How do pharmacists in English general practices identify their impact? An exploratory qualitative study of measurement problems

Karampatakis, Georgios Dimitrios; Ryan, Kath; Patel, Nilesh; Lau, Wing Man; Stretch, Graham

doi:10.1186/s12913-018-3842-y

Cited by 12 publications

(16 citation statements)

References 35 publications

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“…With clarification of roles and responsibilities that integrate pharmacists within the primary care team, improved information that gives them access to patient notes, and improved communication systems that would come from co-location, it appears that pharmacists could contribute to more effective service delivery, quality and impact, increasing capacity and reducing workload for GPs. 170,171 Thus, potentially, MEMORABLE found some support for the developing role of practice-based pharmacists.…”

Section: Reviewing/reconciling Medications [See Chapter 3 Reviewing/mentioning

confidence: 99%

Medication management in older people: the MEMORABLE realist synthesis

Maidment

Lawson

Wong

et al. 2020

Health Serv Deliv Res

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Background The number and proportion of older people in the UK are increasing, as are multimorbidity (potentially reducing quality of life) and polypharmacy (increasing the risk of adverse drug events). Together, these complex factors are challenging for older people, informal carers, and health and care practitioners. Objectives MEMORABLE (MEdication Management in Older people: Realist Approaches Based on Literature and Evaluation) aimed to understand how medication management works and propose improvements. Design A realist approach informed three work packages, combining a realist review of secondary data with a realist evaluation of primary interview data, in a theory-driven, causal analysis. Setting The setting was in the community. Participants Older people, informal carers, and health and care practitioners. Interventions Studies relating to medication management and to reviewing and reconciling medications; and realist-informed interviews. Main outcome measures Not applicable. Data sources MEDLINE, CINAHL (Cumulative Index of Nursing and Allied Health Literature) and EMBASE were searched (all searched from January 2009 to July 2017; searched on 1 August 2017). Supplementary articles were identified by the Research Team. Data were also obtained through interviews. Review methods Searches of electronic databases were supplemented by citation-tracking for explanatory contributions, as well as accessing topic-relevant grey literature. Following RAMESES (Realist And Meta-narrative Evidence Syntheses: Evolving Standards) guidelines, articles were screened and iteratively analysed with interview data, to generate theory-informed (normalisation process theory) explanations. Results Developing a framework to explain medication management as a complex intervention across five stages: identifying problem (Stage 1), starting, changing or stopping medications (Stage 3) and continuing to take medications (Stage 4), where older people, sometimes with informal carers, make individual decisions and follow routines that fit medication management into their day-to-day lives, engendering a sense of control. In getting diagnosis and/or medications (Stage 2) and reviewing/reconciling medications (Stage 5), older people and practitioners share decision-making in time-limited contacts: involving four steps – sense-making, relationships, action and reflection/monitoring (normalisation process theory); and conceptualising burden – through a detailed analysis of Stage 5, generating a theoretical framework and identifying five burden types amendable to mitigation: ambiguity, concealment, unfamiliarity, fragmentation and exclusion. Proposing interventions: risk identification – a simple way of identifying older people and informal carers who are not coping, at risk and who need appropriate help and support; and individualised information – a short, personalised record and reference point, co-produced and shared by older people, informal carers and practitioners that addresses the experience of living with multimorbidities and polypharmacy. Limitations Few studies directly address the complexity of medication management as a process and how it works. Limitations included, having identified the overall complexity, the need to focus the analysis on reviewing/reconciling medications (Stage 5), the exclusion of non-English-language literature, the focus on non-institutionalised populations and the broad definition of older people. Conclusions MEMORABLE explored the complexity of medication management. It highlighted the way interpersonal stages in the medication management process, notably reviewing/reconciling medications, contribute to the mitigation of burdens that are often hidden. Future work Co-produced studies to scope and trial the two proposed interventions; studies to extend the detailed understanding of medication management, linked to burden mitigation; and a study to clarify the medication management outcomes wanted by older people, informal carers and practitioners. Study registration This study is registered as PROSPERO CRD42016043506. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 26. See the NIHR Journals Library website for further project information.

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Section: Reviewing/reconciling Medications [See Chapter 3 Reviewing/mentioning

confidence: 99%

Medication management in older people: the MEMORABLE realist synthesis

Maidment

Lawson

Wong

et al. 2020

Health Serv Deliv Res

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“…The Exeter study noted the potential of a formal, standardised qualification in primary care pharmacy . A small qualitative study in London noted the importance of measuring impact of this new role in pharmacy . However, the Scottish model based on this evaluation and presented below, of a specific competency framework, supported by an IP qualification is an alternative.…”

Section: Discussionmentioning

confidence: 99%

“…[13] A small qualitative study in London noted the importance of measuring impact of this new role in pharmacy. [15] However, the Scottish model based on this evaluation and presented below, of a specific competency framework, supported by an IP qualification is an alternative. In England, all pharmacists have an educational supervisor and a key component of this role was confidence building.…”

Section: Supporting Developing Practicementioning

confidence: 99%

Development of an education and support framework for pharmacists working in GP practice

Matheson¹,

Reid

Stewart

et al. 2020

International Journal of Pharmacy Practice

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Objectives To evaluate the educational support provided for three cohorts of pharmacists to inform an educational support framework for this new career path. Methods This study evaluated training using mixed methods and measured the development of competence and confidence in the professional role as a pharmacist in GP Practice. Data were collected via pro formas before training events, and evaluation questionnaires immediately after events. Qualitative and quantitative content analysis was applied. The outcome evaluation collected data via a repeated measure of self‐assessed competency and confidence via an online questionnaire at three time points. Logistic regression identified predictors of competency and confidence at the end of structured training. Key findings Evaluation of training events was very positive. The theme of clinical and consultation skills was the most professionally satisfying, followed by teamwork and support. However, early work in practice was focussed on management and systems. There were significant improvements in competence and confidence over time. Independent predictors of increased competence in the role in GP Practice were having an Independent prescriber (IP) qualification or undertaking the IP course and having had additional health board training and support. Conclusions Formal training was well received. Early local support from health boards and GP Practices would enable pharmacists to get an earlier grasp of tasks relating to ‘management and systems’ so they could focus on more rewarding clinical tasks. Being an independent prescriber (or working towards this) is essential for the development of competence in this role. An educational support framework model is proposed.

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“…Face-to-face focus groups were then conducted with general practice-based pharmacists (from two West London sites) in which participants were asked to discuss which codes on the list might be useful and suggest any other pharmacists’ activities worth considering as coding options. These focus group discussions were audio-recorded, transcribed verbatim and analysed thematically (for detail, see reference [23]). A further 12 codes were generated from the focus group discussions.…”

Section: Methodsmentioning

confidence: 99%

“…Although the evaluation looked at pharmacists’ perceptions about their roles, it made no quantitative measures of their activities. Moreover, a UK qualitative study revealed that the current coding options are not tailored to pharmacists’ work (available coding having pre-dated the ‘pharmacists in general practice’ scheme) and concluded that they are not fit for purpose to effectively identify the spectrum of pharmacists’ tasks within the general practice environment [23]. The purpose, therefore, of this study was to reach a broad consensus amongst experts on what general practice-based pharmacists’ activities should be recorded on the general practice clinical computer systems.…”

Section: Introductionmentioning

confidence: 99%

Capturing pharmacists’ impact in general practice: an e-Delphi study to attempt to reach consensus amongst experts about what activities to record

et al. 2019

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Background In the UK, there is ongoing integration of pharmacists into general practice as a new healthcare service in primary care. Evaluation of the service involves national measures that require pharmacists to record their work, on the general practice clinical computer systems, using electronic activity codes. No national agreement, however, has been established on what activities to record. The purpose of this study was to attempt to reach consensus on what activities general practice-based pharmacists should record. Methods The e-Delphi method was chosen as it is an excellent technique for achieving consensus. The study began with an initial stage in which screening of a general practice clinical computer system and discussion groups with pharmacists from two ‘pharmacists in general practice’ sites identified 81 codes potentially relevant to general practice-based pharmacists’ work. Twenty-nine experts (pharmacists and pharmacy technicians from the two sites along with experts recruited through national committees) were then invited by e-mail to participate as a panel in three e-Delphi questionnaire rounds. In each round, panellists were asked to grade or rank codes and justify their choices. In every round, panellists were provided with anonymised feedback from the previous round which included their individual choices along with their co-panellists’ views. Final consensus (in Round 3) was defined as at least 80% agreement. Commentaries on the codes from all e-Delphi rounds were pooled together and analysed thematically. Results Twenty-one individual panellists took part in the study (there were 12 responses in Round 1, 18 in Round 2 and 16 in Round 3). Commentaries on the codes included three themes: challenges and facilitators; level of detail; and activities related to funding. Consensus was achieved for ten codes, eight of which related to activities (general and disease specific medication reviews, monitoring of high-risk drugs and medicines reconciliation) and two to patient outcomes (presence of side effects and satisfactory understanding of medication). Conclusions A formal consensus method revealed general practice-based pharmacists’ preferences for activity coding. Findings will inform policy so that any future shaping of activity coding for general practice-based pharmacists takes account of pharmacists’ actual needs and preferences.

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How do pharmacists in English general practices identify their impact? An exploratory qualitative study of measurement problems

Cited by 12 publications

References 35 publications

Medication management in older people: the MEMORABLE realist synthesis

Medication management in older people: the MEMORABLE realist synthesis

Development of an education and support framework for pharmacists working in GP practice

Capturing pharmacists’ impact in general practice: an e-Delphi study to attempt to reach consensus amongst experts about what activities to record

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