et al. Structured, intensive education maximising engagement, motivation and long-term change for children and young people with diabetes: a cluster randomised controlled trial with integral process and economic evaluation -the CASCADE study. Health Technol Assess 2014;18(20).Health Technology Assessment is indexed and abstracted in Index Medicus/MEDLINE, Excerpta Medica/EMBASE, Science Citation Index Expanded (SciSearch ® ) and Current Contents ® / Clinical Medicine. Health Technology AssessmentHTA/HTA TAR ISSN 1366-5278 (Print) ISSN 2046-4924 (Online) Five-year impact factor: 5.804Health Technology Assessment is indexed in MEDLINE, CINAHL, EMBASE, The Cochrane Library and the ISI Science Citation Index and is assessed for inclusion in the Database of Abstracts of Reviews of Effects.This journal is a member of and subscribes to the principles of the Committee on Publication Ethics (COPE) (www.publicationethics.org/).Editorial contact: nihredit@southampton.ac.ukThe full HTA archive is freely available to view online at www.journalslibrary.nihr.ac.uk/hta. Print-on-demand copies can be purchased from the report pages of the NIHR Journals Library website: www.journalslibrary.nihr.ac.uk Criteria for inclusion in the Health Technology Assessment journalReports are published in Health Technology Assessment (HTA) if (1) they have resulted from work for the HTA programme, and (2) they are of a sufficiently high scientific quality as assessed by the reviewers and editors.Reviews in Health Technology Assessment are termed 'systematic' when the account of the search appraisal and synthesis methods (to minimise biases and random errors) would, in theory, permit the replication of the review by others. HTA programmeThe HTA programme, part of the National Institute for Health Research (NIHR), was set up in 1993. It produces high-quality research information on the effectiveness, costs and broader impact of health technologies for those who use, manage and provide care in the NHS. 'Health technologies' are broadly defined as all interventions used to promote health, prevent and treat disease, and improve rehabilitation and long-term care.The journal is indexed in NHS Evidence via its abstracts included in MEDLINE and its Technology Assessment Reports inform National Institute for Health and Care Excellence (NICE) guidance. HTA research is also an important source of evidence for National Screening Committee (NSC) policy decisions.For more information about the HTA programme please visit the website: www.hta.ac.uk/ This reportThe research reported in this issue of the journal was funded by the HTA programme as project number 06/44/05. The contractual start date was in May 2008. The draft report began editorial review in January 2013 and was accepted for publication in June 2013. The authors have been wholly responsible for all data collection, analysis and interpretation, and for writing up their work. The HTA editors and publisher have tried to ensure the accuracy of the authors' report and would like to thank the reviewers...

The evidence-base regarding the quality of professional services from pharmacies in low and middle income countries is limited, but indicates that standards are often deficient. If pharmacists are to contribute effectively to health care, the barriers to the provision of higher quality care and ways in which these might be overcome must be identified and examined.

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ObjectivesMany family carers provide assistance with medicines that is vital for optimal clinical outcomes. Medicines-related tasks are known to contribute to carer burden and stress. This study examined the experiences of family carers when providing medicines-related assistance for a person with dementia, to indicate how services could become more responsive to the specific needs of this group of carers.MethodsSemi-structured interviews were undertaken with family carers and care-recipients identified though a memory clinic in north London and a local Alzheimer's Society. The interview guide, comprising open questions, was informed by previous studies and consultation with stakeholders. Qualitative procedures involving a framework approach were employed in the analysis.Key findingsFourteen interviews with carers and five with care-recipients were conducted. These highlighted the burden and challenges, surrounding medicines-management activities. As well as practical aspects that could be complex, carers were commonly making judgements about the need for and appropriateness of medicines. Although experiences were varied, carers reported difficulties in maintaining supplies, ensuring adherence to regimens and accessing health professionals; and they made some recommendations for service improvements. Carers’ difficulty in obtaining information and advice about medicines was compounded by their desire to allow the care-recipient to retain autonomy over their medicines as long as possible.ConclusionThis study highlights the distinct needs and problems with regard to medicines-management when caring for a person with dementia. As the prevalence of dementia rises, interventions designed to address these specific aspects of reduce carer-burden should be a priority for health professionals.

IntroductionType 1 diabetes (T1D) in children and adolescents is increasing worldwide with a particular increase in children <5 years. Fewer than 1 in 6 children and adolescents achieve recommended glycated hemoglobin (HbA1c) values.MethodsA pragmatic, cluster-randomized controlled trial assessed the efficacy of a clinic-based structured educational group incorporating psychological approaches to improve long-term glycemic control, quality of life and psychosocial functioning in children and adolescents with T1D. 28 pediatric diabetes services were randomized to deliver the intervention or standard care. 362 children (8–16 years) with HbA1c≥8.5% were recruited. Outcomes were HbA1c at 12 and 24 months, hypoglycemia, admissions, self-management skills, intervention compliance, emotional and behavioral adjustment, and quality of life. A process evaluation collected data from key stakeholder groups in order to evaluate the feasibility of delivering the intervention.Results298/362 patients (82.3%) provided HbA1c at 12 months and 284/362 (78.5%) at 24 months. The intervention did not improve HbA1c at 12 months (intervention effect 0.11, 95% CI −0.28 to 0.50, p=0.584), or 24 months (intervention effect 0.03, 95% CI −0.36 to 0.41, p=0.891). There were no significant changes in remaining outcomes. 96/180 (53%) families in the intervention arm attended at least 1 module. The number of modules attended did not affect outcome. Reasons for low uptake included difficulties organizing groups and work and school commitments. Those with highest HbA1cs were less likely to attend. Mean cost of the intervention was £683 per child.ConclusionsSignificant challenges in the delivery of a structured education intervention using psychological techniques to enhance engagement and behavior change delivered by diabetes nurses and dietitians in routine clinical practice were found. The intervention did not improve HbA1c in children and adolescents with poor control.Trial registration numberISRCTN52537669, results.

It is widely believed that pharmacists could make a greater contribution to the provision of primary health care, especially in developing countries. Particular strengths of pharmacy services commonly cited include their accessibility within many communities and the opportunities for advising on the management of health problems. The potential for pharmacy to respond to health care needs and contribute to specific health policy objectives is receiving greater prominence both internationally and in individual countries. However, despite this widely acknowledged potential, developments have been limited. Pharmacy is concerned with promoting the safe and appropriate use of drugs. Drug use in developing countries has frequently been described as irrational. It is influenced by a wide range of factors, including health and drugs policy, the organization and provision of health care, the availability of objective information, and health beliefs and cultural perspectives regarding health and drug therapy. The practices of pharmacy retailers, which are conducted in the context of wider structures and processes of health care provision, have also been questioned. The aim of this paper is to consider possible directions for community pharmacy service development in Ghana. The paper draws on the literature relating to health care, drug use and pharmacy in Ghana to describe the background against which pharmacy services operate. In the context of current directions in pharmacy practice and policy, potential opportunities and barriers regarding the development of services are then addressed.

Dementia is fast becoming a global concern due to a demographic shift towards an older population. Many studies have shown that caring for a family member or friend has a profound and negative impact on the physical, emotional and psychosocial aspects of the caregivers' life. One significant activity that a family caregiver undertakes is assistance with the management of medicines. This review was undertaken to ascertain what the issues are that affect optimal medicines use from the perspectives of people living with dementia and their caregivers, both in the community and care home settings. A literature search was conducted using electronic databases, employing a combination of search terms. A total of 16 studies met the inclusion criteria. Six broad themes were identified, together with some recommendations to improve medicines use in people with dementia. Challenges to medicines use centred on medicines management and administration, the impact on the caregiver and care recipient, their partnership and interface with formal care. Future research should focus on developing targeted interventions that can overcome these challenges to achieve optimal medicines use.

The UK Government has highlighted the need to develop appropriate information and support services for informal carers. Previous research that has investigated informal caring has found that managing medication is one aspect of the caring role that presents its own problems; however, these have not been subject to detailed examination. The objective of the present paper was to report the number and type of problems experienced by informal carers when managing medication for older care recipients, and to relate these to measures of coping and health. This was a cross-sectional survey undertaken in one district in each of four randomly selected health authority areas in England. Structured interviews, comprising closed and open questions, with 184 informal carers and 93 associated older care recipients were conducted in participants' own homes. Data were gathered on the number and type of medication-related problems experienced in relation to the informal caring role, and the impact of these from carers' perspectives in terms of coping and health. Sixty-seven per cent of carers reported problems with at least one medication-related activity. Problems were associated with all types of medication-related activities, and experienced by carers providing different levels of care for older people. Four themes were identified from carers' accounts which illustrated a diversity of practical problems and anxieties: maintaining continuous supplies of medication in the home; assisting with administration; making clinical judgements; and communicating with care recipients and health professionals. Carers reporting greater numbers of medication-related problems were more likely to experience higher levels of carer strain (P < 0.001) and poorer mental health status (P < 0.001). The findings of the present study provide insights to inform the development of primary care services to support informal carers in the management of medication for older people.