ABSTRACT
Introduction: The COVID-19 pandemic has disproportionately affected people with dementia, especially those in care homes (1). The pandemic may have exacerbated existing medication challenges that care home residents with dementia may experience, such as issues with adherence and administration. Aim(s): To explore the views experiences of care home managers in Northern Ireland (NI) about optimising medicines use and accessing primary healthcare services for residents with dementia during the COVID-19 pandemic and identify key lessons for supporting care home staff with medicines optimisation for residents with dementia both now and during future health crises. Method(s): Care home managers were recruited using several approaches which utilised purposive and snowball sampling. Participant sampling and recruitment commenced in January 2022 and finished in July 2022. The interview topic guide was developed based on published literature, current COVID-19 guidelines for care homes, and following discussion within the research team;it was piloted with two nurses with experience of working in care homes. Semi-structured interviews were conducted either using an online video-conferencing platform or via the telephone after obtaining written informed consent from participants. All interviews were audio recorded, transcribed verbatim, and analysed using thematic analysis (2). Analysis of data is ongoing. Result(s): Fourteen interviews were conducted, lasting between 25 and 56 minutes. Findings to date have highlighted the challenges care homes have faced whilst caring for residents with dementia during the pandemic. Participants described changes to the way in which primary healthcare services were provided. In particular, provision of services from general practice (e.g. prescribing, consultations) were mostly conducted over the telephone and/or online and some participants reported that this had an impact on medication review: ''it's only the review of medication that has not been done during the pandemic'' [CHM-07]. Restrictions on visiting to care homes during the initial and middle phases of the pandemic affected aspects of medicines optimisation for residents with dementia and an already stretched care sector: There was a lot of problems prior to COVID. COVID just made those problems monumental'' [CHM-14]. Most participants perceived that community pharmacy services were not affected by the pandemic and medication supply continued: We haven't had an issue with community pharmacy to be honest with you'' [CHM-03]. Participants identified lessons for future health crises including the need for improved communication with general practitioners, the importance of a multidisciplinary team effort to optimise medicines for residents with dementia, along with input from residents' family members, and greater support for care homes. Conclusion(s): This study has highlighted the difficulties that care home managers have faced in accessing general practice services during the pandemic and the impact this has had on residents with dementia receiving medication review. Whilst these findings add to a limited evidence base, they may not be generalisable to other parts of the UK. Future work will focus on development of a questionnaire study with care home managers.
ABSTRACT
Introduction: Community pharmacy is one of the most accessible sectors in the health service and played a key role in responding to COVID-19 (1). Efforts to tackle COVID-19 have required an immediate response from the community pharmacy workforce. Aim: To examine views and experiences of community pharmacists regarding changes in practice/processes in preparation for and response to the COVID-19 pandemic. Methods: A telephone questionnaire was conducted across a geographically stratified sample of community pharmacists in Northern Ireland (NI). Based on the total number of pharmacies (N=528) and an anticipated response rate of 30%, up to 433 pharmacies were to be contacted to achieve a target sample size of n=130 (sampling fraction 24%). The questionnaire sections comprised: (1) measures taken to prevent COVID-19 infection;(2) response to the pandemic, i.e. immediate actions taken, effect on service provision and new/innovative ways of working;(3) pandemic preparedness;(4) communication with GPs and patients;(5) professional knowledge;(6) recovery and future outlook. Data were coded, entered into SPSS v27, and analysed descriptively. Free-text comments were summarised using thematic analysis. Results: One hundred and thirty community pharmacists (175 approached) completed the questionnaire (74% response rate). Pharmacists responded comprehensively to implementing infection control measures, e.g. management of social distancing in the shop (n=125, 96.2%), making adjustments to premises, e.g. barriers/screens (n=124, 95.4%), while maintaining medicines supply (n=130, 100.0%) and advice to patients (n=121, 93.1%). Patient-facing services such as minor ailments and smoking cessation were initially stopped by 115 (88.5%) and 93 (71.5%) pharmacies respectively during the first wave of the pandemic (March-May 2020);by the second wave (Sep-Dec 2020), modified services had resumed in 121 (93.1%) and 104 (79.9%) pharmacies respectively. Newly commissioned services were provided, e.g. emergency supply service (n=121, 93.1%), flu vaccination for healthcare workers (n=101, 77.7%) and volunteer deliveries to vulnerable people (n=71, 54.6%);new initiatives were developed, e.g. measures to flag/assist patients with sensitive issues (n=73, 56.2%). Pharmacies with a business continuity plan increased from 85 (65.4%) pre-pandemic to 101 (77.7%) during the second wave. Free-text responses indicated how pharmacists adapted practice in the front line to reassure and advise the public and maintain essential medicines supply. Pharmacists were least prepared for the increased workload and patients' challenging behaviour, but 126 (96.9%) reported that they felt better prepared during the second wave. Telephone was the main method of communication with patients (n=107, 82.3%) and GPs (n=114, 87.7%). Pharmacists felt they had sufficient training resources available (n=113, 86.9%) to maintain professional knowledge. Pharmacists agreed/strongly agreed that they would be able to re-establish normal services (n=114, 87.7%), were willing to administer COVID-19 vaccines (n=105, 80.7%) and provide COVID-19 testing (n=79, 60.8%) in the future. Conclusion: The high response rate is a strength of the study, but the impact is limited by not including patients or service commissioners. The pharmacy workforce remained accessible and maintained supply of essential medicines and advice to patients throughout the pandemic. Provision of modified and additional services such as vaccination reinforced the clinical and public health role of pharmacy.
ABSTRACT
Introduction: Practice-based pharmacists (PBPs) have been introduced into general practice across the United Kingdom (UK) to relieve some of the pressures within primary care (1,2). However, there is little existing UK literature that has explored healthcare professionals' (HCPs') views about PBP integration and how this role has evolved. Aim: To explore the views and experiences of general practitioners (GPs), PBPs, and community pharmacists (CPs) about PBPs' integration into general practice and their impact on primary healthcare delivery. Methods: Purposive and snowball sampling were used to recruit triads (a GP, a PBP, and a CP) from across five administrative healthcare areas in one region in the UK to participate in one-to-one semi-structured interviews. Sampling of practices to recruit GPs and PBPs commenced in August 2020. These HCPs identified the CPs who had most contact with the general practices in which the recruited GPs and PBPs were working. The interview topic guides were developed based on the published literature, and through discussion within the research team;they were piloted with two GPs, two PBPs, and two pharmacists. Due to the Covid-19 pandemic, interviews were conducted via telephone or Microsoft Teams platform. All interviews were recorded, transcribed verbatim, and analysed using inductive thematic analysis. Results: Eleven triads were recruited from across the five administrative areas. Analysis of interview transcripts is ongoing. Findings to date have revealed four main themes in relation to PBPs' integration into general practices (Table): evolution of the role, PBP attributes, collaboration and communication, and impact on care. A number of areas for development were identified such as patient awareness of the role and communication pathways between PBPs and CPs. Many saw PBPs as a central hub-middleman' between general practice and community pharmacies and between primary and secondary care. Conclusion: Participants reported that PBPs had integrated well, and perceived a positive impact on primary health care delivery. Although recruitment was limited to one UK geographical region, the triad approach provided a more comprehensive overview of the working relationships between the three HCP groups. Further work is needed to increase patient awareness of the PBP role.
ABSTRACT
Introduction: Community pharmacy has played a frontline role during the COVID-19 pandemic (1,2). Governments and professional organisations in the United Kingdom and Republic of Ireland (RoI) have acknowledged the need to support and maximise community pharmacy to maintain delivery of patient care. However, the pandemic's impact on day-to-day changes to community pharmacy practice has not been comprehensively examined across the island of Ireland. Aim: To identify changes as communicated by policy and professional bodies to community pharmacy practice across the island of Ireland in preparation for and/or response to the COVID-19 pandemic, and to compare identified changes in Northern Ireland (NI) and RoI. Methods: Government, health service, regulatory and professional organisation websites in both NI and RoI were searched using relevant search terms (e.g. pharmacist, COVID- 19). Any document (e.g. official publications/reports, website pages, circulars) containing information relating to changes to community pharmacy-related infrastructure, funding/resourcing, legislation, guidelines or policies in preparation for, and/ or response to, COVID-19, published between 1st January and 31st October 2020 was included. Guidelines on clinical use of medicines were excluded as this was considered a separate topic. Initial screening of each website was undertaken by one reviewer. Brief details of potentially relevant documents were collated in a spreadsheet. Following removal of duplicates, full-texts of identified documents were assessed for inclusion by two reviewers independently, with discrepancies resolved through discussion. A content analysis was undertaken. Results: In total, 253 documents were identified. Following removal of duplicates and screening, 98 documents were included in the analysis. Most documents were published in the first three months of the pandemic (March-May 2020). A key theme related to medication prescribing and supply, with changes implemented to ensure continued access to medicines. In both NI and RoI, significant changes were made to emergency supply arrangements (e.g. increase in allowable duration of supply at the request of patients). In RoI, legislative changes were made to recognise Healthmail as the national electronic prescription transfer system and to temporarily extend prescription validity. In NI, many community pharmacy services (e.g. Minor Ailments Service, Medicines Use Review) were 'stood down' during initial months of the pandemic. Much of the communication in NI and RoI related to operational changes to ensure business continuity. In both jurisdictions a temporary register of pharmacists was introduced to allow previously registered pharmacists to contribute to the health service response. Additionally, in NI, General Dental Practitioners were redeployed to assist with community pharmacy response. Other areas of focus across both jurisdictions included infection control within a workplace setting, dealing with situations where staff were affected by COVID-19, and the use of personal protective equipment during pharmacy service provision. Conclusion: This study examined changes in community pharmacy practice across two jurisdictions during the COVID-19 pandemic. Whilst our searches were limited to publicly accessible documents only, the overlap in identified changes reflects the similarities in challenges faced by community pharmacists in adapting and responding to COVID-19. The cross-country comparison may help pharmacists and policy-makers to identify optimal approaches for responding to any future public health crises.
ABSTRACT
Introduction: Frailty is a heightened state of vulnerabilitydue to an accumulation of age-related defects in separatephysiological systems (1). Frailty is becoming increasinglycommon, with up to 50% of older adults being diagnosedwith mild, moderate or severe frailty (35%, 12% and 3%respectively) (2). Community pharmacists may often bethe primary healthcare professional with whom frail olderpeople have most frequent contact due to their convenienceand accessibility. Therefore, it is hypothesised that community pharmacists could play a wider role in frailty identification and medicines optimisation for frail older people.Aim: To explore community pharmacists' knowledge of frailtyand its assessment, their experiences and contact with frail olderpatients in the community pharmacy setting, and their perceptions of their role in optimising medicines for frail older people.Methods:Two strategies were used to recruit community pharmacists registered in Northern Ireland (NI). Community pharmacists were recruited through the Pharmacy Forum NI bi-monthlynewsletter and the School of Pharmacy Undergraduate PlacementNetwork, followed by snowballing. The interview topic guidewas developed based on the published literature, current frailtyguidelines and through discussion within the research team;itwas piloted with four pharmacists. Semi-structured interviewscommenced in March 2020. Due to the Covid-19 pandemic,face-to-face interviews were logistically not possible, thereforetelephone interviews were conducted at a time convenient to participants. All interviews were recorded, transcribed verbatim andanalysed using inductive thematic analysis. Results: To date, 14 interviews have been conducted,lasting between 24 and 72 minutes. Apart from one interview, all were conducted over the telephone. Participant characteristics are summarised in Table 1. Analysis of interviewtranscripts is ongoing. Findings to date have highlighted thekey role community pharmacists feel they play in assistingfrail older patients with their medicines (especially duringthe current pandemic). Many saw themselves as a 'point ofcontact' for frail older people and highlighted the holistic approaches they used to care of such patients: "It's easier to getin contact with us than other healthcare professionals and wetend to be the first port of call really" [CP2]. Interviews highlighted a lack of pharmacist knowledge surrounding frailtyas a condition and its assessment, with participants primarilyfocusing on the physical aspects of frailty (e.g. weight loss,weakness) when observing or 'informally assessing' patients.None of the participants reported formally assessing theirpatients using validated frailty tools or checklists: "It's notsomething that I've ever thought about. We don't have anytools readily available to us that I know of and certainlynothing that would be standardised" [CP1].Conclusion: This study has highlighted that communitypharmacists felt they could contribute to optimising medicines for frail older people. However, the findings emphasisethe need for more formal training for community pharmacists about the clinical aspects of frailty, frailty assessmentand future interventions to address the medicines-relatedissues they have encountered with this patient population.
ABSTRACT
Research has demonstrated the cognitive and mental health benefits of learning new skills and content across the life span, enhancing knowledge as well as cognitive performance. We argue that the importance of this learning-which is not available equally to all-goes beyond the cognitive and mental health benefits. Learning is important for not only the maintenance, but also enhancement of functional independence in a dynamic environment, such as changes induced by the COVID-19 pandemic and technological advances. Learning difficult skills and content is a privilege because the opportunities for learning are neither guaranteed nor universal, and it requires personal and social engagement, time, motivation, and societal support. This paper highlights the importance of considering learning new skills and content as an important privilege across the life span and argues that this privilege becomes increasingly exclusionary as individuals age, when social and infrastructural support for learning decreases. We highlight research on the potential positive and negative impacts of retirement, when accessibility to learning opportunities may vary, and research on learning barriers due to low expectations and limited resources from poverty. We conclude that addressing barriers to lifelong learning would advance theories on life span cognitive development and raise the bar for successful aging. In doing so, our society might imagine and achieve previously unrealized gains in life span cognitive development, through late adulthood. © 2021