Developing, Implementing, and Evaluating the Effectiveness of a Sleep Health Educational Module for Pharmacy Students.

OBJECTIVE: Pharmacists need sleep health knowledge and management skills to deliver evidence-based treatments to patients with sleep disorders/disturbances. This study aimed to develop, implement, and evaluate a pedagogically informed, interactive sleep health educational module for pharmacy students. METHODS: An educational module utilizing a flipped classroom approach, with an interactive lecture, student self-reflection of sleep patterns, case discussions, and pharmacist-patient role-play scenarios, was designed and implemented. A questionnaire assessing pre/post-module changes in knowledge about and attitudes toward sleep health as well as post-module learning satisfaction, was administered to all participating second-year pharmacy students at an Australian university. RESULTS: Mean total knowledge scores for participating students (n = 125, 70.4% female) improved significantly, from a baseline of 11.1 ± 3.8 to 17.1 ± 3.5 post-module (range: 0-25). Attitudes toward sleep health were moderately high at baseline (28.8 ± 3.2) and improved marginally post-module (29.4 ± 3.8) (range: 10-50); however, this increase was insignificant. Participants expressed high satisfaction with the module through subjective feedback, and post-module reflective statements indicated plans for changing sleep behaviors. CONCLUSION: The results of this study have shown that a targeted educational module for pharmacy students improved sleep health knowledge. It appeared that positive attitudes toward sleep health were not significantly increased which may reflect a ceiling effect. Future modules should focus on attitudinal aspects of positive sleep health to enhance pharmacists' skills in providing clinically related sleep health care to patients with sleep disturbance.

Improving sleep health management in primary care: A potential role for community nurses?

AIMS: To explore community nurses sleep health practices and their perspectives on improving sleep health care provision. DESIGN: An exploratory study utilizing the qualitative description methodology. METHODS: Semi-structured interviews were conducted with community nurses from May 2019 - October 2021. Interviews were audio-recorded, transcribed, and subjected to an inductive thematic analysis using a constructivist-interpretive paradigm. RESULTS: Twenty-three Australian community nurses were interviewed. Participants frequently encountered sleep disturbances/disorders in their patients. Data analysis yielded three main themes: (1) Sleep health in the community serviced, (2) sleep health awareness and management, and (3) community nurses' A to Z of improving sleep health. The most common sleep disorder presentations were insomnia and sleep apnea. Although most community sleep apnea cases were appropriately managed, insomnia was often mismanaged. Participants described their sleep health knowledge as deficient, with the majority advocating for increased sleep-related education tailored to their profession. Other important factors needed for improving sleep health provision were standardized patient treatment/referral pathways, increased interprofessional collaboration, and sufficient time for patient consults. CONCLUSION: Community nurses service a patient population that requires increased sleep health care. However, they are currently underequipped to do so, leading to suboptimal treatment provision. Providing community nurses with the appropriate resources, such as increased sleep-related education and standardized treatment frameworks, could enable them to better manage sleep disturbance/disorder presentations, such as insomnia. IMPACT: Little is known about how community nurses care for patients with sleep disturbance/sleep disorders. This study found that contemporary sleep health care was lacking due to knowledge deficits, competing challenges, and a need for standardized care pathways. These findings can inform the development of targeted education/training and standardized guidelines for community nurses providing sleep health care to patients as well as the design of future practice models of care provision. PATIENT OR PUBLIC CONTRIBUTION: Previous research by authors has involved extensive engagement with patients and health professionals, such as community pharmacists, general practitioners, and naturopaths who play a role in sleep health in the primary health care sector. These previous research projects built a significant understanding of the patient and health practitioner experience and have provided the background to the concept and design of this study.

Australian Consultant Pharmacists' Potential Roles in Sleep Health Care: Exploring a New Avenue for Improving the Management of Insomnia.

BACKGROUND: The first-line treatment for insomnia is cognitive-behavioral therapy. However, there is persistent use of pharmacotherapy, particularly, sedative-hypnotics. Consultant pharmacists can provide medication review services for people using multiple medications. Therefore, they are well placed to provide sleep health/insomnia care with regard to sedative-hypnotic use and behavioral treatment recommendations/sleep health education. However, this avenue is, as yet, unexplored. OBJECTIVES: To explore consultant pharmacists' current sleep health-related provisions and what their perspectives are around developing/implementing a consultant pharmacist-led behavioral service for insomnia. METHODS: Qualitative semi-structured interviews were conducted with a convenience-based sample of consultant pharmacists. Interviews were audio-recorded, transcribed, and inductively analyzed. RESULTS: Twenty-four consultant pharmacists were interviewed. Three themes were gauged: 1) Trivializing insomnia and sleep health, 2) Providing patient-centered care, 3) Service implementation - What do we need to consider? Participants commonly dealt with older patients and frequently encountered patients with sleep complaints/taking sleep medications. Generally, it was believed that sleep health was given minimal priority, with other comorbidities taking precedence in health provisions. Patients' attitudes toward management approaches were regarded critical to future treatment developments. While interested in expanding their sleep health/insomnia practice, participants expressed the need for appropriate education/training, funding, and collaborative treatment frameworks. CONCLUSION: Insomnia/sleep health concerns are growing. Primary health professionals need to scale up their sleep health-care provisions to accommodate for this health demand. Consultant pharmacists are interested/willing to expand their sleep-related practice and provide evidence-based insomnia therapies; however, factors such as education/training, service configuration support, and patient attitudes should be addressed.

Sleep health management in community pharmacy: Where are we and where should we be heading?

BACKGROUND: Poor sleep health is now recognised as a significant risk factor for chronic diseases and is associated with considerable comorbidity and mortality. Community pharmacists are primary care clinicians with an integral role in sleep health promotion and chronic sleep disorder management; however, it is unclear to what extent this is currently being undertaken or what the perspectives of Australian community pharmacists regarding their role in sleep health are. OBJECTIVES: To explore community pharmacists' current sleep health practice and perspectives on the potential future of sleep health care in community pharmacy. METHODS: Qualitative semi-structured interviews were carried out with a maximally varied, convenience-based purposive sample of community pharmacists. Interviews were audio-recorded, transcribed verbatim and subjected to, in sequence; an inductive analysis followed by a deductive approach where the inductively derived thematic structure was used as a framework. RESULTS: Twenty-five community pharmacists from two Australian states were interviewed. Insomnia and obstructive sleep apnea (OSA) were the most frequently encountered sleep disorders in community pharmacy presentations. Four key themes were derived from the data: 1) Preparedness, 2) Approach, 3) Capabilities and 4) What needs to change? All participants reported that their sleep health knowledge was insufficient and emphasized the need for more education and training. Although some were engaged in providing OSA services, none of the participants offered services for insomnia or other sleep disorders. Time/task pressures, low health system/health care professional sleep health recognition/awareness and the lack of standardised pharmacy-specific sleep health management guidelines were commonly cited barriers for sleep health service provision. CONCLUSION: Community pharmacists commonly manage day-to-day sleep health; however, most expressed a need for increased sleep health recognition/awareness by the health system, targeted education/training for pharmacists and support for the future provision of community pharmacy-delivered sleep health services. With the appropriate implementation strategies, community pharmacists could utilise their availability and accessibility to improve the future of primary care sleep health management.

The Syrian refugee crisis in Jordan: a cross sectional pharmacist-led study assessing post-traumatic stress disorder.

BACKGROUND: The United Nations has declared the Syrian crisis as the worst humanitarian crisis of the twenty-first century. Pharmacists play a vital role in humanitarian aid and in delivering health advices for refugees. Many Syrian refugees are in need of psychosocial assessments. OBJECTIVE: Objective of this study was to investigate the prevalence of post-traumatic stress disorder (PTSD), assessed by pharmacists among Syrian civilian refugees residing in Amman, Jordan. METHODS: A cross-sectional study involving Syrian civilian refugees living in Amman, Jordan, was conducted using the published and validated Arabic version of the Harvard Trauma Questionnaire (HTQ). Pharmacists recruited civilian Syrian refugees and completed the HTQ. The questionnaire included 45 questions, with the first 16 questions (HTQ-16) intended to assess the trauma symptoms felt by refugees. Assessments were done by the pharmacists and refugees were categorized to suffer PTSD if their mean item score for the HTQ-16 scale was > 2.5. RESULTS: Study participants (n=186; mean age 31.5 years; 51.3% males) had a HTQ-16 mean score of 2.35 (SD=0.53), with a range of 1.19 - 3.63. Over a third of participants (38.7%) were categorized as having PTSD. Males reported significantly worse PTSD symptoms (mean=2.42, SD=0.50) compared to females (mean=2.26, SD=0.57). Correlation between the mean item score for the HTQ-16 and characteristics of the study participants showed higher mean item score correlated with being a male, older in age, a smoker, and if trauma was experienced. CONCLUSIONS: Many Syrian civilian refugees living in Jordan suffer from PTSD. Male participants were found to be more affected by the severity of the disorder. Pharmacists are suitably situated to identify civilian Syrian refugees suffering from PTSD in dire need of help, paving the way for much needed healthcare resources to be delivered to this particular group of refugees.

The Syrian refugee crisis in Jordan: a cross sectional pharmacist-led study assessing post-traumatic stress disorder

Background: The United Nations has declared the Syrian crisis as the worst humanitarian crisis of the twenty-first century. Pharmacists play a vital role in humanitarian aid and in delivering health advices for refugees. Many Syrian refugees are in need of psychosocial assessments. Objective: Objective of this study was to investigate the prevalence of post-traumatic stress disorder (PTSD), assessed by pharmacists among Syrian civilian refugees residing in Amman, Jordan. Methods: A cross-sectional study involving Syrian civilian refugees living in Amman, Jordan, was conducted using the published and validated Arabic version of the Harvard Trauma Questionnaire (HTQ). Pharmacists recruited civilian Syrian refugees and completed the HTQ. The questionnaire included 45 questions, with the first 16 questions (HTQ-16) intended to assess the trauma symptoms felt by refugees. Assessments were done by the pharmacists and refugees were categorized to suffer PTSD if their mean item score for the HTQ-16 scale was > 2.5. Results: Study participants (n=186; mean age 31.5 years; 51.3% males) had a HTQ-16 mean score of 2.35 (SD=0.53), with a range of 1.19 - 3.63. Over a third of participants (38.7%) were categorized as having PTSD. Males reported significantly worse PTSD symptoms (mean=2.42, SD=0.50) compared to females (mean=2.26, SD=0.57). Correlation between the mean item score for the HTQ-16 and characteristics of the study participants showed higher mean item score correlated with being a male, older in age, a smoker, and if trauma was experienced. Conclusions: Many Syrian civilian refugees living in Jordan suffer from PTSD. Male participants were found to be more affected by the severity of the disorder. Pharmacists are suitably situated to identify civilian Syrian refugees suffering from PTSD in dire need of help, paving the way for much needed healthcare resources to be delivered to this particular group of refugees

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Role of the pharmacist in improving inhaler technique and asthma management in rural areas in Jordan.

INTRODUCTION: Pharmacists can have a valuable role in educating patients on correct inhaler technique leading to improved asthma management. Rural areas can benefit from the role of the pharmacist considering the barriers found in attending primary health-care facilities. OBJECTIVES: This study aimed to assess the impact of inhaler technique education delivered by pharmacists on patients' inhaler technique, Asthma Control Test (ACT) score, forced expiratory volume in the first 1 second (FEV1%), and reliever use (puffs/day). METHODS: A pre-post interventional study was conducted over 6 months from February 2017 to July 2017 in rural areas in Jordan. Asthma patients visiting respiratory clinics and using metered dose inhaler (MDI) or turbuhaler (TH) controlled medication were randomly recruited. Inhaler technique was assessed via published checklists. The ACT, FEV1%, and reliever use (puffs/day) were assessed. Patients were educated on inhaler technique via demonstration with return demonstration education. All assessments were repeated 3 months post education. RESULTS: A total of 103 (TH, n=44; MDI, n=59) patients were recruited (mean age=46.5±13.5), 74% females. Patients reported an overuse of their reliever (5.1±4.2 puffs/day). Only 2 patients (1.9%) had well-controlled asthma, while the rest had either moderately (19.4%) or poorly (78.6%) controlled asthma. Patients using the MDI achieved 3.03±4.30 ACT score improvement (p<0.001), which is a clinically significant improvement in control. Patients using the TH achieved a statistically significant improvement of 2.07±4.72 (p=0.031). FEV1% improved significantly for MDI users (p=0.005) but not for TH users (p=0.097). Reliever use decreased significantly for MDI and TH users. CONCLUSION: Asthmatic patients living in rural areas in Jordan reported poor inhaler technique, ACT scores, and FEV1% scores and high use of reliever medications. Pharmacist-led educational intervention resulted in improved inhaler technique scores, ACT scores, and FEV1% scores and lowered reliever use over time.