Patient information leaflets and package inserts of ibuprofen provided in the UK and Thailand: a comparative assessment.

OBJECTIVES: Written medicine information (WMI) is important for ensuring patients understand and use their medicines optimally, but relatively little research has assessed the quality of available WMI. This study assessed the quality of WMI using a sample of leaflets for ibuprofen in the UK and Thailand. METHODS: Leaflets were obtained by purchasing a product from retail outlets or community pharmacies, 18 from each country. In the UK, these were patient information leaflets (PILs); in Thailand, they were package inserts PIs not specifically designed for patients. Leaflets were assessed for content, layout, and readability using standard methods and compared to relevant guidelines. KEY FINDINGS: The UK PILs were uniform and conformed to EU regulatory requirements for content, whereas Thai PIs varied considerably, many failing to include important information required by Thai regulations. Several forms of Thai PIs were found, including some very short leaflets, containing minimal information. The readability of both was rated as poor, all used small font size and had less than desirable white space. Fewer Thai PIs than UK PILs met the Keystone Criteria for ibuprofen. CONCLUSIONS: The extent of variation in format and content of Thai WMI could potentially cause confusion and reduce willingness to read it. PILs, conforming to Thai regulatory guidelines, should be provided with medicines instead. Leaflets in both countries would benefit from improved readability and layout.

Patients' Experiences and Preferences for Medicine Information: An International Comparison Between Malaysia, Thailand, Uganda, and England.

Background: Verbal and written medicine information are available to the public but the quality, ease of access, ease of understanding and use of these resources varies greatly between countries. Timely access to quality medicine information is essential to support patient safety. Objective: This international cross-sectional survey, conducted in low-to high-income countries, aimed to compare experiences of and preferences for medicine information sources among respondents with recent medicine use. Methods: The survey was originally developed in England (Kent), then adapted and translated for use in southern Thailand (Songkhla), Malaysia (Klang Valley), and central Uganda (Kampala). Data were analysed using simple descriptive statistics and Chi-squared tests. Results: A total 1588 respondents were involved in the study. Community pharmacies were the primary source of medicines in all four countries (40.7 to 65.3%). Most respondents (1460; 92%) had received at least one form of information with their medicine, but provision of written medicine information (WMI) varied between countries. A manufacturer's leaflet was the most frequent information source for patients in England, while verbal information was common in Thailand, Malaysia and Uganda. There was commonality across countries in the desire for verbal information with or without WMI (1330; 84.8%); aspects of medicine information wanted most frequently were instructions on medicine use (98.3%), indication (98.2%), name (94.4%) and possible side effects (94.3%); and the importance of providing leaflets with all medicines (87.5%). Fewer than 10% in Uganda would use internet based WMI, compared to between 20% and 55% elsewhere. Conclusion: Preferences for medicine information are similar across countries: verbal information is seen as most desirable, and the most wanted aspects of information are common internationally. Accessibility and understandability are key influences on preferred information sources. In-country regulations and practices should ensure that all medicine users can access the information necessary to maximise safe medicine use.

Pharmacist prescriber smoking cessation intervention during the COVID-19 pandemic.

INTRODUCTION: During the pandemic, smokers who wished to access support to quit faced additional barriers. A smoking cessation service which utilized pharmacist independent prescribers working within community pharmacy was implemented. Clients received behavioral advice via a consultation with an advisor and then three consultations with a pharmacist, who prescribed varenicline, where appropriate. Consultations were by phone or video. This evaluation assessed the self-reported outcomes and experiences of clients and pharmacists. METHODS: A mixed-methods approach was used involving both on-line questionnaires to clients and interviews with a sample of questionnaire respondents and participating prescribing pharmacists. RESULTS: The questionnaire was completed by 85 clients with 59% reporting they had quit. Eleven clients and seven out of eight pharmacists were interviewed. Varenicline had been received by 96% of clients. The best aspects of the service reported by clients in the questionnaire and at interview were support received from the pharmacist and ease of access to varenicline. Clients regarded the service as being 'safe' to access during the pandemic. Nearly three-quarters of client respondents (72%) stated no service improvements were required. However, national supply challenges made collection of varenicline from the nominated pharmacy an issue. Some clients experienced a long wait-time before accessing the service. For pharmacists, the service offered flexibility including the opportunity to contact clients 'out of office' hours without distractions. However, not being physically in the pharmacy could result in them not being able to access the client's medicine history. Pharmacists identified that remote consultations were not ideal for all clients. CONCLUSIONS: Pharmacist prescribers can deliver effective smoking cessation services through remote consultations. Greater flexibility would allow the service to be tailored to the client's need.

Ageing with HIV: Medicine Optimisation Challenges and Support Needs for Older People Living with HIV: A Systematic Review.

BACKGROUND: Older people living with HIV (PLWH) are at increased risks of co-morbidities and polypharmacy. However, little is known about factors affecting their needs and concerns about medicines. This systematic review aims to describe these and to identify interventions to improve medicine optimisation outcomes in older PLWH. METHODS AND DATA SOURCES: Multiple databases and grey literature were searched from inception to February 2022 including MEDLINE, CINAHL, PsycInfo, PsychArticles, the Cochrane Database of Systematic Reviews and the Cochrane Controlled Register of Trials, Abstracts in Social Gerontology, and Academic Search Complete. ELIGIBILITY CRITERIA: Studies reporting interventions/issues affecting older PLWH (sample populations with mean/median age ≥ 50 years; any aspect of medicine optimisation, or concerns). Quality assessments were completed by means of critical appraisal checklists for each study design. Title and abstract screening was led by one reviewer and a sample reviewed independently by two reviewers. Full-paper reviews were completed by one author and a 20% sample was reviewed independently by two reviewers. SYNTHESIS: Data were extracted by three independent reviewers using standardised data extraction forms and synthesised according to outcomes or interventions reported. Data were summarised to include key themes, outcomes or concerns, and summary of intervention. RESULTS: Seventy-nine (n = 79) studies met the eligibility criteria, most of which originated from the USA (n = 36). A few studies originated from Australia (n = 5), Canada (n = 5), Spain (n = 9), and the UK (n = 5). Ten studies originated from Sub-Saharan Africa (Kenya n = 1, South Africa n = 6, Tanzania n = 1, Uganda n = 1, Zimbabwe n = 1). The rest of the studies were from China (n = 1), France (n = 1), Germany (n = 1), Italy (n = 1), the Netherlands (n = 1), Pakistan (n = 1), Switzerland (n = 1), Saudi Arabia (n = 1) and Ukraine (n = 1). Publication dates ranged from 2002 to 2022. Sample sizes ranged from 10 to 15,602 across studies. The factors affecting older PLWH's experience of and issues with medicines were co-morbidities, health-related quality of life, polypharmacy, drug interactions, adverse drug reactions, adherence, medicine burden, treatment burden, stigma, social support, and patient-healthcare provider relationships. Nine interventions were identified to target older persons, five aimed at improving medication adherence, two to reduce drug interactions, and two for medicine self-management initiatives. CONCLUSION: Further in-depth research is needed to understand older PLWH's experiences of medicines and their priority issues. Adherence-focused interventions are predominant, but there is a scarcity of interventions aimed at improving medicine experiences for this population. Multi-faceted interventions are needed to achieve medicine optimisation outcomes for PLWH. TRIAL REGISTRATION: This study is registered with PROSPERO registration number: CRD42020188448.

The Effectiveness and Value of Written Medicine Information Across Asia and Africa: Systematic Review.

Reviews on the role, value, effectiveness and desirable content of written medicine information (WMI) mostly include studies from high-income countries. We reviewed studies from Africa and Asia published between January 2004 and December 2019 to determine (1) the effect of WMI on knowledge and behaviour and (2) whether patients value WMI and their preferences for WMI. We included 16 intervention studies involving almost 3500 participants and 27 surveys of patients/public totalling over 11,000 people. Both the quality of the intervention studies and the reporting quality varied. Surveys were mostly localised, many with inadequate sampling strategies, and hence, were poorly representative of wider populations. However, most included a high proportion of participants with low educational levels. Most of the intervention studies reported significant improvements in knowledge and/or adherence after provision of WMI. Many utilised specially developed WMI in local languages, enhanced by pictograms. Provision of verbal information in addition to WMI showed variable impact. The proportion of people who read WMI, used as an indicator of its value, was reported in 15 surveys, with an overall figure of 74%. The most desirable aspects of WMI reported in 12 studies were indication, side effects, dose/instructions for use, contraindications, precautions and interactions. Nine studies reported local language was desirable. The studies suggest that WMI can improve both knowledge and adherence and is highly valued by people in many countries across Africa and Asia. Mechanisms should be considered by regulatory authorities and manufacturers to facilitate the provision of leaflets in local languages using simple terminology, perhaps enhanced by pictograms.This study is registered with PROSPERO, registration number: CRD42019127001.

Provision and Need for Medicine Information in Asia and Africa: A Scoping Review of the Literature.

Published reviews of written medicine information (WMI) have mainly drawn on studies published in high-income countries, including very few Asian or African studies. We therefore set out to scope the research literature to determine the extent and type of studies concerning WMI for patients/consumers across these two continents. We sought empirical studies published between January 2004 and December 2019, conducted in any Asian or African country, as defined by the United Nations, in English or with an English abstract. The majority of the 923 papers identified were from high-income countries. We retained 26 papers from Africa and 99 from Asia. Most African studies (n = 20) involved patients in the development of PILs, in the assessment of the effectiveness of PILs or in surveys. In contrast, the highest proportion of Asian studies concerned the content of WMI (n = 42). WMI is desired, but needs to be in local languages, and there needs to be more use made of pre-tested pictograms. Existing WMI frequently does not meet local regulatory requirements, particularly locally manufactured products. A number of studies reported potentially positive impacts of providing WMI on knowledge and medicine use behaviours. Provision of medicine information is essential for safe use of medicines in all countries. Internationally agreed guidelines, incorporating good design principles, are needed to ensure the optimal content and design of WMI. The World Health Organization should support African and Asian regulatory bodies to share best practice in relation to WMI for patients/consumers and to develop and implement pan-continental guidelines that take into account consumer needs and preferences.

Patients' Experiences and Perspectives of Receiving Written Medicine Information About Medicines: A Qualitative Study.

PURPOSE: Written medicine information informs patients about the benefits and risks of medicines and supports their safe and effective use. In Thailand, patient information leaflets (PILs) are not obligatory and therefore not routinely supplied. This study aimed to explore the experiences and information needs of patients, their views on PILs and the likely impact of PILs on their knowledge, perceptions and behaviors towards medicines. These factors are important to establish the value of PILs. METHODS: Semi-structured interviews with outpatients who received simvastatin or atorvastatin were conducted exploring their experiences of receiving medicine information, their views on the utility of and need for PILs, the impact of PILs on their behaviors, and recommendations for how PILs could be improved. All interviews were audio-recorded, transcribed verbatim, and analyzed using a framework approach. RESULTS: Thirty interviews were conducted from which four themes emerged: experience of receiving medicine information, views of package inserts and PILs, impact of PILs on knowledge, perceptions and behaviors, and patients' need for medicine information. Most participants received verbal information from healthcare professionals, as well as written information. Verbal information was perceived as being particularly useful to inform about changes to medicine regimens or the long-term adverse effects of medicines. Patients perceived that the PILs had influenced their knowledge about medicines, and also their behaviors including safety awareness, adherence, and engagement with healthcare professionals. Participants suggested that the information in electronic format could provide an additional resource. Some changes to improve the content and general format of the PIL were identified. CONCLUSION: PILs are perceived as useful by patients and met their information needs, although they were viewed as an adjunct to verbal advice provided by healthcare professionals. PILs influenced patients' medicine taking behaviors and encouraged sharing of information with their physicians.

Pharmacy services and role development in UK general practice: a cross-sectional survey.

BACKGROUND: The 'Clinical Pharmacists in General Practice' (CPGP) pilot provided a template for general practice pharmacy professionals' (GPPPs) roles encouraging NHS England to fund >2000 practice-based pharmacists. However, many GPPPs work outside the CPGP initiative and little is known about the services they provide. OBJECTIVES: To explore services provided by all UK GPPPs (pharmacists/pharmacy technicians), including the types of services, perceived benefits and barriers to role development. METHODS: A 26-item electronic questionnaire was developed using SurveyMonkey and piloted during cognitive interviews. A cross-sectional survey was conducted via social media, primary care organisations and emails to CPGP pilot sites between November 2018 and March 2019. Three reminders were sent 1 week apart. KEY FINDINGS: Ninety-one complete responses were received (81 pharmacists; 10 technicians). Over 80% of pharmacists provided clinical services, such as medication reviews or management of long-term conditions. More pharmacists within CPGP pilot managed repeat prescribing requests (P = 0.035). Technicians took responsibility for primarily non-clinical roles, including commissioning or safety alerts/drug recalls. A third of GPPPs wished to develop care home services. Perceived benefits of GPPPs' services included improved utilisation/development of professional skills, identifying medicines-related issues and reduction in medication waste. Respondents were satisfied with professional relationships but reported workload issues, limited patient awareness of their roles and restricted opportunities to contribute to service development, which was associated with unsatisfactory support/mentorship (P < 0.001). CONCLUSION: General practice pharmacy professionals deliver clinical and non-clinical services which may benefit patients, general practice and the healthcare system. General practices and national organisations should provide GPPPs with tailored support and exploit the combined strengths of pharmacists and pharmacy technicians to tackle increased workload.

The use of future scenario thinking for child public health in a local authority.

BACKGROUND: Socioeconomic, cultural, technological, environment and ecological changes are rapidly transforming how children and young people (CYP) grow up, yet their impacts on CYP are difficult to predict. The traditional ways that Public Health practitioners work may not capture such complex and dynamic change. To address this, Lambeth Council used future scenario thinking. METHODS: A literature review looked at political, socioeconomic and other 'transitions' in the borough. Interviews, focus groups and workshops were held with CYP, parents, carers, local statutory and non-statutory stakeholders about the future for Lambeth CYP in the decade ahead. Themes were analysed to identify which had the potential for the biggest impact or the most uncertainty. RESULTS: The main transitions were described, 100 stakeholders interviewed, and five 'drivers' of the future were identified: protracted austerity, technological explosion, demographic shift, 'democratic shake-up' and planetary health. From all these data, four future scenarios were developed: 'communities care for themselves', 'collaborating to care for all', 'nobody cares' and 'who cares?' CONCLUSIONS: New insights were gained about promoting more responsibility for, and active participation of CYP. This led to Lambeth's CYP Plan and the 'Made in Lambeth' campaign aiming to enlist the community and business in creating a child-friendly borough.

Opportunistic screening for atrial fibrillation by clinical pharmacists in UK general practice during the influenza vaccination season: A cross-sectional feasibility study.

BACKGROUND: Growing prevalence of atrial fibrillation (AF) in the ageing population and its associated life-changing health and resource implications have led to a need to improve its early detection. Primary care is an ideal place to screen for AF; however, this is limited by shortages in general practitioner (GP) resources. Recent increases in the number of clinical pharmacists within primary care makes them ideally placed to conduct AF screening. This study aimed to determine the feasibility of GP practice-based clinical pharmacists to screen the over-65s for AF, using digital technology and pulse palpation during the influenza vaccination season. METHODS AND FINDINGS: Screening was conducted over two influenza vaccination seasons, 2017-2018 and 2018-2019, in four GP practices in Kent, United Kingdom. Pharmacists were trained by a cardiologist to pulse palpate, record, and interpret a single-lead ECG (SLECG). Eligible persons aged ≥65 years (y) attending an influenza vaccination clinic were offered a free heart rhythm check. Six hundred four participants were screened (median age 73 y, 42.7% male). Total prevalence of AF was 4.3%. All participants with AF qualified for anticoagulation and were more likely to be male (57.7%); be older; have an increased body mass index (BMI); and have a CHA2DS2-VASc (Congestive heart failure, Hypertension, Age ≥ 75 years, Diabetes, previous Stroke, Vascular disease, Age 65-74 years, Sex category) score ≥ 3. The sensitivity and specificity of clinical pharmacists diagnosing AF using pulse palpation was 76.9% (95% confidence interval [CI] 56.4-91.0) and 92.2% (95% CI 89.7-94.3), respectively. This rose to 88.5% (95% CI 69.9-97.6) and 97.2% (95% CI 95.5-98.4) with an SLECG. At follow-up, four participants (0.7%) were diagnosed with new AF and three (0.5%) were initiated on anticoagulation. Screening with SLECG also helped identify new non-AF cardiovascular diagnoses, such as left ventricular hypertrophy, in 28 participants (4.6%). The screening strategy was cost-effective in 71.8% and 64.3% of the estimates for SLECG or pulse palpation, respectively. Feedback from participants (422/604) was generally positive. Key limitations of the study were that the intervention did not reach individuals who did not attend the practice for an influenza vaccination and there was a limited representation of UK ethnic minority groups in the study cohort. CONCLUSIONS: This study demonstrates that AF screening performed by GP practice-based pharmacists was feasible, economically viable, and positively endorsed by participants. Furthermore, diagnosis of AF by the clinical pharmacist using an SLECG was more sensitive and more specific than the use of pulse palpation alone. Future research should explore the key barriers preventing the adoption of national screening programmes.

Pharmacists detecting atrial fibrillation in general practice: a qualitative focus group study.

BACKGROUND: Atrial fibrillation (AF) affects up to 10% of people aged ≥65 years, yet a third of all cases remain undetected. Practice-based pharmacists are in an ideal position to facilitate opportunistic AF screening, while increasing general practice capacity at a time of workforce crisis. AIM: To explore the perspectives of three stakeholder groups involved in the 'Pharmacists Detecting Atrial Fibrillation' (PDAF) study to elucidate the facilitators and barriers to pharmacist-led AF screening in general practice. DESIGN & SETTING: A qualitative study took place, comprising homogeneous focus groups with stakeholders in Kent, UK. METHOD: The stakeholder groups - patients, general practice staff (GPS), and clinical pharmacists (CPs) - were recruited using convenience sampling. Audio-recordings were transcribed verbatim and analysed using a deductive Theoretical Domains Framework (TDF) approach. RESULTS: Twenty-five patients, four pharmacists, and nine practice staff participated in six focus groups. Three main themes were identified: knowledge and awareness; prioritisation of resources; and environmental considerations. The public's lack of awareness of AF-related risks and pharmacist-led screening services was highlighted. Practice-based pharmacists were perceived as an underutilised educational resource which, together with novel electrocardiogram devices, enabled convenient access to screening while reducing GPs' workload. Participants agreed that AF screening should be incorporated into personalised health checks and at-risk groups should be prioritised, such as care home residents. Patients favoured the general practice environment over the community pharmacy where concerns of privacy, staffing, and commercialisation were raised. CONCLUSION: The findings of this study support the introduction of pharmacist-led AF screening programmes in general practice surgeries. Commissioners should consider the added value of utilising CPs and focus on the delivery of AF screening within an integrated service.

A narrative review on the consultation tools available for pharmacists in the United Kingdom: do they facilitate person-centred care?

OBJECTIVES: To identify consultation tools cited in the published literature and undertake a narrative review which establishes their scope to support the delivery of person-centred medicine-focused consultations between community pharmacists and patients in the United Kingdom (UK). KEY FINDINGS: Nine consultation tools used in a pharmacy context were identified. Four tools (Calgary-Cambridge guide, MRCF, MUR and NMS advanced services and PaCT) were selected for further appraisal. None of the tools identified provided a suitable format or sufficient guidance to address all components required for the delivery of a person-centred patient consultation in practice. SUMMARY: Tools available to UK pharmacists are inadequate for fully supporting delivery of a person-centred consultation in practice. Revision of existing tools or creation of more pharmacy-specific tools will support UK pharmacists' delivery of person-centred consultations in practice.

Engaging patients to access the community pharmacy medicine review service after discharge from hospital: a cross-sectional study in England.

Background The post-discharge Medicines-Use-Review (dMUR) is a commissioned service in England and Wales whereby community pharmacists facilitate patients' understanding of their medicines and resolve any medicine-related problems. This service is poorly utilised. Objective To explore the impact of raising hospital patients' awareness of dMURs on their uptake. Setting Hospital in South East England. Method Patients on medical wards with at least one change (medicine, or dose regimen) to their admission medicines were provided with standardized written and verbal information about the service. Participants were responsible for their own medicines and anticipated that they would be discharged home. Structured telephone interviews conducted 4 weeks after discharge explored any medicine-related issues experienced, and reasons for engaging, or not, with the dMUR service. Responses to closed questions were analysed using descriptive statistics. Responses to open questions were analysed thematically. Ethics approval was obtained. Main outcome measure Proportion of patients who received a dMUR and their motivations or barriers to accessing the service. Results Hundred patients were recruited and 84 interviewed. Their mean (SD) age was 73 (11) years. They were taking a median (range) of 9 (2-19) medicines. 67% (56/84) remembered receiving information about dMURs. Nine (11%) had attempted to make an appointment although four had not received the service because the pharmacist was unavailable. Most (88%) were not planning to access the service. The most common reason given was poor morbidity or mobility (13/31, 42%). Conclusion The use of written and verbal information to encourage patients to use the dMUR service had minimal impact.

Development of a tool to support person-centred medicine-focused consultations with stroke survivors.

OBJECTIVE: To develop a tool to support medicine-focused person-centred consultations between community pharmacists and stroke survivors. METHOD: Semi-structured interviews with 15 stroke survivors and 16 community pharmacists were conducted. Thematic analysis of the data was performed and emerging themes examined to determine their relevance to the principles of delivering person-centred care. Findings were used to generate a framework from which a consultation tool was created. Face validity and the feasibility of using the tool in practice were explored with participating pharmacists. RESULTS: Three major themes were identified; personal, process and environmental factors. A tool, in two parts, was developed, A 'Getting to know me' form which would help the pharmacist to appreciate the individual needs of the stroke survivor and a consultation guide to facilitate the consultation process. Pharmacists considered that both were useful and would support a person-centred medicine-focussed consultation. CONCLUSION: A consultation tool, reflecting the needs of stroke survivors, has been developed and is feasible for use within community pharmacy practice. PRACTICE IMPLICATIONS: Pharmacists must recognise the individual needs of stroke survivors to ensure that they provide consultations which are truly person-centred. The tool developed could support medicine-related consultations with patients with other long term conditions.

Complexity of Medicine Regimens and Patient Perception of Medicine Burden.

From the patient perspective, medicine burden is more than the number of medicines, or the complexity of medicine regimens they need to manage. Relationships between the number of medicines, regimen complexity and patient perception of medicine burden are under-researched. This cross-sectional study measured regimen complexity and determined how this and patient perceived burden are affected by the therapeutic group. Regimen complexity was measured in patients presenting prescriptions to six community pharmacies in South-East England. A sub-sample (166) also completed the Living with Medicines Questionnaire which measures patient perceived burden. The 492 patients were prescribed 2700 medicines (range 1 to 23). Almost half used at least one non-oral formulation. Complexity was correlated strongly with the number of medicines (r = 0.94), number of therapeutic groups (r = 0.84) and number of formulations (r = 0.73). Patients using medicines for skin, eye and respiratory conditions had the highest complexity scores. Increasing the number of medicines, frequency of dosing, number of non-oral formulations and number of different therapeutic groups all increased medicine burden. Although cardiovascular medicines were the most common medicines used by the majority of patients (60%), those for neurological, psychiatric and gastro-intestinal conditions were most strongly associated with high burden. Studies are required to determine medicine burden in different conditions, especially neurological conditions, including chronic pain.

Longitudinal qualitative evaluation of pharmacist integration into the urgent care setting.

PURPOSE: To describe the most effective model for managing, educating, and training pharmacist advanced clinical practitioners (ACPs) in the urgent care center (UCC) setting, role evolution and how to measure their effectiveness. PARTICIPANTS AND METHODS: Ethical approval was obtained to perform a qualitative longitudinal cohort study in three sites, with three pharmacists in each trained as ACPs from 2016 to 2017. ACP role, location, management, mentorship, and supervision were locally determined. ACPs attended focus groups (FGs) at 1 and 3 months (sites 1-3), 6 and 12 months (site 1 only), and the UCC staff were interviewed once with a topic guide regarding training, integration, role, and impact. Verbatim transcriptions were analyzed thematically. RESULTS: Eight ACP FGs and 24 stakeholder interviews produced major themes of communication, management, education and training, role, and outcomes. Effective education, training, and integration required communication of role to address concerns regarding salary differentials, supportive management structure, and multi-professional learning. ACPs reported that the model of workplace training, experiential learning, and university-based education was appropriate. Training was better located in the minor injuries and general practitioner areas. Recommended measures of effectiveness included patient satisfaction and workload transfer. CONCLUSION: The education and training model was appropriate. Communication and management require careful consideration to ensure effective integration and role development. Pharmacists were better located initially in the minor illness rather than major trauma areas. Quality of patient experience resulting from the new role was important in addition to reassurance that the role represented a positive contribution to workload.

Patient experiences of the burden of using medicines for long-term conditions and factors affecting burden: A cross-sectional survey.

Many patients find using medicines burdensome. This paper reports the types of issues people experience with medicines, using a validated measure of medicines burden, and the factors associated with high burden. The cross-sectional study involved patients presenting prescriptions at pharmacies or awaiting appointments at GP practices or outpatient clinics, during October 2015 to December 2016. Adults using at least one regular medicine were asked to complete the Living with Medicines Questionnaire V3 (LMQ-3). The LMQ-3 contains 41 statements rated on a 5-point scale (strongly agree to strongly disagree), with higher scores indicating greater burden, plus a visual analogue scale for self-reporting of overall perceived burden (VAS-burden). For a subsample, access to their medication record was requested, facilitating calculation of the complexity of their medicine regimen using the Medicine Regimen Complexity Index (MRCI). Of 1,888 questionnaires distributed, 684 were returned (36.2%) and medication records obtained for 163. The median number of medicines respondents reported using was 4 (range 1 to 26). Two-thirds (418; 67.0%) used medicines more than once daily, 67 (10.1%) required assistance with medicines and 189 (28.3%) paid a prescription charge. LMQ-3 scores showed a strong positive relationship with VAS-burden scores (r = .547; p < 0.001). LMQ-3 and VAS-burden scores were lower in older age groups, but both increased with increasing number of medicines and dosing frequency. LMQ-3 score was positively related to MRCI score (n = 163; r = .217; p = 0.005), whereas VAS-burden was not. Older respondents reported lower burden in most domains. Higher numbers and frequency of medicines, paying prescription charges, needing support and deprivation increased burden across multiple domains. Factors strongly associated with high LMQ-3 scores were: needing support, high dosing frequency and unemployment. Interventions seeking to reduce medicines burden should consider targeting individuals who need support with using medicines, use at least four medicines, more than twice daily and/or pay prescription charges.

Development and validation of a revised instrument to measure burden of long-term medicines use: the Living with Medicines Questionnaire version 3.

OBJECTIVES: To revise the Living with Medicines Questionnaire version 2 (LMQ-2), which measures the burden of using prescribed medicines, to include cost and expand side effects and social issues. METHODS: New statements were developed and validated through cognitive interviews with medicine users, and these and a global visual analog scale (VAS) were added to the 42-item LMQ-2. Construct validity was assessed through exploratory and confirmatory factor analyses using an online public survey. Criterion-related validity was measured against the Treatment Satisfaction Questionnaire with Medication (TSQM-II) and the EuroQoL 5-level quality of life measure (EQ-5D-5L), in patients using community pharmacies, general practices, and outpatient clinics. Reliability was assessed by test-retest using online public distribution. RESULTS: The 58-item interim instrument (n=729) was reduced to 41 items after factor analysis, which confirmed an eight-domain structure: relationships with health professionals, practicalities, interferences, effectiveness, side effects, concerns, cost, and autonomy, constructed as medicine burden. All subscales, except autonomy, were loaded onto this construct and showed acceptable internal consistency. LMQ-VAS correlated with total LMQ scores (r=0.571). Criterion validation (n=422) demonstrated total LMQ scores negatively correlated with TSQM scores for global satisfaction (r=-0.616); domain scores showed similar correlations: effectiveness (r=-0.628), side effects (r=-0.597), and practicalities (r=-0.529). Total LMQ score was negatively correlated with EQ VAS (r=-0.383) and showed weak/moderate relationships with individual EQ-5D-5L dimensions. Test-retest (n=30) reliability showed intra-class correlation coefficients of 0.954 (total LMQ score), 0.733-0.929 (domain scores), and 0.789 (global item). CONCLUSION: The LMQ version 3 (LMQ-3) instrument has acceptable construct, criterion-related and known-groups validity, and is internally consistent as a measure of medicine burden, although reliability requires further confirmation. It could be used to measure the outcome of interventions designed to reduce the burden of polypharmacy.

Pharmacists detecting atrial fibrillation (PDAF) in primary care during the influenza vaccination season: a multisite, cross-sectional screening protocol.

INTRODUCTION: Atrial fibrillation (AF) affects >6% of people aged 65 years or older. Left undetected and untreated, patients may develop significant cardiovascular complications and have a fivefold increased risk of suffering a stroke. For 40% of all sufferers, AF can be asymptomatic. Every year in the UK, £2.2 billion is spent on AF-related strokes, so there is an urgent need to improve early detection of AF. This study aims to determine the feasibility of using trained clinical pharmacists based in general practices, to screen for AF, using pulse palpation and a single-lead ECG device on participants aged 65 years or older, attending influenza vaccination clinics. METHODS AND ANALYSIS: Seven clinical pharmacists will be trained by a cardiologist to pulse palpate and record single-lead ECGs using the AliveCor Kardia Mobile device. Quantitative analysis will assess the accuracy and ability of the clinical pharmacist to identify pulse irregularities using pulse palpation and to record and interpret a single-lead ECG. The level of agreement of pulse irregularities detected by pulse palpation will be compared with those detected by the single-lead ECG device, as will the level of agreement between the cardiologist and the device's interpretation of the ECG. The proportion of people identified with AF (confirmed by the cardiologist) will be determined. Additional demographic data will be obtained from all participants through a questionnaire. Qualitative data will be captured from the participants, from the clinical pharmacists and from the general practitioners and practice staff to determine their views on this method of AF screening. We aim to recruit 600 participants across general practices within Kent. ETHICS AND DISSEMINATION: This protocol was approved by the London-Riverside Research Ethics committee. The findings of this study will be disseminated through forums including, but not limited to, peer-reviewed journals, national and international conferences.