ABSTRACT
Introduction: The two-year, NHS Education for Scotland (NES) post-registration foundation programme supports early career pharmacists in patient-facing sectors of practice. The experiential programme, based on an eight-element competency framework, also includes webinars, online resources, and tutor support. Learners complete an online evidence portfolio and undertake a summative OSCE. Aim: The aim of this paper is to report the experiences of the community-pharmacist participants, with a focus on the fitness-for-purpose' of the programme. Methods: This was a longitudinal mixed-methods study theoretically underpinned by Miller's triangle and social cognitive theory. Eligible participants were all pharmacists registering for the programme in Scotland in September 2017 and February 2018, all participating Welsh community-pharmacists, and all tutors. Invitation packs were emailed by NES/HEIW staff with names forwarded to researchers following signed consent. Focus groups/interviews (face-to-face or virtual according to participant preference) were undertaken at start, mid-point and exit of programme, to explore expectations (benefits, social gains, professional identify), experiences (challenges, facilitators, meeting of learners' needs) and barriers. Proceedings were digitally recorded, transcribed verbatim and managed using NVivo. Thematic analysis (1) was based on social cognitive theory (transferable behavioural skills and professional attitudes). An inductive analysis additionally identified emergent themes. Participants in Scotland were invited to complete an on-line base-line questionnaire to describe their self-assessed competence against the NES Foundation framework (personal and professional practice, membership of healthcare team, communication, patient centred approach to practice). Data was analysed in SPSS using descriptive statistics. Themes from qualitative and quantitative data were integrated. IRAS ethical approval was not required;NHS Research & Development approval was given. Results: 96 pharmacists registered for the programme: 18 community-pharmacists in Scotland (11 health boards);14 community pharmacists in Wales. In Scotland 15 community-pharmacists completed questionnaires: 9 expected an increase in confidence' and 11 to provide better patient care'. Self-assessed competence against the framework was generally high. Across Scotland and Wales, 12 focus-groups (involving 19 community-pharmacists), 12 community-pharmacist interviews, 10 tutor focus-groups (8 community-pharmacist tutors) and 3 community-pharmacist tutor interviews were conducted. At midpoint and exit pharmacists and tutors reported increased confidence, the ability to reflect and pride in their achievement. Barriers: included lack of protected time;workload;and lack of support (tutor and employer). There were also programme issues (practicalities of portfolio;workplace-based assessment, no access to medical records);and cultural issues in community-pharmacy (speed & safety';lack of recognition). Reasons for dropping out of the programme included: moved geographical area;too experienced;workload pressures;no incentive;no employer support. Four community-pharmacists in Scotland and none in Wales completed the programme. Conclusion: Study limitations include the small numbers, programme delivery limited to Scotland and Wales, and limited response rate to focus-groups/interviews, exacerbated by COVID19. Overall community pharmacist expectations were met, and they perceived the programme was fit-for-purpose and worthwhile. However, barriers particularly related to the community pharmacy context, may have led to the high drop-out rate. These findings should be considered as the new UK-wide RPS curriculum for foundation pharmacists (2) is implemented in Scotland, to optimise its successful delivery.
ABSTRACT
Keywords: Digital, PROMs, Transformation Purpose: Data-driven care, supported by digital technology, is endorsed by the NHS Long Term Plan (2019). Data collection and analysis being vital for evaluation of clinical services, quality improvement and optimal patient care. The COVID-19 pandemic provided an operational barrier to the collection of paper-based patient reported outcome measures (PROMs) at Guy's and St Thomas’ NHS Foundation Trust Integrated Musculoskeletal Physiotherapy department (GSTT iMSK). This accelerated the need for automated, digital systems of data collection. Aim: To implement an automated method of electronic PROM (ePROM) data collection, analysis and reporting. Objectives: • To identify the most suitable condition-specific and/or generic PROMs to employ in GSTT iMSK. • To understand stakeholder preferences regarding PROMs. • To identify a vendor to supply an automated solution for ePROM data collection, analysis and reporting. Methods: The Plan-Do-Study-Act (PDSA) iterative methodology was used with the following sequential steps undertaken: • PLAN: A narrative, scoping review was undertaken to identify the most suitable condition specific and/or generic musculoskeletal PROMs. • DO: Stakeholders (patients, GSTT iMSK and external physiotherapists) were identified and surveyed as to their preferences regarding the use of PROMs. Survey Monkey was used to collect physiotherapist data remotely. Patient data was supplemented with telephone surveys to account for potential selection bias. • STUDY: The review findings were compared against the stakeholder preferences with an aim to optimise completion rate. • ACT: Vendors were vetted against a pre-agreed criteria. Results: PROM suitability: The MSK-HQ was identified as the most suitable generic measure for an MSK service due to;ease of use, anatomical and condition generalisability, and simple scoring system. Stakeholder preferences: All stakeholders felt PROMs were important to deliver data-driven, optimized patient care. Clinicians felt time and method of completion were barriers to PROM use. Patients were prepared to spend 20 minutes completing PROMs if applicable to their pain and care and preferred ePROMs to paper forms. Vendor selection: Many vendors offered digital solutions to automate collection, analysis and reporting of PROMs. However, many were costly and outside the governance/procurement frameworks for GSTT. ‘DrDoctor’, a Trust partner, offered the best solution economically (the system could be built within a current contract at no additional cost) and met all requirements identified during analysis. Conclusion(s): Stakeholders are more likely to engage in PROMs if provided with a user-friendly platform that offers value to the care they will deliver or receive. The MSK-HQ shows excellent validity when used in isolation compared to pathology-specific PROMs and demonstrates that multiple measures are not necessary. Financial restrictions and a focus on value-based care within the NHS make it important to explore existing contracts for digital solutions at no additional cost. Future PDSA cycles will use this automated system via ‘DrDoctor’ to evaluate clinical services and optimise completion rate. Impact: GSTT iMSK is able to use automated systems to evaluate service quality at a population level and undertake regular auditing to ensure acceptable standards are being achieved. A culture of ongoing service evaluation can identify areas of future quality improvement and staff development, whilst redirecting saved administrative resource to different areas. Funding acknowledgements: Unfunded
ABSTRACT
While 'dobbing' is arguably viewed negatively, this behaviour has been on the rise during the COVID-19 pandemic. Drawing on examples from the First World War and the pandemic, this article argues that this increased activity is typical of the Australian community during emergencies, facilitated by extensive legal frameworks that encourage this type of reporting.
ABSTRACT
Background/Introduction: The clinical presentation and natural history of infection with the novel SARS-CoV-2 virus are relatively unknown, as are the risks associated with the infection and use of pharmaceutical agents. Objective/Aim: Adapt existing pharmacovigilance capabilities to ensure appropriate evaluation of the benefit-risk profiles of specific therapies during the ongoing pandemic. Methods: Bristol Myers Squibb (BMS) Epidemiology have created a tool to dynamically estimate background COVID-19 incidence rates by country, time-period, demographic categories, standards of care, and reporting practices. Local data were updated through the course of the pandemic with background rates re-estimated at regular intervals. Cases, severe cases, and deaths per 100,000 were rescaled to the age and geographic distribution of treated patients (in clinical programs or real-world use). Drug-specific Safety Management Teams used these background rates to identify potential COVID-19-related safety signals in investigational and marketed drugs. Real-world data sources were utilized to understand testing and treatment patterns. The BMS Clinical Safety Program (CSP), a systematic data collection capability, reduces reporting bias and further enhances our understanding of adverse events of interest through the development and implementation of event-specific, targeted case report forms (CRFs) within BMS interventional clinical trials. The COVID-19 CSP CRFs collect patient-level COVID-19 data (i.e., risk factors, diagnosis, clinical presentation, progression, treatment, and outcomes). Results: To date, we have not identified signals of increased risk related to COVID-19 infection that warrant additional action for any of our treatments. TriNetX COVID-19 Rapid Response Network data (February 2021) showed that among 250,000 patients with cancer, positivity rates were similar across immunotherapy (2.5%), chemotherapy (2.7%), and hormone therapy (2.5%). Explorys data showed a shift in median nivolumab treatment frequency from Q2W to Q3W among 1,114 patients with negative COVID-19 tests and to Q4W among 129 COVID-19-positive patients continuing treatment. Conclusion: Individual case level findings and background incidence rates are mutually informative;remarkable or unexpected insights from one may prompt further analysis and validation from the other. Leveraging these complementary pharmacovigilance capabilities in parallel continues to provide a flexible and innovative means to identify potential safety signals, both quantitatively (epidemiology) and qualitatively (CSP), as the conditions of the pandemic evolve. The latest CSP adaptation has included incorporation of CRF data points focused on COVID-19 vaccination and its impact. Once sufficient CSP data are available, analysis will help us understand the impact of COVID-19 infections on the efficacy and safety of our investigational therapies and allow comparisons to real-world data.