Undergraduate pharmacy students' perceptions and experiences of a student-led clinic providing preventative services.

OBJECTIVES: Authentic work-based learning is crucial to facilitate the development and preparedness for training healthcare professionals. Such experiences are challenging to design and secure within the clinical environment. One School of Pharmacy established a student-led clinic to provide undergraduate pharmacy students the opportunity to practise physical assessment and communication skills with members of the public. The aim of this study was to explore students' thoughts and perspectives on this experience. METHODS: Undergraduate students were invited to participate in a semi-structured interview after their clinic experience. Transcriptions of the interviews were analysed by reflexive thematic analysis. RESULTS: Twelve students agreed to an interview that took place between October and December 2022. Three themes were identified from the qualitative data which related to external factors that influenced student experience of the clinic, for example, organizational issues and impact of the physical environment; interactions within the clinic environment; and internalized learning for example, professional growth and development, and the appreciating the learning opportunity. CONCLUSIONS: In the current climate, where securing valuable work-based learning opportunity is challenging, student-led clinics offer an environment that is well-received by students and appears to facilitate student professional development. Student clinics are receiving more attention and investment across undergraduate healthcare programmes around the world given advantages such as these. However, they need to be well integrated and structured into the existing training and education and students need appropriate induction to prepare them for the experience and manage expectations.

The impact and user experience of a student-led clinic providing preventative services.

OBJECTIVES: Preventative services are required to address the risk factors for chronic conditions such as cardiovascular disease. The National Health Service Health Checks in England were introduced to provide such services. One School of Pharmacy established a student-led clinic to provide this service to the local community. The clinic was provided by undergraduate pharmacy students and delivered free of charge within a central city locality. The aim was to explore the impact of the clinic on user thoughts and motivations around healthy living and investigate user experience. METHODS: A sequential explanatory mixed methods approach was used consisting of a survey that measured users' thoughts about their health and well-being and experience of the clinic. Qualitative interviews explored the user experience and barriers and facilitators to making healthier lifestyle choices. RESULTS: One hundred and fifty-four members of the public accessed the clinic over the evaluative period. Ninety-six (60%) completed the pre-post survey and 12 participated in follow-up interviews. Users reported statistically significant improvements in how informed, competent and motivated they felt towards making healthier lifestyle choices after the clinic consultation. Interview findings highlighted the positive user experience, reported appreciation for clinic accessibility, availability of healthy lifestyle education, and a desire for more preventative services being as readily available. CONCLUSIONS: The student-led clinic has demonstrated positive impacts on user experience, knowledge, competence, and motivation to make healthier lifestyle choices. The clinic provides proof-of-concept for pharmacy students to deliver preventative community services that aim to improve population health at a time when primary care is experiencing unprecedented challenges.

Digital literacy in undergraduate pharmacy education: a scoping review.

OBJECTIVES: Conduct a scoping review to identify the approaches used to integrate digital literacy into undergraduate pharmacy programs across different countries, focusing on methods for education, training, and assessment. MATERIALS AND METHODS: Following the Joanna Briggs Institute methodology, we searched 5 electronic databases in June 2022: MEDLINE (Ovid), PubMed, Embase, Scopus, and CINAHL. Three independent reviewers screened all articles; data extraction was conducted by 2 reviewers. Any discrepancies were arbitrated by 2 additional reviewers. RESULTS: Out of 624 articles, 57 were included in this review. Educational and training approaches for digital literacy in undergraduate pharmacy programs encompassed a theoretical understanding of health informatics, familiarization with diverse digital technologies, and applied informatics in 2 domains: patient-centric care through digital technologies, and the utilization of digital technologies in interprofessional collaboration. Blended pedagogical strategies were commonly employed. Assessment approaches included patient plan development requiring digital information retrieval, critical appraisal of digital tools, live evaluations of telehealth skills, and quizzes and exams on health informatics concepts. External engagement with system developers, suppliers, and other institutes supported successful digital literacy education. DISCUSSION AND CONCLUSION: This scoping review identifies various learning objectives, teaching, and assessment strategies to incorporate digital literacy in undergraduate pharmacy curricula. Recommendations include acknowledging the evolving digital health landscape, ensuring constructive alignment between learning objectives, teaching approach and assessments, co-development of digital literacy courses with stakeholders, and using standardized guidelines for reporting educational interventions. This study provides practical suggestions for enhancing digital literacy education in undergraduate pharmacy programs.

A qualitative study to explore student learning and development of interprofessional collaboration during an online interprofessional education intervention.

Interprofessional education (IPE) during undergraduate education and training has been found to improve collaboration between health care students. This supports interprofessional working in clinical practice to enhance patient safety and care delivery.Undergraduate students from pharmacy and medical programmes worked online in pairs to review notes of hospital patients due to be discharged. Students were tasked to complete a discharge letter and undertake an online consultation with a simulated patient prior to discharge. Online interactions were recorded and assessed using a validated tool to measure interprofessional professionalism. Students undertook this intervention in different pairings with different patient cases for three iterations after receiving feedback and undertaking a reflective exercise.The aim was to investigate the student learning and development that could be used to inform intervention optimisation and scale-up.Qualitative data were collected from different sources. Method triangulation was employed to develop a comprehensive understanding of the student learning and development. Data was collected from written feedback provided by the assessment team, student reflections on their performance, and from semi-structured interviews conducted with the student pairs and one to one with the assessment team. Content and thematic analysis was used to analyse these data and the Kirkpatrick/Barr evaluation model provided a framework to organise the themes.Eighteen students (nine from each professional programme) completed the study and a total of 27 IPE sessions were conducted. The assessment team completed 54 assessment tools and 31 student reflections were received (from a maximum of 36). Students were interviewed in their interprofessional pairs to yield nine interview transcripts and one interview was conducted with the assessment team.Students reported and were observed to improve in interprofessional collaboration over the three iterations following feedback and rehearsal opportunities. Longitudinal observation and assessment of student interprofessional working in changing teams provided the opportunity to capture the influence of interdependence on student performance and assessment of competence.

Influence of ethnicity on adherence to nonsurgical interventions for COPD: a scoping review.

Objective: Poor therapeutic adherence and the contributing factors have been extensively researched in several chronic diseases, including COPD. However, the influence of ethnicity on adherence to nonsurgical treatment interventions for COPD (e.g. smoking cessation and pulmonary rehabilitation) is not well understood. This scoping review was performed to better understand variations in adherence among people from minority ethnic communities diagnosed with COPD. Method: This scoping review was designed based on the refined frameworks of Arksey and O'Malley, developed by JBI (Joanna Briggs Institute). Systematic searches were performed across three databases: CINHAL (EBSCO), MEDLINE (Ovid) and Embase (Ovid). Results: Out of 3654 identified records, 37 studies were deemed eligible for inclusion; these were conducted in various countries and involved populations of diverse ethnic groups diagnosed with COPD. The included studies considered provision and/or adherence to medication (n=8, 21.6%), smoking cessation (n=11, 29.7%), influenza vaccinations (n=7, 18.9%), pulmonary rehabilitation (n=11, 29.7%) and oxygen therapy (n=2, 5.4%). Outcomes varied widely between studies within a single intervention (e.g. initiation, adherence and completion of pulmonary rehabilitation programme). However, most of the included studies suggested the presence of inequalities linked to ethnicity across interventions. Conclusion: This review indicated the presence of poor adherence to nonsurgical interventions among people from minority ethnic backgrounds living with COPD. However, due to the heterogeneity in population groups considered and compared within the individual studies, it is challenging to identify and understand the key inequalities influencing adherence to nonsurgical interventions. Further research is needed to better explore this.

A pilot study evaluating the feasibility of assessing undergraduate pharmacy and medical students interprofessional collaboration during an online interprofessional education intervention about hospital discharge.

BACKGROUND: Interprofessional education (IPE) has been identified as a strategy towards improving competence at interprofessional working and collaboration within teams. Entrustable professional activities (EPAs) provide a framework for translating competencies into elements of clinical practice, some of which in healthcare are inherently interprofessional. However, it is challenging to reconcile that entrustment decisions about student competence in an interprofessional activity are made about an individual without considering the dynamics and tensions between interprofessional team members and the task itself. This can influence students' development and demonstration of competence at interprofessional collaboration. METHODS: In this study, undergraduate medical and pharmacy students worked in pairs online (Zoom) to undertake the hospital discharge process (a professional activity reliant on interprofessional collaboration) for a simulated patient, producing a hospital discharge letter and completing a consultation with the simulated patient. The online sessions were recorded and interprofessional behaviours were assessed using a validated scale completed by an interprofessional assessment team. Students undertook this IPE intervention three times after receiving feedback and a period of reflection each time. RESULTS: Eighteen students participated across the entire intervention and 27 one-hour online IPE sessions were completed and recorded. Students demonstrated statistically significant improvements in interprofessional behaviours across the three iterations (p < 0.05 for all the sessions). The discharge letter students produced also improved over the three sessions (p = 0.01). Students found the educational sessions useful and relevant. CONCLUSION: This online IPE intervention provided the students with an authentic opportunity to work collaboratively. At the end of each iteration, students received feedback about their work as a team and about the discharge letter, helping students to reflect and purposefully develop their performance. The IPE intervention with this assessment strategy is feasible and allows student development to be captured but has proved to be time and resource intensive.

Intersectional Identities: Making Sense of Skill Development on Clinical Placements.

OBJECTIVE: Little is known about the influence of personal experiences on learners' trajectories toward mastery. Newell's theory of constraints articulates the relationship between environmental, individual, and task-related factors for skill development. This study explores how undergraduate pharmacy students experience skill development on placements and what the barriers and facilitators are within Newell's framework. METHODS: Year 3 undergraduate pharmacy students were invited to take part in focus groups exploring Newell's theory relative to skill development. Verbatim transcripts were analyzed using an interpretive phenomenological approach. RESULTS: Five focus groups were conducted with 16 students. The placement task provided structure through entrustable professional activities (EPAs). The resulting skill development varied but included EPA expected behaviors and also skills for mastery, eg, self-reflection. Students' personal identities acted as both barriers and facilitators. For example, expecting or experiencing racial microaggressions limited participation; having a local accent facilitated rapport with patients. Students worked toward integration into the community of practice (the ward), where the staff was critical to inclusion. Where students had barriers related to their identities, they found it more difficult to access the community of practice. CONCLUSION: Factors related to the community of practice (environment), students' identities (individual), and the EPA behaviors (task) can influence skill development during placement. For some students, these factors will be more prevalent, and elements of their identities may intersect and conflict, acting as both barriers and facilitators to skill development. Educators can consider the influence of intersectionality on student identity when designing and preparing new placements and assessing students.

Enhancing potential impact of hospital discharge interventions for patients with COPD: a qualitative systematic review.

BACKGROUND: Patients with chronic obstructive pulmonary disease (COPD) are frequently readmitted to hospital resulting in avoidable healthcare costs. Many different interventions designed to reduce hospital readmissions are reported with limited evidence for effectiveness. Greater insight into how interventions could be better designed to improve patient outcomes has been recommended. AIM: To identify areas for optimisation within previously reported interventions provided to reduce COPD rehospitalisation to improve future intervention development. METHODS: A systematic review was conducted by searching Medline, Embase, CINAHL, PsycINFO, and CENTRAL in June 2022. Inclusion criteria were interventions provided to patients with COPD in the transition from hospital to home or community. Exclusion criteria were lack of empirical qualitative results, reviews, drug trials, and protocols. Study quality was assessed using the Critical Appraisal Skills Programme tool and results were synthesised thematically. RESULTS: A total of 2,962 studies were screened and nine studies included. Patients with COPD experience difficulties when transitioning from hospital to home. It is therefore important for interventions to facilitate a smooth transition process and give appropriate follow-up post-discharge. Additionally, interventions should be tailored for each patient, especially regarding information provided. CONCLUSION: Very few studies specifically consider processes underpinning COPD discharge intervention implementation. There is a need to recognise that the transition itself creates problems, which require addressing, before introducing any new intervention. Patients report a preference for interventions to be individually adapted-in particular the provision of patient information. Whilst many intervention aspects were well received, feasibility testing may have enhanced acceptability. Patient and public involvement may address many of these concerns and greater use of process evaluations should enable researchers to learn from each other's experiences. TRIAL REGISTRATION: The review was registered in PROSPERO with registration number CRD42022339523.

Community pharmacies as a place for informal carer support in mental health and wellbeing.

There are 5.3 million informal carers in the United Kingdom who take on caring responsibilities for family and friends. Informal carers can be forgotten patients within health and care services, yet because of carer burden, they are at risk of deterioration in health and wellbeing. There are higher levels of anxiety, depression, burnout and low self-esteem amongst carers but, to our knowledge work to date has mainly focused on supporting carers to provide better care for their family member, and less on carers' health and wellbeing. There is increasing interest in social prescribing as a method of linking patients with community-based services to improve health and wellbeing. Initiatives have included social prescribing via community pharmacies which are already recognized to be accessible for support and signposting. The coming together of community pharmacy services and social prescribing could represent a framework to better support carers in their mental health and wellbeing.

The efficacy of sensory neural entrainment on acute and chronic pain: A systematic review and meta-analysis.

Background: Changes to the power of neural oscillations in cortical and sub-cortical structures can change pain perception. Rhythmic sensory stimulation is a non-invasive method that can increase power in specific frequencies of neural oscillations. If the stimulation frequency targets those frequencies related to pain perception, such as alpha or theta frequencies, there can be a reduction in perceived pain intensity. Thus, sensory neural entrainment may provide an alternative to pharmacological intervention for acute and chronic pain. This review aimed to identify and critically appraise the evidence on the effectiveness of sensory entrainment methods for pain perception. Methods: We undertook a systematic search across Medline, Embase, PsycInfo, Web of Science and Scopus in November 2020 to identify studies investigating the efficacy of sensory entrainment on adults. We assessed studies for their quality using the PRISMA checklist. A random-effects model was used in a meta-analysis to measure the effect of entrainment on pain perception. Results: Our systematic review yielded nine studies fitting the search criteria. Studies investigated the effect of visual and auditory entrainment on pain intensity rating, electrophysiological markers of pain and amount of analgesia needed during surgery. The meta-analysis suggests that alpha (8-13 Hz) sensory entrainment is effective for acute pain perception, whereas theta (4-7 Hz) entrainment is effective for chronic pain. Conclusions: Although there is heterogeneity in the current evidence, our review highlights the potential use of sensory entrainment to affect acute and chronic pain. Further research is required regarding the timing, duration and frequency of the stimulation to determine the best application for maximum efficacy.

A qualitative study to investigate community pharmacists' perceptions about identifying and addressing inappropriately prescribed analgesia.

OBJECTIVES: Inappropriate prescribing, particularly for analgesia, is a recognised global problem. This leads to increased morbidity and mortality and presents a significant challenge for patients and the healthcare system. There is a need to identify strategies that best identify inappropriately prescribed analgesia (IPA). This study aims to explore the perspectives and experiences of community pharmacists (CPs) about addressing IPA. METHODS: Semi-structured interviews informed by the Behaviour Change Wheel model and the Theoretical Domains Framework (TDF) were conducted with consenting community pharmacists. Transcripts were coded using a capability, opportunity, motivation model of behaviour (COM-B) model. The COM-B components were mapped to the TDF and behaviour change techniques (BCTs) were identified to address these. KEY FINDINGS: A total of 12 pharmacists who work in community pharmacies in England were interviewed between March and May 2021. COM-B components were identified through analysis and mapped to nine TDF domains. Component 1 referred to 'Capability' of CPs to be involved in addressing IPA (knowledge). Component 2 pertained to 'Opportunity' to identify IPA (e.g. social influence). The 'Motivation' component linked to five TDF domains (e.g. goals). Seventeen BCTs were identified to support CPs in addressing IPA (e.g. environmental context and resources domain mapped to 2 BCTs 'restructuring the physical and social environment'). CONCLUSIONS: CPs expressed mixed perceptions about their involvement in the deprescribing of IPA as part of their daily practice, but they stated that social and environmental barriers needed to be addressed to facilitate their involvement. The identified BCTs provide evidence-based strategies to help the involvement of CPs to identify IPA.

Qualitative investigation of barriers to providing an electronic hospital to community pharmacy referral service for discharged patients.

There has been a sustained interest in transfer of care (ToC) services, from hospital to home, in the past twenty years. In England, an electronic referral (e-referral) service from hospital to community pharmacy has been provided since 2014. However, to date, there has been little information about service implementation and delivery. This study investigates the barriers to this referral process in hospital and community pharmacy settings, and barriers to providing subsequent community pharmacy interventions from the perspectives of the service leaders (SLs), hospital pharmacy staff (HPS) and community pharmacists (CPs). Semi-structured face-to-face or telephone interviews were conducted with the key informants from two tertiary hospitals and nine pharmacies. The Consolidated Framework for Implementation Research (CFIR) tool informed the data collection tools and data analysis. A total of three SLs, ten HPS and nine CPs were interviewed. Data analysis identified various barriers to the provision of the e-referral service. Some were related to (1) patient engagement, e.g., patients' awareness/acceptance of the service, (2) the SLs and other National Health Service hospitals, e.g., lack of monitoring of the service progress, (3) the HPS, e.g., resource limitations, or (4) the CPs, e.g., lack of understanding/appreciation of the service. In-depth understanding of barriers related to the provision of e-referral service are essential to drive improvement and facilitate wider diffusion and adoption. The use of implementation science and behaviour change model as a lens to assess this service enables the identification of certain behaviours that can be modified to produce the required change to drive better implementation and delivery.

Barriers and Opportunities for the Use of Digital Tools in Medicines Optimization Across the Interfaces of Care: Stakeholder Interviews in the United Kingdom.

BACKGROUND: People with long-term conditions frequently transition between care settings that require information about a patient's medicines to be transferred or translated between systems. This process is currently error prone and associated with unintentional changes to medications and miscommunication, which can lead to serious patient consequences. One study estimated that approximately 250,000 serious medication errors occur in England when a patient transitions from hospital to home. Digital tools can equip health care professionals with the right information at the right time and place to support practice. OBJECTIVE: This study aimed to answer the following questions: what systems are being used to transfer information across interfaces of care within a region of England? and what are the challenges and potential opportunities for more effective cross-sector working to support medicines optimization? METHODS: A team of researchers at Newcastle University conducted a qualitative study by performing in-depth semistructured interviews with 23 key stakeholders in medicines optimization and IT between January and March 2022. The interviews lasted for approximately 1 hour. The interviews and field notes were transcribed and analyzed using the framework approach. The themes were discussed, refined, and applied systematically to the data set. Member checking was also performed. RESULTS: This study revealed themes and subthemes pertaining to 3 key areas: transfer of care issues, challenges of digital tools, and future hopes and opportunities. We identified a major complexity in terms of the number of different medicine management systems used throughout the region. There were also important challenges owing to incomplete patient records. We also highlighted the barriers related to using multiple systems and their subsequent impact on user workflow, a lack of interoperability between systems, gaps in the availability of digital data, and poor IT and change management. Finally, participants described their hopes and opportunities for the future provision of medicines optimization services, and there was a clear need for a patient-centered consolidated integrated health record for use by all health and care professionals across different sectors, bridging those working in primary, secondary, and social care. CONCLUSIONS: The effectiveness and utility of shared records depend on the data within; therefore, health care and digital leaders must support and strongly encourage the adoption of established and approved digital information standards. Specific priorities regarding understanding of the vision for pharmacy services and supporting this with appropriate funding arrangements and strategic planning of the workforce were also described. In addition, the following were identified as key enablers to harness the benefits of digital tools to support future medicines optimization: development of minimal system requirements; enhanced IT system management to reduce unnecessary repetition; and importantly, meaningful and continued collaboration with clinical and IT stakeholders to optimize systems and share good practices across care sectors.

Facilitating the transfer of care from secondary to primary care: a scoping review to understand the role of pharmacists in general practice.

BACKGROUND: Limited published research exists on the role of pharmacists in general practice (primary care pharmacists) in facilitating post-hospital discharge care of patients. AIM: To summarise and map the nature and extent of current evidence on the role of primary care pharmacists in facilitating patient discharge from secondary to primary care and to inform future practice and research. METHOD: Six electronic databases were systematically searched from inception to March 2022 for studies published in the English language that described and/or evaluated primary care pharmacist-led interventions for patients following hospital discharge. Grey literature and reference lists of included studies were also searched. Two authors independently screened articles for selection. A structured, pilot-tested form was used for data extraction. RESULTS: Twenty articles were included. The majority of studies (n = 17; 85%) were conducted in the USA. The most frequently reported intervention made by primary care pharmacists were medication reviews (n = 18) and medication reconciliation (n = 16). Studies have demonstrated the emerging roles of pharmacists involving collaboration with other healthcare professionals, review of laboratory monitoring, referrals, and follow-up. A wide range of outcomes such as the impact on hospital readmission rates, healthcare utilisation and reduction of potential adverse drug events were reported. CONCLUSION: Pharmacists in general practice can offer a range of interventions in facilitating transfer of care of patients from secondary to primary care with positive patient and healthcare utilisation outcomes. However, more rigorous research evidence is required to establish the effectiveness, generalisability, acceptability, and sustainability of these services.

The safety and efficacy of gabapentinoids in the management of neuropathic pain: a systematic review with meta-analysis of randomised controlled trials.

BACKGROUND: There are increasing concerns regarding the abusive potential of gabapentinoids putting at risk patients with neuropathic pain requiring long-term pain management. The evidence to support this is rather inconcusive. AIM: This systematic review aimed to evaluate the safety and efficacy of gabapentinoids in the management of neuropathic pain with a focus on randomised controlled trials (RCTs) and categorising the side effects according to the body systems they were affecting. METHOD: Searches were conducted in MEDLINE (PubMed), EMBASE, Web of Science, PsycoINFO, and CINAHL (EBSCO), and included RCTs to identify and critically appraise studies investigating safety and therapeutic effects of gabapentionoids in adults with neuropathic pain. Data extraction was conducted using an established Cochrane form and the risk-of-bias tool was used in the assessment of quality. RESULTS: 50 studies (12,398 participants) were included. The majority of adverse events pertained to the nervous system (7 effects) or psychiatric (3 effects) disorders. There were more adverse effects reported with pregabalin (36 effects) than with gabapentin (22 effects). Six pregabalin studies reported euphoria as a side effect, while no studies reported euphoria with gabapentin. This was the only side effect that may correlate with addictive potential. Gabapentioids were reported to significantly reduce pain compared to placebo. CONCLUSION: Despite RCTs documenting the adverse events of gabapentionoids on the nervous system, there was no evidence of gabapentinoid use leading to addiction, suggesting an urgent need to design studies investigating their abusive potential.

Contextual factors influencing medicines-related interventions to support safe transitions for care home residents post hospital discharge: a systematic review and meta-ethnographic synthesis.

BACKGROUND: Residents of care or nursing homes are at a higher risk of medication-related harm, especially during care transitions. No medicines-related intervention has been identified that supports the safe transition for these residents moving into their residence following hospital discharge. A model of care integrating a number of intervention components is suggested to be most effective AIM: To investigate, via a systematic review and meta-ethnography, the factors which influence the impact of medicines related interventions. METHOD: In December 2020, Pubmed, MEDLINE, EMBASE, PsycINFO, and CINAHL Complete were systematically searched. All studies reporting on medicines-related interventions for residents following hospital discharge were included. Quality assessment was undertaken with a validated tool. Meta-ethnography was used to investigate the factors which influenced how interventions did, or did not work. Findings were mapped to a validated conceptual framework for integrated care. RESULTS: From 3884 studies, nine met the inclusion criteria and were analysed. These were generally of medium quality (n = 6). The interventions were diverse: some tackled the transition process, some tackled follow-up care and some interventions involved both. The meta-ethnography, using the a priori conceptual framework, captured factors reported within the studies that influenced implementation, delivery and/or outcomes. CONCLUSION: The review and synthesis informed the development of a conceptual model for transitionary care for this population group. Researchers and decision-makers can use this as a tool to understand their local context and inform future intervention design, implementation and evaluation in this clinical area.

Role of primary care pharmacists in the post-hospital discharge care of patients: a scoping review protocol.

BACKGROUND: Evidence has shown that there is a significant problem with medication safety when patients are transferred between settings. The role of community pharmacists and hospital pharmacists in facilitating transition of care has been well-researched. However, with the developing role of pharmacists in general practice as part of a multi-disciplinary team, little is known about their role in improving transition of care when patients move from secondary to primary care. The key objective of this scoping review is to understand the nature and extent of the role of primary care pharmacists for patients recently discharged from secondary care. METHODS: This scoping review will follow the Joanna Briggs Institute (JBI) methodology for scoping review underpinned by the Arksey and O'Malley methodology and reported in accordance with the Preferred Reporting Items for Systematic Reviews Extension for Scoping Reviews (PRISMA-ScR) guidelines. The following electronic databases will be systematically searched: MEDLINE, EMBASE, PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science and NICE Evidence. Reference lists of included full texts will be searched for relevant papers, in addition to grey literature which includes websites of relevant professional organisations. Primary studies, published in the English language that involved a primary care pharmacist-led intervention post-hospital discharge will be included. Two independent reviewers will screen studies against eligibility criteria and use a piloted data extraction form to extract data related to the review questions. The data will be presented in tabular form and assessed for key themes to identify gaps and inform future research. DISCUSSION: This scoping review will map current evidence surrounding the role of primary care pharmacists in the post-hospital discharge care of patients. Findings will inform ongoing research to support safer transfer-of-care post-hospital discharge and identify ways in which collaboration between healthcare professionals can be improved. This review anticipates guiding the inclusion of patient and public involvement (PPI) at the consultation stage to validate and build on the findings.

Formative service evaluation of transfer of care service for care home residents after hospital discharge.

OBJECTIVES: This study provides a service description and analysis of a pilot across two sites involving pharmacists aiming to support care home residents with their medications post-discharge. METHODS: An interview with the pilot coordinator was undertaken to understand the pilot service. Service data (March 2020-June 2021) were analysed to investigate what was actually delivered to the care home residents. KEY FINDINGS: One hundred eighty-eight inpatients were referred and 132 received the post-discharge service. One hundred three residents received medicines reconciliation and 29 received an additional structured medication review. The latter cohort was significantly more likely to receive medicines and illness-related information and have medicines stopped. CONCLUSIONS: The service facilitates the provision of medicines information and medicines-related interventions. Further evaluation is required to evidence the value of medicines review alongside the medicines reconciliation.

A review and narrative synthesis of community pharmacist-led interventions to tackle medicines for pain that are misused.

OBJECTIVES: To undertake a state-of-the-art review and narrative synthesis of current evidence investigating community pharmacist-led interventions addressing analgesic medication misuse. To achieve the objective, a systematic database search was undertaken during October and November 2020 across Embase, Medline, Web of Science and Scopus. Community pharmacy interventions were mapped to the Behaviour Change Wheel to investigate the pharmacist and patient behaviours addressed by the interventions. Outcomes about process and effects were extracted. A risk of bias assessment was undertaken. KEY FINDINGS: Five studies undertaken in the USA and Northern Ireland were included. Brief Motivational Interviewing and Medication Therapy Management and the Opioid and Naloxone Education programme demonstrated positive process outcomes and feasibility in delivery. Intervention functions addressing patient and pharmacist behaviours across the studies included education, training, environmental restructuring and enablement. Restrictions were an additional intervention function targeting patient behaviour incorporated in one study. Pharmacist roles involved the identification of potential misusers/abusers, patient education, long-term management, prevention and referral. Low study numbers, non-experimental designs, high risk of bias, incomplete reporting of interventions and heterogeneous outcome measures limited evidence synthesis. SUMMARY: There is limited evidence of pharmacy interventions and their well-tested impact on pharmacists and patients. There is clinical and methodological heterogeneity across studies. It is pragmatic to suggest that a systems-thinking approach is adopted to investigate the potential role of community pharmacists and engage all stakeholders in the design of a theory-informed intervention. More high-quality studies including larger population sizes undertaken for longer periods of time that are rigorously reported are needed to improve the evidence base.

Interventions developed to reduce secondary care utilisation in patients with type 2 diabetes mellitus: a narrative review.

OBJECTIVES: To identify, describe and critically appraise the quality of studies of interventions developed to reduce the rate of secondary care utilisation and investigate interventions' impact on patients with type 2 diabetes mellitus (T2DM). METHOD: Using a systematic approach, five databases were searched between 01 January 1995 and 01 February 2021 (MEDLINE, EMBASE, PsycINFO, CINAHL and Cochrane database). Inclusion criteria were studies (published in English) in adults with T2DM offered intervention(s) involving medicines/services/educational programmes in any country or setting, with investigated outcomes including the rate of hospital admission/re-admission/accident and emergency visits. Validated tools were used to assess the quality and accuracy of reporting the interventions. A narrative synthesis was used to frame the findings. KEY FINDINGS: A total of 4670 papers were identified, which yielded a final 53 studies after screening against the inclusion criteria. Identified interventions were complex interventions (n = 21) including at least two interventions (e.g. improving medication adherence and patient education), medication management (n = 15), patient education programmes (n = 8), lifestyle interventions (n = 5) and other interventions (n = 4; e.g. dental care). After assessing for quality and effectiveness of interventions, 15 studies remained; 7 were medication management interventions (e.g. use of insulin pen) and 8 were complex interventions (e.g. pharmaceutical care and telehealth systems). Complex interventions showed significant improvement in clinical outcomes and reduction in secondary care utilisation. CONCLUSIONS: This narrative review identified potential elements of an effective complex intervention to reduce healthcare utilisation in patients with T2DM. These results could inform the development of interventions to be tested for feasibility, before piloting to assess for outcomes that improve diabetic care, reduce diabetes-related complications and minimise healthcare utilisation.