BackgroundBisphosphonate-related osteonecrosis of the jaw (BRONJ) is a rare, yet significant, adverse effect of bisphosphonate therapy. A multidisciplinary approach to the prevention of BRONJ is recommended due to the significant morbidity and difficulty treating the condition. Current evidence suggests that both general practitioners (GPs) and community pharmacists have limited knowledge relating to BRONJ and that preventative strategies are rarely implemented.ObjectiveTo explore the attitudes and perceptions of GPs and community pharmacists on the risks and preventative strategies for the development of BRONJ.DesignInterpretivist methodological approach using qualitative semistructured interviews.Participants9 community pharmacists and 8 GPs.SettingPrimary Care in North East England and Cumbria, UK.MethodsUsing a Grounded Theory methodology and integrating a process of constant comparison in the iterative enrichment of data sets, semistructured interviews were undertaken, transcribed and analysed using framework analysis. Salient themes were identified and related back to extant literature in the field.ResultsFour salient and inter-related themes emerged: (1) uncertain knowledge, indicating limited exposure of respondents to BRONJ, and limited awareness of the implications of its diagnosis, risk factors and preventative strategies; (2) patient specific, referring to the complexity of patients, patient education and prioritising aspects of care; (3) wider context, indicating a lack of interdisciplinary communication and referral processes between professions, workload pressures, access and patient receptivity to dental services; and (4) professional, reflecting professional roles and responsibilities, authority and educational initiativesConclusionsEffective communication or collaborative care between GPs and community pharmacists for the prevention of BRONJ is not apparent. Interventions to mitigate against the risk of developing BRONJ and clarity of GP and community pharmacy roles are required.

ObjectiveTo explore the impact of medication-related osteonecrosis of the jaw (MRONJ) on quality of life and to explore the attitudes and perceptions of patients towards the multidisciplinary approach to the prevention of the condition.DesignInterpretivist methodology using qualitative semistructured interviews.SettingPrimary care general medical practices and secondary care dental services in England.Participants23 patients; 6 with MRONJ, 13 prescribed bisphosphonates, 4 with osteoporosis not currently prescribed any medication.ResultsPatients felt that MRONJ had a significant negative impact on their quality of life and had poor knowledge of the preventive strategies recommended in the literature. Patients demonstrated positive attitudes towards a multidisciplinary approach to care; however, they perceived prescribers as having the key role in articulating risk. Four salient and inter-related themes emerged from the interviews: (1) perception of knowledge, indicating limited awareness of the condition, risk factors and preventive strategies; (2) quality of life, indicating the lived experiences of patients and the physical, psychological and social impacts of MRONJ; (3) interprofessional management, indicating a perceived organisational hierarchy, professional roles and responsibilities, prioritising aspects of care, articulation of risk and communication and (4) wider context, indicating demands on National Health Service resources and barriers to dental care.ConclusionsMRONJ has a significant detrimental impact on quality of life, yet appropriate preventative education is not apparent. Effective interprofessional patient education and prevention to mitigate against the risk of developing MRONJ is required.

Objective This study aimed to explore patients' experiences of their involvement in the design and delivery of interprofessional education interventions focussing on mental ill‐health for students studying in undergraduate healthcare and healthcare‐related programmes. Design A qualitative methodology using a Grounded Theory approach was used to undertake an iterative series of focus groups with members of a university's Patient, Carer and Public Involvement (PCPI) Group who have a history of mental ill‐health and were involved in the development and delivery of educational interventions for students on undergraduate healthcare and healthcare‐related programmes. Their experiences of being involved in teaching and learning activities, collaboration with academic staff and integration into the academic faculty were explored. Constant comparative analysis facilitated the identification and prioritisation of salient themes. Results Five salient inter‐related themes emerged from the data: (1) reduced stigma and normalisation of experience of illness; (2) enhanced self‐worth; (3) improved well‐being; (4) community and connection; and (5) enduring benefits. Conclusions A supportive university community and a designated academic PCPI co‐ordinator facilitate a supportive environment for patients and carers to develop as educators, contribute to the training of future healthcare professionals and improve their own personal well‐being. Appropriately resourced and well‐supported initiatives to integrate patients, carers and the public into the functions of an academic faculty can result in tangible benefits to individuals and facilitate meaningful and enduring connections between the university and the wider community within which it is situated. Patient and Public Involvement Patients have been involved in the design of the teaching and learning initiatives that this study was primarily focused on. Patients were given autonomy in determining how their experiences should be incorporated into teaching and learning experiences.

Introduction Poor oral health is a significant public health concern, costing the NHS in England £3.4 billion annually. Community pharmacies are easily accessible, frequently visited by patients and the community pharmacy contractual framework requires pharmacies to provide healthy living advice to patients - therefore offering a little explored avenue for the delivery of oral health interventions.Methodology A pilot oral health promotion intervention was introduced in five pharmacies in deprived areas of County Durham between September and December 2016. A mixed methods approach to the evaluation was performed, utilising a patient evaluation questionnaire and semi-structured qualitative interviews with pharmacy staff.Results One thousand and eighty-nine participants received the intervention. Following the intervention 72% of participants perceived their knowledge of oral health as much better, 66% definitely intended to change their oral health habits and 64% definitely thought a pharmacy was the right place to receive advice about oral health. Three themes emerged from the qualitative data: (1) intervention feedback, (2) knowledge gap and (3) service development.Discussion The data demonstrated the acceptability of patients to a community pharmacy based oral health intervention, with most patients reporting intentions to change their oral healthcare habits after receiving the intervention. Previous literature has identified a willingness of pharmacy staff to become involved with oral health; this study provides evidence that patients are also receptive to such services being delivered in the community pharmacy setting. Further work is required to assess the benefits of a community pharmacy based oral health intervention and the potential for further growth of this role.Conclusion A community pharmacy is perceived by patients as an acceptable provider of oral health interventions and has the potential to provide positive changes to the oral health of the population.

ObjectiveTo explore the attitudes towards, and perceptions of, primary care healthcare staff and patients, regarding the role of clinical pharmacists in the provision of oral health advice and collaboration with dentists in general practice.DesignInterpretivist methodology using qualitative semi-structured interviews and focus groups.Participants22 participants; 10 pharmacists; 3 general practitioners; 2 nurses; 1 practice manager; 6 patients.SettingPrimary care general medical practices in the North East of England and the University of Sunderland Patient Carer and Public Involvement group.MethodsOne-to-one semi-structured interviews were performed with primary care healthcare staff. An iterative approach using constant comparative analysis facilitated the ongoing enrichment of data; salient themes were identified using Framework Analysis and related back to extant literature. A focus group was held with patients to further explore key themes.ResultsFour salient and inter-related themes emerged: enhanced clinical roles; indicating rapidly changing roles of pharmacists working in general practice, increased responsibility and accountability of pharmacist prescribers and the delivery of advanced clinical services; limited knowledge; indicating basic understanding of appropriate oral health advice, but limited insight and provision of advice to patients with regards to links with systemic diseases and medication; geographical/situational isolation of the dental team; indicating the disparate contexts and challenges of multidisciplinary working in oral health, and patients’ attitudes towards dental care; integration of oral health advice; indicating the potential of pharmacists to integrate oral health advice into current roles and to target specific patient groups in practice.ConclusionsThe lack of integration between oral and general healthcare services potentially impacts negatively on patient care, requiring further interprofessional oral health education. The developing role of the pharmacist in general practice represents an opportunity to integrate oral health advice and/or interventions into the management of patients in this setting.