63 research outputs found
sj-docx-1-jop-10.1177_02698811241238283 – Supplemental material for Proportion of Antipsychotics with CYP2D6 Pharmacogenetic (PGx) Associations Prescribed in an Early Intervention in Psychosis (EIP) Cohort: A Cross-Sectional Study
No full textSupplemental material, sj-docx-1-jop-10.1177_02698811241238283 for Proportion of Antipsychotics with CYP2D6 Pharmacogenetic (PGx) Associations Prescribed in an Early Intervention in Psychosis (EIP) Cohort: A Cross-Sectional Study by Adam Jameson, Muhammad Faisal, Beth Fylan, Greg C Bristow, Jaspreet Sohal, Caroline Dalton, Gurdeep S Sagoo, Alastair G Cardno and Samantha L McLean in Journal of Psychopharmacology</p
Pharmacist educational interventions for patients with advanced cancer pain living in the community
No full textBackground: At the end of life, patients living in their own homes experience significantly more pain than those who die in either hospital or hospice care (Office for National Statistics, 2015). With an increasing prevalence of this, person-centred medicines optimisation is essential.
Aim: To investigate the feasibility of community pharmacist medicines optimisation services for patients living with advanced cancer pain in community settings.
Methods: Mixed methods were used, adopting a pragmatic stance and approach. Qualitative interviews, a systematic review and meta-analysis and a proof-of-concept study were undertaken.
Results: Patients with advanced cancer pain need support with their medicines which could be provided by a pharmacist. Patients experienced a significant number of medicines related problems, even those already receiving specialist palliative care. Most problems were addressed by pharmacist advice with the remainder being referred for additional prescribing.
Care for patients with cancer pain is currently not person-centred and the current medicines optimisation model is unsuitable for this patient group. An enhanced model of medicines optimisation is therefore presented for patients with advanced cancer and this model can be amended and adopted for other patient groups.
Conclusions: An enhanced medicines optimisation model (MOCAP) has been created to inform person-centred medicines optimisation for patients with advanced cancer pain. Feasibility and acceptability were also confirmed and it can be adapted for further clinical use. This model contributes to the goals of the NHS agenda of choice and control of care as proposed in the NHS Long Term Plan (NHS, 2019b)
Medicines Management after Hospital Discharge: Patients’ Personal and Professional Networks
No full textImproving the safety of medicines management when people leave hospital is an international priority. There is evidence that poor co-ordination of medicines between providers can cause preventable harm to patients, yet there is insufficient evidence of the structure and function of the medicines management system that patients experience. This research used a mixed-methods social network analysis to determine the structure, content and function of that system as experienced by patients. Patients’ networks comprised a range of loosely connected healthcare professionals in different organisations and informal, personal contacts. Networks performed multiple functions, including health condition management, and orienting patients concerning their medicines. Some patients experienced safety incidents as a function of their networks. Staff discharging patients from hospital were also observed. Contributory factors that were found to risk the safety of patients’ discharge with medicines included active failures, individual factors and local working conditions. System defences involving staff and patients were also observed. The study identified how patients often co-ordinated a system that lacked personalisation and there is a need to provide more consistent support for patients’ self-management of medicines after they leave hospital. This could be achieved through interventions that include patients’ informal contacts in supporting their medicines use, enhancing their resilience to preventable harm, and developing and testing the role of a ‘medicines key worker’ in safely managing the transfer of care. The role of GP practices in co-ordinating the involvement of multiple professionals in patient polypharmacy needs to be further explored.University of Bradford studentshi
A mixed-methods exploration of the potential use of pharmacogenomics with patients and healthcare professionals
No full textThis research explores the potential of pharmacogenomic (PGx)-guided care for older patients in secondary care. Using a mixed methods approach, the study demonstrates the efficacy of PGx-guided care for patients aged 65 and above, identifies behaviour change techniques for healthcare professionals to successfully adopt PGx-guided medicines optimisation, and paves the way for future implementation strategies. The research adopted a convergent parallel design, comprised of a systematic review, secondary data analysis of hospital admissions data for older patients and a qualitative interview study with older patients and healthcare professionals. This research provides a proof-of-concept for the use of PGx testing in medicines optimisation, leading to a potential decrease in hospitalisations. Notably, the research showed that 22% of medicines that older hospitalised patients use are PGx-influenced, and exposure to such medicines can help predict the length of hospital stay, unplanned admission and repeat hospitalisation, especially among highly frail patients. The study identified factors critical for implementing PGx, including knowledge, role identity, optimism, intentions, context, and capability beliefs. It highlighted prioritised change techniques such as information about health consequences, behaviour instruction, social support, and outcome goal review as essential guides for PGx champions driving implementation efforts in hospital settings. These findings significantly enhance the understanding of PGx's role in geriatric medicine, providing strategies to overcome potential barriers and suggesting necessary alterations to facilitate its implementation. The study underscores the potential of PGx-guided care to enhance medicines optimisation for older individuals, offering valuable insights to shape policy, practice, and direct future research in this field
Co-creating social licence for sharing health and care data
No full textYesOptimising the use of patient data has the potential to produce a transformational change in healthcare planning, treatment, condition prevention and understanding disease progression. Establishing how people's trust could be secured and a social licence to share data could be achieved is of paramount importance.
The study took place across Yorkshire and the Humber, in the North of the England, using a sequential mixed methods approach comprising focus groups, surveys and co-design groups. Twelve focus groups explored people's response to how their health and social care data is, could, and should be used. A survey examined who should be able to see health and care records, acceptable uses of anonymous health and care records, and trust in different organisations. Case study cards addressed willingness for data to be used for different purposes. Co-creation workshops produced a set of guidelines for how data should be used.
Focus group participants (n = 80) supported sharing health and care data for direct care and were surprised that this is not already happening. They discussed concerns about the currency and accuracy of their records and possible stigma associated with certain diagnoses, such as mental health conditions. They were less supportive of social care access to their records. They discussed three main concerns about their data being used for research or service planning: being identified; security limitations; and the potential rationing of care on the basis of information in their record such as their lifestyle choices. Survey respondents (n = 1031) agreed that their GP (98 %) and hospital doctors and nurses (93 %) should be able to see their health and care records. There was more limited support for pharmacists (37 %), care staff (36 %), social workers (24 %) and researchers (24 %). Respondents thought their health and social care records should be used to help plan services (88 %), to help people stay healthy (67 %), to help find cures for diseases (67 %), for research for the public good (58 %), but only 16 % for commercial research. Co-creation groups developed a set of principles for a social licence for data sharing based around good governance, effective processes, the type of organisation, and the ability to opt in and out.
People support their data being shared for a range of purposes and co-designed a set of principles that would secure their trust and consent to data sharing.This work was supported by Humber Teaching NHS Foundation Trust and the National Institute for Health Research (NIHR) Yorkshire and Humber Patient Safety Translational Research Centre (NIHR Yorkshire and Humber PSTRC)
From hospital to home: a mixed methods exploration of post-discharge medicines management for older people living with long-term conditions
No full textThere are numerous threats to medication safety at care transitions, which are
heightened for older people, because they live with multiple long-term
conditions as well as polypharmacy, and have frequent hospital admissions.
Whilst evidence of the severity and scale of these medicines-related problems
exists, there is insufficient detail about the lived experience of post-discharge
medicines management, in particular what helps or what hinders, and how
better support could be enabled. This thesis, underpinned by the Medicines
Research Council framework for complex intervention design, aimed to find
acceptable intervention components, which would enhance patient
experience.
This research followed a sequential, mixed method design to: establish the
evidence base through critical literature review, develop theory using an
interview study grounded in behaviour change theory, and finally to model
potential intervention components by expert consensus. Interviews revealed
that there were gaps in current service provision, which impacted on
participants’ knowledge of and capabilities with their medicines. Despite these
challenges, some participants took actions to safeguard from problems after
discharge. The literature review found that effective components of trialled
interventions were self-management advice, post-discharge telephone follow up and medicines reconciliation. Further behaviour change techniques from
the literature, alongside expert consensus and theory-driven analysis of interview findings resulted in final selection of eight potential components.
Real-world implementation of these must be coupled with key changes to
current healthcare practices and policy, including better engagement with patients and carers, as well as pro-active post-discharge follow-up. Future work must carefully explore how these components can be tested pragmatically
Making it work for me: beliefs about making a personal health record relevant and useable
No full textYesBackground: A Personal Health Record (PHR) is an electronic record that individuals use to manage and share their
health information, e.g. data from their medical records and data collected by apps. However, engagement with
their record can be low if people do not find it beneficial to their health, wellbeing or interactions with health and
other services. We have explored the beliefs potential users have about a PHR, how it could be made personally
relevant, and barriers to its use.
Methods: A qualitative design comprising eight focus groups, each with 6–8 participants. Groups included adults
with long-term health conditions, young people, physically active adults, data experts, and members of the voluntary
sector. Each group lasted 60–90 min, was audio recorded and transcribed verbatim. We analysed the data using
thematic analysis to address the question “What are people’s beliefs about making a Personal Health Record have
relevance and impact?”
Results: We found four themes. Making it work for me is about how to encourage individuals to actively engage with
their PHR. I control my information is about individuals deciding what to share and who to share it with. My concerns is
about individuals’ concerns about information security and if and how their information will be acted upon. Potential
impact shows the potential benefits of a PHR such as increasing self-efficacy, uptake of health-protective behaviours,
and professionals taking a more holistic approach to providing care and facilitating behaviour change.
Conclusions: Our research shows the functionality that a PHR requires in order for people to engage with it. Interactive
functions and integration with lifestyle and health apps are particularly important. A PHR could increase the effectiveness
of behaviour change apps by specifying evidence-based behaviour change techniques that apps should incorporate. A
PHR has the potential to increase health-protective behaviours and facilitate a more person-driven health and social care
system. It could support patients to take responsibility for self-managing their health and treatment regimens, as well as
helping patients to play a more active role when care transfers across boundaries of responsibility.Leeds Informatics Boar
Older Care Home Residents' Views of Intergenerational Practice
No full textInternationally, there is growing interest in strengthening intergenerational connectivity through intergenerational practices. Intergenerational practice has mainly focused on independent older people. This small UK qualitative study explored 16 care home residents' views of connections they have and would like with younger generations. Findings revealed that organized intergenerational practice needs to be guided, time-limited, and purposeful, drawing on a mutual exchange of experiences, knowledge, and lifelong skills, and opening opportunities for acquiring new skills. Intergenerational practice in care homes needs to consider the type of intergenerational interaction residents want and support needed for participation
Barriers and enablers to the uptake of direct oral anticoagulants (DOACs) for stroke prevention in atrial fibrillation. A qualitative study with patients and staff in three health economies
No full textImplementation and uptake of novel and cost-effective medicines can improve patient
health outcomes and healthcare efficiency. However, the relative uptake of new
medicines recommended by the National Institute for Health and Care Excellence often
lags behind other comparative countries’ health systems. One example is the uptake
of direct oral anticoagulants (DOACs) for stroke prevention in atrial fibrillation, which
was slow and had a high level of unexplained variation across different health
economies in England. This research aimed to explore barriers and enablers to the
uptake of DOACs from the perspectives of patients, healthcare professionals, and key
stakeholders by conducting systematic and narrative reviews and semi-structured
interviews. Data collected from 21 patients, 23 healthcare professionals, and 23 key
stakeholders recruited from three different health economies was analysed using the
Framework method. The findings identified a range of intersecting factors acting as
barriers and/or enablers to the uptake DOACs. While there were a wide range of
experiences and views, an agreement between patients and healthcare
professionals/key stakeholders on several identified factors was observed. Attributes
of the innovation, characteristics of patients and prescribers, local health economy
readiness for change, implementation process, and external health system context
were suggested as influences. Mapping of the findings to the Diffusion of Innovations
in Service Organisations model identified 11 components for a future toolkit
development to facilitate uptake of nationally recommended new medicines. This
thesis highlighted the role of patients, consideration of all costs associated with new
medicines, and compatibility with the health economy’s care model impact on the
uptake
Developing a research community within an online healthcare feedback platform
No full textYesCare Opinion is an online feedback platform supporting patients to author stories about their care. It is not known whether authors would be willing to be involved in improving care through research. The aims of this study were to explore the views and preferences of Care Opinion authors about joining an online research community and to pilot new research community functionality.
Five hundred and nine Care Opinion authors were invited to take part in an online survey in June 2019. Survey items included questions about participants' willingness to take part in research and their preferences for supporting processes. Data were analysed descriptively. Authors were invited to consent to join a research community and were asked to participate in three pilot studies.
One hundred and sixty-three people consented to take part in the survey (32%). Participants indicated they would like to know the time commitment to the project (146, 90%), details about the organization carrying out the research (124, 76%) and safeguarding information (124, 76%). Over half indicated that they did not know how to get involved in healthcare research (87, 53%). Subsequently, 667 authors were invited to join the research community, 183 (27%) accepted, and three studies were matched to their expressed preferences for project attributes or organization type.
Many people who leave online feedback about their experiences of healthcare are also willing to join a research community via that platform. They have strong preferences for supporting University and NHS research. Eligibility and acceptance rates to join pilot research studies varied. Further work is needed to grow the research community, increase its diversity, and create relevant and varied opportunities to support research.
Four members of the Safety In Numbers patient and public involvement and engagement (PPIE) group advised about survey development.National Institute for Health and Care Research (NIHR) Yorkshire and Humber Patient Safety Translational Research Centre (NIHR Yorkshire and Humber PSTRC
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