Introduction Increased mortality has been demonstrated in older adults with COVID-19, but the effect of frailty has been unclear. Methods This multi-centre cohort study involved patients aged 18 years and older hospitalised with COVID-19, using routinely collected data. We used Cox regression analysis to assess the impact of age, frailty, and delirium on the risk of inpatient mortality, adjusting for sex, illness severity, inflammation, and co-morbidities. We used ordinal logistic regression analysis to assess the impact of age, Clinical Frailty Scale (CFS), and delirium on risk of increased care requirements on discharge, adjusting for the same variables. Results Data from 5,711 patients from 55 hospitals in 12 countries were included (median age 74, IQR 54–83; 55.2% male). The risk of death increased independently with increasing age (>80 vs 18–49: HR 3.57, CI 2.54–5.02), frailty (CFS 8 vs 1–3: HR 3.03, CI 2.29–4.00) inflammation, renal disease, cardiovascular disease, and cancer, but not delirium. Age, frailty (CFS 7 vs 1–3: OR 7.00, CI 5.27–9.32), delirium, dementia, and mental health diagnoses were all associated with increased risk of higher care needs on discharge. The likelihood of adverse outcomes increased across all grades of CFS from 4 to 9. Conclusions Age and frailty are independently associated with adverse outcomes in COVID-19. Risk of increased care needs was also increased in survivors of COVID-19 with frailty or older age.

Background: With an aging population, the appropriate, effective and safe use of medicines is a global health priority. However, “‘medically under-served” patients continue to experience significant inequalities around access to healthcare services. Aim: This study forms part of a wider project to co-develop and evaluate a digital educational intervention for community pharmacy. The aim of this paper is to explore the medicine needs of patients from marginalized communities and suggest practical way on how services could be better tailored to their requirements. Method: Following ethical approval, qualitative data was gathered from: (1) workshops with patients and professionals (n = 57 attendees); and (2) qualitative semi-structured interviews (10 patients and 10 pharmacists). Results: Our findings revealed that patients from marginalized communities reported poor management of their medical conditions and significant problems with adherence to prescribed medicines. Their experience of pharmacy services was found to be variable with many experiencing discrimination or disadvantage as a result of their status. Discussion: This study highlights the plight of medically under-served communities and the need for policy makers to tailor services to an individual’s needs and circumstances. Furthermore, patients and professionals can work in collaboration using a co-production approach to develop educational interventions for pharmacy service improvements.

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.

BackgroundAs global life expectancy increases, older people with chronic diseases are being required to manage multiple and complex medicine regimes. However, polypharmacy raises the risk of medicine-related problems and preventable hospital admissions. To improve medicine use, English community pharmacies are commissioned to deliver Medicines Use Reviews (MURs), which are typically delivered from the pharmacy. People who are homebound rarely receive the service. This paper describes the uptake and impact of a pilot project that seeks to provide domiciliary Medicines Use Reviews (dMURs).MethodsParticipating pharmacists collected data on their dMUR activity over a 12-month period. Outcome measures (eg, adherence, side-effects, pharmacist assessment of preventable hospital admissions) were recorded. Pharmacists were also invited to submit written testimonies of their experiences of undertaking dMURs.ResultsOut of 433 possible pharmacies eligible to take part in the pilot, 186 pharmacies expressed an interest, and 91 actively engaged in providing the dMUR service. The total number of dMURs performed were 1092 (mean number performed by each pharmacy was 12). Two thirds of patients reported problems and concerns about side-effects and missed doses regarding their medicines. Pharmacists’ assessment to prevent hospital admissions found that over one-third of the dMURs had contributed towards preventing either a possible or likely emergency hospital admission. Twelve pharmacists’ testimonies were submitted providing context of the problems patients faced with medicines.DiscussiondMURs are feasible and improve patient medicines use. The results indicate that dMUR potentially prevents hospital admissions and readmissions. dMURs offer an opportunity to support the self-care agenda and ensure homebound patients can successfully manage their medicines.

Further to plans to make England ‘smoke-free’ by 2030, a new English community pharmacy smoking cessation service was launched in March 2022. The service includes offering people admitted to hospital an opportunity to enrol on a smoking cessation service that allows care to be maintained through their community pharmacy upon discharge. There is a high expectation for this service, which is expected to increase 1-year quit rates by 11% and in its first year, save the UK NHS £85 million in healthcare resources. The service also offers opportunities for pharmacists to assume a greater role in managing the long-term care of smokers. However, as with any new service, without careful monitoring of the implementation, there may be unforeseen and unintended consequences for what are otherwise well-intentioned actions. For instance, despite existing smoking cessation services being effective, historically there has always been poor smoker uptake, particularly people from less affluent backgrounds and from marginalised groups. Questions also arise about service adoption and implementation and how the risks associated with transitions between care providers will be managed. This timely commentary explores and examines these issues. Specifically, we add to the debate by focusing on the extent to which the new service caters or enables people from disadvantaged groups to participate fully. The challenges of adoption and implementation in pharmacies are discussed as well as the strategies to overcome foreseeable problems that might arise during transitions of care.