitis) alongside an exist-
pling was used to recruit the participants who were then ing minor ailments scheme. Additional clinical skills
interviewed at work or over-the-telephone depending on training was provided for pharmacists providing the ser-
preference. The topic guide for both participant groups vice. There were 8000 appointments available in the initial
broadly covered constructs of the Normalization Process pilot. Patients contact their practice as normal where
Theory Model2 to identify the factors required for inte- reception staff can book fixed time appointments for suit-
gration of the screening service into routine work. able patients with their local pharmacist.
Results: Interviews were conducted with 25 young people, Aim: To evaluate the GP2Pharmacy service via analysis
22 pharmacists and 2 contract managers as key infor- of quantitative consultation data, specifically in refer-
mants. Among young people, concerns regarding privacy ence to the provision of prescription only medicines via
and feeling judged when requesting a chlamydia kit were PGDs and patient feedback questionnaire responses.
perceived barriers ‘Don’t make it feel like there’s a mas- Methods: All GP2Pharmacy consultations are recorded
sive elephant in the room.’ Pharmacists suggested further on PharmOutcomes and South Tyneside CCG provided
training needs to deliver a more young people-friendly access to anonymised consultation and patient feedback
service to maximise cognitive participation ‘Training is a questionnaire data at 3 months and 6 months into the
bit more. . .required on how to talk to youngsters. . . they pilot. Data were statistically analysed using SPSS V25;
sometimes don’t know how to talk to somebody about particular attention was given to variables (including
what’s happened to them’. All three participant groups patient age, referring surgery and presenting complaint)
believed that the accessible location and opening hours of affecting the outcome and evaluation of the
Opioid Use 9
consultation, using chi-squared tests. Any questionnaire Introduction: Opioid prescribing has risen considerably
free text comments were qualitatively explored for in the UK over the last 20 years 1 and with it, comes
insight. increased risks to population health2. Opioid dose is an
Results: In the first six months of the service, 741 patients indicator of potential harm, but understanding the bur-
were referred to one of the community pharmacies den of different opioid medicines can be hampered by
enrolled in the service (n = 24) to provide advice (15%), the numerous doses, strengths and products available.
treatment with an over-the-counter product (47%) or Aims: The study aimed to describe trends in prescribing
same day referral back to the GP (14%). Six patients were of opioid analgesics for non-cancer pain across Wales
referred to urgent care. A PGD medication was provided between 2005–2015, using an oral morphine equivalent
in 21% of consultations, including 79 patients for nitrofu- dose (OMED) measure to compare dose burden between
rantoin, 37 patients for fusidic acid and ten patients for drugs.
phenoxymethylpenicillin.. Of patients accessing the ser- Methods: The Secure Anonymised Information Linkage

vice, 24% were under 13 and 12% were over 65 years of databank (SAIL) was searched using validated NHS
age. Reception staff referred 96% of patients. read-codes to identify prescriptions for oral and trans-
Further analysis highlighted that the range of pre- dermal opioid medicines issued in Primary Care Prac-
senting complaints did not fully utilise the wide range of tices in Wales between 2005–2015. A proxy-measure for
PGDs available under the service, for example, aciclovir OMED was developed, due to the lack of data for pre-
for shingles. Furthermore, over half of all PGD referrals scription directions and quantity normally required to
came from just two surgeries out of 14 registered for the calculate OMED. The devised measure allocated OMED
service (P ≤ 0.001, Cramer’s V = 0.243). based on the strength of each product prescribed. The
The feedback from patients highlighted the benefits OMED was multiplied by the recommended daily dose
of increased and quicker access to a healthcare profes- (Medicines.org) and the number of prescriptions issued
sional. Negative comments included booking an each year to determine annual totals for each drug.
appointment and locum pharmacists not having an ade- Data were measured in repeated, annual cross-sections
quate understanding of the service. and adjusted for population. Statistical analysis used
Conclusion: While this analysis highlights the potential Kruskal-Wallis H tests, as data were not normally dis-
viability of extended minor ailment schemes, with many tributed.
patients highlighting the benefits of easier access to Results: Just over 23.5million prescriptions from 345 Pri-
required medications through their community pharma- mary Care General Practices were included in the analy-
cist, there was an underuse of available appointments and sis. Total annual OMED doubled from 37,662,65 mg to
specifically those that require provision of prescription 76,428,768 mg in the 11 years examined.
only medications via a PGD. The quantitative approach Overall, 71% of the opioid burden between 2005–2015
utilised within this research meant some emerging themes was due to 3 drugs; codeine (35%), tramadol (22%) and
could not be explored fully. A qualitative strand is cur- morphine (14%). There was a statistically significant dif-
rently underway to further explore facilitators and barri- ference (P < 0.001, H = 73.5, ฦ2=0.8) between the groups
ers to the service with key stakeholders. of drugs examined. Large increases in OMED were noted
for morphine (Table 1) in particular.
Reference
Table 1. Daily oral morphine equivalent dose (mil-
ligrams) issued on prescription, given as annual totals
1. Reducing pressure in general practice; NHS Eng- and adjusted to population, stratified by drug
land; https://www.england.nhs.uk/gp/gpfv/workload/
Total daily oral morphine equivalent dose
releasing-pressure/ [Accessed online 11/04/2019].
(mg) prescribed
Total all
Opioid Use Year Codeine Morphine Tramadol opioids
2005 13743115 3293220 7865695 37662651

Examining trends in opioid prescribing 2015 25593382 17047800 14252335 76428768
burden using an oral morphine Percentage change 86.2 417.7 81.2 102.9
equivalence measure in a primary care (%)
2005–2015
population: a retrospective, cross- Total daily oral morphine equivalent dose
sectional study of primary care (mg) per 1000 population
2005 5916 1422 3397 16266
prescribing data 2015 10581 7063 5905 31665
Rate change (%) 78.8 396.6 73.8 94.7
E. Davies, C. Phillips, B. Sewell, M. Jones and 2005–2015
J. Rance Oral morphine equivalent dose per
prescription issued (mg)
Swansea University, Swansea, UK
Table 1. (Continued) Many of these deaths include those who inject illicit
drugs, so may access NSP and people currently or
Total daily oral morphine equivalent dose
(mg) prescribed
recently in treatment for their addiction. Evidences sug-
gest OST reduces both overdose and overall mortality
Total all but more needs to be done to prevent these deaths. UK
Year Codeine Morphine Tramadol opioids guidance describes pharmacy practice to reduce over-
dose but the extent to which such guidance is imple-
2005 17 86 36 23
mented is questionable1.
2015 19 68 38 32
Percentage change 16.2 20.6 5.7 35.5
Aim: To describe CPs’ self-reported adherence to guide-
(%) lines for preventing overdose deaths.
2005–2015 Methods: A cross-sectional quantitative telephone sur-
vey was undertaken with CPs in England. A random

stratified sampling technique was adapted to get repre-
Conclusion: Large increases in OMED burden were sentative sample from 6% of registered pharmacy pre-
observed over the 11 years studied. The patterns in pre- mises. Information was sent to the participants in
scribing, in particular the drugs responsible for the main advance by post and verbal consent was taken before
burden are different to those described in England.1 the survey was administered by phone. The question-
Although the proxy OMED measure is an estimate, the naire was developed based on published literature and
trends described are an accurate reflection of prescribing was piloted before use. Eligibility criteria were set as
in Wales and give a new insight into the burden on the those who provided any OST service. The survey was
population. Future work is needed to better understand administered between January and May 2019. SPSS 25
the reasons for such large increases in opioid prescribing software was used for data management and analysis.
and the differences between Wales and the rest of the Data were subjected to descriptive analysis1.
United Kingdom. Results: A total of 253/750 responses (34%) were
received of which 56% (n = 142) were male. Based on
the eligibility, where known, the response rate was
References
39% (n = 253/657). Over three-quarter (77%, n = 194)
received formal training to deliver OST services how-
1. Curtis HJ, Croker R, Walker AJ, Richards GC, ever only 40% (n = 102) were asked to provide any
Quinlan J, Goldacre B. 2019. Opioid prescribing evidence of training. The provision of NSP (18%,
trends and geographical variation in England, 1998– n = 45) and THN (1.6%, n = 4) services were poor. A
2018: a retrospective database study. The Lancet. significant proportion (21%, n = 54) reported to never
Psychiatry, 6(2), pp.140–150. counsel patients about overdose risks. Only half (50%,
2. Taylor S, Annand F, Burkinshaw P, Greaves F, n = 126) counselled at the initiation stage and a third
Kelleher M, Knight J, Perkins C, Tran A, White M, (32%, n = 81) did so when there was a change in
Marsden J. Dependence and withdrawal associated dose/circumstances. The majority (63%, n = 160) did
with some prescribed medicines: an evidence review. not ensure patients have access to naloxone to treat
Public Health England, London. 2019. accidental opioid overdose. While all pharmacists
(100%, n = 253) checked prescriptions for legal cor-
rectness; one-fifth (19%, n = 48) did not always estab-
Community pharmacists’ role in lish its clinical appropriateness. Almost all CPs
preventing Opioid Substitution Therapy- consulted the prescriber (97%, n = 245) when three or
related deaths: a national survey of more consecutive doses have been missed but only
two-thirds (62%, n = 157) withheld dose from intoxi-
English community pharmacists cated patients.
Conclusion: Guidance which is pertinent to legal
R. Yadav1, J. Scott1, P. Rogers1 and aspects (e.g. prescription legality) is more closely
D. Taylor2 adhered to than those requiring knowledge and profes-
sional judgement (e.g. clinical assessment, withholding
1 2
University of Bath, Bath, UK and Victoria University Wellington, dose). OST patients are more likely to suffer overdose
Wellington, New Zealand
fatality during initiation and abstinence stage, the lack
of overdose counselling in these critical stages, there-
Introduction: Community pharmacists (CP) dispense the fore, is an area of immediate concern. The ‘mechanics
majority of Opioid Substitution Therapy (OST) pre- of delivering the service’ forms the central premise of
scriptions in England, and also provide related services, the current practice and the notion of ‘preventing over-
such as Supervised Consumption (SC), Needle & Syr- dose death’ is peripheral. Pharmacists’ education on
inge Programmes (NSP) and Take Home Naloxone overdose prevention, their motivation to intervene in
(THN). Opioid overdose deaths have increased dramati- risk situations, improving access to NSP and THN in
cally in many high-income countries in recent years. pharmacies all needs attention. Nonparticipation of
Opioid Use 11
two large multiple chains in the survey is one of the of stakeholders involved in intervention implementation
limitations of this research. in England. We tested the resulting programme theo-
ries with the published literature and survey data. We
iteratively refined the programme theories to include
Reference only those supported by the evidence and combined
this final set of theories into one (mid-range theory)
1. Department of Health and Social Care. Drug misuse which was presented to the stakeholder panel for any
and dependence: UK guidelines on clinical management. further refinement.
Available from: https://www.gov.uk/government/ Results: From 56 published and 16 implemented inter-
publications/drug-misuse-and-dependence-uk-guideline ventions representing primary care, hospital, specialist
s-on-clinical-management [Accessed on 3rd Oct 2019]. pain facilities and the prison service, doctors were most
frequently involved in delivering opioid tapering inter-

ventions whilst pharmacists were often the drivers of
A theory and evidence-based health establishing tapering interventions. Of the nine pro-
service model for tapering opioids in gramme theories generated after initial stakeholder panel
chronic non-cancer pain: a realist review refinement, seven were supported by the evidence to
generate the final mid-range theory. The overarching
D. Bhattacharya, H. Whiteside, C. Hill, enabler to practitioners engaging with an opioid taper-
ing programme is presence of a clear expectation that
E. Tang, B. Atkins, K. Kantilal and Y. Loke opioid tapering is their responsibility. This may be
University of East Anglia, Norwich, UK achieved in a variety of ways including incentivisation.
Practitioners are further enabled by programmes incor-
porating information about the consequences of excess
Introduction: Numerous interventions have been devel-
opioid use and guidelines on how to taper; these were
oped to address opioid overuse for chronic non-cancer
often prepared by pharmacists. Programmes should fur-
pain. A 2017 systematic review identified several effec-
ther enable practitioners by equipping them with appro-
tive interventions for tapering long-term opioids yet lim-
priate knowledge and skills to initiate tapering
ited progress has been made with successfully
discussions and navigate the patient pathway. All mem-
integrating these into routine healthcare practice1. This
bers of the healthcare system should adopt a consistent
lack of adoption may be due to limited understanding
approach to opioid tapering. Providing access for
of the barriers and enablers to practitioners delivering
patients to comprehensive education, appropriate levels
these interventions in the real-world environment. Real-
of psychological and physical support addresses patient-
ist methodology combines theory with research and
related barriers to tapering.
practice evidence to understand the mechanisms by
Conclusions: Inferences are limited by the survey data
which intervention components exert their effect. This
being derived only from one country, however, through
understanding enables effective components to be trans-
combining with the peer-reviewed literature representing
lated from the trial to the real-world environment whilst
numerous countries, we have greater confidence in the
maintaining efficacy.
likely transferability of findings. Healthcare organisa-
Aim: To understand from the practitioner perspective,
tions commissioning opioid tapering programmes should
what elements of opioid tapering interventions work.
therefore ensure that all components of the mid-range
Methods: The theoretical domains framework under-
theory are addressed. Characterisation of each compo-
pinned the realist review; it comprises 14 domains each
nent should be determined by individual health systems
representing barriers and enablers to practitioners
according to existing structures and resources.
implementing a behaviour. For each domain, we for-
mulated programme theories regarding the require-
ments for a healthcare professional to effectively taper Reference
opioids. We refined these through discussion with a
stakeholder panel of eight primary and secondary care
pharmacists and doctors. We identified relevant pub- 1. Frank, J. W., et al. (2017). Patient Outcomes in
lished literature from the 2017 systematic review of Dose Reduction or Discontinuation of Long-Term
interventions for tapering long-term opioid therapy1. Opioid Therapy: A Systematic Review. Ann Intern
We combined these data with a semi-structured survey Med 167(3): 181–191.
Polypharmacy Transcripts were analysed by content analysis using a

framework approach to identify key themes. The emer-
gent coding scheme was reviewed, agreed and the main
A qualitative study to refine a theory- themes were developed into a framework matrix.
based intervention to improve Results: Interviews were conducted with 13 GPs in 12
appropriate polypharmacy in older practices, across five counties. Key themes identified
were: clinical scenario used in the video, engagement
people in primary care with and length of video, potential enablers and barri-
ers to intervention implementation. GPs were positive
A. Gorman1, A. Rankin2, H. Barry2, about the intervention and thought it ‘would probably
C. Cadogan3, G. Gormley4, T. Fahey5, fit into most practices’ and that the video ‘was concise
C. Ryan1, E. Gardner6, A. Agus6, and useful’. Some concerns were noted about time con-

straints (‘obviously if you had more time, we would be
C. Leathem7, M. Maxwell7, G. Molloy8, much more thorough about things’) and a lack of
A. Ferrett9, P. McCarthy10 and C. Hughes2 resources (‘at this moment in time the resources are dif-
ficult’). Minor suggestions to the video component
1
School of Pharmacy and Pharmaceutical Sciences, Trinity College included ‘some up to date medical evidence-based medi-
Dublin, Dublin, Ireland 2School of Pharmacy, Queen’s University Belfast,
cine’ and ‘tools you can use to perform medication
Belfast, UK 3School of Pharmacy and Biomolecular Sciences, Royal
College of Surgeons in Ireland, Dublin, Ireland 4School of Medicine, reviews’. GPs suggested small additions to the interven-
Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, tion, including a staff information sheet and a patient
UK 5Department of General Practice, Royal College of Surgeons in recruitment poster.
Ireland, Dublin, Ireland 6Northern Ireland Clinical Trials Unit, Belfast, UK Conclusions: Using a theoretical basis for development,
7
Northern Ireland Clinical Research Network Primary Care, Belfast, UK
8
School of Psychology, National University of Ireland, Galway, Galway,
this study follows recommendations by the Medical
Ireland 9Public Involvement Enhancing Research Northern Ireland, Research Council in the development of complex inter-
Belfast, UK and 10Donegal Volunteer Centre, Donegal, Ireland ventions, enhancing the rigour of the study. However,
not all counties were represented and the views
Introduction: Polypharmacy is considered ‘one of the expressed are not generalisable. However, findings from
most pressing prescribing challenges’1 and is often this study have enabled refinements to be made to an
viewed negatively. Appropriate polypharmacy acknowl- existing intervention to account for contextual differ-
edges multiple medications may be required for older ences between ROI and NI practices. The refined inter-
people (≥65 years) with multimorbidity, emphasises the vention package will be used in the larger cross-border
need to ensure that prescribing is evidence-based and pilot cRCT.
potential drug interactions are avoided. Members of
the research team have previously developed an inter-
References
vention to improve appropriate polypharmacy, using
the Theoretical Domains Framework (TDF). The inter-
vention includes a video demonstrating how to pro- 1. Payne RA, Avery AJ. Polypharmacy: one of the
mote appropriate polypharmacy during a typical greatest prescribing challenges in general practice. Br
general practitioner (GP) consultation with an older J Gen Pract. 2011; 61(583):83–84.
patient and a patient recall process. Preliminary testing 2. Cadogan CA, Ryan C, Gormley GJ, Francis JJ,
was completed in two general practices in Northern Passmore P, Kerse N, Hughes C. A feasibility study
Ireland (NI)2. The next stage of the research will test of a theory-based intervention to improve appropri-
the intervention in a larger pilot cluster randomised ate polypharmacy for older people in primary care.
controlled trial (cRCT) across NI and the Republic of Pilot and Feasibility Stud. 2018; 4:23.
Ireland (ROI).
Aim: To refine the existing intervention prior to imple- Exploring the nursing practice
mentation in a pilot cRCT in both jurisdictions to
account for possible differences in context and practice
surrounding co-administration of
in ROI. multiple medicines in intensive care
Methods: A purposive sample of 12 general practices in units
the six border counties of ROI (Cavan, Donegal, Lei-
trim, Louth, Monaghan, Sligo) were recruited. Semi- M. Oduyale1, N. Patel1, M. Borthwick2 and
structured interviews were conducted with recruited GPs
who were asked for their views on the intervention.
H. Osborn1
Questions related to the video content, recall process, 1
University of Reading, Reading, UK and 2Oxford University Hospitals,
mode of delivery, and required changes for the ROI Oxford, UK
context. Interviews were audio-recorded and transcribed
verbatim; an in-depth familiarisation process was under- Introduction: Intensive care unit (ICU) patients are usu-
taken (repeated reading and listening to interviews). ally prescribed multiple intravenous infusions, which
Polypharmacy 13
sometimes exceed the number of available venous access co-administration of medicines is common practice and
sites. To ensure administration, medicines can be co- that there is a need for compatibility data that is rele-
administered through the same lumen of a venous cathe- vant to current clinical practice. Since nurses prefer to
ter using a Y-site connector. This increases the chances use a quick reference compatibility guide, organisations
of combining incompatible medicines that can present in should direct more attention towards updating such
the form of precipitates and lead to catheter occlusion resources on a regular basis to reflect medicine use
and occurrence of potentially fatal venous embolism within ICUs.
which can compromise patient care1. Therefore, it is
important that compatibility is assessed prior to co-
administration. Reference
Aim: To explore the practice of medicine co-administra-
tion and how medicine compatibility is assessed amongst 1. Benlabed M, Perez M, Gaudy R, Genay S, Lannoy

ICU nurses. D, Barthelemy C, Odou P, Lebuffe G, Decaudin B
Methods: A cross-sectional survey was conducted (2018) Clinical implications of intravenous drug
among ICU nurses across 22 hospitals in England incompatibilities in critically ill patients. Anaesth
between February 2019 and August 2019 through the Crit Care Pain Med. https://doi.org/10.1016/j.accpm.
use of an online questionnaire. The questionnaire was 2018.04.003
developed to investigate the process of co-administra-
tion, how compatibility is assessed in practice and how
nurses manage co-administration challenges. Using eight
An exploration of the ‘medicines work’
ICU nurses across two hospitals, the questionnaire was of people living with complex
validated using content validity. The final questionnaire polypharmacy regimes in very remote
consisted of 23 items (open and closed questions) and and rural Scotland: keeping the patient
was distributed via email. Data were analysed using
descriptive statistics. at the centre
Results: An estimate of 899 nurses received the ques-
tionnaire, and a total of 297 nurses responded (esti- A. Grant1, K. MacLure1, K. Gallacher2,
mated response rate of 33%). The average content T. Dreischulte3, A. Mair4 and D. Stewart5
validity for the questionnaire had value of 0.82 revealing
1
a high level of agreement. The majority (84.2%; Robert Gordon University, Aberdeen, UK 2University of Glasgow,
Glasgow, UK 3University of Dundee, Dundee, UK 4Scottish,
n = 277) of the nurses worked in adult ICUs with
Government, UK and 5University of Qatar, Doha, Qatar
44.8% having over 10 years’ professional experience in
ICUs. Most nurses (94%; n = 278) combine medicines
down the same lumen and 70.9% (n = 197) use a Y-site Introduction: With an aging population there are
connector to facilitate co-administration. Of those who increasing numbers of people who are self-managing
use a Y-site connector, 81.7% (n = 161) reported co- multiple morbidities, their healthcare and often complex
administering two medicine combinations, 26.9% medication regimes (polypharmacy). The more condi-
(n = 53) three combinations and 7.6% (n = 15) four tions a person has the more medications they are likely
combinations. Before co-administering medicines, 99.3% to be prescribed. Medications can interact creating side-
(n = 276) of nurses checked for medicine compatibility. effects and more medications are then prescribed for
The resources used to check compatibility include cross those interactions resulting in increased ‘medicines
table compatibility charts, experience, drug monographs, work’1. The risk of medication-related problems
Trissel’s Handbook of Injectable Drugs, MEDUSA – increases with each drug prescribed and those with more
injectable medicines guide, pharmacists, colleagues and conditions may experience more treatment burden and
the British National Formulary (BNF). However, 69.4% lower quality of life. People with multiple morbidities
(n = 206) of nurses felt that these resources have limited receiving complex polypharmacy regimes (10 + medici-
compatibility information for commonly used medicines nes) are often elderly and frail.
in ICU, with the compatibility chart ranking as the most Yet the work for patients in self-managing their
preferred resource (66.7%, n = 198) because it was quick complex polypharmacy has yet to receive sociological
to use. Trissel’s was least used with some nurses never attention. The ‘medicines work’ of self-managing com-
having heard of it. In the absence of compatibility data, plex polypharmacy is needed to better understand
co-administration was avoided by 69.9% (n = 206) of how the burden impacts on patients’ everyday life,
nurses. However, to ensure that patients still received their agency and capacity to self-manage, the
their medication most nurses either prioritised infusions resources and support networks they utilise, strategies
or requested additional venous access. for (un)intentional non-adherence and (non-) compli-
Conclusions: A limitation of this study is that we did ance1. Novelty and inclusivity are added to the
not obtain an even distribution of responses across Eng- research by seeking the voices and experience of very
land meaning that findings are not as generalisable. The remote and rural patients resident on Scotland’s smal-
use of a national questionnaire has helped identify that ler islands.
Aim: The aim of this study was to explore the experi- Influences on Prescribing
ences of very remote and rural patients polypharmacy
regimes in self-managing their ‘medicines work’ using
Burden of Treatment theory. The relationship between first-line
Methods: Qualitative research using self-reporting longi- therapy in Parkinson’s disease patients
tudinal diaries with follow-up in-depth face-to-face and social deprivation status, does a
interviews2 was conducted with patients resident in out-
lying islands of Orkney. Fully informed consent was
delay in PD diagnosis mediate this
gained with permission to audio-record interviews. Dia- relationship?
ries and interviews were based on Burden of Treatment
Theory (BTT) which focuses on Capacity (Agency, Rela- K. Orayj1,2, A. Lacey3, A. Akbari3,
tionality, Control, Opportunities); Expressing capacity M. Smith1, O. Pickrell3 and E. Lane1

(Functional performance, Social skill, Social capital,
1
Structural resilience); Patient work (Sensemaking, Cog- School of Pharmacy and Pharmaceutical Sciences, Cardiff University,
nitive participation, Collective action, Reflexive monitor- Cardiff, UK 2King Khalid University, Abha, Saudi Arabia and 3Swansea
University Medical School, Swansea, UK
ing). The diaries, issued in advance, were designed to
capture patients’ prescribed medications, daily regime,
(non-)adherence and (non-)compliance, support with Introduction: Some UK studies have found a signifi-
medications and daily ‘medicines work’ over one week. cantly lower incidence of Parkinson’s disease (PD) in
The semi-structured interviews explored in more depth the most socially deprived areas1. This led to the
factors which impact their medication regime, access to hypothesis that those who reside in socially deprived
healthcare and quality of life including ‘medicines areas may be more likely to experience delays in a PD
work’. diagnosis1. Levodopa is the mainstay therapy in manag-
Results: NHS Orkney staff screened GP-held patient ing PD motor symptoms. However, due to the motor
records to identify island residents on 10 + medications. side effects, including levodopa-induced dyskinesia,
Of the 12 patients identified, 11 consented to take part some clinicians delay levodopa treatment and initiate
and were mailed longitudinal diaries. These were com- levodopa sparing strategies such as monoamine oxidase
pleted by most patient participants (n = 9). Two cited B (MAO-B) inhibitors2 that do not display such side
difficulty in writing up their diaries due to a stroke effects.
(n = 1) or rheumatoid arthritis (n = 1). Challenges of Aim: To examine the effect of social deprivation on PD
data collection were experienced as participants were incidence rates and to identify any differences in pre-
resident on the islands of Hoy (n = 8) and Westray scribing decision making with respect to initiating levo-
(n = 4). Most were male (n = 8); ages ranged 54 to dopa therapy vs MAO-B inhibitors in areas of different
81 years. Remote island living was not viewed as a dis- social deprivation. Our hypothesis is that if a higher
advantage as patients spoke positively of their health- social deprivation status is associated with a lower PD
care experience (access to GP, Nurse Practitioner, repeat incidence rate, and also associated with a high rate of
medications) and quality of life despite the ‘medicines initiating levodopa as first-line therapy, this could be
work’. because patients who live in areas with higher levels of
Discussion: Early analysis of the data collected from this social deprivation are more likely to experience delayed
small sample reflects the qualitative themes of the coun- PD diagnosis.
ter the expected ‘medicines work’ load and age of Methods: We conducted a population-based study of res-
patients managing polypharmacy in very remote and idents in Wales, UK, aged 40 years or older and newly
rural Scotland. Further analysis and comparison with treated with PD medications between 2000 and 2016,
the literature are underway. using the Secure Anonymised Information Linkage
(SAIL) Databank. Patient characteristics, comorbidities,
and first-line therapy were extracted. The social depriva-
References tion status was classified according to the Welsh Index of
Multiple Deprivation (WIMD) 2011 scale (quintile 1 –
1. Demain S, Goncßalves A-C, Areia C, Oliveira R, most deprived, up to quintile 5 – least deprived). The
Marcos AJ, Marques A, et al. Living with, manag- annual incidence of PD was estimated using the Read
ing and minimising treatment burden in long term codes for PD diagnosis. Poisson regression was used to
conditions: a systematic review of qualitative estimate the incidence rate ratio (IRR) across the study
research. PLoS One. 2015;10. period. A series of logistic regressions were run to deter-
2. Bowling, Ann (2014) Research methods in health: mine the effect of WIMD quintile on first-line therapy
investigating health and health services. 4th Edition, choice. Other variables including sex, comorbidities, and
Maidenhead, GB. McGraw Hill; Open University previous medications history were controlled for.
Press, 536 pp. Results: After analysing 16,693,205 single person-years
during 2000–2016, the incidence rate of PD was
Influences on Prescribing 15
significantly lower in the most deprived quintile com- Aim: This study investigated influences on prescribing
pared to the least deprived quintile (IRR = 0.82, 95% in general practice. The objectives were to: (1) Explore
CI 0.77–0.87). Patients who lived in the least deprived determinants of prescribing behaviour from pre-
quintile area were 22.1% less likely to be prescribed scribers’ perspectives. (2) Explore the use/influence of
levodopa compared to patients from the most deprived National Institute of Health and Care Excellence
quintile area (P-value = 0.007). Conversely, patients (NICE) and other guidelines on prescribing. (3)
who lived in the least deprived quintile area were 98.8% Explore the role and potential of general practice-
more likely to be prescribed MAO-B inhibitors based pharmacists (PBPs) to promote evidence-based
(P < 0.0001). prescribing.
Conclusions: Given that MAO-B inhibitors are often Methods: Semi-structured qualitative telephone inter-
used as initial therapy to spare patients from the motor views and focus groups were conducted with: (i) gen-
side effects of levodopa, individuals with lower socioeco- eral practice-based prescribers: General Practitioners

nomic status may be diagnosed later in their disease, in (GPs), nurses and PBPs (ii) key informants: individu-
which case the prescriber may commence treatment with als working in national, regional and local roles, with
levodopa as the disease has progressed. This interpreta- responsibility for influencing, measuring and monitor-
tion is reinforced by the fact that the incidence of PD ing general practice prescribing. A target sample
was significantly lower in the most deprived areas, which matrix was developed to reflect a range of partici-
may be due to delayed diagnosis. Given their accessibil- pants, including prescribers from various professional
ity, pharmacists could play a role in identifying early backgrounds and diverse general practice characteris-
signs and symptoms of PD in socioeconomically tics, and key informants working in assorted NHS
deprived area. Further research exploring this unwar- roles. Recruitment was through local and regional
ranted variation in care and how it may be addressed is contacts and snowball sampling. Interviews and focus
needed. groups were audio-recorded and transcribed verbatim.
Data collection took place between November 2018
and April 2019. Data saturation was considered to be
References achieved when the sample matrix was complete and
no new themes were identified. Thematic data analysis
1. Horsfall L, Petersen I, Walters K, Schrag A. Time was used to identify themes about the influences on
trends in incidence of Parkinson’s disease diagnosis prescribing and the PBP’s role.
in UK primary care. J Neurol. 2013;260(5):1351– Results: Interviews were completed with 17 prescribers
1357. (GPs (n = 6), pharmacists (n = 6), nurses (n = 5)) and
2. Schapira AH, Obeso J. Timing of treatment initia- six key informants. One focus group was conducted
tion in Parkinson’s disease: a need for reappraisal? with five key informants. Although prescribers and key
Annals of Neurology. 2006 Mar;59(3):559–62. informants stated that guidelines fundamentally influ-
ence prescribing, they also identified competing influ-
ences including the prescriber’s professional background
What influences the uptake of and experience, demographic profiles of patient popula-
prescribing guidelines in UK general tions and attitudes of individual patients. Media por-
trayals of medicines and public opinion were identified
practice? A qualitative study as substantial influences. Prescribers identified practice-
level influences, e.g. attitudes towards shared learning.
M. Carter1, S. Chapman1, P. Nishtala1 and M. Key informants emphasised the impact of NHS organi-
Watson2 sational policies and availability of services on prescrib-
ing practice. These individuals also highlighted
1
University of Bath, Bath, UK and 2University of Strathclyde, Glasgow, underlying problems (e.g. polypharmacy) as well as
UK
‘medicines optimisation’ principles (e.g. safe prescribing)
developed to address these issues. Both samples identi-
Introduction: Despite the increasing medicines’ budget and fied the contribution made by PBPs to medicines exper-
widespread availability of evidence-based guidelines to tise and knowledge and mentioned variation in PBPs’
inform the rational use of medicines, considerable varia- practice roles. Prescribers’ views were mixed about how
tion exists in guideline uptake and application by clinicians much PBPs’ may influence prescribing in the future.
1
. The range of health professionals who prescribe in gen- Key informants were concerned about support and
eral practice may contribute to this variation. Recent NHS career progression for PBPs.
policy supports pharmacists’ inclusion in general practice Conclusions: Prescribing in the general practices repre-
teams. Pharmacists’ professional skills are viewed by some sented in this study (mostly larger, with lower depriva-
as suited to fostering an evidence-based and patient- tion levels) is influenced by factors which compete
centred approach to prescribing 2. To develop strategies with guidelines. This qualitative research study did not
which reduce variation and promote evidence-based pre- quantify the relative importance of these factors.
scribing, there is firstly a need to identify the key determi- Strategies to promote evidence-based prescribing
nants of current prescribing behaviour. should reflect these influences on prescribers in varied
practice settings and take account of the expanding Results: Thirteen interviews were carried out, lasting
range of professionals with prescribing roles in general between 17 and 48 minutes, with an average length of
practice. 32 minutes. Table 1 shows participant characteristics.
Current practice was found to be moving through a per-
iod of change, with a shift towards preference for
References DOACs, especially for patients with non-valvular atrial
fibrillation (AF). The main themes identified were (1) an
1. Ewbank L, Sullivan K, McKenna H, Omojomolo D. overarching theme of change, (2) barriers and facilita-
The rising cost of medicines to the NHS: what’s the tors to appropriate use of oral anticoagulants, (3) pro-
story? : The King’s Fund; 2018 [Available from: fessional-related factors affecting drug choice and (4)
https://www.kingsfund.org.uk/publications/rising- perceptions of the shared decision making process.
cost-medicines-nhs. Many professionals have a preferred DOAC which they

2. Barnett NL. Opportunities for collaboration between use, but the reasons for preference vary. Perceived
pharmacists and clinical pharmacologists to support advantages of DOACs included a beneficial overall clini-
medicines optimisation in the UK. British journal of cal effect in treating certain indications from evolving
clinical pharmacology. 2019. trial data, convenience due to reduced monitoring, and
ability to use certain DOACs in compliance aids. Tools
to aid the shared decision making process were not
Attitudes and perceptions of widely used, and there was a perception that shared
professionals to anticoagulation: decision making was not comprehensively approached.
warfarin versus novel/direct oral
Table 1. Participant characteristics
anticoagulants
Role and specialty Number of participants
K. Stewart-Watson1,2, S. Wilkes1 and Consultant – cardiology 1 male, 1 female
R. Thomson3 Registrar – cardiology 1 male, 1 female
Consultant – stroke 1 male, 1 female
1
University of Sunderland, Sunderland, UK 2South Tyneside and Consultant – care of the elderly 1 male, 1 female
Sunderland NHS Foundation Trust, Sunderland, UK and 3Newcastle GP 1 male
University, Newcastle, UK Hospital pharmacist 3 male, 1 female
Introduction: The National Institute for Health and

Conclusions: The landscape with regards to oral antico-
Care Excellence (NICE) recommended direct oral anti-
agulation options was found to be in a period of
coagulants (DOACs) for a variety of indications as
change, and there appeared to be a move towards a
equal alternatives to warfarin, and stated that the
preference for DOACs over warfarin. As the prescribing
patient’s values and preferences should be used to guide
of oral anticoagulants is changing towards greater num-
choice of agent in a shared decision making process1.
bers of patients prescribed DOACs, there is a need to
However, uptake of DOACs had been patchy and slow
review the provision of anticoagulation services. One
across the UK2. Identifying the perceived barriers to
limitation in this study is that most participants were
using DOACs could help to develop strategies to over-
professionals from secondary care, with only one partici-
come these and enable their use where appropriate.
pant in primary care. Another limitation is that partici-
Aim: The study aimed to investigate the attitudes and
pants tended to mainly prescribe anticoagulation for
perceptions of professionals towards oral anticoagula-
AF, however attitudes and perceptions towards use of
tion, and the choice between warfarin and the DOACs.
DOACs in other indications may differ.
Methods: One-to-one semi-structured interviews were
conducted between May and July 2018. Participants
were recruited using snowball and convenience sampling, References
across four NHS trusts and one Clinical Commissioning
Group. Inclusion criteria were that participants should 1. National Institute for Health and Care Excellence.
be either a hospital pharmacist, general practitioner, or Anticoagulants, including non-vitamin K antagonist
cardiology or care of the elderly registrar or consultant, oral anticoagulants (NOACs). Key therapeutic topic
and involved in the initiation of oral anticoagulation. A [KTT16]. 2016. Available at: https://www.nice.org.
topic guide was used to aid the interview process; this uk/advice/ktt16 [accessed 27/08/2019]
included questions regarding the participant’s role in pre- 2. Association of the British Pharmaceutical Industry
scribing anticoagulation, how they felt about the choices Stroke in Atrial Fibrillation Initiative. NOACs:
of oral anticoagulants, how they discussed this with Innovation in anticoagulation – Optimising the pre-
patients, any concerns they had regarding DOACs, and vention of AF-related stroke. 2014. Available at:
if and how they used any materials to aid in shared deci- http://www.abpi.org.uk/publications/noacs-innovation-
sion making. Interviews were transcribed verbatim and in-anticoagulation/ [accessed 27/08/2019]
analysed using framework analysis.
Older People 17
Older People challenging to handle; “These are the Codeine Phos, and
I shoot those all over.” Limited knowledge of these char-
acteristics when prescribing and dispensing restricted the
The design of patient centric drug role of healthcare professionals in this area. They did,
products to improve adherence and however, highlight the potential for improved involve-
acceptance in older people – a ment via increased collaboration with carers and by
actively enquiring about difficulties. Due to the qualita-
qualitative interview study tive nature of this study, the extent to which results can
be generalised to the wider older adult population is
Z. Shariff1, D. Kirby1, C. Miller2, limited. However, the study has key implications for the
S. Missaghi3, A. Rajabi-Siahboomi3 and future role of healthcare professionals in the provision
I. Maidment1 of patient centric drug products.

Conclusion: Drug manufacturers should consider physi-
1
Aston University, Birmingham, UK 2
Colorcon, Kent, UK and cal attributes during drug development to ensure opti-
3
Colorcon, Harleysville, USA mum patient adherence and reduce the potential for
medication errors. Future work taking into account the
Introduction: Elderly patients represent a very heteroge- views of the industry on this topic will help to further
neous patient population and are the major user group inform the development of patient centric drug products
of multiple prescribed medicines. Age-related changes for older people. However, in order to ensure these are
mean that this population can encounter barriers then prescribed and dispensed appropriately, the role of
towards taking medicines orally. Taking into account health and social care professionals must further be
these changes during drug development can lead to a defined and explored.
patient centric drug product that provides patients with
the best overall benefit to risk profile1. Further work is
needed to identify how the physical characteristics of
References
drug products can be optimised to ensure optimum
patient adherence and acceptance. 1. Stegemann S., Ternik RL., Onder G., Khan MA.,
Aim: To understand the key issues faced by older peo- van Riet-Nales DA. Defining Patient Centric Phar-
ple and family/informal carers when using/administering maceutical Drug Product Design. Aaps Journal.
oral solid dosage forms from the perspectives of all 2016;18(5):1047–55.
those involved in an individual’s therapy. 2. Braun V, Clarke V. Using thematic analysis in psy-
Methods: Purposeful sampling was used to identify chology. Qualitative Research in Psychology. 2006;3
older people (aged 65 or above taking at least one oral (2):77–101.
solid dosage form), their informal carers and health/so-
cial care professionals with experience of working with Factors affecting physician
older people. Older people and their carers unable to
speak English or lacking capacity to consent were implementation of hospital pharmacists’
excluded. The study was advertised on recruitment web- medication appropriateness
sites (including Join Dementia Research and People in recommendations in older adults
Research), within care homes, and also via NHS organi-
sations (including NHS Dudley CCG, University Hospi- K. Dalton1, A. Fleming1, D. O’Mahony2,3 and
tals of North Midlands NHS Trust and NHS Southern
Derbyshire CCG). The study made use of placebo S. Byrne1
tablets to provide participants with a point of reference 1
Pharmaceutical Care Research Group, School of Pharmacy, University
to help communicate their ideas. Interviews were audio College Cork, Cork, Ireland 2Department of Geriatric Medicine, Cork
recorded and transcribed verbatim. Thematic analysis University Hospital, Cork, Ireland and 3Department of Medicine,
was used to analyse the data2. University College Cork, Cork, Ireland
Results: A total of 52 interviews were conducted: 18
older people, 7 informal carers and 27 health/social care Introduction: Pharmacists’ recommendations to physi-
professionals. All interviews were analysed together in cians concerning medication appropriateness signifi-
order to examine the relationship between different par- cantly reduce potentially inappropriate prescribing,
ticipant groups. Key themes included: the impact of for- adverse drug reactions, and medication-related readmis-
mulation characteristics on the medication-taking sions in hospitalised older adults. Intervention studies
process; the current role of health/social care profession- with a high proportion of prescribing recommendations
als when providing patient centric products and how implemented are more likely to result in better patient
this role can be improved. Formulation characteristics outcomes than those with lower rates of implementa-
had a significant impact on medication identification, tion, which typically result in non-significant differences
handling, swallowability and overall adherence. 6 mm in patient outcomes. Reasons for non-implementation of
round tablets were more difficult to swallow and pharmacist recommendations must be identified and
overcome in order to improve the delivery of pharmacist implementation of pharmacist recommendations, aiming
interventions in the interests of patient safety and for significant improvements in both medication appro-
improved patient outcomes. priateness and clinical outcomes for hospitalised older
Aim: The aim of this study was to explore the views of adults.
pharmacists and physicians to identify the key factors
affecting physician implementation of pharmacists’ med-
ication appropriateness recommendations in hospitalised Reference
older adults.
Methods: Semi-structured face-to-face interviews based 1. Cane J, O’Connor D, Michie S. Validation of the
on the Theoretical Domains Framework (TDF)1 were theoretical domains framework for use in behaviour
conducted with hospital pharmacists and physicians change and implementation research. Implement Sci.
who provided care to older adults in two acute univer- 2012; 7: 37.

sity teaching hospitals in the Republic of Ireland
between August 2018 and August 2019. Participants
were purposively sampled based on years of post-qualifi-
Service evaluation of the Medicines
cation experience, and were recruited via email, text Optimisation in Older People (MOOP)
message, or face to face at their place of work using a service for frail older patients in the
combination of convenience sampling and snowballing. acute care setting
The interviewer had no previous relationship or estab-
lished rapport with any of the interviewees prior to
D. Saeed1, R. Miller2, K. Miller3,
study commencement. Interviews were audio-recorded
and transcribed verbatim. Content analysis was K. Madden3, L. Doherty3, T. Ferris3,
employed to identify the key themes and predominant C. Darcy4, A. Friel4, L. Armstrong3,
TDF domains that influence physician implementation
of pharmacist recommendations.
M. Alcorn3 and C. Parsons1
Results: Interviews were conducted with 6 pharmacists 1
Queen’s University Belfast, Belfast, UK 2Department of Health,
and 8 physicians, with an average interview length of Belfast, UK 3South Eastern Health and Social Care Trust, Lisburn, UK
33 minutes. Five key factors were found to affect physi- and 4Western Health and Social Care Trust, Derry/Londonderry, UK
cian implementation of pharmacist recommendations: i)
Clinical relevance and complexity of the recommenda- Introduction: Frailty is a geriatric syndrome in which
tion: recommendations of higher priority and those that physiological systems have decreased reserve and resis-
do not require complex decision-making are implemented tance against stressors1. Frail older people in acute care
more readily. ii) Inter-professional communication: rec- who are taking multiple medicines (polypharmacy) are
ommendations provided verbally, particularly those com- at increased risk of potentially inappropriate prescribing
municated face to face with confidence and assertiveness, (PIP). A consultant/specialist pharmacist-led medicines
are more likely to be implemented than written recom- optimisation service (Medicines Optimisation in Older
mendations. iii) Physician role and identity: the grade, People [MOOP]) has demonstrated improved prescribing
specialty, and personality of the physician significantly appropriateness and medication cost savings in interme-
affect implementation. iv) Knowing each other and devel- diate care in Northern Ireland2. This model has been
oping trusting relationships: previous acquaintance and adapted for frail patients and is currently being rolled
the development of inter-professional trust and rapport out to patients admitted to a frailty ward in one hospi-
greatly facilitate recommendation implementation. v) tal in Northern Ireland.
Hospital environment: organisational issues such as docu- Aim: To evaluate the impact of the MOOP model on
mentation in the patient notes, having the opportunity to outcomes for frail older people admitted to the acute
intervene, and the clinical pharmacy model all affect care setting.
implementation. Method: The following data were extracted from a data-
Conclusion: This is the first study to evaluate the under- base of routinely collected data for patients enrolled into
lying behavioural determinants affecting physician this service from 1st May 2019 onwards: demographics;
implementation of pharmacist recommendations con- NHS resource utilisation; length of stay; frailty score;
cerning medication appropriateness in older adults. The falls data; medication data; number of medications pre-
utilisation of the TDF in formulating the topic guides scribed. Medication Appropriateness Index (MAI),
and analysing the transcripts revealed additional themes AntiCholinergic Cognitive Burden (ACB) score, Anti-
that would otherwise not have been identified. However, cholinergic Effect on Cognition (AEC) score and falls
acknowledging that participants were recruited from just risk were calculated. Based on these baseline parameters,
two Irish hospitals and that different clinical pharmacy individualised pharmaceutical care plans were imple-
models exist, the key factors affecting recommendation mented. Clinical interventions were graded using the
implementation identified in this study may not be Eadon criteria and cost savings were estimated using the
transferable to all hospital settings. Nevertheless, the ScHARR model. Statistical analysis was undertaken
study findings will likely aid in the development of theo- using SPSS; the Wilcoxon signed ranks test was used
retically informed interventions with increased physician
Pharmacist Prescribing 19
(P ≤ 0.05 considered significant). The Hospital Trust care: a new innovative model Article. Eur J Pers
Innovation, Research and Development team confirmed Cent Healthc. 2016;4(1):46–52.
that ethical approval was not required, as this was a ser-
vice evaluation. Pharmacist Prescribing
Results: Data collection is ongoing. Seventy-two
patients were recruited into the service as of mid-Sep-
tember 2019, aged between 71–98 years (mean age Clinical supervision for nurse and
85.0 6.1 years), the majority (77.8%) were female, pharmacist independent prescribers:
56.9% were admitted with a history of falls or because a Delphi study
of falls, and 22.2% of patients had fragility. Most
patients (84.7%) had mild to severe frailty (Clinical
R. Bullingham, M.C. Weiss and R. Deslandes
Frailty Scale 5–7). Almost all (97.2%) had polyphar-

macy, and about half (48.6%) had two frailty syn- Cardiff University, Cardiff, UK
dromes (polypharmacy, immobility, incontinence,
delirium/cognition issues, falls). The most common com-
Introduction: Previous research by the authors found
bination of frailty syndromes (27.8%) was polyphar-
that the clinical supervision of nurse (NIP) and pharma-
macy, falls and delirium. Of 380 interventions made
cist (PIP) independent prescribers in primary care in
after medication review; 71.3% were assessed as having
Wales was variable. Most clinical supervision was infor-
an Eadon grade of 4 or more, indicating that these
mal in structure and, in some cases, ad-hoc. Findings
interventions were significant and resulted in improved
suggested that formal clinical supervision is preferred
care standards. A total cost saving of £54,467–£115,926
yet is not readily available. Exploring the perception of
was made as a result of these interventions. As shown in
the ideal purpose, content and structure of clinical
Table 1, specialist pharmacist-led medicines optimisation
supervision is imperative to creating a usable model to
resulted in a significant reduction in median scores for
improve the quality of clinical supervision.
MAI, ACB, AEC, falls risk, total number of drugs and
Aim: To identify if there is consensus amongst NIPs
number of drugs associated with falls.
and PIPs on the purpose, content and structure of effec-
tive clinical supervision and, if so, on what parameters
Table 1. Median scores for ACB, AEC, MAI, falls risk,
there is agreement.
total number of drugs, and number of drugs associated
Methods: A two-phase E-Delphi survey was conducted
with fall before and after clinical pharmacist review.
using the platform Online Surveys with an expert panel of
primary care NIPs and PIPs. The inclusion criteria were:
a UK qualified NIP or PIP, currently employed in a pri-
mary care prescribing role without necessarily prescrib-
ing, NHS employed or NHS contracted and working in
Wales. Participants who participated in the first phase of
this research were initially approached. They were identi-
fied by NHS gatekeepers (nurse and pharmacist prescrib-
ing leads) across the seven Welsh Health Boards. Social
media was used to recruit other participants that met the
expert panel criteria. The descriptors used in the survey
were informed by earlier qualitative research. The surveys
included quantitative ratings and open text comments.
Conclusion: These preliminary results demonstrate that All survey responses were anonymised with consent
the MOOP service contributes to safer and more appro- implied by return of the survey. The survey consisted of
priate prescribing for frail older people in acute care as two rounds. Findings were analysed using descriptive
well as demonstrating medication cost savings. The statistics for quantitative findings and content analysis for
strength of this study lies in the combination of different open text responses. Interquartile ranges (IQR) were used
clinical parameters to evaluate prescribing appropriate- for determining the level of consensus with an IQR < 1
ness. It is limited by being performed in a single ward in defined as consensus, an IQR between 1–2 was reviewed
one hospital. and an IQR > 2 defined as no consensus.
Results: 22 participants (15 pharmacists and seven nurses)
were recruited from all seven Welsh Health Boards. 22
References responded to round one (100%), 16/22 (73%) responded
to round two. The descriptors were divided into three cate-
1. Clegg A, Young J, Lliffe S, Rikket MO, Rockwood gories: purpose, content and structure. Of the 16 descrip-
K. Frailty in Older People. Lancet. 2013;381 tors in round 1, eight met consensus (and not included in
(9868):752–62. round two). Round two had eight descriptors and consen-
2. Miller R, Darcy C, Friel A. Consultant pharmacist sus was met on four. An example of a descriptor that met
case management of older people in intermediate consensus under each category is listed in table 1. Findings
suggested that clinical supervision should be available at sheet and consent form were sent to potential participants
whatever level the supervisee feels is appropriate. Partici- by gatekeepers. These were directors of independent phar-
pant findings also suggested that the purpose, content and macist prescribing courses, pharmacist leads in each HB,
structure of clinical supervision should not reinforce a local primary care pharmacist leads and the Pharmacists
supervisor dominant structure. in Practice: All Wales Community of Practice (PIPCOP)
event director in Wales. Written consent was obtained
Table 1. Examples of descriptors from participants. Interviews were audio-recorded and
Purpose “The purpose of clinical supervision is to support me in transcribed ad verbatim. Thereafter, thematic analysis
my clinical practice” was used to analyse the data.
Content “Reflection on clinical practice should be a key part of Results: Interviews were conducted with 10 IPPs, which
clinical supervision” lasted between 33 and 78 minutes. Six themes emerged
Structure “There needs to be flexible guidance for clinical from the data, including their role as an independent

supervision sessions so independent prescribers can to
prescriber, change in the role over time, satisfaction in
access appropriate support for their needs”
the role, perceived benefits of the role, and the facilita-
tors and barriers to the role. All participants perceived
Conclusion: This is the first study to identify the level of their role as prescribers positively. However, some
consensus amongst NIPs and PIPs on what is required for reported the topic of indemnity as a barrier and they
effective clinical supervision. This study was limited by the required more clarity in terms of what they are covered
small number of participants and that it was conducted to prescribe and to do. Conflicting views were reported
solely in Wales. The findings will inform a model of clinical about working within more than one general practice as
supervision to support an inclusive and supportive clinical some perceived it positively as it increased their experi-
supervision session which is both flexible and user-friendly ence and scope of practice. Whereas, others perceived it
to suit the diversity of prescribers in primary care. Future as a barrier as they thought that it lacks the continuity
work will explore stakeholders’ views on the clinical super- of practice and found it difficult to build new relation-
vision model so it can be used in practice. ships with other healthcare professionals.
Conclusion: This study is the first qualitative study to
Independent pharmacist prescribers’ explore the views of IPPs regarding their prescribing
role in primary care in Wales. It revealed important
views of their role as prescribers in themes that could be relevant to all IPPs working in the
primary care settings in Wales primary care sector across the UK. A study limitation is
that interviews were conducted over the telephone,
S. Alghamdi, R. Deslandes and K. Hodson which lacks the face-to-face communication that could
help in building a rapport with participants in order to
Cardiff University, Cardiff, UK
obtain more details. Future work should focus on
exploring views of the stakeholders who work with IPPs
Introduction: Since 2015, the number of independent regarding their role as prescribers.
pharmacist prescribers (IPPs) in primary care in Wales
has increased greatly. This is due to the implementation
of the Primary Care Plan in Wales 1 and primary care References
clusters 2, which aimed to train more non-medical
healthcare professionals, including pharmacists, as inde- 1. Our plan for a primary care service for Wales up to
pendent prescribers. This initiative hoped to increase March 2018. Available at: http://www.cpwales.org.
patients’ access to treatment, improve primary care ser- uk/getattachment/.
vices, and relieve pressure on General Practitioners 2. Inquiry into Primary Care: Clusters. Available at:
(GPs). The views of IPPs regarding their role as pre- http://www.assembly.wales/laid%20documents/cr-ld
scribers in primary care in Wales are important to 11226/cr-ld11226-e.pdf.
inform future developments and to understand this
advancement within pharmacy practice. No other
research has previously been undertaken on to investi- Community pharmacists’ experiences of
gate the role of IPPs in primary care in Wales. undertaking an IP qualification – a
Aim: To describe the role of independent pharmacist pre- qualitative analysis
scribers working within primary care in Wales and to explore
their views on how their role is embedded in primary care. C. Tierney
Methods: Semi-structured telephone interviews were con-
ducted with IPPs working in primary care settings from University of Sunderland, Sunderland, UK
all seven health boards (HB) in Wales. Ethical approval
was obtained from the Cardiff School of Pharmacy and Introduction: Non-medical prescribing began in the Uni-
Pharmaceutical Sciences. Purposive sampling was used to ted Kingdom with the launch of the Supplementary Pre-
recruit all the participants who met the inclusion criteria scribing qualification in 2003, followed by the addition of
of this study. An invitation email, participant information
Wellbeing and Community Pharmacy 21
the Independent Prescribing qualification in 20061. Since Conclusions: This study specifically explored community
the introduction of these qualifications, uptake amongst pharmacists’ experiences of undertaking an IP qualifica-
community pharmacists has been relatively low as high- tion at a UK university. Themes that emerged have the
lighted by the General Pharmaceutical Council (GPhC) potential to help educators better understand the rea-
Registrant Survey in 20132. As the demands and strains sons why uptake amongst community pharmacists has
placed upon the national healthcare system to provide been historically low and how this can be addressed The
timely and efficient care increases, the need for indepen- research was limited by the relatively small sample size
dent prescribers within the community sector is increas- of students from one university, and therefore these
ing, in order to reduce the strain on other prescribing findings cannot be said to be representative of commu-
healthcare professionals. Previous studies have not nity pharmacists around the UK.
addressed why community pharmacist enrolment on inde-
pendent prescribing courses is disproportionately low

compared to pharmacists from other sectors. References
Aim: To examine community pharmacists’ experiences
of undertaking an Independent Prescribing qualification 1. Pharmacyregulation.org. (2019) Pharmacist indepen-
at a UK university and the perceived barriers and facili- dent prescriber | General Pharmaceutical Council.
tators to their studies. [online] Available at: https://www.pharmacyregulation.
Methods: A qualitative approach to data collection was org/education/pharmacist-independent-prescriber
adopted through semi-structured interviews with phar- 2. Phelps, A. et al. (2013) GPhC Registrant survey.
macists either currently studying on or recently com- Prepared for the General Pharmaceutical Council.
pleted the Independent Prescribing qualification. London: NatCen. Available at: https://www.
Twenty-eight potential participants were identified from pharmacyregulation.org/registrant-survey-2013.
programme records with purposive sampling to select
only pharmacists from a community pharmacy back-
ground, and invited to interview. Interviews were con-
Wellbeing and Community Pharmacy
ducted in person at a venue chosen by the interviewee
or over the phone if more convenient to them and audio The current and potential role of
recorded. Recordings were transcribed verbatim and community pharmacy in asset-based
analysed using NVivo 11 software to code data and
explore emerging themes. approaches to health and wellbeing:
Results: Interviews took place with ten pharmacists. a qualitative study
Three main themes emerged from the analysis of the
transcribed interviews: A desire for career progression J. Astbury1, E. Schafheutle1, J. Brown2 and C.
versus a clear element of self-doubt in their ability to Cutts2
succeed, financial barriers to study and career progres-
sion, lack of opportunities to use the qualification. The 1
University of Manchester, Manchester, UK and 2
Health Education
experiences of the community pharmacists interviewed England, Manchester, UK
were generally positive with the main driving force to
enrolment being the desire to further their knowledge Introduction: Health assets can be conceptualised as col-
and advance their careers “The IP course was always lective resources, including relational, social, environ-
one I wanted to do and it was a kind of a natural progres- mental, and physical facets that foster the welfare of
sion from everything I’ve done to further myself”. Barriers individuals and communities.
to their studies included lack of confidence and financial Asset-based approaches aim to improve wellbeing,
issues arising from time away from work to attend uni- protect against ill-health, and reduce health inequalities
versity and the compulsory hours with their designated by capitalising upon existing assets, strengths, and
medical practitioner “So, there’s financial barriers for resources of individuals and communities, as opposed to
community pharmacists. . .having time out of work to go focusing upon needs and deficits. Asset-based
and study at university and then spend the time having approaches are increasingly used as a basis for public
ninety hours’ worth of supervised training”. Lack of health initiatives and as a framework to support the
opportunities to use the independent prescribing qualifi- transformation of health and social care services1. To
cation within community pharmacy is forcing pharma- date, there has been scant consideration of the potential
cists to work spilt sector or leave community pharmacy role for community pharmacy.
altogether “To be honest, then I didn’t see really a way Aim: To explore the current and potential role of com-
that I would use it in community pharmacy”. Suggestions munity pharmacy in asset-based approaches.
to improve the independent prescribing course at the Methods: Participants included community pharmacy
university included increasing training on the diagnostic practitioners and project leads, and public health policy
element of consultations as community pharmacists and strategic leads from across the UK. Participants were
found this area challenging and the utilisation of phar- recruited purposefully through local networks and social
macist independent prescribers during the teaching of media for qualitative semi-structured telephone interviews
the course.
between June and October 2019. Transcripts were anal- Exploring a Theory of Change and Challenges in
ysed inductively using simultaneous inductive open cod- Evaluation. Leeds: Leeds Beckett.
ing and deductive coding using Theory of Change2.
Results: Fifteen participants were interviewed. Pharmacy A UK-Japan comparative qualitative
participants conceptualised their current and potential
involvement in asset-based approaches at the level of
study on pharmacists’ experiences about
working with individuals or communities. On an indi- health and wellbeing hub functions in
vidual level, asset-based approaches were understood as community pharmacy – preliminary
the adoption of increasingly person-centred and analysis
strength-based approaches towards consultations with
patients and customers. At a community level, asset-
N. Arakawa1, S. Yamamura2 and I. Bates3
based working was seen as the ‘contribution’ that phar-

macies made, or could make, to the communities in 1
University of Nottingham, Nottingham, UK 2Josai International
which they were situated beyond current standard com- University, Chiba, Japan and 3University College London, London, UK
missioned services. This contribution was often aligned
with the notion of strengthening social capital and non- Introduction: Japan and the United Kingdom (UK) face
medicalised approaches to enhancing individual and significant healthcare challenges due to an ageing popu-
public wellbeing. The adoption of asset-based lation. Both governments are keen to promote commu-
approaches was felt to have reciprocal benefits for indi- nity pharmacies (CPs) as health and wellbeing hubs. In
viduals, communities, the pharmacy workforce, and the Japan, ‘community-based integrated care systems’ have
pharmacy profession. There was limited evidence of a been implemented focusing on the prevention in com-
systemic adoption of asset-based working within the munity, embedding CPs as ‘Health Support Pharmacies
pharmacy sector. The changing landscape of community (HSP)’1. The UK has nationalised the ‘Healthy Living
pharmacy practice and shift towards patient-facing clini- Pharmacy (HLP)’ scheme, aiming to better use CP for
cal roles was felt to offer expanded relational opportuni- improving public health and redress health inequalities2.
ties to engage and collaborate with individuals, The aims of both HSP and HLP are similar; however,
communities, and other stakeholders. The adoption of their approaches differ in terms of service delivery.
asset-based approaches was challenged or enabled by a Aim: The study aim was to explore and compare lived
number of factors including the availability of protected experiences of pharmacists in the delivery of the HSP in
time and resources, workplace and organisational cul- Japan or HLP in the UK, to inform further improve-
ture/values, strategic leadership, commissioning, funding ment of public health services in both countries.
arrangements, and lack of community pharmacy pres- Methods: Semi-structured interviews were conducted in
ence within primary care networks. Interviewees sug- Japan and the UK with pharmacists working either in
gested opportunities to support integration, including HSP or HLP. The ethical approval was obtained from
further development of ‘healthy living pharmacies’, the Research Ethics Committees of the University. Pur-
resources to support pharmacy teams to develop collab- posive sampling was applied to reach registered pharma-
orative relationships with other organisations/sectors, cists working in HLP/HSP that have obtained HLP/
greater access to and inclusion in local asset maps/direc- HSP accreditation, via professional networks, targeting
tories, and a programme of enabling funding. Further 15 participants from each country, or until data satura-
exploration of community pharmacies’ potential involve- tion was reached. An interview schedule was developed
ment in non-medicalised approaches to improving well- by NA and face validated in the research team, includ-
being, including social prescribing, were also suggested. ing career background, pharmacy-staffing, engagement
Conclusions: Whilst small-scale, this is the first study to with and impact of HSP or HLP, challenges of service
explore asset-based approaches within the context of delivery, and further improvement. The interviews were
community pharmacy. The study provides valuable conducted in Japanese and English, as appropriate.
insights into the potential for community pharmacy to Consent was obtained from all participants before inter-
support the health and wellbeing of individuals and views. Interviews were audio-recoded and transcribed
communities and play a more central role in the reduc- verbatim. Transcribed Japanese interviews were trans-
tion of health inequalities, by incorporating and con- lated into English using forward-backward translation
tributing to asset-based approaches in their localities. method. Transcribed data were analysed thematically.
Results: 16 interviews in Japan were conducted in July and
August 2018, and 15 interviews in the UK between April
References
and August 2019. Five themes emerged regarding chal-
lenges in HSP/HLP provision; understanding concepts of
1. Rippon, S. & Hopkins, T. (2015) Head, hands and schemes, training, awareness of services and pharmacist’s
heart: asset-based approaches in health care. Lon- role, sustainability of services, and access to services and
don: The Health Foundation. information. Of the five themes, ‘sustainability of services’
2. Rippon, S. & South, J. (2017) Promoting Asset was strongly concerned both in Japan and UK. Further,
Based Approaches for Health and Wellbeing. five themes emerged for further improvements in HSP/
Wellbeing and Community Pharmacy 23
HLP including; professional development, raising aware- the intervention based on theory and several iterations
ness of services and pharmacist’s role, securing resources, to develop the PPI (Table 1) to be tested in one inde-
systems and regulations, and innovation. Opinions related pendent CP in a deprived area of South Wales.
to ‘securing resources’ theme have significant difference
between Japan and UK, as HSP in Japan is not linked with Table 1. Summary of the design of the PPI
remuneration and requires extra funding. Whilst the UK Type of Title of
also struggle securing funding, although overall service Timeframe Session Structure Deliverer
quality associated remuneration was addressed.
Conclusion: This is the first study to compare pharma- Six weekly One to one, Seven one-to- Wellbeing
cists’ experiences in health and wellbeing functions of sessions plus 30– one Sessions Facilitator
one follow-up 45 minutes plus diary to
CP in the UK and Japan. Different service requirements
over a total in length be completed
and delivery between HSP and HLP limit the interpreta-

eight weeks 3 days a week
tion of direct comparison of pharmacists’ experiences.
However, the study indicates varying experiences under
the common themes, according to their levels of imple- A semi-structured interview schedule was designed to
mentation and understanding of services of individual capture participants’ views about the PPI, covering
pharmacists and pharmacies in each setting. Future seven broad areas. Key informants were approached
work includes developing recommendations to each due to their in-depth knowledge of healthcare, public
country from their experiences of different approaches health or community pharmacy systems in Wales. Stake-
towards health and wellbeing hub functions in CP. holders were either staff members at the CP study site,
general practitioners or well-being professionals working
within the local community. Interviews were audio-
References recorded, transcribed verbatim and analysed using a
combination of framework and thematic analysis.
1. Ministry of Health, L.a.W., 2035 Japan Vision: Results: Fifteen semi-structured interviews were con-
Health Care. 2015, Ministry of Health, Labour and ducted (seven key informants; eight stakeholders). Seven
Welfare: Tokyo. overarching themes emerged from the data. These were
2. Holden, M., Introducing the Healthy Living Phar- (n = number of sub-themes) related to: 1) Intervention
macy. SelfCare, 2015. 6(2): p. 21–25. design (n = 6; overall impression, views on diary, session
duration, concepts, timeframe, one to one consultation),
2) Title of the wellbeing facilitator (n = 2; overall
impression, suggestions), 3) Identifying the target popu-
The design and delivery of a community lation, with suggestions, 4) Recruitment (n = 4; commu-
pharmacy-based positive psychology nity, community pharmacy, self-referral, mixed-referral),
5) Factors to support implementation (n = 4; evaluation
intervention: a feasibility study process, wellbeing facilitator, community pharmacy, par-
ticipant), 6) Challenges to implementation (n = 3; partic-
J. Ward, A. Sparkes, P. Hewlett, A. Prior and ipant, wellbeing facilitator, community pharmacy) and
D.H. James 7) Impact of the intervention (n = 3; community wellbe-
ing, community healthcare services, community phar-
Cardiff Metropolitan University, Cardiff, UK
macy).
Conclusions: Overall, the feedback from the interviewees
Introduction: Community pharmacy (CP) has been was positive and the findings supported the use of a CP-
recognised as providing an appropriate setting for public based setting for implementing a PPI with the appropri-
health interventions. With recent policies focusing on ate infrastructure in place. The findings from this phase
enhancing the health and well-being of the population will be utilised to inform the design and delivery of the
in Wales1,2, this research applies positive psychology PPI, with further feasibility testing within Phase 3 of the
(PP) to the design of a well-being intervention. The goal MRC framework. The study setting is limited to one
of PP is to redirect attention away from pathology, dis- independent CP which may not be representative of all
ease and weaknesses towards the study of human flour- pharmacies in Wales, however, these preliminary find-
ishing. This study is part of a larger programme of ings can be used to support future research.
research to design and test the implementation of a
pharmacy-based well-being service.
Aim: To explore the views of key informants and stake- References
holders on the feasibility of implementing a positive psy-
chology intervention (PPI) in a CP setting. 1. Future Generations Commissioner for Wales. (2017).
Methods: The Medical Research Council (MRC) frame- Annual Report 2017–2018. https://futuregenerations.
work for complex interventions was used as the basis wales/wp-content/uploads/2017/02/Draft-Strategic-
for the study design. This paper focuses on Phase 2, Plan-ENG-1.pdf (Retrieved 26 July 2019)
‘Feasibility and Piloting’. Phase 1 involved modelling of
2 Welsh Pharmaceutical Committee. (2019). Pharmacy: incorporate BCTs to support this. A face-to-face com-
Delivering a Healthier Wales. https://www.rpharms. ponent may also be required alongside digital commu-
com/recognition/all-our-campaigns/pharmacy-delive nication to address wider barriers to medicines taking.
ring-a-healthier-wales (Retrieved 30 September 2019). This support has been previously been delivered by
community pharmacists in services such as medicines
Co-designing Interventions use reviews. It is important that stakeholders and
intended recipients of new interventions are involved
in any design process.
Co-design of a new community Aim: To co-design a personalised two-way automated
pharmacy delivered text message text messaging intervention combined with a community
intervention with patients and pharmacy consultation to support medication adherence.
Methods: A human-centred design (HCD) approach

professionals to support medicines was used1. Six prototypes were developed based on a
adherence systematic review. Three of these were presented to
patients, including a personalisation questionnaire,
G. Donovan1, N. Hall1, J. Ling1, F. Smith2 and patient information leaflet and video of an introduction
S. Wilkes1 to the intervention in a community pharmacy. A further
two prototypes were presented to professionals including
1
University of Sunderland, Sunderland, UK and 2
University College two diagrammatic representations, one of how the ques-
London, London, UK tionnaire would personalise the text message interven-
tion and a second which suggested how the intervention
Introduction: It is estimated that 30%–50% of patients could be integrated into existing care pathways. Both
do not take medicines as prescribed. Medication tak- groups were also shown a video of a consultation incor-
ing can be described as a behaviour, at which beha- porating the intervention with a community pharmacist.
viour change techniques (BCTs) could be applied. Nominal group technique was used as a framework to
Text messages have been highlighted as a potential gather feedback for the co-design process. This used
tool to support medicines adherence and could focus groups with patients and professionals to generate
Table 1. Highest ranked statements for each of the prototypes tested
Co-designing Interventions 25
statements about the prototypes; items that participants The author conducted a grounded theory (GT) synthesis
liked and items that they felt needed to be changed. to integrate data from existing qualitative studies about
These were summarized and formulated into a ranking women’s adherence to hormonal treatment in breast can-
questionnaire which was then sent out to all participants cer to develop an in-depth explanatory model of medica-
either on paper or online. tion experiences in this condition. Afterwards, the author
Results: Nine patients and 21 healthcare professionals conducted a GT based interview study with women who
(pharmacists, nurses, general practitioners) were included have been taking hormone therapy following a breast
in the co-design process across five focus groups. 17 par- cancer diagnosis. The results combined from both studies
ticipants also took part in the ranking exercise. The led to the development of an all encapsulating GT with
design concept was positively received by all participants. three main categories; 1) The treatment of breast cancer:
A summary of the highest ranked statements can be prescription of a long-term drug; 2) The treatment of
found in Table 1. There was agreement that a pharmacy breast cancer: adhering to the long-term treatment; 3)

setting and a review by a pharmacist was desirable by The treatment of breast cancer: stopping the long-term
both patients and professionals. Changes suggested by treatment. These categories were represented using com-
patients also included ensuring that recipients understood plex tables but needed to be simplified if they were to help
that communication was automated during the consulta- patients in the future.
tion. Professionals additionally liked the range BCTs Aim: To develop the GT categories into a set of three
included in the intervention, especially the support for pictograms and validate these with survivors.
habit formation. However, they felt uncomfortable with Methods: The pictograms were developed by the author
the use of more negatively framed BCTs and wanted more in consultation with their supervisor. Essentially, each
support included for patients to use home monitoring of the main categories was represented by one overall
equipment. Changes highlighted as part of the co-design pictogram showing the patient journey with a series of
process have now been incorporated into a final design small labelled drawings. The pictograms were validated
which is undergoing ‘live’ prototyping as part of the next for accuracy and meaning by an independent group of
cycle of the HCD process. researchers (n = 10) who acted as reviewers by complet-
Conclusions: HCD methods were effective for supporting a content validity questionnaire. The Content Valid-
ing a co-design process to assess initial acceptability of a ity Index (CVI) was the proportion of researchers who
new behavioural intervention to support medicines agreed that the labelled drawing represented a detailed
adherence. Other researchers may also find HCD meth- description given alongside it (taken from the original
ods helpful as for co-production of interventions with GT model). After making revisions that were acceptable
patients and professionals. The intervention ultimately to the 10 reviewers, the finalized pictograms were dis-
will also require testing for effectiveness using a clinical cussed with breast cancer survivors (n = 12) whose
trial design. responses were obtained in interviews. They were asked,
for example, if the pictograms encapsulated their own
experiences.
Reference Results: Of the 76 labelled drawings, 13 had an
CVI < 0.8 and were therefore modified. The finalized
1. IDEO. The Field Guide To Human-Centered versions elicited positive responses from the survivors,
Design. 2014. https://doi.org/10.1007/s13398-014- with all 12 reporting that their own experiences were
0173-7.2. captured well by the pictograms. For example, “I think
that sums it up very well and actually it’s helped me to
tell you more about my treatment cycle” and “Year.
The development of pictograms to That is me to a tee. That’s quite scary. Yeah, that is
illustrate women’s experiences with quite scary.” This gave the respondents some comfort
adjuvant hormone therapy for breast that they were not alone in experiencing difficulties with
cancer their treatment.
Conclusion: The developed pictograms were found to be
helpful by breast cancer survivors and therefore have
O. AlOmeir, N. Patel and P. Donyai
the potential be useful when communicating with new
University of Reading, Reading, UK patients as they embark on hormonal treatment for
breast cancer. Future research should assess the applica-
bility of these pictograms in a clinical setting, which is
Introduction: Breast cancer is the most common type of
yet to be tested and is a weakness of the current work.
cancer diagnosed in the UK, accounting for 30.8% of all
malignant female cancer registrations in 2016 (1). The
treatment includes the use of long-term endocrine therapy References
in hormone receptor (HR) positive cases, which account
for two thirds of all breast cancer diagnoses. Despite its
importance research has shown a reluctance by some 1. Cancer registration statistics, England – Office for
women to fully adhere to such long-term treatment (2). National Statistics [Internet]. [cited 2019 May 16].
2. Spring LM, Gupta A, Reynolds KL, Gadd MA, Table 1. Results of thematic analysis
Ellisen LW, Isakoff SJ, et al. Neoadjuvant Endo- Theme Sub-theme
crine Therapy for Estrogen Receptor–Positive Breast
Cancer: A Systematic Review and Meta-analysis. Supervision Wide exposure to pharmacists
JAMA Oncol. 2016 Nov 1;2(11):1477–86. from different practice
backgrounds was identified as
an influencing factor that
Early Careers helped the trainees develop
Continuous feedback from these
supervisors enabled increased
Multi-sector pre-registration training: reflection and professional
development
qualitative analysis of pre-registration Self-confidence Participants discussed the

trainees’ perceptions of a pre- responsibility they felt to help
others learn and how that
registration training programme in encouraged their own
academia and community pharmacy personal progression
The self-imposed pressure to
K. Davison1, A. Sturrock1, J. Hardisty1 and K. impress academic staff and
integrate into an academic
Bullen1,2 team served to enable a
1
higher level of personal
Univeristy of Sunderland, Sunderland, UK and 2MD&AG Burdon Ltd,
development
Gateshead, UK
Participants perceived an
increased preparedness to
Introduction: Multi-sector pre-registration training is practice in comparison to
continually evolving and has become a popular choice their peers in single sector
for trainees1. In 2013 the University of Sunderland training
developed a novel pre-registration training programme Meeting demands Communication barriers
in collaboration with a regional community pharmacy. between the different sites led
to participants feeling ‘caught
Since that time fourteen trainees have successfully
in between’ the two
completed the training but no formal evaluation has Balancing the requests and
been previously conducted. This study explores the expectations of different
experiences of pharmacists having undergone such training sites was also
training. highlighted as an additional
Aim: To explore retrospective perceptions of registered pressure not experienced in
pharmacists towards their experiences of pre-registration single sector training
training across academia and community pharmacy and
to understand the benefits and limitations of such train- A high level of maturity in participants’ responses
ing. A focus was also placed on establishing trainees’ was also identified by researchers, potentially attributa-
self-perceptions of preparedness to practice after under- ble to an obvious self-motivation to improve and
going this training. achieve.
Methods: A purposive sample of registered pharmacists Conclusion: Stakeholders involved in pre-registration
(n = 12) who undertook a pre-registration training pro- training and delivery of pharmacy education may find
gramme in academia and community pharmacy between the results of this study informative and could poten-
2013 and 2019 participated in one to one semi-struc- tially use the findings to influence development of fur-
tured interviews. A recruitment email with details of the ther future multi-sector pre-registration training
study was sent to potential participants (n = 14) who programmes involving academia. Multi-sector pre-regis-
had completed the training programme during the speci- tration training has been explored previously across hos-
fied timeline. Consent was obtained from participants pital pharmacy, community pharmacy and general
prior to interview. The topic guide was designed by the practice2, but there is a paucity of evidence regarding
project team to explore the positive and negative experi- training in academia. The participants in this study per-
ences of the training programme and perceptions of the ceived their training experience as being extremely posi-
participants’ preparedness to practice. Interviews were tive with all participants stating they would encourage
conducted over the telephone by an independent others to undertake similar training. The participants in
researcher. Interviews were audio recorded, transcribed this study had been selected as suitable trainees for a
verbatim and thematic analysis was conducted using a multi-sector post based on academic ability and personal
framework approach. attributes so were by default likely to be highly moti-
Results: Thematic analysis highlighted three key themes vated individuals.
with a range of sub-themes (see Table 1).
Safety in Prescribing 27
References reported positive changes in their confidence and clinical

knowledge, which were attributed to a structured training
programme and a supportive environment “there’s an
1. Health Education England (2018). Evaluation
aura of supporting you to do what you want to do”. How-
Report – Applicant preferencing of prospective
ever, there was a sense from some FPs that these improve-
training programmes in the National Preregistration
ments also developed over time with experience “in
Pharmacist Recruitment Scheme for England and
hindsight [the programme] has helped me, but I don’t think
Wales. Available @ https://www.hee.nhs.uk/sites/
it would be any different if I completed it or not”. A lack of
default/files/documents/National%20Pre-reg%20
time, excessive workload and inadequate support and
Pharmacist%20Recruitment%20Preferencing%20
feedback were reported as barriers to professional devel-
Evaluation%20Report.pdf
opment. Furthermore, participants recognised the impor-
2. Wales Centre for Pharmacy Professional Education
tance of learning and continual development and its

(2017). Evaluating a multi-sector pre-registration train-
contribution to patient care “from a patient point of view,
ing programme in North Wales: perceptions of pre-
I think I’d rather be seen by someone who has [completed
registration pharmacists and their tutors. Available @
training] than not”. There was acknowledgement that fur-
http://www.nwssp.wales.nhs.uk/sitesplus/documents/
ther support for development at postgraduate level is
1178/abstract_for_integrated_pre-reg_pharmacists_
required, including support from experienced colleagues,
posts_final1.pdf
and guidance from pharmacy organisations.
Conclusions: To the best of our knowledge this is the
Understanding the transition first qualitative study exploring the transition experi-
experiences of foundation (early career) ences of FPs undergoing structured work-based training.
pharmacists within Great Britain (GB) Preliminary findings suggest FPs benefit can be better
supported with challenges of transition. It is important
to recognise that the findings of the study may not gen-
H. Chang and I. Bates
eralisable due to the small sample size. This study is
University College London, London, UK part of a wider project; findings will be triangulated with
findings from a knowledge acquisition study to build a
picture of developmental pathways and transitions for
Introduction: There is growing consensus internationally
FPs. This will enable policy makers, training providers,
that healthcare professionals should not be trained for
and educational bodies to develop programmes to sup-
specific jobs, but to be flexible and adaptable. This
port the transformation of a pharmacist workforce
approach will enable pharmacists to better respond to
equipped for the future.
and meet the complex pharmaceutical care needs of
patients and the public1. Structured developmental path-
ways underpinned by evidence-based frameworks can References
facilitate the creation of a safe and effective pharmacist
workforce that can better respond to future healthcare
challenges. Development programmes for foundation 1. World Health Organization. Preparing a health care
pharmacists (FPs) at postgraduate level are still being workforce for the 21st century: The challenge of
refined, and no unified model for all pharmacy sectors chronic conditions. Geneva; 2015.
exists. There is a need to understand how pharmacists 2. Glaser BG, Strauss AL. The Discovery of Grounded
develop and progress in their careers and professional Theory: Strategies for Qualitative Research. New
practice, in particular their transition experiences, where Jersey: AldineTransaction; 1967.
evidence is limited.
Aim: To explore the professional development transition Safety in Prescribing
experiences of FPs undergoing structured work-based
training.
Methods: A purposive sample of FPs working across Facilitating patient safety: key barriers
community and hospital pharmacy within GB were and facilitators to prescribing error
recruited. Details of the study were shared on professional reporting and learning across primary
networks, social media and through gatekeepers. A topic
care
guide was developed and piloted with 5 FPs. Semi-struc-
tured telephone interviews were conducted with 11 FPs,
which lasted between 30 and 80 minutes. The interviews
N. Hall1, K. Bullen1, N. Wake2,3,
were audio-recorded, transcribed verbatim, coded using a J. Sherwood1, S. Wilkes4 and G. Donovan1
grounded approach and thematically analysed using a 1
constant comparison method2, in NVivo v12. University of Sunderland, School of Pharmacy, Faculty of Health
Sciences and Wellbeing, Sunderland, UK 2Northumbria Healthcare
Results: The emerging themes were: individual develop- NHS Foundation Trust, North Shield, UK 3NHS Specialist Pharmacy
ment outcomes; organisational challenges to develop- Service, London, UK and 4University of Sunderland, School of
ment; and a need for additional support. Participants Medicine, Faculty of Health Sciences and Wellbeing, Sunderland, UK
Introduction: There are well-established benefits from which errors should be reported, how, when and to
reporting medication errors and identifying patterns to where. There was some acknowledgment of a potential
help prevent future harm. In the UK, prescribing errors increased role for community pharmacy in the identifica-
originating from general practice and other community tion of wider prescribing error patterns. Our findings
services are often identified and rectified within commu- suggest that feedback and learning need to have a local
nity pharmacy. Organisational structures within NHS focus, be perceived to have positive and significant
primary care mean that boundaries between these inde- potential to change practice, and be tailored appropri-
pendent organisations may act as barriers to error ately to each setting. Further research is required to help
reporting and associated learning. identify consensus on how best to facilitate cross-organi-
Aim: To identify key facilitators and barriers to cross- sational knowledge sharing, learning and prescribing
organisational prescribing error reporting and learning quality improvement.
across primary care and to explore the role of commu-

nity pharmacy within this.
Methods: Qualitative semi-structured face-to-face and References
telephone interviews were conducted with a purposive
sample of pharmacists, prescribers and other key stake- 1. Atkins L, Francis J, Islam R, et al. (2017) A guide
holders from across North East England. Interviews to using the Theoretical Domains Framework of
explored: facilitators and barriers to prescribing error behaviour change to investigate implementation
reporting in primary care; the influence of decision-mak- problems. Implement Science 12: 77.
ing processes and healthcare context; and the role of 2. Ritchie J and Spencer L. (1994) Qualitative data
community pharmacy in optimising prescribing error analysis for applied policy research. In: Bryman A
reporting and learning. Data collection and analysis and Burgess RG (Eds) Analyzing qualitative data.
were underpinned by the Theoretical Domains Frame- 173–194.
work (TDF)1. Framework analysis2 was used for coding
and charting the data with the assistance of NVivo soft-
ware (V12).
Exploring the role of community
Results: Interviews included perspectives from primary pharmacists in deprescribing
care prescribers (n = 11), pharmacists (n = 12) and other
key stakeholders (n = 12). Findings highlight how deci- D. Kelly1,2 and L. Glynn1
sion-making processes, practices and beliefs around pre- 1
Graduate Entry Medical School, University of Limerick, Limerick,
scribing error reporting differ significantly across and
Ireland and 2Health Research Institute, University of Limerick,
within different primary care organisations resulting in Limerick, Ireland
variability in reporting and potential gaps in knowledge.
Emergent themes were mapped to the TDF. Social influ-
Introduction: Deprescribing is the planned and super-
ences, environmental context and resources (e.g. organi-
vised process of stopping or reducing the dose of a med-
sational cultures, local leadership and relationships,
icine that might be causing harm or no longer providing
heterogeneous regulatory and reporting processes and
benefit. This idea has gathering interest over the past
systems, and beliefs about ownership, accountability
decade due to growing concerns about the overuse of
and responsibility) play a key role in the opportunities
medications and patient outcomes. As the primary pre-
and motivation to report prescribing errors. For exam-
scribers for most patients, physicians are the logical
ple, within general practice, approaches to risk manage-
health care practitioner to champion deprescribing.
ment were mainly described within “significant event”
Pharmacists scope of practice focuses on managing med-
and quality improvement paradigms. In community
ication therapy, therefore they may also contribute to
pharmacy, the focus was on checking and rectifying
the deprescribing process.
errors (rather than reporting) along with a clear distinc-
Aim: The aim of the study is to explore how community
tion between the reporting processes associated with dis-
pharmacists in Ireland are involved in the deprescribing pro-
pensing and prescribing errors. Beliefs about
cess and to inform the design of interventions that could
consequences of reporting also influenced reporting
enhance community pharmacists’ roles in deprescribing.
behaviour (e.g. stigma and blame; compliance with regu-
Methods: We used an explorative qualitative study
latory and contractual frameworks; medico-legal issues;
design, using semi-structured interviews with pharma-
impact on working relationships; and availability of
cists based in the community in the Mid-West of Ire-
feedback and learning potential). Constraints on the
land. Community pharmacists were recruited through
ability to report included: the ease of use of reporting
purposive sampling to represent urban and rural set-
systems; conflicting workload pressures; and varied indi-
tings, years of experience and position as pharmacist
vidual interpretations of terminology, procedural knowl-
owner/manager or staff. We selected pharmacists who
edge, potential significance and wider learning potential
varied with respect to important characteristics to allow
associated with different types of prescribing errors.
for comparison of data across different contexts and
Conclusion: There seems to be a lack of clarity and con-
participant characteristics to enhance understanding as
sistency across primary care in relation to beliefs about
well as increase transferability of the findings.
whose responsibility it is to report prescribing errors,
Technology 29
The interviews were conducted by phone, audio- Introduction: The Maternal and Newborn Clinical Man-
recorded and transcribed. Ethics approval for this study agement System (MN-CMS) project has introduced an
has been received from University of Limerick Research Electronic Health Record (EHR) to four Irish maternity
Ethics Committee (Education and Health Sciences). hospitals, with implementations planned for the remain-
Thematic analysis was carried out. Codes with common ing fifteen units. The transition from paper-based to
features were grouped together as emerging themes, electronic records represents a significant change in
before being assigned to overarching themes, describing workflow for healthcare professionals (HCPs). Previous
the phenomenon underlying the study. studies indicate that HCPs are concerned that EHRs
Results: A total of 10 community pharmacists partici- may decrease time for patient care by increasing time
pated in semi-structured interviews. The themes identi- spent on documentation and medication-related tasks1.
fied include medication review and reconciliation, Aim: To determine the impact of an EHR on task time
relationship with local GPs, remuneration, access to the distribution in a Neonatal Intensive Care Unit (NICU);

patient’s medical file, experience of pharmacist, defined to determine the impact of the EHR on frequency of
scope of practice and workload. Medication reconcilia- contact with the ‘patient zone’ and frequency of inter-
tion and medication information, and education were ruptions to tasks; and to explore HCPs perceptions of
considered positive roles for a pharmacist to perform the EHR.
and within their scope of practice. Pharmacists reported Methods: A mixed-methods, pre-post, time and motion
being proactively engaged in these roles and how medi- study in a 39-bedded tertiary level NICU was con-
cation reviews can occasionally involve recommending ducted. Convenience sampling was used to recruit nurses
deprescribing. The relationship with the GP was viewed and doctors working in the NICU. Data were collected
by interviewees as both a facilitator and a barrier to by two independent observers in 8-week blocks, before
pharmacist participation in deprescribing. Several phar- and after implementation of the EHR. An electronic
macists in rural settings reported having limited capacity data collection tool was used to collate time spent on
to undertake new services. The introduction of some pre-validated tasks related to direct care, professional
form of remuneration for pharmacist medication reviews communication, reviewing of charts, documentation,
or deprescribing services was collectively reported by and medication-related tasks (2). Interruptions to tasks
interviewees as an incentive for involvement. and frequency of contact with the patient zone were also
Conclusion: This study highlights that deprescribing quantified. Statistical significance was assessed using
linked to medication review is within the scope of prac- two-sample proportion tests, two-sample t-tests, and
tice of community pharmacists and there is potential for two-sample Wilcoxon rank-sum tests. A Bonferroni cor-
community pharmacists to become more involved in this rection set significance at P ≤ 0.0025. Qualitative data
area. Facilitators and barriers to integrating the service pertaining to participants’ thoughts on the EHR were
into current community pharmacies were identified, collected via survey and summarised using descriptive
including lack of remuneration, which reflected health statistics. Qualitative and quantitative data were triangu-
system and policy barriers frequently reported in the lit- lated where appropriate.
erature in other jurisdictions. The importance of collab- Results: Forty-six NICU nurses and 17 paediatric regis-
orative relationships with local GPs was also identified. trars were recruited over both phases, with 169.23 hours
The small number of participants and the purposive data collected. There were non-significant changes in the
sampling from one geographic area may be a limitation proportions of time spent by nurses on all tasks. Doc-
of the study. These findings may contribute to the devel- tors’ proportion of time spent on professional communi-
opment of deprescribing services in primary care involv- cation increased from 15.4% to 26.0% (P < 0.001).).
ing community pharmacists. Significant increases to median task times were seen for
both doctors and nurses. Frequency of interruptions to
Technology tasks decreased post-implementation (P < 0.001), as did
frequency of contact with the patient zone (P < 0.001).
The overall positive perceptions of the EHR identified
Impact of an electronic health record on in phase 1 did not change significantly post-implementa-
task time distribution in a neonatal tion, but usability issues were identified by individuals.
intensive care unit: a mixed methods ICC values >0.80 were observed for each task category,
indicating good inter-rater reliability.
study Conclusion: This was the first time and motion study to
quantify the impact of this EHR on NICU task time
J. Devin1, J. Costello1, N. McCallion2, distribution. Importantly, the EHR did not redistribute
E. Higgins3, B. Kehoe3, B. Cleary3 and time towards documentation and medication-related
tasks. Perceptions of the EHR remain largely positive
S. Cullinan1
15 months’ post-implementation. Strengths of the study
1
School of Pharmacy and Biomolecular Sciences, Royal College of include the pre-post design and validated data collection
Surgeons in Ireland, Dublin, Ireland 2Neonatology Dept., The Rotunda tool. Limitations include the use of two data collectors,
Hospital, Dublin, Ireland and 3Pharmacy Dept., The Rotunda Hospital, although good inter-rater reliability was observed.
Dublin, Ireland
NICU-specific findings may not be generalisable beyond
this setting. Findings have implications for future itera- Deductive analysis of the data revealed three broad
tions of MN-CMS by establishing a baseline for evalua- themes: implementation, system attributes and stake-
tion. Recommendations include ongoing training and holder engagement. Aspects of implementation such as
support for clinical staff, and engagement with system the collaboration with local professional organisations
users to address usability issues and ensure quality of were the same across the systems. In contrast, only
care. RTP utilised a pre-determined marketing strategy
involving speaker circuits, publications and newsletters.
System attributes, such as the level of IT integration
References were different across the systems, with DMR being the
most integrated hence saving stakeholder time and
1. Baysari M, Richardson L, Zheng WY, Westbrook J. allowing full data extraction. RTP and PharmOut-
Implementation of electronic medication manage- comes notified community pharmacists of patient

ment systems in hospitals: a literature scan. Sydney: admission and discharge whereas DMR only notified
ACSQHC; 2016. on patient discharge.
2. Westbrook JI, Li L, Georgiou A, Paoloni R, Cullen In terms of stakeholder engagement, RTP provided
J. Impact of an electronic medication management automated routine electronic feedback to hospital
system on hospital doctors’ and nurses’ work: a con- pharmacists about the outcomes of the referrals and
trolled pre-post, time and motion study. J Am Med hospital pharmacy staff using PharmOutcomes held
Inform Assoc. 2013;20(6):1150–8. semi-regular meetings with hospital pharmacists to dis-
cuss high-level outcomes from referrals. DMR pro-
vides no regular feedback to hospital pharmacists.
Improving the discharge medicines Additionally, RTP and PharmOutcomes keep commu-
nity pharmacists accountable for referrals by accessing
review service in Wales: learning from a list of non-actioned referrals and following them up.
the comparison of technology-supported RTP is the only system to keep hospital pharmacists
UK transfer of care systems accountable through staff-led meetings to discuss why
eligible patients weren’t referred. No new themes
R. James1, K. Hodson1, E. Mantzourani1, C. emerged from subsequent inductive analysis of the
data.
Way2, A. Gray3 and M. Burnley4 Conclusion: The results suggest that while all systems
1
Cardiff School of Pharmacy & Pharmaceutical Sciences, Cardiff, UK have the same aim, they have different methods of
2
NHS Wales Informatics Service, Cardiff, UK 3East Lancashire Hospitals implementation and provision. Good practice high-
NHS Trust, Blackburn, UK and 4Community Pharmacy West Yorkshire, lighted in this study that could be integrated into the
Leeds, UK DMR system includes marketing strategies to advertise
the DMR and its benefits, increased accountability of
Introduction: In 2011, the Welsh Government imple- stakeholders in relation to referrals, integration of
mented the Discharge Medicines Review (DMR) service patient admission notifications to community pharma-
to reduce the risks associated with transfer of care. The cists and providing feedback to hospitals after a DMR,
DMR initially involved paper transmission of discharge in line with evidence from the 2014 service evaluation1.
information to community pharmacy with a follow-up The use of key informant semi-structured interviews
adherence support service, updated in 2015 to allow gathered a deep description of each transfer of care
electronic transmission of discharge information1. Other system which was not found in literature. Results have
localities in the UK have developed their own technol- limited generalisability since only UK systems were
ogy-supported transfer of care systems: Refer-to-Phar- studied.
macy (RTP), PharmOutcomes and Help for Harry
(HFH)2.
Aim: To compare and contrast UK technology-sup-
References
ported transfer of care systems in order to highlight
areas of good practice that can be used to recommend 1. Hodson K, James D, Smith M, Turnbull L. Evalua-
improvements for the DMR service. tion of the DIscharge Medicines Review Service
Methods: A generic qualitative methodology was [Internet]. 2014 [cited 2018 Dec 10]. Available from:
applied with semi-structured interviews, utilising an http://www.cpwales.org.uk/Contract-support-and-IT/
interview guide informed by literature. Purposive sam- Advanced-Services/Discharge-Medicines-Review-(DMR)/
pling identified four participants for their role in the Evaluation-of-the-DMR-Service/Evaluation-of-the-
development and implementation of their respective DMR-service.aspx
transfer of care2. Audio recordings were transcribed ad 2. Royal Pharmaceutical Society. Hospital referral to
verbatim and analysed deductively utilising thematic community pharmacy: An innovators’ toolkit to sup-
analysis. port the NHS in England [Internet]. 2014 [cited 2018
Results: Three interviews were undertaken including key Nov 12]. Available from: http://www.rpharms.com/
informants for DMR, RTP and PharmOutcomes. promoting-pharmacy-pdfs/moc-report-full.pdf
General Practice Pharmacy 31
collaboration with PBPs, 32.9% of respondents (n = 73)

showed disagreement or ambivalence to the statement
General Practice Pharmacy ‘my role and the PBP’s role in patient care are clear’.
Many respondents agreed/strongly agreed that PBPs
Community pharmacists’ experiences could provide a better link to general practice for com-
munity pharmacists (84.2%, n = 187) and that the intro-
with, views of, and attitudes towards, duction of the PBP role could have a positive impact on
general practice-based pharmacists: a patient outcomes (81.5%, n = 181). However, a large
cross-sectional survey study proportion of respondents (85.5%, n = 190) showed dis-
agreement or ambivalence with the statement ‘patients
H.E. Barry, R. Clarke and C.M. Hughes understand the difference between community pharmacists
and PBPs’.

Queen’s University Belfast, Belfast, UK Conclusion: This study has revealed that community
pharmacists are in frequent contact with PBPs about a
Introduction: Regional five-year pilot schemes have been range of medication-related issues. Whilst there
introduced in the United Kingdom to embed pharma- appeared to be evidence of positive collaboration
cists in general practices. In Northern Ireland (NI), it is between community pharmacists and PBPs, recognition
anticipated there will be 300 whole time equivalent prac- of individual roles was less clear which may impact
tice-based pharmacists (PBPs) in post by 2020/211. upon the successful integration of PBP within general
Whilst the evidence-base relating to PBP implementation practice and primary care. The effect of non-response
is growing, little is known about key stakeholders’ per- bias may limit the generalisability of the findings to the
spectives of the PBP role, and particularly those of com- wider community pharmacist population in NI. Further
munity pharmacists. work to explore patients’ understanding and views of
Aim: To determine the nature and frequency of profes- pharmacist roles in primary care is needed to corrobo-
sional contact between community pharmacists and rate community pharmacists’ concerns.
PBPs, and to explore community pharmacists’ attitudes
towards and views of PBPs.
Methods: A questionnaire was mailed on two occasions References
during February and March 2019, to all community
pharmacies in NI (n = 531). The questionnaire was 1. Strategic Leadership Group for Pharmacy. Practice-
developed following a literature review and comprised based pharmacists’ statement. 2016. (Online) Avail-
four sections. Section A collected sociodemographic able at: https://www.health-ni.gov.uk/sites/default/
data about respondents and the community pharmacies files/publications/health/practice-based-pharmacists.
in which they worked. Section B determined the fre- pdf (Accessed 03 Oct 2019).
quency, methods, and nature of contact that community 2. Van C, Costa D, Abbott P, Mitchell B, Krass I.
pharmacists had with local PBPs. Section C explored Community pharmacist attitudes towards collabora-
community pharmacists’ attitudes towards collaboration tion with general practitioners: development and val-
with PBPs, using an adapted version of the Attitudes idation of a measure and a model. BMC Health
Towards Collaboration Instrument for Pharmacists Serv Res. 2012; 12: 320.
(ATCI-P)2. Section D explored community pharmacists’
views about the PBP role. Responses were coded and An Evaluation of a transition training
entered into SPSS v22. Descriptive analyses were used
where appropriate, and responses to open-ended ques- programme for pharmacists working in
tions were analysed thematically. Ethical approval was GP settings
obtained for this study.
Results: Two hundred and twenty-two community phar- S. Bartlett and A. Bullock
macists (41.8%) responded. The majority (68.5%,
n = 152) were employee pharmacists and had been prac- Cardiff University, Cardiff, UK
tising as a pharmacist, on average, for 16.2 (SD 11.9)
years. Nearly all respondents (98.2%, n = 218) had been Introduction: With an ageing population, increase in
in contact with a local PBP, with most (63.1%, n = 140) chronic illness, complexity of medication and
in contact at least three times a week. A small propor- polypharmacy, general practice surgeries struggle to
tion of respondents (9.9%, n = 22) reported difficulty in meet the health demands of today’s society1. This situ-
making contact with PBPs. Common reasons for con- ation is exacerbated by a GP recruitment crisis. One
tact related to prescription queries or amendments to approach to alleviate such pressures and ensure the
prescriptions, unavailability of medications, and queries provision of appropriate patient care is the integration
related to hospital discharge. Whilst community phar- of pharmacists into the primary care skill-mix in GP
macists displayed largely positive attitudes towards settings. Evidence from Scotland shows that this can
free-up GP time and improve patient safety2. How- References

ever, there is no research into this role across Wales.
Health Education and Improvement Wales (HEIW)
1. Stone, M.C. and Williams, H.C. Clinical Pharma-
devised a new training programme to support pharma-
cists in General Practice: Value for Patients and the
cists to transition into the GP setting. The 12-month
Practice of a New Role. British Journal of General
programme is centred on a competency-based frame-
Practice. 2015;65(635):262–263.
work developed in partnership with the Royal Phar-
2. Torjesen, I. Practice Based Pharmacists Free up Five
maceutical Society. Participants are supported by an
Hours of GP Time a Week. BMJ. 2018;362.
experienced GP pharmacist tutor for guidance and
competence assessment.
Aim: To ensure best patient care, pharmacists require Evaluating community pharmacists’
sufficient, relevant training for this GP practice-based perspectives of collaborative working

role. This study aimed to evaluate the new transition with GPs: a focus group study
training programme in Wales, reporting on whether it
adequately prepares pharmacists to show competence
R. Venables1, S. Harris2, E. Mills2,3,
for GP-based roles, programme strengths and limita-
tions and areas for development. S. Chotai1, M. Tariq1 and S. White1
Method: Telephone interviews and focus groups were 1
School of Pharmacy and Bioengineering Keele University, Keele, UK
conducted with all ten pharmacists enrolled on the 2
Green Light Pharmacy, London, UK and 3UCL School of Pharmacy,
Welsh pilot programme (tutees) and their tutors. One- London, UK
to-one telephone interviews were held with tutees mid-
way through the transition programme and focus
Introduction: Inter-professional collaboration is defined
groups with tutees and tutors towards the end of the
as “when multiple health workers from different profes-
programme. All conversations were recorded and tran-
sional backgrounds work together with patients, families,
scribed. Data were coded in NVivo and analysed the-
carers (caregivers), and communities to deliver the highest
matically.
quality of care”1. Recent NHS strategy promotes the col-
Results: Five key themes were identified: pharmacists’
laborative working of GPs and Community Pharmacists,
motives for working in GP settings and pursuing the
however historically, GP and Pharmacist collaborations
transition programme, learning and development needs
have been sparse, and barriers to collaborative working
of tutees, experiences of the transition programme,
have been widely reported in literature. A novel project
suggestions for programme improvements, and future
was designed to facilitate collaborative working between
prospects. Tutees joined the programme with varied
GPs and Community Pharmacists, including an evalua-
previous experience; several with prior experience of
tion to explore this further. The project included: dedi-
the general practice environment. Pharmacists chose to
cated time to observe each other’s practices, leadership
make this transition for a variety of reasons, including
training and a quality improvement project.
to further utilise their clinical skills and to work more
Aim: To evaluate Community Pharmacists perspectives
sociable hours. Tutees commonly desired to develop
of collaborative working with GPs using a focus group
their clinical and consultation skills, and more
(FG) informed by a conceptual model of collaboration.
broadly, their confidence and competence around
Methods: Following the six-month project, the GP-Com-
working in this different setting. The most valued ele-
munity Pharmacist project participants (N = 10) were
ment of the programme was the tutor support, and
invited via email to participate in a multidisciplinary FG,
tutees particularly appreciated their tutor visiting them
using a pre-designed guide, informed by Bradley et al.
in their own practice. Both tutees and tutors felt it
(2012) model of collaboration as the data collection tool.
was important that the programme could be tailored
Seven themes were covered2: locality, service provision,
to match individual needs of pharmacists, particularly
trust, knowing each other, communication, professional
given their varied prior experience and existing skills.
roles and professional respect. The FG was designed to
A flexible approach was welcomed and deemed essen-
explore partner collaboration and shared understanding
tial. In terms of the future, tutees were looking to fol-
of collaborative working within the GP-Community
low a number of different career directions; several
Pharmacist project, thus it was decided to conduct this in
intended to pursue the independent prescriber qualifi-
a multidisciplinary fashion. Data were audio recorded
cation to further enhance their role and contribution
and analysed using thematic analysis.
to patient care.
Results: Four GP-community pharmacist pairs partici-
Conclusion: Although this study is based on self-report
pated in the FG. Themes related to barriers to collabo-
and does not include formal performance assessments or
rative working were identified: Communication, IT,
observation of practice, the programme appears to suc-
Cost, Time, Insight to Professional Role, Trust and
cessfully support pharmacist transition to working in
Mutual Dependency and Education. Pharmacists dis-
GP settings. It enables them to evidence their compe-
cussed problems that could inform future education on
tence for this role. The tutor-tutee relationship is central
collaborative working; e.g. ‘one of the biggest barriers
in supporting pharmacist development and achieving
would be changing mind-sets.’ Pharmacists also discussed
role competencies.
General Practice Pharmacy 33
their trust in GPs as being inherent, ‘the trust is always Introduction: Collaborative patient-centred working
there. Its inherent otherwise, we wouldn’t be where we are between healthcare professionals within the British
at the moment.’ Pharmacists reported ‘I didn’t know what National Health Service (NHS) is one of its core strate-
it looked like from the GP side,’ and ‘I didn’t know that gic values. The recently published NHS Long Term
they had all these extra bits they had to do,’ highlighting Plan1 specifically encourages better integration of com-
lack of ‘Insight to Professional Role [of a GP]’ as a rea- munity pharmacists (CPs) within primary care teams
son for joining the project. Positive feelings about how due to their skillset and regular engagement with
collaborations have strengthened throughout this project patients; this has come as a result of workforce short-
were reported by pharmacists, e.g. ‘I have a better appre- ages and financial pressures on general practitioners
ciation of the challenges that the doctors face’ and ‘it did (GPs) and urgent care. Whilst pharmacists are currently
break a lot of barriers because we’ve started to communi- being integrated into general practices as “practice-based
cate with the Practice Managers and the GPs a lot more.’ pharmacists”, insight is needed regarding optimising col-

Conclusion: FG results highlight that this project, laborative working between CPs and GPs. Thus, a sys-
through facilitating collaborative practice has: improved tematic review (PROSPERO: CRD42018087846) was
both pharmacists’ knowledge and insight of the role of undertaken.
a GP, highlighted that pharmacists feel they have trust- Aim: To describe existing collaborative models in pri-
ing relationships with GPs and also shown that through mary care that involve CPs and GPs in terms of their
close collaboration, effective communication is drivers, purpose, impact on stakeholders (CPs, GPs and
improved. Pharmacists reported improved positivity patients) and evaluation, and to explore the extent to
towards future inter-professional working. This study which existing models align with seven published con-
also identified barriers to collaboration which require ceptual models.
further exploration. This was a small-scale study, thus Methods: Full papers were included of primary empiri-
future studies evaluating GP and pharmacist collabora- cal research on collaborative working that involved CPs
tive working using larger sample sizes should be con- and GPs. Standard systematic review methods were
ducted. Study results should be utilised to inform future adopted2. Electronic databases were searched including:
studies to develop data collection tools exploring the Embase, MEDLINE, CINAHL Complete, Web of
stages of collaborative working of HCPs. Science Core Collection (on 14–15/03/2018; no restric-
tions were applied, e.g. language). Included studies’ ref-
erence lists were screened for additional references.
References Validated risk-of-bias tools were used where appropri-
ate; when that was not possible, risk of bias was pre-
1. World Health Organization. Framework for action sented using a narrative summary. Identified models
on inter-professional education & collaborative prac- were aligned to conceptual models with regard to model
tice. Geneva: World Health Organization. http:// characteristics (e.g. setting) and success determinants
apps.who.int/iris/bitstream/10665/70185/1/WHO_HRH_ (e.g. clear responsibilities for each collaborator
HPN_10.3_eng.pdf. Published 2010. Accessed on 20/09/ involved).
2019. Results: Following 19,036 database hits (up to 15/03/
2. Bradley, F., Ashcroft, D., Noyce, P. (2012). Integra- 2018), data limitation was applied for the period 01/01/
tion and differentiation: A conceptual model of gen- 2009 until 15/03/2018 generating 1,955 hits. In total, 43
eral practitioner and community pharmacist papers (37 studies) were included in a narrative synthesis
collaboration. Research in Social and Administrative (Figure 1). The included studies were quantitative (29/
Pharmacy. 8; 36–46. 43), qualitative (7/43) or mixed methods (7/43). Whilst
many studies investigated existing collaborations, many
involved the research teams in a key role as initiators/
A worldwide view of collaboration coordinators of the service (33/43). Included papers
models involving community mainly focused on evaluating collaborative services (29/
pharmacists and general practitioners: a 43) rather than specifically exploring a model’s charac-
systematic literature review teristics and how they influenced its performance (2/43
and 11/43, respectively). CPs’ effectiveness as team
members varied in terms of clinical, process and finan-
M. Liaskou1, A. Brandon-Jones2,
cial outcomes. The identified models were categorised
M.C. Watson3 and P.J. Rogers1 into five main groups. The most common factors of suc-
1
cessful models included the CP collecting patient infor-
Department of Pharmacy and Pharmacology, University of Bath,
Bath, UK 2School of Management, University of Bath, Bath, UK and
mation, discussion with healthcare professional(s) to
3
Institute of Pharmacy and Biomedical Sciences, University of produce a care plan/report (with/without patient
Strathclyde, Glagow, UK involvement), and patient follow-up by the CP/GP.

Figure 1. Adapted PRISMA flowchart2
Analysis of the identified models’ purpose, drivers, CPs’ Patient Safety

location, clarity on responsibilities and communication
reflected characteristics of the seven existing conceptual
models. Using patient-held information about
Conclusions: This review identified key features of CP- medicines to enhance patient safety: a
GP collaborations worldwide. A limitation of this mixed methods study
review was that despite standardised data extraction,
not all studies presented every element in each model, S. Garfield1,2, B. Jubraj3, D. Furniss4,
which was outlined in the research objectives (e.g. dri-
vers). Further research on current collaborative working M. Etkind1, F. Husson1, J. Norton1,5,
between CPs and GPs in primary care is required to M. Williams1, D. Ogunleye1 and
provide evidence-based recommendations for daily prac- B. Dean Franklin1,2
tice and policy on improving the flow of primary care
services through successful CP-GP collaborations, while 1
Imperial College Healthcare NHS Trust, London, UK 2University
maintaining pharmacy resources within the community. College London School of Pharmacy, London, UK 3Kings College
London, London, UK 4University College London, London, UK and
5
Imperial Patient Safety translational research Centre, London, UK
References
Introduction: Poor transfer of information about medici-
1 NHS, 2019. The NHS Long Term Plan. England. nes across healthcare settings has been identified as a
Available from: https://www.longtermplan.nhs.uk/ major cause of medication errors.1 Many patients who
wp-content/uploads/2019/01/nhs-long-term-plan.pdf take medication carry patient-held information about
[Accessed 13/02/2019] medicines (‘PHIMed’). However, it is not known how
2 Moher, D., Liberati, A., Tetzlaff, J., Altman, D. and PHIMed is used to improve patient safety, nor what its
Group, T.P., 2009. Preferred Reporting Items for Sys- key features are.
tematic Reviews and Meta-Analyses: The PRISMA Aim: To identify how PHIMed is used to support
Statement. PLoS Med, 6(7), p.e1000097. patient safety, key features that support this, and barri-
ers and facilitators to its use.
Patient Safety 35
Methods: We used a mixed-methods design comprising 2. Blandford A, Furniss D. DiCoT. A Methodology

two focus groups with patients and carers, 16 semi-struc- for Applying Distributed Cognition to the Design of
tured interviews with healthcare professionals, 60 semi- Teamworking Systems. Proceedings of the 12th
structured interviews with PHIMed users, a quantitative international conference on Interactive Systems
features analysis of PHIMed solutions available in the 2005;5:26–38.
UK, and usability testing of four PHIMed tools. We used
purposive sampling to recruit participants through our A qualitative exploration of the
personal and professional networks, a clinical research
network and support groups. We searched the literature, strengths and weaknesses of Jordan’s
app stores and data collected from participants to identify pharmacovigilance system
PHIMed solutions available in the UK. Findings were tri-
angulated using thematic analysis, with Distributed Cog- H. Garashi, D. Steinke and E. Schafheutle

nition for Teamwork (DiCoT) models2 used as sensitising
University of Manchester, Manchester, UK
concepts. Lay members of our advisory group con-
tributed to data analysis alongside researchers.
Results: We identified a wide range of mechanisms Introduction: Pharmacovigilance (PV) plays a vital role
through which PHIMed improved patient safety. These in ensuring medicines’ safety. Although PV is generally
included: creating connectivity between disjointed care well established in developed nations, it remains largely
settings, enhancing situation awareness (‘Hang on, I am underdeveloped in the Arab World. In an initiative to
on this as well. Is it ok to be on [them] together?’), unify PV practice across the Arab World, the ‘guideline
enabling patients to check they were being given the cor- on good PV practices (GPVP) for Arab countries’ was
rect medication, ease of communication during consulta- created by the League of Arab States’ Higher Technical
tions, acting as an aide-memoire for patients during Committee for Medicines1. Four years have since
appointments, empowering patients to understand more passed, yet little is known about how countries in the
about their own medicines, reminding the patient to region have implemented the guideline. A better under-
take their medicines, and reminders to reorder. Different standing of the strengths and weaknesses of the more
PHIMed tools met different needs. However, of 103 developed systems within the Arab World will improve
tools examined (61 digital, 42 paper-based), none met policy development and implementation in lesser devel-
the core needs of all users that had been identified from oped ones.
the data. A key barrier to PHIMed use was lack of Aim: As part of a wider programme to inform the
patient and carer awareness that healthcare information implementation of the GPVP for Arab countries in
systems can be fragmented, which meant that they had Arab countries with nascent pharmacovigilance systems;
not identified a need for PHIMed (‘I always assumed this study aimed to identify the main strengths and
the hospitals would know [what medicines I was tak- weaknesses of the PV system in Jordan, an Arab coun-
ing]’). PHIMed use was facilitated by encouragement try which has a well-established national PV centre
from healthcare professionals. (NPVC) as part of its drug regulatory authority.
Conclusions: This is the first in-depth study of a wide Methods: Semi-structured face-to-face interviews were
range of PHIMed solutions. We considered contextual conducted with individuals involved in the implemen-
factors relating to the use of PHIMed as well as the tools tation of the PV policy in the Jordan Food and
themselves. Other strengths of the study are our relatively Drug Administration (JFDA), regional PV centres,
large and varied sample for qualitative work, our mixed and pharmaceutical companies operating in the coun-
methods design and our strong patient and public try. Following JFDA and university ethics committee
involvement. The study was limited to one geographical approval, purposive and snowball sampling was used
area at one point in time. However, the main findings are to recruit eligible participants, who were emailed
likely to be relevant across settings. Our findings suggest study details via a gatekeeper at the JFDA. Inter-
that PHIMed can contribute to the reduction of medica- views were audio-recorded with written consent, tran-
tion-related risk. Interventions are needed to raise aware- scribed verbatim, and analysed using thematic
ness of the role of PHIMed in enhancing patient safety. framework analysis.
Such interventions should empower patients to identify a Results: Sixteen participants were interviewed: five from
method that suits them best from a range of options, the JFDA, two from regional PV centres, and nine from
avoiding a ‘one size fits all’ approach. pharmaceutical companies. The major perceived
strengths of Jordan’s PV system can be grouped into
three main themes: 1) the NPVC, (2) the country’s PV
References policy and guideline, and (3) other general factors. In
terms of the NPVC, this included its early establishment
1. Kwan JL, Lo L, Sampson M, Shojania KG. Medi- and membership in the WHO Programme for Interna-
cation reconciliation during transitions of care as a tional Drug Monitoring (PIDM). Regarding the coun-
patient safety strategy: a systematic review. Ann try’s PV policy, examples were its use of the Arab and
Intern Med 2013;158(5 Pt 2):397–403. EU GPVP guidelines as a basis, feasibility in terms of
implementation, and domestic focus. With respect to Based on the SI definition and extrapolation of patient
other general factors, these included the presence of harm data, approximately 110 medicines related SI
regional PV centres covering the entire country as well reports were anticipated that year. However, only three
as increasing awareness levels amongst reporters regard- medication-related SIs were reported during the year.
ing PV. The perceived weaknesses centred on five This under-reporting may be attributed to a poor under-
themes: (i) reporting-related issues, (ii) lack of resources, standing of the SI definition and lack of explicit guidance
(iii) NPVC deficiencies, (iv) regional PV centres’ issues, on medication incidents constituting a SI. This study
and (v) pharmaceutical companies-related issues. One aimed to develop a practitioner-led consensus definition
example of reporting-related issues was under-reporting. of a medicines related SI to inform policy and practice.
Lack of resources included both human and financial. Method: Consensus was determined through use of a
NPVC deficiencies included its lack of independence three-staged electronic-Delphi technique. An anonymous
from the JFDA, and its staff’s lack of continuous train- survey was distributed by e-mail to an international panel

ing. Examples of regional PV centres’ issues were lack of 107 practitioners (physicians, surgeons, pharmacists,
of interconnectivity and autonomy. Finally, with respect nurses and risk managers). Participants were asked to rate
to pharmaceutical company-related issues, these the extent to which they agreed with the general definition
included the absence of a dedicated PV department and of a SI and 30 clinical scenarios representing a medicine-
personnel. related SI. Clinical scenarios encompassed a range of
Conclusions: This study offers detailed insights into the medication incident types (e.g. prescribing, dispensing,
strengths and weaknesses of Jordan’s PV system, which preparation, administration and monitoring errors), dif-
will provide valuable insights for other Arab countries ferent medication, level of patient harm and preventabil-
with nascent PV systems to design or improve their PV ity. Participants were asked to rate agreement on a 5-
systems. Future work will involve exploring the point Likert scale from strongly disagree to strongly
strengths and weaknesses in two other Arab countries agree. Consensus was defined as 80% agreement.
with less well-developed PV systems than Jordan’s in Results: Responses were obtained from 22% (23/107),
order to compare and contrast the differences between 70% (16/23) and 69% (11/16) of respondents in each
the three countries. This will facilitate making recom- round respectively. Consensus was achieved for the cur-
mendations for the development of a more robust PV rent SI definition. The panel were in agreements that the
system in Arab World countries with nascent PV sys- SI definition should also include: adverse events with the
tems. potential to cause permanent harm or death; involve
deliberate harm; result in reproductive toxicity; involve
medicines subject to a Government patient safety alert/
Reference notice; are attributable to a medical device; result in over-
dose of a prescribed/unprescribed medication (regardless
1. League of Arab States. Guideline on good pharma- of the medication involved); administration to the incor-
covigilance practice (GVP) for Arab countries. rect patient; involve lack or inappropriate monitoring of
Cairo: League of Arab States; 2014. medication and the prescribing and/or administration of
a medication to which the patient has a known allergy.
Discussion: Despite the low response rate to the initial
Defining a medicines related serious survey, the general SI definition was considered applica-
incident – an E-Delphi study ble to medicines related SIs by international experts.
However, an expanded list of incident types that consti-
K.L. James1, C. Baillie2, A. Evans3 and tute a medicine-related SI was developed. It is proposed
A. Carson-Stevens2 that use of this revised and explicit definition of a medi-
cine-related SI would facilitate reporting and learning
1
Cardiff and Vale University Health Board, Cardiff, UK 2School of from medication incidents at an organisational and
Medicine, Cardiff University, Cardiff, UK and 3Welsh Government, national level, thereby safeguarding patient safety and
Cardiff, UK
ensuring excellence in clinical care. However, the appli-
cation of the definition in practice was not evaluated.
Introduction: Serious Incidents (SIs), are defined as Further work is needed to validate and test the defini-
adverse events which causes considerable harm to tion for user acceptability through application to real-
patients, families, carers and staff, include never events, life situations occurring in clinical practice.
and/or events that have a negative impact on the reputa-
tion and ability of an organisation to deliver effective and
quality healthcare service. Government requires a detailed Reference
investigation to be undertaken of all SIs occurring within
the National Health Service (NHS) and hold organisa- 1. Welsh Government. Data workbooks and explorer
tions accountable for implementing actions to address tool based on incidents reported to the National
identified concerns. Between 2017/18, approximately 2660 Reporting and Learning System (NRLS). (2018).
medication safety incidents were reported by NHS Wales https://www.gov.wales [accessed 23rd August 2018]
to the UK National Reporting and Learning System1.
Undergraduate Education 37
Adverse drug reactions in UK primary Conclusion: ADRs place a significant burden on UK

primary care and UK patients, with 3% of patients hav-
care consultations: a retrospective
ing ADR-related consultations, equivalent to approxi-
cohort study to evaluate impact on mately 1.57 million people per year. These patients
appointments and treatment subsequently have increased rates of treatment discon-
discontinuation tinuation and consultations in primary care, suggesting
that they may have poorer disease management or
S. Chapman1, K. Man2 and L. Wei2 unmet needs. This study has limitations including: 1)
many ADRs may not be discussed by patients with pri-
1
University of Bath, Bath, UK and 2University College London, London, mary care providers or recorded in the CPRD meaning
UK that these findings will not represent the full picture of
ADRs in UK primary care; 2) we only took a ‘snap-

Introduction: Adverse drug reactions (ADRs) are shot’ of follow-up consultations and discontinuation in
directly cause morbidity, hospitalization and mortality. 2015 and so it is likely that additional discontinuations
Patient concerns about ADRs are associated with treat- and consultations may have occurred, and 3) it is not
ment non-adherence and escalation and healthcare seek- possible to draw a causal link between ADR-related
ing, further increasing the burden of illness on patients. consultations and these outcomes. However, our results
Pharmacists have a key role in informing patients about highlight that there may be missed opportunities to
adverse effects and supporting them to make decisions reduce healthcare utilization, patient morbidity and
about treatment. No study has explored the overall bur- treatment discontinuation during ADR-related consulta-
den of ADRs in UK general practice. tions in UK primary care. It is not known whether the
Aim: To quantify the prevalence of ADR-related con- recent focus on practice-based pharmacists will address
sultations in UK primary care and impact on primary this need.
care appointments and treatment discontinuation.
Methods: We conducted a retrospective cohort study Undergraduate Education
using routinely collected data from UK primary care
practices participating in the Clinical Practice Research
Datalink (CPRD). As per CPRD procedures, Indepen- Does an early longitudinal community
dent Scientific Advisory Committee approval was sought practice placement for pharmacy
prior to accessing anonymised patient-level data Patients students promote learning by
prescribed at least one medication who discussed an
ADR in a consultation in 2014 were identified and they
establishing more opportunities for
were followed up until the end of 2015. We compared connection with patients, curriculum
their rates of subsequent consultations and treatment integration and professional
discontinuation in 2015 to those of matched controls engagement? A Mixed Methods Study
(by age, gender, practice and whether they had a GP
consultation within 3 months of the case’s ADR-related A. Kerr, T. Pawlikowska, F. Boland and
consultation) who had no ADR-related consultation
using zero-inflated Poisson regression. We calculated the J. Strawbridge
incidence rate ratios (IRR) and the 95% confidence
RCSI, Dublin, Ireland
intervals to compare consultation rates between the
ADR and control groups.
Results: In 2014, 96,865 patients, equivalent to 3% of Introduction: Longitudinal clinical placements are
all patients had at least one ADR-related consultation. defined as involving “a regular, recurrent placement in
Of these, 96,087 were matched to 190,977 controls (up the same setting with the same supervisor over a period
to 2 controls per case) who had no ADR-related consul- of time”. The underlying mechanism promoting learning
tation. Women were more likely to have an ADR- is “continuity” in its varying forms of patient, supervi-
related consultation than men (65% vs 35%). There was sor and longitudinal exposure. Longitudinal placements
a 33.1% increase in consultation rate for 2015 (IRR have been reported to promote learning by establishing
1.331, 95% CI 1.329 to 1.333) in the ADR group com- more opportunities for connection with patients
pared with the control group with a median number of (“continuity of care”), integrating knowledge, skills and
consultations per patient of 33 (interquartile range attitudes across science and practice (“continuity of cur-
(IQR), 19–52) in the ADR group and 20 (IQR, 11–34) riculum”) and enhancing supervision, role modelling
in the control group. Treatment discontinuation in 2015 and mentoring (“continuity of supervision”)1. The longi-
was higher in patients with an ADR-related consultation tudinal community pharmacy placement (LCPP) in the
in 2014, than patients without an ADR-related consulta- institution was designed for second year students to
tion. For example, 10.1% patients with an ADR-related attend the same community pharmacy site for a half
consultation in 2014 discontinued aspirin in the follow- day each week for 12 weeks.
ing year, whereas only 6.5% of controls did so.
Aim: This study sought to answer the question: Does an References

early longitudinal community practice placement for
pharmacy students promote learning by establishing
1. Thistlethwaite J, Bartle E, Chong A, Dick M, King
more opportunities for connection with patients, cur-
D, Mahoney S et al. A review of longitudinal com-
riculum integration and professional engagement?
munity and hospital placements in medical educa-
Methods: This was an explanatory mixed methods
tion: BEME Guide No. 26. Medical Teacher.
study. Data for the quantitative before and after study
2013;35(8):e1340–e1364.
were collected using a validated tool called the Student
2. Aronson B, Janke K. Measuring a state of mind
Pharmacist Inventory of Professional Engagement (S-
indicative of thriving using the Student Pharmacist
PIPE)2 and the questionnaire, also contained questions
Inventory of Professional Engagement (S-PIPE).
related to connection with patients and curriculum inte-
Research in Social and Administrative Pharmacy.
gration. Qualitative semi-structured interviews, focussed

2018;14(7):678–685.
on continuity of care, curriculum and supervision, with
students, supervisors and practice-educators were con-
ducted following the 12-week longitudinal placement. Pharmacy Longitudinal Clerkship (PLC):
The interviews focused on continuity of care, curriculum a pilot placement developing MPharm
and supervision and were thematically analysed. students’ clinical skills for patient-
Results: 78% (n = 47/60) students completed the ques-
tionnaire. Significant increases in the sum scores for pro- centred care through general practice
fessional engagement (S-PIPE) and sub-scores for integration in remote and rural settings
belonging, meaningful experience and connectedness
were recorded post-placement. Some increases were C. Innes1,2, G. Rushworth2, A. Brown1, B.
recorded relating to connection with patients. The Addison1, Y. Wedekind3, I. Rudd4,
majority of students agreed that the placement helped
them to contextualise and apply knowledge learned A. Power5 and S. Cunningham1
from modules. 13 students and 12 pharmacists were 1
Robert Gordon University, Aberdeen, UK 2HPERC, NHS Highland,
interviewed. Most participants described the placement Inverness, UK 3HMEC – NHS Highland, Inverness, UK 4NHS Highland,
supporting curriculum integration, considering the sug- Inverness, UK and 5NHS Education Scotland, Glasgow, UK
gested learning activities very useful to promote integra-
tion of module content and practice. Continuity of care Introduction: Research in older people in remote and
was not as widely discussed as some pharmacists had rural (R&R) areas shows a lack of access to pharmacy
seen this as more of an observational placements and services1 but pharmacists offer value in R&R General
students saying they did not get the chance to speak to Practices.2 Undergraduate R&R Longitudinal Integrated
patients. However, some pharmacists allowed their stu- Clerkships exist in medicine courses and a pilot R&R
dents to serve customers and practice patient coun- Pharmacy Longitudinal Clerkship (PLC) was supported
selling, which from a student lens was very useful, by the Scottish Government and NHS Education for
particularly when they built relationships with patients Scotland to enhance student clinical skills for patient-
they saw recurrently. Pharmacists and students felt that centred care (PCC) and help recruitment issues. Enhanc-
the longitudinal nature of the placement promoted ing PCC through experiential learning and clinical skills
building a professional working relationship over time. development supports a 5 Year integrated MPharm.
However, some pharmacists were not there on a number Aim: To identify, characterise and quantify the structures
of student placement days, limiting the opportunity to and processes for a PLC and explore the outcomes arising
build a relationship and students felt that days where including the views and experiences of all participants.
locums were working were less beneficial. Method: The 11-week PLC was based in GP practices in
Conclusions: The LCPP promotes professional engage- the NHS Highland Board area. Mixed methods were used
ment through role modelling, professional working rela- for data generation. Information on structures and pro-
tionships and repeated supervisor interactions. cesses was systematically gathered throughout the project.
Curriculum integration is promoted through learning The outcomes were explored through qualitative methods
activities, and the longitudinal nature of the placement using semi-structured interviews with participating stu-
allowed for opportunities to link to modules being stud- dents and GP tutors. Informed written consent was
ied at the same time and for linking to more modules. obtained from all participants. An interview schedule was
Patient-centred beliefs are promoted but issues including developed and piloted using the Theoretical Domains
not seeing interaction to completion and inconsistences Framework (TDF). Interviews were audio-recorded, tran-
in level of interaction with patients, depending on place- scribed verbatim and analysed using thematic analysis.
ment. Possible issues to be addressed include reviewing Results: Structures (resources) and processes required for
the 3 hours’ duration of the day and more guidance on a PLC were identified and included; overarching learning
the expected level of interaction with patients. outcomes, training timetable induction and support tuto-
rials, quantification of funding required for student travel
and accommodation and GP Practice contracts and
Undergraduate Education 39
payment, requirements for and cost of clinical equipment Introduction: New models for pharmacy practice aim to
‘Kit Bag’ for each student, robust processes for student increase pharmacy’s contribution to patient outcomes. If
recruitment, liaison and communication with GP prac- pharmacy graduates are to adopt the patient-focused,
tices, and student attendance monitoring and support. clinical-service practice orientation underpinning these
Interviews evaluating outcomes have been carried out models an understanding of how practice orientation is
with 2 students that completed the pilot PLC to-date and shaped during undergraduate education is needed. While
the 2 linked GP tutors. Emerging themes from students experiential learning exposes students to practice, in the
include; greater understanding of PCC and application of context of limited curriculum opportunities, in this
knowledge and skills: “I did use my knowledge quite a lot study, we investigate the extent to which practice experi-
and it does get you thinking ‘cause they’re real ence contributes to pharmacy students’ practice orienta-
patients”[SP1], “it’s totally different with a real life tion and career preferences.
patient”[SP2], increased confidence and optimism: “I feel Aim: To identify final year pharmacy students’ Profes-

like I’ve just become more and more confident”[SP1], “I do sional Practice Orientation (PPO), and the association
know that I can solve problems”[SP2], “I feel more pre- between this, practice experience, commitment to prac-
pared for what’s coming”[SP2] and excitement for being a tice and career preferences.
pharmacist: “excited to start pre-reg and actually be a Methods: Final year undergraduate pharmacy students
pharmacist” [SP1]. For GP tutors, themes included Issues/ from five MPharm programmes (n = 465) were invited
challenges/differences – supporting pharmacy v medical to complete a survey capturing number of placements
students, positive experiences and personal development, completed in hospital and community pharmacy dur-
concerns and need for enhanced ‘clinical’ preparation. ing each year of their MPharm, career preference,
Conclusion: The outcomes of this pilot, although limited commitment to practice, and Professional Practice Ori-
by number of participants and settings, were extremely entation (PPO). PPO was measured using an adapted
positive in terms of student and tutor experience and infor- validated tool assessing pharmacy service orientation1.
mation has been garnered on requirements for resources In our study PPO was operationalised via three
and processes for future development. As a result, funding dimensions: orientation (preference for clinical vs busi-
has been secured to extend it for five students to five GP ness career); focus (patient vs medicine career prefer-
practices each year for the next two years. Evaluation of ence) and future career pathway (alternative vs
outcomes will continue; further work will include longitu- traditional career preference). Variation in PPO, calcu-
dinal follow-up of students to determine the success of the lated as the mean of the three scales, was investigated
programme in enabling students to progress to advanced using t-tests and ANOVA; a lower PPO score indi-
level clinical practice in R&R settings. cated preference for a clinical rather than business
career, a focus on the patient compared with the med-
icine, and an alternative career pathway compared
References with a traditional one; correlation between PPO and
total number of MPharm practice placements was also
1. Rushworth GF, Cunningham S, Pfleger S, Hall J, investigated.
Stewart D. A cross-sectional survey of the access of Results: Three hundred and fifty-two students com-
older people in the Scottish Highlands to general pleted the survey (75.7% response rate). Most students
medical practices, community pharmacies and pre- (n = 351; 99.4%) had at least one placement in both
scription medicines. Research in Social and Adminis- community and hospital pharmacy organised by their
trative Pharmacy 2017; pii: S1551-7411 (16) 30400-4. programme and many also self-organised a placement
https://doi.org/10.1016/j.sapharm.2017.01.002. in hospital (n = 118) and community pharmacy
2. Stewart D, Anthony B, Morrison C, MacRae Y, (n = 240). Mean number of placements in community
Dixon L, Friel E, Yoong E, Cunningham S, and hospital pharmacy varied significantly between the
MacLure K. (2017) Evaluating pharmacist input into programmes (P < 0.001) (range 8–16 for both commu-
the pharmaceutical care of patients in dispensing nity and pharmacy placements). Mean PPO score was
medical practices in remote and rural areas of Scot- 12.36; no correlation with total community or phar-
land. Family Practice 2017;34(4):491–499. macy placements was found (P > 0.05), suggesting
placements had not influenced respondents’ practice
orientation. Students with a preference for a commu-
Pharmacy practice orientation: an nity pharmacy career scored significantly higher than
investigation of final year students’ those with a preference for hospital pharmacy, indicat-
career preferences ing a practice orientation towards business, focused
more on medicines than patients and following a tra-
S. Willis1, P. Harsha1, J. Barry2, ditional career pathway amongst this subgroup (mean
13.54 vs 10.95; P < 0.001); those strongly committed
V. Silkstone1 and S. Haughey2 to practising pharmacy scored significantly lower than
1
University of Manchester, Manchester, UK and 2Queens University, those whose commitment was weak (mean 11.93 vs.
Belfast, UK 13.37; P = 0.002).
Conclusion: While limited by the use of an adapted gave their consent by ticking a box on the front of the
tool for measuring pharmacy practice orientation and questionnaire. Questions explored frequency of access,
lack of data capturing duration or content of practice how and when podcasts were used and perceptions on
experience, findings provide some insight into final usefulness. A combination of closed questions to explore
year students’ career preferences and orientation podcast use, and 10-point rating scales and free text
towards future practice. Noticeably, while new models comments to capture student perceptions were used.
for practice are organised around a concept of the Data from completed questionnaires were entered onto
patient as the ‘social object’ of pharmacy, respondents Microsoft Excel; simple descriptive statistics were used
preferring a career in community pharmacy were more to analyse the numerical data and a thematic analysis
likely to have been orientated towards medicines and performed on comments provided.
on business priorities, despite policy-makers’ emphasis Results: There were 441 questionnaires completed (re-
on the need for this sector to increasingly provide sponse rate of 73%). Analysis of quantitative data

patient-centred, clinical services. revealed that the majority of students (249, 56.5%)
watched full podcasts on a single occasion with fewer
skipping to specific parts for a single clarification (74,
Reference 16.9%). Notably, reported podcast use was greater
across all year groups for modules assessed by examina-
1. Clark BE, Mount JK. Pharmacy service orientation: tion with access predominantly in the week following
a measure of organizational culture in pharmacy the lecture and before examinations. Analysis of respon-
practice sites. Research in Social and Administrative dent comments identified two themes around lecture
Pharmacy. 2006; 2(1). attendance and study habits; podcasts helped students
catch up on missed lectures and allowed them to revisit
difficult content. However, some comments revealed
An evaluation of pharmacy student use behaviours of concern to educators; the need to capture
and perceptions of lecture-capture lectures verbatim and justification to not attend lectures:
podcasting “.. allows you to write up everything the lecturer says
enabling you to never miss a single detail”. “I mostly
J. Silverthorne, J. Ouyang and Y.Y. Chow don’t come to lectures because I know that I can access it
via podcasts.”
University of Manchester, Manchester, UK Conclusion: This study achieved a good response rate
and provided further insight into the varied ways in
Introduction: Blended learning is used by pharmacy which undergraduates engage with podcasts. The study
schools in the UK, where didactic teaching is used was limited to one university and so findings may not
alongside novel methods such as simulation. As students be generalisable, and student responses were not
are frequently familiar with newer technology, many linked with assessment marks to explore effects on
universities have also implemented lecture-capture pod- performance. The study was further limited by a lack
casting (live video recording of slides with audio of lec- of subgroup analysis (e.g. mature students), due to
turer narrative) as a tool to supplement learning. insufficient respondents. There is still scant evidence
Emerging research suggests that it is popular1 and that on the educational advantages of podcasts and how
pharmacy students are well engaged2. A key advantage students should use them in order to improve assess-
of podcasts is that they can be accessed at any time and ment performance, which are important areas for
played multiple times. However, there is mixed opinion future research.
on whether podcasting decreases engagement with lec-
tures and its effect on academic performance. There is
therefore a need to better understand how students use References
podcasts and their perceptions of them.
Aim: To investigate how pharmacy undergraduates 1. Scutter S, Stupans I, Sawyer T, King, S. How do
engage with lecture capture podcasts to facilitate their students use podcasts to support learning? Aus-
learning and their perceptions of their usefulness. tralasian Journal of Educational Technology. 2010;
Methods: A questionnaire was distributed to all phar- 26(2):180–191.
macy undergraduates at a university in the north of 2. Pearce K, Scutter S. Podcasting of health sciences
England. An information sheet was emailed a week lectures: Benefits for students from a non-English
before, with the questionnaire distributed during com- speaking background. Australasian Journal of Edu-
pulsory classes over a one-week period. Participants cational Technology. 2010; 26(7):1028–1041.
Users’ and Caregivers’ Views 41
Users’ and Caregivers’ Views Conclusion: This is the first study to provide an insight
into caregivers’ experiences and perspectives of assess-
ment and management of pain in end-stage dementia. It
Caregivers’ perspectives of pain highlights the complexity and the difficulties encoun-
assessment and management in people tered by caregivers in achieving adequate pain assess-
with advanced and end-stage dementia: ment and management in this vulnerable patient
population. Further research into how expectations of
a qualitative analysis of an online caregivers can be met to ensure a comfortable, pain-free
discussion forum death is warranted. The strength of this study lies in the
analysis of posts from an online discussion forum, which
C. Parsons and K. Clarke represents a large data source. Talking Point users were
anonymous and the forum can be considered to be a

Queen’s University Belfast, Belfast, UK
large naturally occurring focus group; the risk of social
desirability bias was therefore minimized. Limitations
Introduction: Pain assessment and management in must be considered in interpreting the study findings;
advanced and end-stage dementia are challenging; in one website was analysed therefore generalizability or
these stages of dementia, people are often unable to transferability to a wider population cannot be assumed.
effectively communicate their pain, which increases the
risk of under-assessment and under-treatment of pain in
this vulnerable patient population1. Little is known Reference
about the experiences of informal caregivers (family
members, friends) of people with advanced and end- 1. De Witt Jansen B, Brazil K, Passmore P, Buchanan
stage dementia with regard to pain assessment and man- H, Maxwell D, McIlfatrick SJ, Morgan SM, Watson
agement. M, Parsons C. Evaluation of the impact of telemen-
Aim: The aim of this study was to investigate the expe- toring using ECHO© technology on healthcare pro-
riences of informal caregivers of people with advanced fessionals’ knowledge and self-efficacy in assessing
and end-stage dementia with respect to pain assessment and managing pain for people with advanced demen-
and management. Study objectives were to systemati- tia nearing the end of life. BMC Health Serv Res
cally search the discussion threads and posts of the 2018;18:228.
online Talking Point discussion forum, hosted by the
Alzheimer’s Society for anyone affected by dementia, to
explore the experiences of caregivers and family mem- A qualitative study exploring service
bers of people with advanced dementia in assessment users’ experiences of NHS patient
and management of pain nearing the end of life. medicines helpline services
Method: Qualitative analysis of archived discussion
threads and posts of the Talking Point online forum. M. Williams, A. Jordan, J. Scott and M. Jones
All threads between 2005 and January 2019 were
searched using combinations of the following search University of Bath, Bath, UK
terms: ‘pain’, ‘pain assessment’, ‘pain management’, ‘de-
mentia’, ‘advanced dementia’, ‘severe dementia’, ‘pain Introduction: Patient medicines helpline services (PMHS)
relief’, analgesia’, ‘end of life’, ‘morphine’, ‘fentanyl’, have been set up at some National Health Service
‘syringe driver’, ‘paracetamol’, ‘codeine’, ‘diamorphine’, (NHS) Trusts in the UK, with the aim of providing a
‘buprenorphine’, ‘patch’, ‘oxycodone’. Brand names medicines information service to recently discharged
were searched: ‘Oxynorm’, ‘Oxycontin’, ‘MST’, ‘Sevre- hospital patients and their carers. Seeking to understand
dol’, ‘Mezolar’, ‘Butec’, ‘Butrans’. Relevant threads were the experiences of service users may result in improved
analysed thematically. The School of Pharmacy Ethics healthcare services, and a recent systematic review high-
Committee granted ethical approval for the study and lighted that, to date, studies of PMHS have predomi-
the Alzheimer’s Society granted permission for use of nantly examined the views of service users using user
archived discussions from the Talking Point website. satisfaction surveys1. However, survey studies have limi-
Results: The search yielded 118 posts made by 79 users tations, such as not enabling participants to provide
within 53 threads, which spanned the full period of information that is important to them, nor allowing par-
forum activity. Seven key themes emerged from data ticipants to respond using their own words. Surveys are
analysis: (1) the importance of being comfortable, pain therefore not well suited to explore why and in what
free and dignified; (2) inadequate/inappropriate assess- ways services are useful, nor how they could be
ment and management of pain; (3) healthcare profes- improved. In order to achieve this, qualitative methods
sional/family fears over ‘strong’ pain relief; (4) fighting would be more appropriate.
or advocating for pain relief; (5) timely access to pain Aim: In order to explore the benefits and potential limi-
relief; (6) interactions/communication with healthcare tations of PMHS, and thus develop recommendations
professionals and other family members; and (7) emo- for service improvement, the following research question
tional burden and impact on caregivers.
was to be addressed: What are patients’ and carers’ Perceptions of migraine and experiences
experiences of using an NHS PMHS?
of its management: a qualitative study
Methods: Recruitment was conducted via seven NHS
Trusts in England (four acute Trusts, one mental health using theoretical framework analysis
Trust, one specialist Trust, and one community Trust).
Invitations to participate were sent from Trusts to help- R. Evans and D. James
line enquirers who agreed to receive study information.
Cardiff Metropolitan University, Cardiff, UK
Interested individuals contacted the research team to par-
ticipate. Study materials (interview schedule, study infor-
mation sheet) were reviewed by seven members of the Introduction: Migraines can have negative effects on
public (recent patients and carers) prior to their use. The many areas of a person’s quality of life, such as social,
interview schedule primarily focused upon the enquiry work and family life. The physical impact on the indi-

reason, perceived helpfulness of the service, perceived vidual can also result in negative feelings, such as
ways to improve the service, perceived impact of the use depression. Migraine sufferers develop different coping
of the service, and what would have been done had the strategies to manage their condition, which often include
PMHS not existed. Semi-structured interviews were con- both pharmacological and non-pharmacological treat-
ducted via telephone. Interviews were audio-recorded and ment. It is important that pharmacy professionals have
transcribed verbatim. Transcripts were imported to a good understanding of how patients make decisions
NVivo (version 12) and analysed using thematic analysis2. about what migraine treatments to take and when, in
Results: Forty service users participated in this study order to play an effective role in helping to manage their
(patients = 33%, carers = 18%; female = 58%, condition. A number of health psychology theories have
male = 42%; White or White British = 95%, predomi- been developed to understand human behaviour in
nantly having used a PMHS from an acute NHS Trust, response to illness, such as Leventhal’s Common Sense
95%). Two themes were generated from the analysis: – Self-Regulatory Model (CS-SRM)1.
Timeliness, and Best-placed to help. The findings illus- Aim: To explore individuals’ experiences and percep-
trate how PMHS provide support during the uncertain tions of migraines and their treatment.
transition of care period, when patients and carers often Methods: A qualitative methodology was adopted using
feel vulnerable because support is less available. Partici- one-to-one semi-structured interviews. An interview sched-
pants described how PMHS met their need for timely ule was designed based on the five components of the CS-
and easily accessible support and quick resolution of SRM1 applied to migraines to capture perceptions of iden-
their queries. However, there was recognition that tity, cause, time-line, cure-control and consequences. Other
PMHS could be improved by being available during open-ended questions related to experiences of migraines
evenings and weekends, and also by increasing their pro- and its management. Inclusion criteria were individuals
motion. PMHS were perceived as being best-placed to over 18 years whom had experienced at least one migraine
help to answer enquiries that arose from hospital care. in the last six months. Participants were recruited via snow-
Participants described feeling reassured from speaking ball-sampling, starting with an email invitation to individu-
to pharmacy professionals, and PMHS were perceived als known to the research team. Interviews were audio-
as the optimal service in terms of knowledge and exper- recorded, transcribed verbatim and theoretical framework
tise regarding questions about medicines. analysis was conducted, followed by thematic analysis for
Conclusions: This study highlights that PMHS are seen data that did not map onto the theory2.
as a valuable means of accessing timely medicines-related Results: Of the eleven participants interviewed, nine
support at a time when patients and carers may be feel- were females and ages ranged from 20 to 59 years. Nine
ing particularly vulnerable. However, PMHS could be were educated to degree level or above and five had a
improved by being available during evenings and week- background in healthcare disciplines. Four overarching
ends, and by increasing their promotion. We recommend themes emerged from the data. Three themes mapped
that providers of PMHS consider whether this is achiev- directly on to the CS-SRM. These were: 1) Emotional
able, in order to better meet the needs of service users. illness representations (two sub-themes a. Life-related
and b. Disease-specific); 2) Cognitive illness representa-
tions (five sub-themes a. Identity, b. Cause, c. Timeline,
References d. Control/cure and e. Consequences); 3) Behaviour
(two sub-themes a. Seeking advice and b. Medicine-tak-
ing). One further overarching theme emerged from the
1. Williams MJ, Jordan AL, Scott JA, Jones MD. A
remaining data, 4) Attitude towards migraine (two sub-
systematic review examining the effectiveness of
themes a. Treatment-related and b. Disease-related).
medicines information services for patients and the
Conclusion: Theoretical framework analysis was success-
general public. International Journal of Pharmacy
fully employed in this small-scale study, since participants’
Practice, 2019.
experiences and perceptions of migraines mapped on to all
2. Braun V, Clarke V. Successful Qualitative Research.
elements of the psychological theory utilised, the CS-SRM.
A Practical Guide for Beginners. London, UK: Sage
The findings highlighted a number of different treatment-
Publications Ltd; 2013.
related and disease-specific issues, which influenced the
Users’ and Caregivers’ Views 43
personal strategies adopted for managing migraines. Addi- group participants were recruited through Bloodwise Ambas-
tionally, the emotional aspect of the condition was a strong sadors, CML Support and support groups via Facebook.
feature of the interviews. These are all important consider- The questionnaire was developed using questions from the
ations when consulting with patients who experience National Cancer Patient Experience Survey (NCPES) and
migraines. The study had a number of limitations due to findings following a literature review, which also informed
the likelihood of sampling bias due to the method of the focus group and interview topic guides. Written consent
recruitment and small number of interviews. However, was received from patients before participation. The ques-
these data provide a good basis for the next quantitative tionnaire was reviewed by a non-participating CML patient
phase of the research, to design a questionnaire to capture and all participants completed a paper version as part of the
the perceptions and experiences of a larger sample of interview or focus group. Interviews and focus groups were
migraine sufferers from a more diverse population. audio-recorded and transcribed verbatim before undergoing
thematic analysis.

Results: For two focus groups, n = 8 and interviews
References
n = 5, Table 1 shows the common themes. All partici-
pants (n = 13) completed the questionnaire. Questions
1. Leventhal H, Meyer D & Nerenz D (1980). The relating to education on side effects scored lower than the
common sense representation of illness danger. In national average. However, the question about involve-
Medical Psychology, Edited by: Rachman S. 27–30. ment in decisions about care and treatment, the focus
New York, NY: Pergamon. group participants scored this at 86% and interview par-
2. Gale N, Heath G, Cameron E et al (2013). Using ticipants at 80% vs a national score of 77% in 2018.
the framework method for the analysis of qualitative
data in multi-disciplinary health research. BMC Table 1. Common Qualitative Themes
Medical Research Methodology, 13, 117. https://doi. Theme Participant Quote
org/10.1186/1471-2288-13-117.
Standards of “. . .they lost my blood five times. . ..”“the lab
Care should be certified, we need to be sure that
Web-based video consultations: are they they will send it within time”
acceptable to patients with Chronic Continuity of “I would say the web based consultation,
Myeloid Leukaemia (CML)? the team whatever it is, if it chopped around from
different people all the time it really wouldn’t
be a good idea. . .”
T.W.T. Ng Flexibility “I don’t think it has to be either or, I think
that’s of a hybrid, could probably work very
UCL School of Pharmacy, London, UK
well.”
NHS Context “I think a web based consultation would be
Introduction: In recent years there has been a rise in offer- perfectly acceptable, but only if the
ing web-based video consultations in the NHS and private efficiencies are generated. . .. . .”
healthcare. In 2015, the Independent Cancer Taskforce
recommended a review of “how digital technologies might Conclusion: The qualitative aspect of the study may
be used to drive improvements in patient experience”1 for have limited the number of participants however, it
example by minimising the need for some patients to tra- allowed for exploration in greater depth and themes to
vel to appointments. CML is a chronic cancer and some emerge to inform future studies on video consultation
patients are stable on long term treatment. Providing clin- acceptability. The results suggest certain factors relating
ical tests were undertaken locally to their home, a video to patient experience need to be considered before
consultation could save such patients travelling to a spe- launching such a service and acceptability varied
cialist centre. The VOCAL study2 is one of the few pub- depending on the management of these factors. How-
lished studies on video consultations with cancer patients, ever, most participants would be accepting of such a ser-
using Skype to support a NHS hepato-pancreato-biliary vice if the NHS benefitted.
cancer service. This paper identified a need to analyse the
acceptability of this type of service.
Aim: To explore whether it would be acceptable to References
CML patients at a NHS tertiary cancer centre to have
follow-up appointments using web-based video consulta-
tions and evaluate their experience. 1. Independent Cancer Taskforce Achieving world-class
Methods: A mixed methods study was undertaken using cancer outcomes: a strategy for England 2015–2020.
semi-structured interviews, focus groups and a questionnaire. Cancer Research UK; 2015
Interviews were conducted with CML patients from the can- 2. Greenhalgh T, et al. Virtual online consultations:
cer centre, and focus groups with patients recruited across the advantages and limitations (VOCAL) study. BMJ
UK with the aim of comparing views and experiences of Open. [online] 2016; 6; e009388. [Accessed 30th
patients across the wider CML population. Eligible interview March 2017]. Available: https://doi.org/10.1136/
participants were identified using purposeful sampling. Focus bmjopen-2015-009388

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4 International Journal of Pharmacy Practice 2020; Supplement S1

studies evaluating a DT-based intervention for surgical

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*Behaviour change technique achieved consensus to accept in the intervention at stage 1.

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2005 13743115 3293220 7865695 37662651

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Polypharmacy Transcripts were analysed by content analysis using a

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Introduction: The National Institute for Health and

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Table 1. Highest ranked statements for each of the prototypes tested

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References reported positive changes in their confidence and clinical

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collaboration with PBPs, 32.9% of respondents (n = 73)

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free-up GP time and improve patient safety2. How- References

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Analysis of the identified models’ purpose, drivers, CPs’ Patient Safety

Methods: We used a mixed-methods design comprising 2. Blandford A, Furniss D. DiCoT. A Methodology

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Adverse drug reactions in UK primary Conclusion: ADRs place a significant burden on UK

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Aim: This study sought to answer the question: Does an References

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