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 societal disruptions due to the novel coronavirus (COVID-19) pandemic are well noted, especially in the context of science, technology, engineering, and mathematics (STEM) education. Absent a concerted effort to sustain hands-on learning opportunities in STEM amid the crisis, the consequences of COVID-19 may exacerbate existing inequities and racial disparities among youth of color further stratifying the STEM fields. In the current study, we applied a mixed-method descriptive case study design, using online learning theory and culturally responsive pedagogy as our conceptual framework, to describe how participants experienced this camp, held online due to disruptions of COVID-19, in the southeastern region of the USA. We also share findings from the implementation of a justice bots project, which enabled participants to connect social justice and engineering. Participants included middle school youth, undergraduate engineering students, and in-service math and science teachers. Data sources entailed focus groups, pre-post surveys, observations, and artifacts. Our results indicated that participants experienced gains in their communication skills, positive changes in attitudes toward STEM for middle school youth, established meaningful connections, and enhanced their technical knowledge. Middle school youth reported enjoying the online summer camp environment, though they had experienced more than a year of education online. Undergraduate engineering students asserted that it was challenging to communicate coding and other technical knowledge virtually but having to do so strengthened their capacity to teach others while honing their own competencies. Lastly, in-service math and science teachers reported a better understanding of the connection between engineering and social justice based on their experiences in the camp. We conclude this article with implications for engineering education. © 2022, Purdue University Press. All rights reserved.
ABSTRACT
Background. We developed a syndromic algorithm for COVID-19 like illness (CLI) to provide supplementary surveillance data on COVID-19 activity. Methods. The CLI algorithm was developed using the Electronic Medical Record Support for Public Health platform (esphealth.org) and data from five clinical practice groups in Massachusetts that collectively care for 25% of the state's population. Signs and symptoms of CLI were identified using ICD-10 diagnosis codes and measured temperature. The algorithm originally included three categories: Category 1 required codes for coronavirus infection and lower respiratory tract infections (LRTI);Category 2 required an LRTI-related diagnosis and fever;Category 3 required an upper or lower RTI and fever. The three categories mirrored statewide laboratory-confirmed case trends during spring and summer 2020 but did not detect the increase in late fall. We hypothesized this was due to the requirements for fever and LRTI. Therefore, we added three new categories defined by milder symptoms without fever: Category 4 requires LRTIrelated diagnoses only;Category 5 requires upper or lower RTI or olfactory/taste disorders;and Category 6 requires at least one sign of CLI not identified by another category. Results. The six-category algorithm detected the initial surge in April 2020, the summer lull, and the second surge in late fall (see figure). Category 1 cases were not identified until mid-March, which coincides with the first laboratory-confirmed cases in Massachusetts. Categories 2 and 3, which required fever, were prominent during the initial surge but declined over time. Category 5, the broadest category, declined during February and March 2020, likely capturing the end of the influenza season, and successfully detected the spring surge and fall resurgence. Weekly number of COVID-19 like illnesses by category, February 2, 2020 through May 8, 2021 Conclusion. A syndromic definition that included mild upper RTI and olfactory/ taste disorders, with or without fever or LRTI, mirrored changes in laboratory-confirmed COVID-19 cases better than definitions that required fever and LRTI. This suggests a shift in medically attended care and/or coding practices during initial vs subsequent surges of COVID-19, and the importance of using a broad definition of CLI for ongoing surveillance.
ABSTRACT
BACKGROUND: There is a lack of evidence on how the multimodal dynamic process of resilience has impacted personal adaptation of frontline healthcare professionals, working under extreme pressure during the COVID-19 global pandemic. OBJECTIVES: To explore resilience, burnout and wellbeing for UK pharmacists in patient-facing roles, including individual and organisational factors that align to the ABC-X theoretical model of the dynamic process of resilience. METHODS: A non-experimental pragmatist research design was adopted, with a cross-sectional online survey distributed via social media and professional networks between June and July 2020. Quantitative data aligned to a positivist research paradigm was collected using validated scores, to statistically analyse wellbeing, burnout and resilience. Qualitative textual data, consistent with an interpretivist research paradigm, were analysed following an inductive thematic approach. RESULTS: A total of 199 surveys from pharmacists working within community, hospital and GP sectors were analysed. Wellbeing scores were strongly correlated to resilience scores. Wellbeing and resilience scores were both inversely correlated with burnout scores. Two-thirds of participants were classified as high-risk within the burnout scales.Key stressors were highlighted by participants, who described how individual resources and perceptions shaped their experience, which overall contributed to their burnout. Organisations that supported pharmacists embraced change and quickly adopted new ways of working, such as teleconsultations, flexible and remote working, redesign of workflow, alongside clear guidance. However, there was also reported frustration at lack of, slow or conflicting guidance from employers. CONCLUSIONS: This study adds to the growing evidence base for how individuals are affected by adverse events in a dynamic environment, alongside the role that employers can play in supporting individual and organisational resilience. It provides an opportunity to learn from pharmacists' responses to the COVID-19 pandemic, and a call to action for healthcare organisations to rebuild and invest resources into sustained support for staff wellbeing.
ABSTRACT
Introduction: COVID-19 has acted as a catalyst for radical changes in the working practices of pharmacists. Whilethere is emerging evidence of adaptability mitigating burnoutamongst pharmacists in other countries (1), what has yet tobe established is the extent to which the well-being and resilience of pharmacists in the UK may be supported throughchanges in intra and inter-professional working practices.Aim: As part of a wider project aiming to explore the impact of COVID-19 on pharmacists' wellbeing and resilience,in this abstract we present findings exploring the impact onworking relationships within pharmacy and multidisciplinary teams.Methods: An online questionnaire containing validatedmeasures of wellbeing and resilience and free-text openquestions exploring the impact of COVID-19 on workingpractices was piloted on five practising pharmacists. Thisquestionnaire was subsequently distributed via social mediaand professional networks in June 2020. Convenience sampling was used whereby any UK-registered pharmacist in apatient-facing role was eligible to take part. Inductive thematic analysis of the free text responses was conducted. Thisabstract presents one key theme;intra and inter-professionalrelationships.Results: A total of 202 questionnaires were completed(Table 1), with 192 participants entering free-text responses. Participants reported pharmacy teams becoming closer,supporting one another and working more cohesively. Workredesign and staff upskilling were given as positive examplesof practice change in response to the pandemic. Reportedchallenges included managing conflict within a team due toheightened stress, sustaining staff morale, exhaustion, andprioritising others to the detriment of their own wellbeing:"I have no time for myself as I'm too busy keeping the dayto day working and supporting my team emotionally. I'memotionally exhausted and at home I withdraw and ignorethe outside world as I'm at breaking point but don't want mycolleagues to see this."Inter-professional relationships sometimes improved as aresult of more effective communication, extended networkingand pharmacists feeling valued and recognised as integralto multidisciplinary working. Supportive inter-professionalworking was described as a "Great sense of comradery-we're in this together". Yet for others, inter-professionalworking proved challenging, with non-engagement of clinicians, frequently changing guidance from senior management, and restricted staff interaction due to remote or shiftworking. Conclusions: Whilst for some the pandemic facilitated improved inter-and intra-professional interactions, for othersthis was viewed as challenges of daily practice. Due to recruiting via social media, this study is limited by the responsenumbers and is therefore not representative of all UK registered pharmacists. However, a key strength is that pharmacists from all sectors of practice responded, in comparisonto other studies which have focused solely on communitypharmacists. Results from this study can be used to supportsustainable change in fostering collaborative working withinpharmacy and multi-professional healthcare teams.