ABSTRACT
BACKGROUND: The Pharmacy Integration Fund (PhIF) was established in England in 2016, with funded learning programmes or 'pathways' designed to support the development of clinical pharmacy practice in a range of settings. Despite pharmacy staff being well positioned to provide more clinical work, limited research has investigated behaviour change training targeted at widespread practice transformation. OBJECTIVE(S): To investigate implementation of PhIF learning in practice, using the COM-B model of behaviour change. METHODS: An online survey distributed in February and October 2020 included questions on motivations for learning, confidence in target behaviours and impact of PhIF training on behaviour. The October 2020 survey also included questions exploring the effect of the COVID-19 pandemic. Quantitative data were analysed in SPSS. v.27 (IBM). Inferential statistics were used to compare between the pathways (Primary care pathways [PCP], Post-registration pathway [PRP] and Accuracy Checking Pharmacy Technician [ACPT] pathway). Free text comments were categorised and themed. RESULTS: Three-hundred and eighty-three responses were received (49% PRP learners, 39% PCP learners and 12% ACPT learners). Learners generally had the capacity and opportunities to apply learning, and were strongly motivated to implement behaviours in practice, although learners based in community pharmacy (those on the PRP) were less likely to report receiving employer support. Enhanced knowledge/skills (capacity) were more commonly reported than change to patient-facing activities, leading clinical services and conducting medication reviews with patients with complex needs (clinical practice behaviours targeted by the pathways). The COVID-19 pandemic heightened barriers to implementing practice change. CONCLUSIONS: Implementation of a range of clinical practice behaviours following at scale training appears to have been largely successful. Despite this, the community pharmacy context, where funded service opportunities may be lacking, continues to present challenges to workforce transformation plans. More work is needed to understand how training can be implemented to promote practice change for pharmacy professionals in all settings.
ABSTRACT
The COVID-19 pandemic forced organizations into rapid transition to virtual workplace settings. Librarians at the University of South Florida conducted a study to discover trends in team communication dynamics among academic librarians working remotely during this period. This study was motivated by a desire to gauge the perceived degree of positive or negative impact on group communication dynamics and connectedness before and after the transition, with attention paid to factors that inform team communication. This study used a quantitative approach employing a cross-sectional survey administered to the population of professional academic librarians in the United States. Survey findings exhibited small shifts in dynamics, opening a path for more nuanced examination. Effects on librarianship due to the pandemic are still being felt;it is a topic with long reach and impact, which merits examination. © 2022, Association of College and Research Libraries. All rights reserved.
ABSTRACT
Background and Aim: The Australian Therapeutic Goods Administration (TGA) released Therapeutic Goods (Standard for Faecal Microbiota Transplant Products) (TGO 105) Order 2020 as a regulatory framework for fecal microbiota transplantation in Australia in September 2020. BiomeBank established a stool donor screening program and quality management system to produce fecal microbiota transplants as a Class 2 Biological;however, the feasibility of such a screening program was unknown. The aim of this study was to assess the eligibility and retention rates of potential stool donors over a 12-month period. Method(s): Stool donors were recruited in Adelaide through local flyers, targeted online advertising, and word of mouth. Data on the donor screening program were prospectively collected, including donor demographic details, screening and stool donation results at each stage of the screening, and donation process from 1 January to 31 December 2021. Result(s): Of 135 enquiries to the stool donor program during 2021, 55 people were excluded based on age and distance from the collection center. The remaining 80 potential donors were sent a donor screening questionnaire, and 65/80 (81.3%) were deemed ineligible based on established donor screening criteria. The remaining 15 potential donors (11%) underwent physician assessment, 11 (73.3%) of whom passed and progressed to blood, swab, and stool testing. Two of the remaining potential donors failed screening tests (with positive stool screening tests for an extended-spectrum beta lactamase-producing organism, one of whom also tested positive for hepatitis B core antibody on blood), and a third did not complete testing. The final outcome was eight new stool donors (5.9% of initial enquiries) being enrolled in the donor program in 2021. This was in addition to two donors who carried over from 2020. The median age of donors was 36.9 years (range, 27.6-47.1), and 50% of donors were female. The mean weight of accepted donations was higher for male than female donors (212 vs 120 g;P < 0.001). The median number of donations processed per donor was 7.0 (IQR, 1.8-28.8), the median number of 8-week donation periods per donor was 2.5 (IQR, 1-6), and the median number of donations processed per 60-day donation period was 3.2 (IQR, 1-5.1). There were 21 donated samples that were rejected due to issues detected on the day of donation (n = 14) or being too small to process (n = 7). In terms of donor retention in the program, half the donors (5/10) were retained at the end of 2021, with discontinuation being the result of personal choice, poor engagement, or ineligible occupation. In addition, 60% of the donors (6/10) incurred a total of seven temporary suspensions during the year due to various factors: antibiotic exposure (n = 2), ineligible medication (n = 1), gastroenteritis (n = 1), upper respiratory tract infection (n = 1), COVID-19 exposure risk (n = 1), and raw oyster ingestion (n = 1). Conclusion(s): A minority of potential stool donors are eligible to become stool donors. In addition, retention of donors in the program and maximizing the yield from a donation period were difficult due to strict donor screening criteria, frequent exposures to common pathogens, and the ongoing commitment required from donors. Despite this, BiomeBank was able to produce fecal microbiota transplants under the TGA-regulated Class 2 Biologicals framework and meet increasing demand for this product in Australia using a rigorous donor screening program.
ABSTRACT
[Formula presented] Background: Sickle cell disease (SCD) is a chronic blood disorder, which disproportionately impacts Black individuals. Hydroxyurea therapy prevents SCD-related complications;yet it is underutilized, which contributes to further health inequities. Mobile health (mHealth) apps for patients and providers have the potential to improve hydroxyurea adherence. Our objective was to use the RE-AIM framework to evaluate the impact of the COVID-19 pandemic on implementation and effectiveness of patient and provider hydroxyurea (HU) mHealth apps (InCharge Health app and HU Toolbox app, respectively) in two large academic medical centers. Methods: Patient-level data (n=46) were collected between 11/2019-7/2020. Adherence was measured by calculating Percentage of Days Covered (PDC) from prescription records over 24 weeks before implementing the mHealth apps and during 12 and 24 weeks of implementation. As a response to the COVID-19 pandemic and to reduce virus spread, both sites temporarily suspended non-emergent clinical activities. During implementation, Site A clinics shut down for approximately 2 months (3/2020-5/2020) and Site B clinics for 7 months (3/2020-10/2020). To better understand contextual factors associated with mHealth implementation, we purposively sampled participants according to app use level (high vs low) and conducted semi-structured interviews with adult SCD patients, providers (physicians, nurse practitioners, and physician assistants), administrators, and research staff between 6/2020 and 3/2021. Results: A total of 46 patients participated and contributed to the PDC hydroxyurea adherence data. Mean change in PDC, adjusted for baseline PDC, was greater at Site A than at Site B (12-weeks: difference = 16.59%, p=.01, Figure 1A;24-weeks: difference = 15.08%, p=.01, Figure 1B). Eleven patients (mean age 26.2 years old, 64% males, 100% Black, 73% HbSS, 45% low app users) and 11 providers (mean age 36.7 years old, 73% females, 36% Black, 54.5% physicians, average 8 years in practice, 36% low app users) completed the semi-structured interviews across the 2 sites. Site B was more affected during the COVID-19 pandemic where patients had difficulty obtaining hydroxyurea and other challenges related to reaching their providers and clinic setting for non-urgent or emergent reasons. In addition, participants with lower baseline hydroxyurea adherence level, as measured by PDC, had a more remarkable improvement in their PDC values at 12 weeks (Figure 1C) and 24 weeks (Figure 1D) Additional qualitative data focused on the implementation process were collected from 3 administrators, and 4 research staff. Among patients, both high and low app users reported the pandemic was a barrier to getting needed care (e.g., difficulty getting to hospital/clinic) and obtaining hydroxyurea;this was particularly a concern among low app users at Site B. Among providers, all but 2 high app users reported the pandemic did not impact app use, but nearly all low users perceived the pandemic to be a barrier to using the provider app because fewer patients came to clinic for maintenance SCD visits during the COVID-19 pandemic. Low users also reported the pandemic would negatively impact continued use of the app. Administrators and research staff also said reduced in-person clinic visits were a barrier to app implementation. Conclusions: mHealth apps are promising tools for improving hydroxyurea adherence among adolescents and adults with SCD. Contextual data show that some patients who experienced challenges accessing healthcare during COVID-19 pandemic have also experienced challenges navigating mHealth implementation. A focus on removing barriers to mobile apps use during care disruptions will likely improve patient and provider mHealth apps implementation, and ultimately, reduce health inequities for this vulnerable population. Our findings suggest that strategies such as including an mHealth facilitator has the potential to help addressing some of these implementation challenges. Note: Sherif Badawy and Lisa DiMarti o are co-first authors with equal contribution [Formula presented] Disclosures: Badawy: Sanofi Genzyme: Consultancy;Bluebird Bio Inc: Consultancy;Vertex Pharmaceuticals Inc: Consultancy. Shah: Alexion: Speakers Bureau;Bluebird Bio: Consultancy;CSL Behring: Consultancy;Emmaus: Consultancy;GBT: Consultancy, Research Funding, Speakers Bureau;GLG: Consultancy;Guidepoint Global: Consultancy;Novartis: Research Funding, Speakers Bureau. Hankins: Bluebird Bio: Consultancy;UpToDate: Consultancy;Vindico Medical Education: Consultancy;Global Blood Therapeutics: Consultancy.