18 research outputs found
Correction to: ‘It is designed for everybody to find their own level and to improve themselves’; views of older people and instructors of the Falls Management Exercise (FaME) programme
No full textLeher Gumber, Stephen Timmons, Carol Coupland, John R. F. Gladman, Steve Iliffe, Denise Kendrick, Natasher Lafond, Pip Logan, Tahir Masud, Dawn A. Skelton, Clare Timblin, Elizabeth Orton, 'It is designed for everybody to find their own level and to improve themselves'; views of older people and instructors of the Falls Management Exercise (FaME) programme, Age and Ageing, Volume 51, Issue 2, February 2022, afac023, https://doi.org/10.1093/ageing/afac023 In the originally published version of this manuscript, Clare Timblin was omitted from the author list in error. This error has been corrected online.</p
Negotiating professional boundaries: professional and organisational contingencies for pharmacist prescribing
No full textThis thesis explores boundary work, practices and changes in the pharmacy profession. Specifically it examines boundary changes that support non-medical prescribing practice for pharmacists in the context of prescribing policies and strategies which both utilise the skills of the pharmacist and also give patients greater choice and access to services.
The last decade has observed a transformation in the boundaries of health professionals enabled through the creation of new roles and the expansion of traditional roles. With reference to the principles set out in the NHS Plan, NHS modernisation and the subsequent introduction of non-medical prescribing have brought about a number of changes in policy and practice for health care professionals. In addition, The Royal Pharmaceutical Society’s 2013 Medicines Optimisation, good practice guidance outlines guiding principles for medicine optimisation that compliment and support improved patient outcomes and NHS policy – in particular empowering patients and the public to make the most of medicines. Research shows that while there are increasing numbers of pharmacists registered as nonmedical prescribers and the numbers of those who are actually practicing as non-medical prescribers has continued to rise, there are still areas where groups are having to make “significant personal sacrifices” to implement and maintain the necessary competence to prescribe. Research suggests that there is still more that needs to be done in order to achieve more supportive environments for non-medical prescribers.
Pharmacists have been referred to for many years as being “underutilised” and “over trained” and capable of a far greater remit than the dispensing of medication that has typically been associated with pharmacists. In addition, the policies that developed to address different health care needs and outcomes also go some way towards changing boundaries and adapting the roles that pharmacists have.
This thesis first considers, the role of the pharmacist and what their occupational and professional boundaries are perceived to be. The thesis goes on to examine how pharmacists enact extended roles in practice. Lastly, the institutional and organisational factors that impact the subsequent practices of pharmacists and the services they deliver is explored.
Using qualitative research techniques, this study was carried out in three NHS Trusts across a range of settings with a range of health care practitioners. The study was organised in two parts. First, a series of exploratory interviews were carried out with a pharmacists, medical and support staff. Second, ethnographic non-participant observations with pharmacists in different settings were undertaken.
The empirical findings suggest that the boundary work between third parties is not a tension point or a point of conflict as suggested in theory and previous research around boundary work in the health care setting and the inter-professional context. Rather, the boundary is a non-issue in relation to role expansion of pharmacist non-medical prescribers. The findings imply that the ability to share tasks, expand, and change roles is largely shaped by changing contexts and organisational factors. The study data has been used to help develop a model whereby different practices and principles that affect and guide the position of pharmacists and their boundaries as well as negotiations of practice are considered. The model uses the principles Scott’s (2008b) Three Pillar and combines elements of Zietma and Lawrence’s (2010) boundary and practice work cyclical diagram. The model in this thesis is developed alongside the data analysis. The intention of the model is to provide a template that with further refinement could be used when looking at other professionals or professional groups interchangeably. The features of the model in theory will be able to be adapted when considering different professional interactions, task sharing or role identification within an organisation for example. The model and its development will be discussed in further detail throughout the thesis. The overall research findings, suggest that the scale to which non- medical prescribing is practiced by pharmacists across the range of settings is greatly determined by the organisation. This includes the way in which pharmacist nonmedical prescribing is used in practice, its ease of implementation and the subsequent role of the practicing health care professional
Negotiating professional boundaries: professional and organisational contingencies for pharmacist prescribing
No full textThis thesis explores boundary work, practices and changes in the pharmacy profession. Specifically it examines boundary changes that support non-medical prescribing practice for pharmacists in the context of prescribing policies and strategies which both utilise the skills of the pharmacist and also give patients greater choice and access to services. \ud
\ud
The last decade has observed a transformation in the boundaries of health professionals enabled through the creation of new roles and the expansion of traditional roles. With reference to the principles set out in the NHS Plan, NHS modernisation and the subsequent introduction of non-medical prescribing have brought about a number of changes in policy and practice for health care professionals. In addition, The Royal Pharmaceutical Society’s 2013 Medicines Optimisation, good practice guidance outlines guiding principles for medicine optimisation that compliment and support improved patient outcomes and NHS policy – in particular empowering patients and the public to make the most of medicines. Research shows that while there are increasing numbers of pharmacists registered as nonmedical prescribers and the numbers of those who are actually practicing as non-medical prescribers has continued to rise, there are still areas where groups are having to make “significant personal sacrifices” to implement and maintain the necessary competence to prescribe. Research suggests that there is still more that needs to be done in order to achieve more supportive environments for non-medical prescribers.\ud
\ud
Pharmacists have been referred to for many years as being “underutilised” and “over trained” and capable of a far greater remit than the dispensing of medication that has typically been associated with pharmacists. In addition, the policies that developed to address different health care needs and outcomes also go some way towards changing boundaries and adapting the roles that pharmacists have.\ud
\ud
This thesis first considers, the role of the pharmacist and what their occupational and professional boundaries are perceived to be. The thesis goes on to examine how pharmacists enact extended roles in practice. Lastly, the institutional and organisational factors that impact the subsequent practices of pharmacists and the services they deliver is explored.\ud
\ud
Using qualitative research techniques, this study was carried out in three NHS Trusts across a range of settings with a range of health care practitioners. The study was organised in two parts. First, a series of exploratory interviews were carried out with a pharmacists, medical and support staff. Second, ethnographic non-participant observations with pharmacists in different settings were undertaken. \ud
\ud
The empirical findings suggest that the boundary work between third parties is not a tension point or a point of conflict as suggested in theory and previous research around boundary work in the health care setting and the inter-professional context. Rather, the boundary is a non-issue in relation to role expansion of pharmacist non-medical prescribers. The findings imply that the ability to share tasks, expand, and change roles is largely shaped by changing contexts and organisational factors. The study data has been used to help develop a model whereby different practices and principles that affect and guide the position of pharmacists and their boundaries as well as negotiations of practice are considered. The model uses the principles Scott’s (2008b) Three Pillar and combines elements of Zietma and Lawrence’s (2010) boundary and practice work cyclical diagram. The model in this thesis is developed alongside the data analysis. The intention of the model is to provide a template that with further refinement could be used when looking at other professionals or professional groups interchangeably. The features of the model in theory will be able to be adapted when considering different professional interactions, task sharing or role identification within an organisation for example. The model and its development will be discussed in further detail throughout the thesis. The overall research findings, suggest that the scale to which non- medical prescribing is practiced by pharmacists across the range of settings is greatly determined by the organisation. This includes the way in which pharmacist nonmedical prescribing is used in practice, its ease of implementation and the subsequent role of the practicing health care professional
'It is designed for everybody to find their own level and to improve themselves'; views of older people and instructors of the Falls Management Exercise (FaME) programme
No full textArticle available to read at the publisher's website here: https://doi.org/10.1093/ageing/afac023.
Correction also published here: https://doi.org/10.1093/ageing/afac091.Background Older adults are at increased risk of falls due to ageing, decreased muscle strength and impaired balance. Clinical trials have demonstrated the efficacy and effectiveness of the Falls Management Exercise (FaME) programme in improving functioning and preventing falls. However, programme completion is often low, impacting the potential benefits of FaME. Objective To explore the barriers and facilitators for participation and completion of the FaME programme from an instructor and participant perspective. Methods Semi-structured interviews were conducted with 20 FaME users and seven Postural Stability Instructors from the East Midlands region of England, UK. Interviews were conducted using a topic guide and explored their views of the programme, intended benefits, reasons for participating, instructor’s approach and venue facilities. Data were transcribed verbatim and analysed using thematic analysis. Written informed consent was obtained from all participants and instructors. Results Common themes identified by participants and instructors for adherence related to perceived health benefits, psychological well-being, intervention characteristics, cost, instructors’ qualities, opportunity to socialise, venue accessibility and facilities. Further factors such as maintaining independence, discipline, relationship with peers and caring responsibilities influenced participants’ engagement with the programme. Instructor factors such as progression were also reported as important predictors. Conclusions Instructor and participant factors influence uptake, attendance and adherence of FaME. The findings from this study can inform the development and improvement of additional falls-prevention programmes. It can also guide marketing strategies to promote uptake of exercise-based falls-prevention programmes among older adults.https://doi.org/10.1093/ageing/afac09
Effect of oral prednisolone on symptom duration and severity in nonasthmatic adults with acute lower respiratory tract infection: a randomized clinical trial
No full textImportance: Acute lower respiratory tract infection is common and often treated inappropriately in primary care with antibiotics. Corticosteroids are increasingly used but without sufficient evidence.
Objective: To assess the effects of oral corticosteroids for acute lower respiratory tract infection in adults without asthma.
Design, Setting, and Participants: Multicenter, placebo-controlled, randomized trial (July 2013 to final follow-up October 2014) conducted in 54 family practices in England among 401 adults with acute cough and at least 1 lower respiratory tract symptom not requiring immediate antibiotic treatment and with no history of chronic pulmonary disease or use of asthma medication in the past 5 years.
Interventions: Two 20-mg prednisolone tablets (n = 199) or matched placebo (n = 202) once daily for 5 days.
Main Outcomes and Measures: The primary outcomes were duration of moderately bad or worse cough (0 to 28 days; minimal clinically important difference, 3.79 days) and mean severity of symptoms on days 2 to 4 (scored from 0 [not affected] to 6 [as bad as it could be]; minimal clinically important difference, 1.66 units). Secondary outcomes were duration and severity of acute lower respiratory tract infection symptoms, duration of abnormal peak flow, antibiotic use, and adverse events.
Results: Among 401 randomized patients, 2 withdrew immediately after randomization, and 1 duplicate patient was identified. Among the 398 patients with baseline data (mean age, 47 [SD, 16.0] years; 63% women; 17% smokers; 77% phlegm; 70% shortness of breath; 47% wheezing; 46% chest pain; 42% abnormal peak flow), 334 (84%) provided cough duration and 369 (93%) symptom severity data. Median cough duration was 5 days (interquartile range [IQR], 3-8 days) in the prednisolone group and 5 days (IQR, 3-10 days) in the placebo group (adjusted hazard ratio, 1.11; 95% CI, 0.89-1.39; P = .36 at an α = .05). Mean symptom severity was 1.99 points in the prednisolone group and 2.16 points in the placebo group (adjusted difference, −0.20; 95% CI, −0.40 to 0.00; P = .05 at an α = .001). No significant treatment effects were observed for duration or severity of other acute lower respiratory tract infection symptoms, duration of abnormal peak flow, antibiotic use, or nonserious adverse events. There were no serious adverse events.
Conclusions and Relevance: Oral corticosteroids should not be used for acute lower respiratory tract infection symptoms in adults without asthma because they do not reduce symptom duration or severity
“We got more than we expected.” Older people’s experiences of falls-prevention exercise interventions and implications for practice. A qualitative study.
No full textAim: To explore the experiences of older adults participating in strength and balance exercise programmes and understand participants’ rationale for programme uptake and completion. Background: Regular physical activity, specifically strength and balance exercises, have been shown to improve health and wellbeing and reduce the risk of falling in older adults. With the number of people living into older age increasing, understanding older people’s experiences of strength and balance programmes and what encourages their take-up and completion, is extremely important. This paper reports on the qualitative experiences of older adults that previously participated in ProAct65+, a randomised controlled trial of Falls Management Exercise programme (FaME) and Otago Exercise Programme (OEP) versus usual care.Methods: Ten general practices in Nottinghamshire and Derbyshire, England who participated in the ProAct65+ trial were approached to take part. Using maximum variation sampling (age, gender, falls history, fear of falling and trial arm) we recruited, via the practices, 30 people that had participated in the FaME (n=15) or OEP (n=15) trial arms. Participants were interviewed in their own homes. Interviews were audio-recorded, transcribed verbatim and thematically analysed. Findings: We identified 5 themes: choice of exercise programme; commitment, discipline and motivation; benchmarking, feedback and monitoring; benefits of the exercise programmes and reactions to the end of the programmes. There were four sub-themes within the benefits theme: pleasure and boredom; social interaction and isolation; physical benefits, and knowledge and understanding.This study has outlined the experiences and identified specific barriers and facilitators to uptake and completion of falls prevention exercises by older adults. The perspective and experiences of these participants is important if programmes are to be designed to meet the needs of the target population. Insights from this study will enable commissioners to develop and provide appropriate falls-prevention exercise programmes that encourage high uptake and programme completion
Use it or lose it: a qualitative study of the maintenance of physical activity in older adults
No full text'Use it or lose it': maintenance of physical activity in older adults: a qualitative study
No full textBACKGROUND: Lack of physical activity (PA) is a recognised global public health problem, which is increasing in prevalence with a detrimental impact on the pattern of disease worldwide. In the UK, older adults comprise the most sedentary group, with only 57% of males and 52% of females aged 65-74 years and 43% of males and 21% of females aged 75-84 years meeting PA recommendations. PA confers multiple health benefits including increased stamina, muscle, bone and joint strength, increased independence and reduced risk of falls in old age. Despite benefits experienced during time-limited PA programmes, increased PA is not always continued. This study aimed to provide a better understanding of PA maintenance behaviours in older people
MOESM1 of Use it or lose it: a qualitative study of the maintenance of physical activity in older adults
No full textAdditional file 1. Keeping Active Interview Guide
