Mindfulness for people with chronic pain: Factors affecting engagement and suggestions for programme optimisation.

INTRODUCTION: Chronic pain is a common, multifactorial condition and pharmacological treatments have limited benefits. Mindfulness is a holistic approach that might be of value in the management of chronic pain. However, attrition rates from mindfulness-based interventions are high and factors affecting engagement are unknown. The aim of this study was to inform the design of a mindfulness programme that would be accessible and acceptable for people with chronic pain. METHODS: Interpretative phenomenological analysis of interview data from people with chronic pain who had taken part in an 8-week mindfulness programme based on mindfulness-based stress reduction revealed factors affecting engagement with and suggestions for tailoring the programme. Factors were grouped into physical, psychological and social domains. Further suggestions for tailoring the programme to address these factors were generated through a nominal group of healthcare professionals and a focus group with service users who had chronic pain. FINDINGS: Physical factors included disability and discomfort with some practices; psychological factors included expectations of the mindfulness programme and understanding the relationship between mindfulness and pain; and social factors included loneliness and support from others. The proposed modifications to the mindfulness programme supported by healthcare professionals and/or service users to address these are described in this paper. PUBLIC CONTRIBUTION: This study involved public contributions at a number of stages. The University of Aberdeen Division of Applied Health Sciences Service User Group (who were members of the public with chronic pain) was involved in the design of the study. Patients with chronic pain recruited from general medical practice who took part in the mindfulness programme were interviewed on their experience of the programme. Patients with chronic pain who attended the mindfulness programme, and healthcare professionals with expertise in chronic pain and/or mindfulness, attended meetings to design a tailored mindfulness programme for people with chronic pain.

"I'm empowered to look after myself" - Mindfulness as a way to manage chronic pain: An interpretative phenomenological analysis of participant experiences in Scotland.

BACKGROUND AND PRIMARY AIM: Chronic pain is a common problem that can impact on psychological and social wellbeing and activity levels. Despite pharmacological treatments, there is often a lack of improvement in physical and emotional functioning and health-related quality of life. Mindfulness meditation has become an increasingly popular self-management technique. The aim of the study was to explore the experiences of patients with chronic pain who took part in a mindfulness programme. METHODS: A mixed-methods feasibility study was carried out. Participants were aged 18 years or over with non-malignant chronic pain recruited from general medical practices in Fort William, Scotland. In 2013 participants undertook an eight-week mindfulness programme based on Mindfulness-Based Stress Reduction (MBSR) and were interviewed immediately post-programme and at eight-months' post-programme. Analysis of qualitative data involved Interpretative Phenomenological Analysis (IPA). FINDINGS: Thirty-four patients consented to take part in the study; twenty-four took part in the programme (14 attended four or more sessions, 10 attended one to three). Twenty-three were interviewed. Participant experiences of the programme were themed under: factors affecting experience (influence of earlier life events; the process of taking part in, and of relating to, the programme); and effects of the programme (impact on emotions, mental health, adverse events and a process of change). The process of change, resulting after better understanding the relationship between mindfulness and pain, involved learning to 'listen to the body', gaining a sense of community, learning to accept pain, and approaching life with more self-care, awareness, appreciation and empowerment. CONCLUSION: Participants reported a variety of experiences. For some, these included undergoing a process of change which may have supported them in living with their painful condition. This contributes to our understanding of how mindfulness could benefit people with chronic pain.

Consumer internet purchasing of medicines using a population sample: A mixed methodology approach.

BACKGROUND: Malta has an average of 3-4 private community pharmacies per locality, providing patients with easy access to medicines yet according to general statistics gathered from European organisations, Internet is used to purchase various online products with medicines being amongst them. OBJECTIVES: To identify patterns around internet purchasing of medicines among Maltese residents. METHODS: The study followed a mixed methods approach, employing a cross-sectional survey followed by semi-structured interviews. A random sample of 1996 residents were selected from the Maltese electoral register to participate in a postal questionnaire designed to gather data about purchasing prescription-only-medicines (POM) as well as over-the-counter (OTC) medicines. Results were analysed using descriptive statistics and Chi-square to establish associations between responses. Five interviews investigated participants' concerns related to sourcing of medicines. The participants were purposively chosen from the questionnaire respondents. Data were analysed using thematic analysis. RESULTS: The survey had a 22% response rate (N = 444) (60% female; mean age 52 years ±â€¯17). Two (0.45%) participants reported purchasing POMs online in the past, while 4.3% (n = 19) purchased OTCs including vitamins, supplements and herbal combinations. The main reasons for OTC online purchasing were lack of local availability (n = 6; 1.4%) and lower price (n = 11; 2.5%). A total of 89% (n = 395) of respondents provided a reason for not purchasing online, with safety issues being the primary reason for 41% (n = 181) of these. Interviewees expressed disregard towards internet purchasing of medicines that was evident from the themes that emerged: definition of 'medicines', health autonomy and trust in self-care, relationships and trust in health professional, restrictions of medicine supply, influence of cost, need for options. CONCLUSIONS: The Maltese appear to be rather cautious and do not purchase POMs online, citing the risks that may be associated with internet purchasing. With regards to OTCs, a small percentage purchase these online and exposing them to risks associated with unauthorised sites.

Defining the Role of the Pharmacy Technician and Identifying Their Future Role in Medicines Optimisation.

BACKGROUND: Traditionally, pharmacy technicians have worked alongside pharmacists in community and hospital pharmacy. Changes within pharmacy provide opportunity for role expansion and with no apparent career pathway, there is a need to define the current pharmacy technician role and role in medicines optimisation. AIM: To capture the current roles of pharmacy technicians and identify how their future role will contribute to medicines optimisation. METHODS: Following ethical approval and piloting, an online survey to ascertain pharmacy technicians' views about their roles was undertaken. Recruitment took place in collaboration with the Association of Pharmacy Technicians UK. Data were exported to SPSS, data screened and descriptive statistics produced. Free text responses were analysed and tasks collated into categories reflecting the type of work involved in each task. RESULTS: Responses received were 393 (28%, n = 1380). Results were organised into five groups: i.e., hospital, community, primary care, General Practitioner (GP) practice and other (which included HM Prison Service). Thirty tasks were reported as commonly undertaken in three or more settings and 206 (84.7%, n = 243) pharmacy technicians reported they would like to expand their role. CONCLUSIONS: Tasks core to hospital and community pharmacy should be considered for inclusion to initial education standards to reflect current practice. Post qualification, pharmacy technicians indicate a significant desire to expand clinically and managerially allowing pharmacists more time in patient-facing/clinical roles.

The influence of organisational climate on care of patients with schizophrenia: a qualitative analysis of health care professionals' views.

BACKGROUND: Organizational climate relates to how employees perceive and describe the characteristics of their employing organization. It has been found to have an impact on healthcare professionals' and patients' experiences of healthcare (e.g. job satisfaction, patient satisfaction), as well as organizational outcomes (e.g. employee productivity). This research used organizational theory to explore dynamics between health care professionals (pharmacists, doctors and nurses) in mental health outpatients' services for patients taking clozapine, and the perceived influence on patient care. SETTING: Seven clozapine clinics (from one NHS mental health Trust in the UK) which provided care for people with treatment resistant schizophrenia. METHODS: This study used qualitative methods to identify organizational climate factors such as deep structures, micro-climates and climates of conflict that might inhibit change and affect patient care. Using Interpretative Phenomenological Analysis, semistructured interviews were conducted with 10 healthcare professionals working in the clinics to explore their experiences of working in these clinics and the NHS mental health Trust the clinics were part of. MAIN OUTCOME MEASURE: Health Care Professionals' perceptions of the care of patients with treatment resistant schizophrenia. RESULTS: Three superordinate themes emerged from the data: philosophy of care, need for change and role ambiguity. Participants found it difficult to articulate what a philosophy of care was and in spite of expressing the need for change in the way the clinics were run, could not see how 'changing things would work'. There was considerable role ambiguity with some 'blurring of the boundaries between roles'. Factors associated with organizational climate (role conflict; job satisfaction) were inhibiting team working and preventing staff from identifying the patients' health requirements and care delivery through innovation in skill mix. There were mixed attitudes towards the pharmacist's inclusion as a team member. CONCLUSIONS: Our findings suggest deficiencies within the clinics that may be manifestations of the wider culture of the NHS. The implications for mental health outpatient clinics are that local initiatives are crucial to the implementation of recovery models; clear guidance should be provided on the skill mix required in clozapine clinics and interprofessional learning should be encouraged to reduce role conflict.

Relationship between personality traits and pharmacist performance in a pharmacy practice research trial.

BACKGROUND: Pharmacy practice research is one avenue through which new pharmacy services can be integrated into daily pharmacy practice. However, pharmacists' participation in this research has not been well characterized. Drawing from the literature on work performance and personality traits, 4 hypotheses were developed to gain insight into pharmacists' performance in a pharmacy practice research trial. METHODS: This study was an observational, cross-sectional survey of pharmacists participating in a research trial. All pharmacists were asked to complete the Big Five Inventory (BFI), a validated, reliable instrument of personality traits. These results were then compared with measures of pharmacists' performance in the trial. RESULTS: Thirty pharmacists expressed interest in participating in the trial; 23 completed the BFI and 14 actively participated in the pharmacy practice research trial. No statistically significant differences were identified in the examination of the predetermined hypotheses. Exploratory analyses revealed significant relationships between the BFI trait of extroversion and pharmacists' participation in the study, obtaining prescribing authority for the study and the number of patients lost to follow-up. DISCUSSION: In addition to identifying a number of personality traits that have been shared by other samples of pharmacists, this work suggests the possibility of an interaction between pharmacists' personality traits and their performance in a pharmacy practice research trial. CONCLUSION: Future research should better characterize the relationship between pharmacists' personality traits and participation in pharmacy practice research trials to gain insight into the context of pharmacy practice and how pharmacists are integrating this research into their practices.

Comparison of sole nurse and team-delivered community clozapine services for people with treatment-resistant schizophrenia.

AIM: To compare sole nurse and doctor-led multidisciplinary team delivery of community clozapine services for people with treatment-resistant schizophrenia. BACKGROUND: Around 20% of people with schizophrenia are treatment resistant and fail to respond to front line medications. Clozapine, a second-line treatment, has potentially serious side effects requiring regular monitoring. Different models of community clozapine services are emerging in the British National Health Service, but there is little evidence about which is best. DESIGN: Questionnaire survey of service users. METHODS: All patients on the lists of seven clozapine clinics (four sole nurse, three multidisciplinary team) in one trust were invited to participate, 2009-2010. Forward stepwise regression was used to investigate associations between patient well-being, functioning, self-efficacy and satisfaction, and clinic model attended, controlling for socio-demographic and health characteristics and processes of care. Use (and costs) of other health and social services accessed was compared between models. RESULTS: Sixty-six service users (35% participation rate) responded. Well-being and functioning were associated with patient characteristics and processes of care, not clinic model. Patients managed by sole nurses reported, over 3 months: more community psychiatric nurse visits and hospital psychiatrist appointments. Clinic list size affects costs per patient. CONCLUSIONS: Multidisciplinary team delivery may reduce use of other services. Although multidisciplinary team delivery is regarded as best practice, sole nurses can effectively provide clozapine services and may be warranted in areas of low population density.

Personality traits of hospital pharmacists: toward a better understanding of factors influencing pharmacy practice change.

BACKGROUND: The profession of pharmacy has adopted a mandate to become more patient-centred; however, significant change in this direction has not been achieved. OBJECTIVE: To characterize the personality traits of hospital pharmacists in one Canadian province, to provide insights into potential barriers to practice change. METHODS: A cross-sectional survey of hospital pharmacists was conducted in Alberta, Canada. An invitation to participate was sent to all 766 hospital pharmacists practising in the province's 2 health service organizations. The survey was based on the Big Five Inventory, a validated, reliable instrument that uses a 5-point Likert scale to measure the traits of extraversion, agreeableness, conscientiousness, neuroticism, and openness. RESULTS: Of the 347 pharmacists who completed the survey (45% response rate), the majority (297 [86%]) were staff pharmacists working full time in an urban setting. The average age of respondents was 41 years (standard deviation [SD] 11 years), and the average period in practice was 17 years (SD 11 years). Respondents' mean scores were 3.2 (SD 0.7) on extraversion, 3.8 (SD 0.4) on agreeableness, 4.0 (SD 0.4) on conscientiousness, 2.5 (SD 0.7) on neuroticism, and 3.5 (SD 0.6) on openness. Total frequency counts revealed that respondents tended toward stronger expression of extraversion, agreeableness, conscientiousness, and openness and low levels of neuroticism (with the latter indicating stability). CONCLUSION: The Big Five Inventory represents a novel approach to examining pharmacists' change-related behaviours. Improving understanding of hospital pharmacists' personality traits will provide insights for the development of training and support programs tailored specifically to this group.

CONTEXTE: La profession de la pharmacie s'est donné pour mandat d'être plus axée sur le patient, mais les changements importants pour y parvenir n'ont pas été au rendez-vous. OBJECTIF: Caractériser les traits de la personnalité des pharmaciens d'hôpitaux d'une province canadienne afin de dégager une meilleure compréhension des obstacles potentiels aux changements dans la pratique. MÉTHODES: Une enquête transversale a été menée en Alberta, au Canada, auprès de pharmaciens d'hôpitaux. Une invitation à y participer a été envoyée aux 766 pharmaciens d'hôpitaux exerçant dans les deux organismes de services de santé de la province. L'enquête était basée sur l'Inventaire des cinq grands facteurs de personnalité (Big Five Inventory), un instrument validé et fiable utilisant une échelle de Likert à 5 points pour mesurer l'extraversion, l'agréabilité, la conscience, le névrosisme et l'ouverture. RÉSULTATS: Des 347 pharmaciens ayant participé à l'enquête (taux de réponse de 45 %), la majorité (297 [86 %]) était des pharmaciens pratiquant à temps plein en milieu urbain. L'âge moyen des répondants était de 41 ans (écart-type [ÉT], 11 ans) et la période d'exercice moyenne était de 17 ans (ÉT, 11 ans). Les scores moyens des répondants étaient les suivants : extraversion : 3,2 (ÉT, 0,7); agréabilité : 3,8 (ÉT, 0,4); conscience : 4,0 (ÉT, 0,4); névrosisme : 2,5 (ÉT, 0,7); et ouverture : 3,5 (ÉT, 0,6). Le nombre total d'occurrences a révélé une tendance des répondants à une plus forte expression des facteurs d'extraversion, d'agréabilité, de conscience et d'ouverture, et à un faible taux de névrosisme (ce dernier facteur exprimant la stabilité émotionnelle). CONCLUSION: L'Inventaire des cinq grands facteurs de personnalité représente une approche novatrice pour évaluer les comportements des pharmaciens face au changement. Une meilleure compréhension des traits de personnalité des pharmaciens d'hôpitaux permettra de dégager les données nécessaires au développement de programmes de formation et de perfectionnement propres à ce groupe. [Traduction par l'éditeur].

Pharmacists and nurses as independent prescribers: exploring the patient's perspective.

BACKGROUND: Little is known about patients' opinions upon the development of non-medical prescribing (NMP). OBJECTIVE: To explore the opinions of patients on the development of NMP. METHODS: In-depth interviews using qualitative methodology (Interpretative Phenomological Analysis). Eighteen interviews were undertaken in Bristol (Sites 1 and 3), Swindon (Site 2) and Brighton (Site 4). [Site 1 = primary care, GP prescriber (n = 5), Site 2 = secondary care, consultant prescriber (n = 5), Site 3 = primary care (n = 5) and Site 4 = secondary care (n = 3) (both pharmacist supplementary prescribers.] Participants (n = 18) were randomly sampled from patients under the care of the participating prescriber. Participants were aged between 42 and 81 years of age (n = 11 male and n = 7 female). Interviews took place between January and August 2006. RESULTS: Participants expressed concerns about clinical governance, privacy and whether sufficient space were available to provide the service in community pharmacies. Participants acknowledged the expert drug knowledge of pharmacists and their accessibility. These factors enhanced acceptability of this role for pharmacists. Nurses were highly regarded, accepted and preferred as prescribers with few concerns. CONCLUSIONS: The results indicate support for pharmacists and nurses as prescribers, which aid successful implementation. Further research may be needed to evaluate the level of understanding that the public has of NMP and their views of the service once NMP is more widely established. Stakeholders should be mindful that the public may be hesitant regarding the professionalism, quality and clinical governance standards of clinics in community pharmacies in particular.

What happens when doctors are patients? Qualitative study of GPs.

BACKGROUND: Current evidence about the experiences of doctors who are unwell is limited to poor quality data. AIM: To investigate GPs' experiences of significant illness, and how this affects their own subsequent practice. DESIGN OF STUDY: Qualitative study using interpretative phenomenological analysis to conduct and analyse semi-structured interviews with GPs who have experienced significant illness. SETTING: Two primary care trusts in the West of England. METHOD: A total of 17 GPs were recruited to take part in semi-structured interviews which were conducted and analysed using interpretative phenomenological analysis Results: Four main categories emerged from the data. The category, 'Who cares when doctors are ill?' embodies the tension between perceptions of medicine as a 'caring profession' and as a 'system'. 'Being a doctor-patient' covers the role ambiguity experienced by doctors who experience significant illness. The category 'Treating doctor-patients' reveals the fragility of negotiating shared medical care. 'Impact on practice' highlights ways in which personal illness can inform GPs' understanding of being a patient and their own consultation style. CONCLUSION: Challenging the culture of immunity to illness among GPs may require interventions at both individual and organisational levels. Training and development of doctors should include opportunities to consider personal health issues as well as how to cope with role ambiguity when being a patient and when treating doctor-patients. Guidelines about being and treating doctor-patients need to be developed, and GPs need easy access to an occupational health service.

Experiencing "the other side": a study of empathy and empowerment in general practitioners who have been patients.

Work-related pressures and susceptibility to health problems mean that many general practitioners (GPs) will, at some stage, experience the role of patient. However qualitative evidence about their experiences of illness and patienthood is sparse. Our study offers an interpretative perspective on GPs' experiences of illness and the influence that this has had on their practice. Seventeen GPs who had experienced significant illness took part in semistructured interviews. Data were analyzed using interpretative phenomenological analysis (IPA). The findings highlight the relationship between empathy and empowerment and explore the role of self-disclosure of GP status by GPs in consultations. We make suggestions as to how empathy in doctor-patient relationships can be developed through consideration of power and status as well as through interaction with patients from similar backgrounds. Future research should focus on more specific ways to integrate these ideas into medical training.

Clinical governance issues arising from the Mental Health and Learning Disabilities Pharmacy Workforce Survey (England) 2006.

OBJECTIVES: In the last 10 years changes in the Government's agenda for medicines management and improved patient safety have resulted in unprecedented calls for the provision of mental health pharmacy services. This has not been reflected in pharmacy workforce planning or budgets. We aim to ascertain pharmacy staffing levels in Mental Health Trusts and whether supply of medicines and delivery of clinical pharmacy services are at an appropriate level. METHODS: All Chief/Lead Pharmacists for Mental Health Trusts in England were sent a questionnaire. Follow-up was done twice by e-mail at 2-week intervals. KEY FINDINGS: The response rate was 48% (n = 38 usable questionnaires), and results showed that many Trusts were providing little more than a basic supply service. Pharmacy services equating with risk-management were often provided on an ad hoc basis. Staffing levels were reported as insufficient, with mainly part-time staff. A basic pharmacy ward visit was only offered by 60.8% (n = 14/23; not all participants answered all questions) of respondents, at the 100% level (i.e. a daily service). Six of 31 respondents receiving pharmaceutical services from external organisations reported no formal signed agreements with the external provider. CONCLUSIONS: The increasing emphasis on community-based mental health teams, while still retaining on-site provision and Department of Health initiatives to improve patient safety via medicines management, has placed great strain on mental health pharmacy services. The resultant pharmaceutical input from external drivers is not reflected in appropriate pharmacy staffing levels. The results raise some serious governance issues.

The changing nature of prescribing: pharmacists as prescribers and challenges to medical dominance.

This paper investigates the potential threat to medical dominance posed by the addition of pharmacists as prescribers in the UK. It explores the role of prescribing as an indicator of professional power, the legitimacy and status of new pharmacist prescribers and the forces influencing professional jurisdictional claims over the task of prescribing. It draws upon 23 interviews with pharmacist supplementary prescribers. Data suggest that the legitimacy of pharmacists as prescribers, as experienced in the workplace, has been aided by: (1) blurred definitions of prescribing; (2) the emphasis on new prescribers' competence urging pharmacist prescribers to limit their areas of clinical practice; and (3) a team approach to patient management. Competence, self-limitation on practice and the benefits of team working as part of the ideology of patient safety were thus an important influence on pharmacists' jurisdictional claim over prescribing. While pharmacists have successfully negotiated a role for themselves as prescribers, medicine has retained its high status, relative to other health professionals and with patients; it controls the knowledge base relevant for prescribing practice and has managed to develop an 'overseer' role over the process of prescribing. Prescribing, as an indicator of medicine's autonomy of control over their work and professional status, has changed. Yet the extent to which new prescribers have been able to threaten the professional dominance of medicine is debatable.