Background: Vulnerable patients from marginalized groups (e.g., people with disabilities, people experiencing homelessness, black and minority ethnic communities) experience higher rates of ill-health, inequitable access to healthcare and low engagement with screening services. Addressing these disparities and ensuring healthcare provision is impartial and fair is a priority for the United Kingdom (UK) healthcare system. Aim: Using Levesque’s access conceptual framework, this study explored the views of patients from marginalized groups, specifically on how access to pharmacy services could be improved and their experiences of receiving a medication review service. Method: Qualitative data were collected via semi-structured interviews on patient experiences of pharmacy services and how access to these could be improved (n = 10). Interviews of patients who had received a medication review from their pharmacist were also conducted (n = 10). Using an interpretivist approach, five ‘demand-side’ dimensions of Levesque’s access conceptual framework were explored (ability to perceive a need for medication support, their ability to seek this support, ability to reach the pharmacy, ability to pay and engage). Results: The findings exposed the medicine, health and social care challenges of vulnerable people and how these are often not being adequately managed or met. Using the access formwork, we unpack and demonstrate the significant challenges patients face accessing pharmacy support. Discussion: Pharmacy organizations need to pay attention to how patients perceive the need for pharmacy support and their ability to seek, reach and engage with this. Further training may be needed for community pharmacy staff to ensure services are made accessible, inclusive and culturally sensitive. Effective engagement strategies are needed to enable the provision of a flexible and adaptable service that delivers patient-centred care. Policy makers should seek to find ways to reconfigure services to ensure people from diverse backgrounds can access such services.
1 We have assessed the potential of several m-opioid receptor antagonists to elicit a response in the guinea-pig isolated ileum in the presence of, and following overnight exposure to, morphine. 2 Naloxone, D-Phe-Cys-Tyr-D-Trp-Orn-Thr-Pen-Thr-NH 2 (CTOP), (7)-5,9a-diethyl-2-(3-furylmethyl)-2'-hydroxy-6,7-benzomorphan (MR2266), but not D-Phe-Cys-Tyr-D-Trp-Arg-Thr-Pen-Thr-NH 2 (CTAP), produced a transient inhibition of electrically-evoked contractions of the guinea-pig ileum. The eect of 1 mM CTOP, but not that to MR2266, was inhibited by 1 mM somatostatin. 3 Naloxone (0.3 mM), CTOP (3 mM), CTAP (3 mM) and MR2266 (0.3 mM) antagonized the inhibitory eect of morphine on electrically-evoked contractions of the guinea-pig to a similar degree and, following 60 min exposure to morphine, produced non-sustained contractions. The response to 3 mM CTOP was signi®cantly smaller than that to 3 mM CTAP. None of the antagonists produced a response in the absence of morphine. 4 Following overnight exposure of the ileum to 0.3 mM morphine (48C), and repeated washing to remove the agonist, all four antagonists elicited non-sustained contractions. However, the responses to 3 mM CTOP and 0.3 mM MR2266 were signi®cantly smaller than those elicited by 0.3 mM naloxone and 3 mM CTAP. Somatostatin (1 mM) signi®cantly reduced naloxone-induced contractions, but not those to CTAP. 5 While all four m-opioid antagonists elicited contractions in the presence of, and following prolonged exposure to, morphine, dierences between them were noted which may be a consequence of non-opioid actions.
1 The a 2A and a 2D -adrenoceptor subtypes are thought to be species homologs most easily di erentiated on the basis of the potency of antagonists. In the present study we have compared the e ect of rilmenidine with two other selective a 2 -adrenoceptor agonists, UK-14304 (5-bromo-6-[2-imidazolin-2-ylamino]-quinoxaline) and clonidine, against electrically-evoked contractions in ®ve isolated preparations from the rat, guinea-pig and pig, and, where possible, determined the receptor subtype involved. 2 UK-14034, clonidine and rilmenidine produced concentration-dependent inhibition of the electricallyevoked contractions of the rat isolated vas deferens and tail artery and the guinea-pig ileum. These inhibitory e ects were reversed by the selective a 2 -adrenoceptor antagonist, RX-811058 (1 mM), except in the rat tail artery preparations where the remaining neurogenic response was inhibited; evidence for the involvement of`innervated' a 2 -adrenoceptors. Both clonidine and UK-14304 produced concentrationdependent inhibition of responses in the porcine isolated tail artery and urinary bladder but clonidine was markedly less e cacious in these preparations. In contrast, rilmenidine failed to inhibit the neurogenic contractions in either preparation. 3 Although rilmenidine failed to elicit a detectable response in either the porcine isolated tail artery or urinary bladder, it (10 mM and 30 mM, respectively) competitively antagonised the inhibitory e ects of UK-14304 with an estimated dissociation constant of (pK B ) 5.82 and 5.93, respectively. 4 Prazosin (1 mM) failed to alter the e ect of UK-14304 against neurogenic contractions in the porcine isolated urinary bladder, while rauwolscine (pK B 8.87) was 10 fold more potent than phentolamine (pK B 7.56). On the other hand, phentolamine (pK B 8.42) was only marginally more potent than rauwolscine (pK 8.05) against clonidine-induced inhibition of electrically-evoked contractions of the guinea-pig isolated ileum. This pharmacological evidence with antagonists supports the presence of a 2D -adrenoceptors in the rat and guinea-pig and the a 2A -adrenoceptors in the pig. 5 We have demonstrated that rilmenidine, unlike clonidine and UK-14304, is devoid of any agonist activity at prejunctional a 2A -adrenoceptors in the pig, but is an e cacious agonist at a 2D -adrenoceptors in the rat and guinea-pig.
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