Background Pharmacist services in general practice are expanding worldwide, with evidence to show pharmacists’ presence in general practice has financial, workload, and clinical benefits. Yet, little is known globally about general practitioners’ (GPs’) views on their presence in general practice. Objective To synthesize the qualitative research evidence on GPs’ views of pharmacist services in general practice. Methods Qualitative evidence synthesis; 8 electronic databases were searched from inception to April 2021 for qualitative studies that reported the views of GPs regarding pharmacist services in general practice. Data from included studies were analyzed using thematic synthesis. The Confidence in the Evidence from Reviews of Qualitative research (CERQual) approach was used to assess the confidence in individual review findings. Results Nineteen studies were included, which captured the views of 159 GPs from 8 different countries. Four analytical themes describing the factors that should be considered in the development or optimization of pharmacist services in general practice, based on the views of GPs, were developed from the coded data and descriptive themes: (i) optimal environment for a pharmacist, (ii) the ideal pharmacist characteristics, (iii) complex stakeholder relationships, and (iv) benefits of an effective pharmacist. Conclusion Based on the synthesis of GPs’ views, we have created a conceptual model of factors that should be considered by policymakers, GPs, pharmacists, and other relevant stakeholders when developing or optimizing pharmacist services in general practice going forward.
Introduction older adults are at risk of adverse outcomes due to a high prevalence of polypharmacy and potentially inappropriate medications (PIMs). Deprescribing interventions have been demonstrated to reduce polypharmacy and PIMs. However, deprescribing is not performed routinely in long-term care facilities (LTCFs). This qualitative evidence synthesis aims to identify the factors which limit and enable health care workers’ (HCWs) engagement with deprescribing in LTCFs. Methods the ‘best-fit’ framework approach was used to synthesise evidence by using the Theoretical Domains Framework (TDF) as the a priori framework. Included studies were analysed qualitatively to identify LTCF barriers and enablers of deprescribing and were mapped to the TDF. Constructs within domains were refined to best represent the LTCF context. A conceptual model was created, hypothesising relationships between barriers and enablers. Results of 655 records identified, 14 met the inclusion criteria. The ‘best-fit’ framework included 17 barriers and 16 enablers, which mapped to 11 of the 14 TDF domains. Deprescribing barriers included perceptions of an ‘established hierarchy’ within LTCFs, negatively affecting communication and insufficient resources which limited HCWs’ engagement with deprescribing. Enablers included tailored deprescribing guidelines, interprofessional support and working with a patient focus, allowing the patients’ condition to influence decisions. Discussion this study identified that education, interprofessional support and collaboration can facilitate deprescribing. To overcome deprescribing barriers, change is required to a patient-centred model and HCWs need to be equipped with necessary resources and adequate reimbursement. The LTCF organisational structure must support deprescribing, with communication between health care systems.
We develop an improved bound for the chromatic number of graphs of maximum degree ∆ under the assumption that the number of edges spanning any neighbourhood is at most (1 − σ ) ∆ 2 for some fixed 0 < σ < 1. The leading term in the reduction of colours achieved through this bound is best possible as σ → 0. As two consequences, we advance the state of the art in two longstanding and well-studied graph colouring conjectures, the Erdős-Nešetřil conjecture and Reed's conjecture. We prove that the strong chromatic index is at most 1.772∆ 2 for any graph G with sufficiently large maximum degree ∆. We prove that the chromatic number is at most 0.881(∆ + 1) + 0.119ω for any graph G with clique number ω and sufficiently large maximum degree ∆. Additionally, we show how our methods can be adapted under the additional assumption that the codegree is at most (1 − σ )∆, and establish what may be considered first progress towards a conjecture of Vu.
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