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1.
BMJ Open ; 11(9), 2021.
Article in English | ProQuest Central | ID: covidwho-1842771

ABSTRACT

IntroductionThe use of remote monitoring technology to manage the care of patients with COVID-19 has been implemented to help reduce the burden placed on healthcare systems during the pandemic and protect the well-being of both staff and patients. Remote monitoring allows patients to record their signs and symptoms remotely (eg, while self-isolating at home) rather than requiring hospitalisation. Healthcare staff can, therefore, continually monitor their symptoms and be notified when the patient is showing signs of clinical deterioration. However, given the recency of the COVID-19 outbreak, there is a lack of research regarding the acceptance of remote monitoring interventions to manage COVID-19. This study will aim to evaluate the use of remote monitoring for managing COVID-19 cases from the perspective of both the patient and healthcare staff.Methods and analysisDischarged patients from a large urban teaching hospital in Ireland, who have undergone remote monitoring for COVID-19, will be recruited to take part in a cross-sectional study consisting of a quantitative survey and a qualitative interview. A mixed methods design will be used to understand the experiences of remote monitoring from the perspective of the patient. Healthcare staff who have been involved in the provision of remote monitoring of patients with COVID-19 will be recruited to take part in a qualitative interview to understand their experiences with the process. Structural equation modelling will be used to examine the acceptance of the remote monitoring technology. Latent class analysis will be used to identify COVID-19 symptom profiles. Interview data will be examined using thematic analysis.Ethics and disseminationEthical approval has been granted by the ethical review boards at University College Dublin and the National Research Ethics Committee for COVID-19-related Research. Findings will be disseminated via publications in scientific journals, policy briefs, short reports and social media.

2.
BMJ Open ; 11(8), 2021.
Article in English | ProQuest Central | ID: covidwho-1842680

ABSTRACT

ObjectivesCOVID-19 has prompted the reconfiguration of hospital services and medical workforces in countries across the world, bringing significant transformations to the work environments of hospital doctors. Before the pandemic, the working conditions of hospital doctors in Ireland were characterised by understaffing, overload, long hours and work–life conflict. As working conditions can affect staff well-being, workforce retention and patient outcomes, the objective of this study was to analyse how the pandemic and health system response impacted junior hospital doctors’ working conditions during the first wave of COVID-19 in Ireland.Methods and analysisUsing a qualitative study design, the article draws on semi-structured interviews with 30 junior hospital doctors. Informed by an abductive approach that draws iteratively on existing literature and empirical data to explain unexpected observations, data were analysed using inductive and deductive coding techniques to identify the key themes reflecting the experiences of working in Irish hospitals during the first wave of COVID-19. We use the Consolidated Criteria for Reporting Qualitative Research to present this research.ResultsOur analysis generated three themes which demonstrate how COVID-19 prompted changes in medical staffing which in turn enhanced interviewees’ work environments. First, interviewees felt there were more doctors staffing the hospital wards during the first wave of the pandemic. Second, this had positive implications for a range of factors important to their experience of work, including the ability to take sick leave, workplace relationships, collective workplace morale, access to senior clinical support and the speed of clinical decision-making. Third, interviewees noted how it took a pandemic for these improvements to occur and cautioned against a return to pre-pandemic medical staffing levels, which had negatively impacted their working conditions and well-being.ConclusionsInterviewees’ experience of the first wave of COVID-19 illustrates how enhanced levels of medical staffing can improve junior hospital doctors’ working conditions. Given the pervasive impact of staffing on the quality of interviewees’ work experience, perhaps it is time to consider medical staffing standards as a vital job resource for hospital doctors and a key policy lever to enhance medical workforce retention. In a global context of sustained COVID-19 demands, pressures from delayed care and international health worker shortages, understanding frontline experiences and identifying strategies to improve them are vital to the development of more sustainable work practices and to improve doctor retention.

3.
BMJ Open ; 11(7), 2021.
Article in English | ProQuest Central | ID: covidwho-1842606

ABSTRACT

ObjectiveTo describe primary health care (consultation characteristics and management) for patients contacting their general practitioner (GP) with a respiratory tract infection (RTI) early on in the COVID-19 pandemic in contrasting European countries, with comparison to prepandemic findings.SettingPrimary care in 16 countries (79 practices), when no routine SARS-CoV-2 testing was generally available.Design and participantsBefore (n=4376) and early in the pandemic (n=3301), patients with RTI symptoms were registered in this prospective audit study.Outcome measuresConsultation characteristics (type of contact and use of PPE) and management characteristics (clinical assessments, diagnostic testing, prescribing, advice and referral) were registered. Differences in these characteristics between countries and between pandemic and prepandemic care are described.ResultsCare for patients with RTIs rapidly switched to telephone/video consultations (10% in Armenia, 91% in Denmark), and when consultations were face-to-face, GPs used PPE during 97% (95% CI 96% to 98%) of contacts. Laboratory testing for SARS-CoV-2 in primary care patients with RTIs was rapidly implemented in Denmark (59%) and Germany (31%), while overall testing for C reactive protein decreased. The proportion of patients prescribed antibiotics varied considerably between countries (3% in Belgium, 48% in UK) and was lower during the pandemic compared with the months before, except for Greece, Poland and UK. GPs provided frequent and varied COVID-related advice and more frequently scheduled a follow-up contact (50%, 95% CI 48% to 52%). GPs reported a slightly higher degree of confidence in the likely effectiveness of their management in face-to-face (73% (very) confident, 95% CI 71% to 76%) than in virtual consultations (69%, 95% CI 67% to 71%).ConclusionsDespite between-country variation in consultation characteristics, access to SARS-CoV-2 laboratory testing and medication prescribing, GPs reported a high degree of confidence in managing their patients with RTIs in the emerging pandemic. Insight in the highly variable pandemic responses, as measured in this multicountry audit, can aid in fine-tuning national action and in coordinating a pan-European response during future pandemic threats.

4.
International Journal of Environmental Research and Public Health ; 19(9):5191, 2022.
Article in English | ProQuest Central | ID: covidwho-1837855

ABSTRACT

The incidence and mortality rates of cervical cancer are rising among young women in Japan. In November 2021, the Japanese Ministry of Health, Labour, and Welfare reinstated the active recommendation for the human papillomavirus (HPV) vaccine, which was discontinued in June 2013 due to reports of adverse reactions, including chronic pain and motor dysfunction, following vaccination. However, vaccine hesitancy among the younger generation remains, and it is essential to identify the barriers in vaccination uptake. Therefore, we aimed to conduct a randomized study using different methods of providing educational contents to improve health literacy regarding cervical cancer and HPV vaccination among female students in Japan. Here, we present the results of our preliminary report and discuss current topics related to HPV vaccination in Japan. Data were collected from 27 female students—divided into three groups: no intervention, print-based intervention, and social networking service-based intervention—using the health literacy scale and communicative and critical health literacy scale. Our primary results indicate that participants’ knowledge and health literacy improved post-intervention. Therefore, medical professionals must provide accurate scientific knowledge regarding routine HPV vaccination and the risk of cervical cancer to young women to improve their health literacy and subsequently increase the HPV vaccination rates.

5.
International Journal of Environmental Research and Public Health ; 19(9):4965, 2022.
Article in English | ProQuest Central | ID: covidwho-1837335

ABSTRACT

The aim of this study was to initiate a co-design process with adolescents to inform the development of a targeted health literacy intervention for implementation in designated socioeconomically disadvantaged post-primary schools in Ireland. Purposely developed vignettes were explored in a series of eight workshops that were conducted separately with staff (n = 26) and students (n = 33) across four schools. Data was analysed using content analysis. A number of key health topics were identified as important and influential for the participants in this context: food choices, mental health and wellbeing, physical activity and sedentary behaviour, sleep and substance misuse. Participants also suggested many health-related capacity building actions. Participants recognized that many of these health topics and capacity building actions were intertwined and also highlighted that some of these actions may be more feasible and/or impactful than others. For example, students and school staff both indicated the need to use relevant, applied and engaging approaches to improve health literacy and subsequent health behaviour. The co-design process adopted empowered stakeholders to actively engage in the design and development of future intervention strategies, which may increase the likelihood of acceptability, effectiveness and sustainability of the resulting intervention.

6.
International Journal of Political Economy ; 51(1):65-76, 2022.
Article in English | ProQuest Central | ID: covidwho-1830538

ABSTRACT

Similar to the Eurozone crisis, Ireland engineered a more successful bounce back from the COVID-19 shock than crisis-hit peers. This article argues that the Irish path is less of a product of a generalizable export-led growth strategy, but, rather, can be explained by a set of idiosyncratic features. Using a wide array of macroeconomic indicators, the analysis assesses the opportunities and risks associated with Ireland's distinct path. It shows how strong ties to the United States, and emergence as the European hub for the world’s fastest growing firms sets Ireland apart from European peers. The US is a reliable “spender of last resort,” countercyclically spending and borrowing, boosting growth prospects of trading partners. Irish sectoral specialization in pharmaceutical manufacturing and digital services was also a boon in this crisis. The pandemic created opportunities for health-related industries;reliance on digital technologies helped digital firms. The article also finds, however, that banking on tech and pharma giants has significant limitations. First, multinationals’ accounting tricks artificially inflate economic statistics, and these two sectors are most affected. Second, to the extent that there is job-sustaining activity, it is not straightforward how the success of these sectors is transmitted to the rest of the economy. In the aftermath of the Eurozone crisis, the hospitality industry played a significant role as a “‘transmission belt,” receiving spillovers from the high value-added export sector. Since lockdowns hit hospitality the most, the social insurance function of fiscal policy is of paramount importance to ensure a more broad-based recovery.

7.
Cogent Education ; 8(1), 2021.
Article in English | ProQuest Central | ID: covidwho-1830440

ABSTRACT

School closures and remote learning resulted in major disruptions for final-year secondary school students who were due to take their examinations in June 2020. Using the Constructivist-Grounded Theory method, we conducted 14 in-depth interviews to gain insight into the impact of the coronavirus restrictions on the lives, education and plans of graduating secondary school students in Ireland. While participant responses to the pandemic were diverse, they can be categorised as those who were shielded against negative implications of the pandemic;those who struggled with worry and uncertainty;and those who became discontent as they awakened to the shortcoming of policymaking. Instead of assuming uniform effects of the pandemic in young populations, we need to be attuned to the diverse pathways whereby some young adults can tap into their resources (including creativity and social networks) while others need extensive support to make up for lost opportunities and isolation that ensued from the pandemic.

8.
Quality Progress ; 54(12):14-15, 2021.
Article in English | ProQuest Central | ID: covidwho-1824153

ABSTRACT

EMPLOYEE SATISFACTION The COVID-19 pandemic caused people to yearn to be happier, more fulfilled at work by Henry J. Lindborg Conducting employee surveys to assess quality improvement, strategic alignment, cultural values, and employee satisfaction and engagement showed me that widespread overwork without adequate recognition often coexists with quality aspirations. While teaching a graduate-level class for educators that included a values inventory and detailed time diary, I learned that the burdens of teaching and administration-especially in urban schools-consumed lives, but change was possible for individuals even in failing systems. Ireland, for example, "launched a National Remote Work Strategy in January 2021, intended 'to ensure that remote working is a permanent feature in the Irish workplace' in order to maximize economic, social and environmental benefits.

9.
Rivista Sperimentale di Freniatria: La Rivista della Salute Mentale ; 145(2):37-52, 2021.
Article in English | APA PsycInfo | ID: covidwho-1817910

ABSTRACT

The Covid-19 pandemic crisis has caused, in addition to the serious effects on the health systems, a sharp slowdown in the Italian and European economy, mainly weighing on the weakest sections of the population with a worrying increase in economic and social inequalities. Using a multidisciplinary approach, this study focuses on the link between socio-economic fragility and epidemic exposure to Covid-19 in Italy and Europe, with a triple objective: to monitor the main dimensions of increased inequalities within the economy and society through an academic literature review;to empirically understand the reasons for national differences in the spread and lethality of the Covid-19 virus at European level;to provide, on the basis of the results obtained in pursuing the previous two objectives, a key to understanding the main public policies for a healthier, more inclusive and sustainable Italy and Europe. (PsycInfo Database Record (c) 2022 APA, all rights reserved) (Italian) La crisi pandemica da Covid-19 ha determinato, oltre ai gravi effetti sul piano sanitario, un forte rallentamento dell'economia italiana ed europea, pesando principalmente sulle fasce piu deboli della popolazione con un preoccupante aumento delle disuguaglianze economico-sociali. Mediante un approccio multidisciplinare, questo studio si concentra sul collegamento tra la fragilita socio-economica e l'esposizione epidemica al Covid-19 in Italia ed Europa, con un triplice obiettivo: monitorare le principali dimensioni delle accresciute disuguaglianze all'interno dell'economia e della societa mediante un'analisi della letteratura scientifica;comprendere empiricamente le ragioni delle differenze nazionali nella diffusione e letalita del virus da Covid-19 a livello europeo;fornire, sulla base dei risultati ottenuti nel perseguimento dei precedenti due obiettivi, una chiave di lettura delle principali politiche pubbliche per un'Italia ed un'Europa piu sane, inclusive e sostenibili. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

10.
Geriatric Orthopaedic Surgery and Rehabilitation ; 12:14-15, 2021.
Article in English | EMBASE | ID: covidwho-1817121

ABSTRACT

Introduction: In January 2021, Ireland was undergoing the 'Third Wave' of COVID-19, with almost 2,000 persons hospitalised with COVID-19. Over 50% of all COVID-19-related deaths in the EU have occurred in those aged 80 years and older. The same patient cohort is also at high risk sustaining a fragility fracture, leading to an admission to the orthopaedic rehabilitation ward. This study examines a patient group in whom these two scenarios coincided, describing a patient cohort who having sustained a fragility fracture, later contracted COVID-19. This study aims to describe the characteristics and outcomes of orthopaedic rehabilitation patients with COVID-19 and to examine the response of an orthopaedic rehabilitation ward to an outbreak of COVID-19. Methods: This is a retrospective observational study. Data from 26 hospitalised patients aged over 65 years with COVID-19 at an Irish orthopaedic rehabilitation ward was collected. Symptom profile, degree of COVID-19 severity, Clinical Frailty Scale (CFS), Charleston co-morbidity scores, laboratory and radiological data were reviewed. Individual treatment pathways were recorded for each patient. Infection control records were reviewed to examine the response of the ward to an outbreak of COVID-19. Results: Patient mortality rate was 7.7% (n = 2). Median survivor age was 79.5 years (IQR 70-85.5). Mean CFS and Charleston Co-morbidity scores were 4.15;(SD1.6) and 5.08, respectively. The majority of patients (n = 25, 96%) were categorised as mild COVID-19 cases. Delirium was noted in more than 10% of patients (n = 3, 11.6%). One patient (n = 1, 3.8%) required non-invasive ventilation. In those whose disease was classifies as severe (n = 2, 7.7%), intubation/resuscitation were not deemed appropriate and when they deteriorated, comfort measures were taken. The majority of patients (n = 21, 81%) were able to return home upon discharge. Three patients (11.5%) had increased care needs and required long term care to be arranged. Conclusion: An outbreak of COVID-19 requires a multidisciplinary approach with a focus on not only medical management but also clinical workforce management, patient flow, management of access to the wards and information and communications management. The overall outcomes in this group, including mortality and proportion discharged to long term care, were positive when compared to similar cohorts of elderly hospitalised patients with COVID-19. These outcomes support a multidisciplinary model of care.

11.
Geriatric Orthopaedic Surgery and Rehabilitation ; 12:72-73, 2021.
Article in English | EMBASE | ID: covidwho-1817115

ABSTRACT

Introduction: Each year over 3,700 patients over the age of sixty were hospitalised with a hip fracture in Ireland. The recognition of the growing burden of fragility fractures on the health service needs to be factored into the future development of hospital services. The IHFD is a clinically led, web based audit of hip fracture casemix, care and outcomes. The National Office of Clinical Audit (NOCA) provides operational support and governance for the IHFD. All 16 eligible hospitals in the Republic of Ireland are now entering data. It is clinically supported by the Irish Gerontological Society (IGS) and the Irish Institute of Trauma and Orthopaedics (IITOS). The IHFD has been recording data since 2012 and has captured over 25,000 cases to date. Methods: Data is collected through the Hospital In-Patient Enquiry (HIPE) portal in collaboration with the Healthcare Pricing Office (HPO). The IHFD audit was based originally on the six standards of care as published by the British Orthopaedic Association and British Geriatric Society in the "Blue Book", the Care of Patients With Fragility Fracture (2007), but in 2017 the IHFD published the Irish Hip Fracture Standards (IHFS), in 2018 these standards formed the basis of a Best Practice Tariff (BPT), that is, a payment of €1000 per case that meets the IHFS. In 2021 a new standard for early mobilization will become part of the BPT. Results: 33% of patients were admitted to an orthopaedic ward or went to theatre within four hours, 75% of patients received surgery within 48 hours, 3% of patients developed a pressure ulcer, 56% of patients received a nutritional risk assessment to identify risk of malnutrition, 82% of patients were seen by a geriatrician, IHFS 5: 91% of patients received a bone health assessment, 85% of patients received a specialist falls assessment, 78% of patients were mobilised by a physiotherapist on the day of or day after surgery, 28% of patients were discharged directly home. Median of length of stay: 11 days. Conclusion: The coverage has improved consistently year on year and 99% was achieved in 2020. There has been an improvement in all IHFS with a minor disimprovement in 2020 due to COVID. The focus of the audit going forward will be support the hospitals to recover from the impact of the COVID pandemic, to increase the number of patient care meeting the BPT, to support the hospitals to adopt a culture of quality improvement using the IHFD data and to develop a longer term outcome dataset.

12.
Clinical Cancer Research ; 27(6 SUPPL 1), 2021.
Article in English | EMBASE | ID: covidwho-1816916

ABSTRACT

Objective The COVID-19 pandemic has placed an inexorable strain on endoscopy services worldwide, affecting the diagnosis of esophago-gastric (EG) cancer and Barrett's esophagus (BE). As coronavirus infection rates rose many professional bodies advised that all endoscopy, except emergency and essential procedures, be stopped immediately. We sought to quantify the decline in EG cancer and BE diagnoses following implementation of British Society of Gastroenterology (BSG) guidance related to COVID-19 and the psychosocial effects on BE patients. Methods We examined EG cancer and BE diagnoses in Northern Ireland from March-September 2020 and compared them with the three-year average number of patients during the same time period between 2017-2019 by utilizing Northern Ireland Cancer Registry (NICR) data. The psychosocial impact of COVID-19 was assessed using an online survey, which included validated WHOQOL-BREF and EQ-5D-5L quality of life measures, and was completed by 24 BE patients from April-May 2020. Results During the first six months of the pandemic the proportion of EG cancer and BE diagnoses declined by 26.6% and 59.3%, respectively, compared to expected levels. In April, BE diagnoses fell by 95.5% but by September, whilst EG cancer rates had returned to baseline, BE cases remained suppressed by approximately 20%. We estimate that these declines in diagnosis represent 53 'missed' EG cancer and 236 'missed' BE diagnoses. In the online survey sample, BE patients reported consistently lower quality of life scores than population norms, and highlighted a number of concerns with regard to their health and care. Conclusion The COVID-19 pandemic has resulted in an abrupt decline in EG cancer and BE diagnoses and has profoundly impacted the wellbeing of BE patients. Our study represents the first report of the impact of COVID-19 on the diagnosis of BE. Strategies to mitigate the ongoing effects of the pandemic are urgently required to preserve the ability to rapidly detect and diagnose cancer and pre-malignant conditions.

13.
Clinical Cancer Research ; 27(6 SUPPL 1), 2021.
Article in English | EMBASE | ID: covidwho-1816904

ABSTRACT

In an effort to limit physical contact during the COVID-19 pandemic, there has been rapid implementation of virtual cancer care clinics using messaging, audio, and video communication. This model has advantages, particularly in convenience for patients who do not have to travel to a distant centre for specialist care, but has the potential to limit communication and also omits physical examination. The aim of this survey study was to assess whether patients attending the oncology unit at a tertiary care academic cancer centre were satisfied with the virtual clinic model and explore challenges in the delivery of virtual care. We also surveyed medical oncology trainees and consultant oncologists in the centre on the use of virtual care. Methods: All patients attending St Vincent's University Hospital Oncology, Dublin, Ireland, who had received a virtual oncology clinic appointment were invited by text message to participate in a survey study analysing attitudes towards virtual oncology clinics. Medical oncology trainees and consultants working were also invited to give their opinions. Results: Between April and October 2020, 207 patients (of 600 invited) who had at least one virtual clinic consultation responded to the survey. 95% had their consultation via telephone, and 5% by email. 80% reported satisfaction with the experience. 85% received timely notice of their appointment, but 50% of patients did not receive a telephone call at the scheduled time. 80% of patients thought they had enough time with the doctor. Some patients who were travelling from outside Dublin found virtual clinics more convenient. 50% of patients want to continue virtual consultations post Covid-19;the main criticism was that patients want to receive the call at the appointed time. 14 medical oncology trainees (of 18 invited)and 6 consultants (of 8 invited) responded to the survey. 92% of trainees and 100% of consultants believed virtual care is inferior to face to face care. 85% of junior doctors and 100% of consultants surveyed found clinical assessment more difficult via virtual consultation, but 76% of trainees and 100% of consultants found virtual clinics more time efficient. 62% of trainees reported face to face clinics as better for education from consultants. 80% of consultants believed the education of trainees was inferior in virtual clinics. 62% of trainees and 100% of consultants would like to continue virtual care in some form post Covid -19. Conclusions: Irish patients attending a tertiary academic cancer centre were mostly satisfied with the telephone consultations they had with their oncology team. Satisfaction rates were lower among the doctors than patients, reflecting doctors' difficulties in clinical assessment and teaching opportunities using virtual care. This survey highlights the need for more advanced technical platforms (including video calling and real time messaging) to provide excellent virtual care, as well as the development of new strategies for medical education through virtual clinics.

14.
Clinical Cancer Research ; 27(6 SUPPL 1), 2021.
Article in English | EMBASE | ID: covidwho-1816900

ABSTRACT

Introduction: The aim of this study was to evaluate the impact of COVID-19 on pathological diagnoses of cancer in Northern Ireland, and assess potential inequalities across subgroups of the population. Methods: Data from the four Northern Ireland pathology labs were used to assess trends in pathological cancer diagnoses from 1st March to 12th September 2020 overall and by cancer site, gender and age. These trends were compared to the same timeframe from 2017-2019. Results: Between 1st March and 12th September 2020 there was a 23% reduction in cancer diagnoses compared to the same time period in the preceding three years. Although some recovery occurred in August and September 2020, this revealed inequalities across certain patient groups. Pathological diagnoses of lung, prostate and gynaecological malignancies remained well below pre-pandemic levels. Males and younger/middle-aged adults, particularly the 50-59 year old patient group, also lagged behind other population demographic groups in terms of returning to expected numbers of pathological cancer diagnoses. Conclusions: There is a critical need to protect cancer diagnostic services in the ongoing pandemic to facilitate timely investigation of potential cancer cases. Targeted public health campaigns may be needed to reduce emerging inequalities in cancer diagnoses as the COVID-19 pandemic continues.

15.
International Journal of Pharmacy Practice ; 30(SUPPL 1):i15-i16, 2022.
Article in English | EMBASE | ID: covidwho-1816116

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.

16.
International Journal of Pharmacy Practice ; 30(SUPPL 1):i8-i9, 2022.
Article in English | EMBASE | ID: covidwho-1816112

ABSTRACT

Introduction: When prescriptions are being processed in pharmacies and an activity occurs that requires the return to a previous procedural step to correct the process, this is known as rework' (1). This may include labelling errors or the incorrect dispensing of medications, and ultimately adds to pharmacists' workload. Given that increasing community pharmacists' workload negatively affects their job satisfaction, well-being, and patient care, it is vital that rework is minimised in everyday practice. To date, little is known regarding the prevalence of this rework phenomenon in community pharmacies or how this might be prevented. Aim: To evaluate the cause and frequency of prescription rework in community pharmacies. Methods: A data collection form was created for community pharmacists to self-record the instances and causes of prescription rework occurring in their workplace across a two-week period. After piloting the form with two pharmacists in different pharmacies, community pharmacists in Ireland were invited to participate in the study using convenience sampling and snowballing. Only participating pharmacists were aware of when data collection was occurring in their pharmacy to minimise the Hawthorne effect with other staff (2). Descriptive statistics were used to describe rework frequency according to the different causes, as well as the pharmacist and pharmacy characteristics. Results: Eight participating pharmacists were recruited (four male and four female;median 4 years' post-qualification experience) from five independent pharmacies and three chain pharmacies. In total, 325 reworks were recorded across 65 days between June 2021 and August 2021. Rework was recorded on 92.9% of the study days, with an average of 5 reworks/day - whereby the average per pharmacist ranged from 1.82 to 15 reworks/day. The data collection form's pre-specified rework categories captured 91.7% of reworks, with the remainder assigned as other'. The three most frequent rework categories were those due to labelling errors (22.8%), prepared prescriptions which required opening and repackaging (15.1%), and medication owed to patients (13.9%). The people involved in reworks included: pharmacists alone (33.5%), technicians alone (20.3%), pharmacists and technicians (14.8%), pharmacists and patients (10.2%), and pharmacists and prescribers (4%). Conclusion: This study shows that rework happens regularly in community pharmacies and has provided an insight into the causes of rework in this setting. While individual pharmacist and pharmacy characteristics may have influenced rework frequency, it was not possible to conclusively establish these associations with the small sample size, due to the difficulty of recruiting pharmacists during the COVID-19 pandemic. These findings are valuable as they highlight areas where pharmacy staff can reduce rework and will help inform strategies to minimise this in future - thus reducing workload and facilitating more time for staff to focus on providing care to patients in community pharmacies.

17.
International Journal of Pharmacy Practice ; 30(SUPPL 1):i22-i23, 2022.
Article in English | EMBASE | ID: covidwho-1816104

ABSTRACT

Introduction: Housebound patients may face challenges to their medicines management due to reduced household mobility and potential lack of access to healthcare services. Previous literature has explored the medication-related needs of housebound patients from pharmacists' perspectives (1-2). However little work has focussed on the patient/family perspective. In this study, we used data obtained from those staying at home as much as possible during the COVID-19 pandemic to fill this gap. Aim: To explore home medicine practices and safety for people who were housebound during the COVID19 pandemic and to create guidance, from the patient/family perspective, for enabling pharmacists to facilitate safe medicine practices for this population. Methods: Interviews were carried out with people who were taking at least one long term medication and met the criteria for ?shielding' and/or were over 70 years of age during the first wave of the COVID-19 pandemic in the UK and/or their family carers. Respondents were recruited through patient and public involvement representatives, the research team's networks, and support groups. Potential participants were approached via personal contact and social media. Interviews were conducted by telephone or video conferencing and participants asked about their medicines management while staying at home. Inductive thematic analysis was carried out. Patient and public involvement representatives were involved in the data analysis alongside the researchers. Results: Fifty people were interviewed (16 males, 34 females;mean age 68 years, range 26-93 years). Interview data suggested diversity of experiences of medicines management while staying at home. Some respondents reported no or little change, others an initial crisis followed by re-stabilisation, and others that the pandemic was a tipping point, exacerbating underlying challenges and having negative effects on their health and wellbeing. Medicine safety issues reported included omitted doses and less-effective formulations being used. Participants also described experiencing high levels of anxiety related to obtaining medicines, monitoring medicines and feeling at risk of contracting COVID-19 while accessing medicine-related healthcare services. Key factors identified as facilitating a smooth transition included patients' own agency, support from family, friends and community, good communication with pharmacy staff, continuity of pharmacy services and synchronisation of medicines supply so that a maximum of one collection/delivery was required each month. Conclusion: The study findings that we have presented relate to the UK only;this may limit the generalisability of our findings to other countries. Findings from Ireland are in the process of being analysed and will provide a basis of comparison. In addition, more females took part than males, despite efforts to address this. However, our findings suggest pharmacy staff can support medicines management for people who are housebound by synchronisation of medicines supply, delivering medicines where possible, developing/raising awareness of alternative means of communication, providing continuity of pharmacy services and signposting any community support available.

18.
International Journal of Pharmacy Practice ; 30(SUPPL 1):i21-i22, 2022.
Article in English | EMBASE | ID: covidwho-1816102

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.

19.
Brain Injury ; 36(SUPPL 1):3, 2022.
Article in English | EMBASE | ID: covidwho-1815747

ABSTRACT

Acquired Brain Injury (ABI) consists of any trauma to the brain. While the world has been dealing with the Covid-19 pandemic, the prevalence of ABI is a pandemic of a silent nature which is nonetheless an emerging health burden. Global estimates suggest that traumatic brain injury (injury caused by an external force) affects 10 million people annually (Hyder et al., 2007). In light of Covid-19, those working in the field of Neuro-rehabilitation had to adapt in order to provide vital support and continued rehabilitation for those with ABI. Many services switched to a Tele-Rehabilitation (TR) strategy to allow rehab to continue remotely while maintaining physical distancing. TR has been widely utilized in countries such as the United States, and Australia, and has a strong evidence base for its efficacy. This presentation will use case studies to explore the adaptation of TR by an ABI Neuro-rehabilitation service, and discuss how we can use this time as an opportunity to reconceptualize the way we structure neuro-rehabilitation in Ireland to combat service shortages, and in doing so improve outcomes for our clients.

20.
Brain Injury ; 36(SUPPL 1):7, 2022.
Article in English | EMBASE | ID: covidwho-1815744

ABSTRACT

In March 2020 with the onset of the Covid-19 pandemic, Acquired Brain Injury Ireland as a specialist community rehabilitation service provider, moved from a face-to-face to a largely tele-rehabilitation model of service in the community. Our services are inter-disciplinary led with highly trained Rehabilitation Assistants working on a one-to-one basis with the client to implement the Individualised Rehabilitation Plan. Due to successive national lockdowns, social distancing measures and the health and safety risk posed by the pandemic, this model of service, largely provided in the person's home was on longer possible. Therefore, we quickly adapted to provide our range of interventions using a variety of online platforms and methods of engagement. Almost a year into the pandemic we conducted a survey of our clients which aims to provide a snapshot of how they are experiencing their usage of technology during the COVID-19 pandemic. The survey was administered using Survey Monkey software in February 2021 during our third National Level 5 lockdown. A total of nine questions were asked, eight multiple choice, one open-ended where respondents were invited to submit their ideas for the future use of technology in their rehabilitation. There were 134 respondents in total, all ABI Ireland clients currently using our services. Overall, clients' use of technology during the pandemic has been largely positive. In the main, they had access to the necessary equipment and broadband services that they needed to get on-line. Many continue to require on-going support to engage. The respondents provided ratings on how useful or not technology usage was during the pandemic and how easy/difficult they found using technology for rehabilitation, The research explored the advantages and disadvantages of using technology and respondents were asked to rate their future preferences. Finally, the research explores respondents' ideas for the future in relation to using technology. The responses were wide and varied with training in tech for cited, as well as information on the most appropriate apps/ online resources. More creative solutions are required for those with sensory, visual and hearing impairments. It is clear from our findings that, despite the drawbacks, technology has an important role in the future delivery of rehabilitation programs and that clients want to have a combination of in-person and tech responses available to them. Many respondents used the opportunity to point out that nothing takes the place of human contact.

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