The value of domiciliary medication reviews - a thematic analysis of pharmacist's views.

BACKGROUND: Domiciliary medication reviews are thought to enable comprehensive medication reviews centred around the needs of individuals. However, there is no clear consensus on where the value of these services lie. AIM: To determine the value of domiciliary medication reviews to service providers through semi-structured focus groups, interviews and thematic analysis. METHOD: Study participants were recruited from domiciliary medication review services provided in the United Kingdom. Semi-structured focus groups and interviews were analysed using thematic analysis. RESULTS: Six themes were identified: the scope of domiciliary medication review services, the professional role, advantages over traditional settings, disadvantages of domiciliary medication reviews for the professional, levels of engagement and outcomes. CONCLUSION: Pharmacy professionals believe that the domiciliary setting provides advantages over traditional healthcare settings when conducting medication reviews. They believe it enables a more in-depth review of an individual's medications and needs. The traditional clinical outcomes recorded by services may not be capturing the holistic impact of domiciliary medication reviews.

To What Extent Is the World Health Organization's Medication Safety Challenge Being Addressed in English Hospital Organizations? A Descriptive Study.

OBJECTIVES: Our study aimed to explore to what extent the priority areas and domains of the World Health Organization (WHO)'s third Global Patient Safety Challenge were being addressed in a sample of hospital organizations. METHODS: A qualitative approach was taken using a combination of focus groups, semistructured interviews, and documentary analysis in 4 UK teaching hospital organizations. A purposive sampling strategy was adopted with the aim of recruiting health care professionals who would be likely to have knowledge of medication safety interventions that were being carried out at the hospital organizations. Medication safety group meeting notes from 2017 to 2019 were reviewed at the hospital organizations to identify interventions recently implemented, those currently being implemented, and plans for the future. A content analysis was undertaken using the WHO's third Global Patient Safety Challenge priority areas and domains as deductive themes. RESULTS: All the domains and priority areas of the WHO Medication Safety Challenge were being addressed at all 4 sites. However, a greater number of interventions focused on "health care professionals" and "systems and practices of medication management" than on "patients and the public." In terms of the priority areas, the main focus was on "high-risk situations," particularly high-risk medicines, with fewer interventions in the areas of "transitions of care" and "polypharmacy." CONCLUSIONS: More work may be needed to address patient and public involvement in medication safety and the priority areas of transitions of care and polypharmacy. Comparative global studies would help build an international picture and allow shared learning.

The value of domiciliary medication reviews: a thematic analysis of patient views.

Background Medication reviews are recognised as essential to tackling problematic polypharmacy. Domiciliary medication reviews (DMRs) have become more prevalent in recent years. They are proclaimed as being patient-centric but published literature mainly focuses on clinical outcomes. However, it is not known where the value of DMRs lies for patients who participate in them. Objective To determine the value of domiciliary medication reviews to service users. Setting Interviews took place with recipients of domiciliary medication reviews residing in the London boroughs of Islington and Haringey. Method Semi-structured interviews analysed using thematic analysis. Main outcome measure Themes and sub-themes identified from interview transcripts. Results Five themes were identified: advantages over traditional settings, attributes of the professional, adherence, levels of engagement and knowledge. Conclusion For many patients, the domiciliary setting is preferred to traditional healthcare settings. Patients appreciated the time spent with them during a DMR and felt listened to. Informal carers felt reassured that the individual medication needs of their relative had been reviewed by an expert.

The outcome of domiciliary medication reviews and their impact: a systematic review.

OBJECTIVES: Medication reviews in the domiciliary setting are becoming more prevalent internationally. Understanding the benefits of these reviews is essential to ensuring quality healthcare services. To date there has not been a systematic evaluation of the outcomes of these services and their impact on patients. A systematic review of the literature was undertaken with a view to understanding the impact of medication reviews in this setting. Controlled and uncontrolled studies were included. Outcomes were categorised according to the ECHO model. A narrative synthesis was developed. KEY FINDINGS: Nineteen out of 31 papers included demonstrated an improvement in outcome. Clinical outcomes were the most commonly measured and humanistic outcomes the least commonly measured. Domiciliary medication reviews (DMRs) services are presented as providing benefit. However, it is difficult to quantify the impact of services from the published outcomes. SUMMARY: Future work should focus on demonstrating the meaningful changes to patients that DMRs have enabled.

Legal and professional implications of shared care: a case study in oral anticoagulation stroke prevention therapy.

BACKGROUND: Policy initiatives and technological advances enable the use of integrated shared care models of healthcare delivery whereby the focus of care is moved from the hospital to the community, and also of models where patients take increasing responsibility for monitoring and treatment. Such shifts may or may be perceived to change professional roles and responsibilities with implications to the delivery of a professionally and legally acceptable standard of care. We focus on oral anticoagulation and stroke prevention therapy to examine some possible professional and legal implications of the increasing use of shared care. METHODS: This paper sought to explore how changes in service delivery influence the discharge of professional responsibilities to patients receiving oral anti-coagulation therapy in the context of clinicians' legal and professional duties. We used a case study of the implementation of a distributed care anti-coagulation service. Qualitative data were collected using complementary methods: participant observation, reflective journaling and legal analysis. RESULTS: Concerns identified by this study included a fear of litigation among both hospital and community-based professionals, a reluctance to embrace an extended role, uncertainty among professionals about the extent of their responsibilities and associated difficulties around adequate exchanges of information. These concerns reflected uncertainty among professionals about the legal and professional scope of the duty of care they owed patients. CONCLUSION: The findings from this study emphasise the importance of clear role definition, communication and inter-agency cooperation for the successful implementation of a shared care service in which threats to professional and legal standards of care are minimised.

The role of the pharmacy technician in the skill-mixed district nursing team.

Registered nurses in the district nursing service delegate a broad range of medication administration activities to healthcare assistants. Although healthcare assistants have provided extra capacity, not all activities are suitable for delegation to unregulated practitioners. At the same time, their competency assessment is often patient-specific and demands significant registered nursing input. The purpose of this 6-month pilot programme was to test the premise that the employment of a pharmacy technician in the district nursing service would enhance productivity levels and deliver cost savings. Activities delegated included the administration of oral tablets and subcutaneous insulin and low molecular weight heparin injections. The evaluation found that the introduction of the pharmacy technician was associated with neither enhanced productivity nor more than modest cost savings. However, role redesign is a long-term activity and their role could be built on with further competency analysis.

Producing an information leaflet to help patients access high quality drug information on the Internet: a local study.

OBJECTIVES: To develop a patient information leaflet (PIL) to help local patients meet their drug information needs using the Internet, and to perform a preliminary evaluation of this tool. METHODS: Development--a cross-sectional survey of the drug information needs of local patients using a semi-structured questionnaire; assessment of websites offering free, consumer-orientated medicines information using set criteria; identification of consensus criteria to evaluate the quality of health-related on-line information; evaluation--views on a draft patient information leaflet from a focus group. RESULTS: Those surveyed felt that being directed to high-quality websites and being provided with assessment criteria for on-line information would be useful. The three websites fulfilling most of the set quality criteria were Surgery Door (www.surgerydoor.co.uk), InteliHealth (www.intelihealth.com) and medlineplus (www.nlm.nih.gov/medlineplus). The six most frequently cited assessment criteria were currency, authorship, commerciality, relevance, links and attribution. A draft leaflet was constructed listing the above three websites and six criteria along with tips on how to search the Internet effectively. A focus group reacted favourably. CONCLUSION: The Internet is a source of drug information--an information leaflet may help to guide local patients through its variable information quality.