ABSTRACT
Introduction: There was an increase in antipsychotic prescribing for people with dementia during the COVID-19 pandemic (1). To explain this increase, the current study was conducted to explore the views of staff working in care homes for the elderly during the pandemic on the use of antipsychotics for residents with Behavioural and Psychological Symptoms of Dementia (BPSD). Aim(s): The aim was to explore the use of antipsychotics for people with BPSD during the COVID-19 pandemic by interviewing staff in care homes about their experiences during that time. Method(s): Semi-structured interviews were conducted online with staff working in ten UK elderly care settings using convenience sampling. Participants mainly onsite care home staff were recruited through online networks, for example, Twitter, and support groups such as CHAIN and NIHR clinical research network. Interviews were conducted between May 2021-March 2022, were audio recorded, transcribed verbatim, and analysed inductively using thematic analysis in NVivo version 12. Result(s): Ten interviews were completed with managers (n=2), care staff (n=6) and nurses (n=2) in nursing homes (n=7) and residential homes (n=3) (all were female). The first theme 'Challenges experienced in care provision' entails challenges experienced in the care environment;residents were confined to their rooms, activities were suspended, staff were absent and stressed, and family visits were barred. The reduced human contact affected residents' sense of self, mental and physical wellbeing, and in turn, their behaviours. The second theme 'Prescribing process' refers to doctors prescribing medicines in response to staff raising concerns. The third theme 'Attitude toward antipsychotics' denotes participants' positive and negative beliefs about antipsychotics. The positive beliefs included antipsychotics being the right choice and beneficial, an increased need and continued use of antipsychotics, use of a combination of medications and weighing the risks and benefits of antipsychotics. The negative beliefs included reports of adverse effects and short-term benefits of antipsychotics, antipsychotics not always beneficial, benefits in deprescribing, dislike for antipsychotics and belief antipsychotics are the last resort. Some expressed the need for antipsychotics had not increased but been driven by health professionals involved. The fourth theme 'Other psychotropic medication' alluded to other commonly used psychotropic medications and associated risks and benefits. The fifth theme 'Measures implemented within care settings' represented strategies implemented to avert the initiation or bolster antipsychotic deprescribing such as non-pharmacological approaches, nurses' assessment of residents before requesting antipsychotics, multidisciplinary consultation, and medication review. Conclusion(s): This is the first study that reports care home staff views on antipsychotic use for residents with dementia during the pandemic. The limitations include that only views of female respondents were obtained and the limited sample size. Care homes faced enormous challenges in the provision of care services to residents with dementia during the pandemic. The multitude of difficulties experienced in care homes due to lack of preparedness may have influenced staff to have positive views of antipsychotics and their use as an option during the pandemic. It's important to acknowledge and address these difficulties for example through education and training interventions to help with future preparedness.
ABSTRACT
Introduction: Many people in the United Kingdom (UK) are turning to the internet to obtain prescription medicines. This introduces a significant public health risk and patient safety concerns, for example because the internet is a source of fake medicines. According to an estimate by the UK government, 1 in 10 people in the UK bought a fake medical product online in 2021 (1). To help address this problem, it is important to understand why people buy prescription medicines online in the first place. Aim(s): This qualitative study aimed to identify why people in the UK purchase medicines online, including their perceptions of risks posed by the availability of fake medicines online. The focus was on prescription-only medicines (POMs). Method(s): Semi-structured interviews were conducted with adults based in the UK who had previously purchased medicines online. Purposive sampling was adopted to achieve diversity regarding participants' experiences and demography. The interviews were conducted online using Microsoft Teams. The recruitment process started in April- 2021 and ended in May-2022. The recruitment was continued until no new codes were identified (data saturation was reached). Interview transcripts were analysed using thematic analysis with the Theory of Planned Behaviour (TPB) acting as a framework to develop the coding of themes (2). Result(s): Twenty participants (12 female, 8 male) were interviewed. Participant age groups were 18-29 (n = 4), 30-39 (n = 4), 40-49 (n = 5), 50-59 (n=4), and >=70 (n = 3). Participants had bought various types of POMs (e.g., antibiotics, and high-risk controlled medicines). Participants demonstrated awareness of the presence of fake medicines online, and they understood risks associated with them. The factors that influenced participants to buy medicines online were grouped into themes including advantages (Avoiding long waiting times;Bypassing gatekeepers;Medicines availability;Lower costs;Convenient process;Privacy) and disadvantages (Medicines safety concerns;Medicines quality concerns;Higher costs;Online payment risks;Lack of accountability;Engage in an illegal behaviour) of purchasing medicines online, the social influencing factors (Interactions with healthcare providers;Other consumers' reviews and experiences;Words of mouth by friends;Influencers' endorsement), the barriers (General barriers;Website specific barriers) and facilitators (Facilitators offered by the illegal sellers of medicines;Facilitators offered by various internet platforms;COVID-19 outbreak as facilitating condition;Consumer personability) of the purchase as well as factors that lead consumers to trust (Website features;Product appearance;Positive previous purchase experience) the online sellers of medicines. Conclusion(s): The in-depth insight into what could drive people in the UK to buy medicines online could enable the development of effective and evidence-based public awareness campaigns that warn consumers about the risks of buying fake medicines from online sources. The findings could also help researchers to design other interventions to prevent people from buying POMs online. A limitation of this study is that although the interviews were in-depth and data saturation was reached, the findings may not be generalisable as this was a qualitative study. However, the TPB which informed the analysis has well-established guidelines to develop a questionnaire, for a future quantitative study.