Publications by authors named "Trudi Mcintosh"

6 Publications

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The use of theory in the development and evaluation of behaviour change interventions to improve antimicrobial prescribing: a systematic review.

J Antimicrob Chemother 2020 09;75(9):2394-2410

School of Pharmacy and Life Sciences, Robert Gordon University, Aberdeen, UK.

Objectives: This systematic review (SR) reviews the evidence on use of theory in developing and evaluating behaviour change interventions (BCIs) to improve clinicians' antimicrobial prescribing (AP).

Methods: The SR protocol was registered with PROSPERO. Eleven databases were searched from inception to October 2018 for peer-reviewed, English-language, primary literature in any healthcare setting and for any medical condition. This included research on changing behavioural intentions (e.g. in simulated scenarios) and research measuring actual AP. All study designs/methodologies were included. Excluded were: grey literature and/or those which did not state a theory. Two reviewers independently extracted and quality assessed the data. The Theory Coding Scheme (TCS) evaluated the extent of the use of theory.

Results: Searches found 4227 potentially relevant papers after removal of duplicates. Screening of titles/abstracts led to dual assessment of 38 full-text papers. Ten (five quantitative, three qualitative and two mixed-methods) met the inclusion criteria. Studies were conducted in the UK (n = 8), Canada (n = 1) and Sweden (n = 1), most in primary care settings (n = 9), targeting respiratory tract infections (n = 8), and medical doctors (n = 10). The most common theories used were Theory of Planned Behaviour (n = 7), Social Cognitive Theory (n = 5) and Operant Learning Theory (n = 5). The use of theory to inform the design and choice of intervention varied, with no optimal use as recommended in the TCS.

Conclusions: This SR is the first to investigate theoretically based BCIs around AP. Few studies were identified; most were suboptimal in theory use. There is a need to consider how theory is used and reported and the systematic use of the TCS could help.
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September 2020

The behaviors and experiences of the community pharmacy team on the provision of multi-compartment compliance aids.

Res Social Adm Pharm 2018 04 9;14(4):347-355. Epub 2017 Apr 9.

School of Pharmacy and Life Sciences, Robert Gordon University, The Sir Ian Wood Building, Garthdee Road, Aberdeen, AB10 7GJ, UK. Electronic address:

Background: Multi-compartment compliance aids (MCAs) are repackaging systems for solid dosage form medicines. Acknowledging the lack of evidence that MCAs improve adherence or clinical outcomes, the Royal Pharmaceutical Society has expressed concern that MCAs have 'become regarded as a panacea for medicines use'.

Objectives: To determine the behaviors and experiences of the community pharmacy team around MCA provision.

Methods: A cross-sectional survey was conducted in 26 community pharmacies in the north east of Scotland. Survey items were grouped into: current activities in the provision of MCAs; potential influences on these activities; reports of patient experiences; and demographics. Data were analysed using descriptive and inferential statistics, and content analysis of responses to open questions. Principal component analysis (PCA) was performed on the items of potential influences on activities.

Results: Data were collected from 136 community team members (median 4, range1-10 per pharmacy; 32.3% pharmacists). All were involved in some aspect of MCA provision and within the same pharmacy, several different staff positions were commonly involved in the same activity. PCA gave seven components; the lowest scores were obtained for the component of 'others expecting me to provide MCAs'. Participants agreed that GPs, patients and their families, and carers expected them to provide MCAs. Positive experiences of MCA provision were in themes of promoting patient adherence, reducing patient stress and enhancing patient monitoring. Further negative experiences were in of lack of shared patient decision making, worsening adherence and generation of medicines waste, and dealing with changing medicines. MCAs were not always considered to be the most appropriate solution.

Conclusion: While community pharmacy teams value MCAs, there may be issues around staff assignment to particular roles, expectations from others and reports of negative patient experiences. A systematic approach to MCA provision and monitoring involving the multidisciplinary health and social care team is warranted.
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April 2018

Piloting the United Kingdom 'Prescribing Safety Assessment' with pharmacist prescribers in Scotland.

Res Social Adm Pharm 2018 01 6;14(1):62-68. Epub 2017 Jan 6.

School of Clinical Sciences, College of Medicine and Veterinary Medicine, The University of Edinburgh, The Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK. Electronic address:

Background: Prescribing is a complex task requiring considerable knowledge and skills. The Prescribing Safety Assessment (PSA) was developed by the British Pharmacological Society and the United Kingdom (UK) Medical Schools Council. Between February and June 2014, over 7000 final year medical students undertook the PSA, with an overall pass rate of 94%. Independent prescribing for suitably trained pharmacists was introduced in the UK in 2006. To date there has been little focus on any objective measures of prescribing safety.

Objective: To determine the PSA performance of a pilot group of pharmacist prescribers in Scotland relative to medical students and to test the feasibility and acceptability of running the PSA.

Methods: A group of 59 pharmacist prescribers took part in ten events. The PSA consisted of 30 questions to be completed over 60 min. All questions had been used in the 2014 assessments for final year medical students. The PSA was undertaken online under invigilated conditions, mirroring the medical student assessment. One month later, participants were invited to complete an online evaluation questionnaire.

Results: The mean overall PSA scores (±SD) were 87.5% ± 8.7 (range 52-98) compared to a 88.5% for medical students. Based on an Angoff passmark of 76.0%, 53 pharmacists (89.8%) passed compared to an overall pass rate in PSA 2014 of 94%. Pharmacists performed equivalently to medical students in all assessment areas, with a slightly lower performance in the prescribing, drug monitoring and data interpretation questions offset by better performance in prescription review and adverse drug reactions. Feedback was positive in relation to appropriateness, relevance and level of difficulty of the PSA although several commented that they were practicing in very specific clinical areas.

Conclusion: These pilot events have benchmarked the PSA performance of pharmacist prescribers with final year medical students, and feedback confirmed feasibility and acceptability.
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January 2018

Influences on prescribing decision-making among non-medical prescribers in the United Kingdom: systematic review.

Fam Pract 2016 12 20;33(6):572-579. Epub 2016 Aug 20.

School of Pharmacy and Life Sciences, Robert Gordon University, Aberdeen, UK and

Background: Suitably qualified non-medical healthcare professionals may now prescribe medicines. Prescribing decision-making can be complex and challenging; a number of influences have been identified among medical prescribers but little appears to be known about influences among non-medical prescribers (NMPs).

Objective: To critically appraise, synthesize and present evidence on the influences on prescribing decision-making among supplementary and independent NMPs in the UK.

Methods: The systematic review included all studies between 2003 and June 2013. Included studies researched the prescribing decision-making of supplementary and independent NMPs practising in the UK; all primary and secondary study designs were considered. Studies were assessed for quality and data extracted independently by two researchers, and findings synthesized using a narrative approach.

Results: Following duplicates exclusion, 886 titles, 349 abstracts and 40 full studies were screened. Thirty-seven were excluded leaving three for quality assessment and data extraction. While all studies reported aspects of prescribing decision-making, this was not the primary research aim for any. Studies were carried out in primary care almost exclusively among nurse prescribers (n = 67). Complex influences were evident such as experience in the role, the use of evidence-based guidelines and peer support and encouragement from doctors; these helped participants to feel more knowledgeable and confident about their prescribing decisions. Opposing influences included prioritization of experience and concern about complications over evidence base, and peer conflict.

Conclusion: While there is a limited evidence base on NMPs' prescribing decision-making, it appears that this is complex with NMPs influenced by many and often opposing factors.
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December 2016

A qualitative study of UK pharmacy pre-registration graduates' views and reflections on pharmacist prescribing.

Int J Pharm Pract 2016 Apr 8;24(2):139-41. Epub 2015 Oct 8.

School of Pharmacy and Life Sciences, Robert Gordon University, Aberdeen, UK.

Background: Pre-registration pharmacy graduates are a key group in relation to developing and implementing innovations in practice.

Objective: To explore the views and reflections on pharmacist prescribing of UK pre-registration pharmacy graduates.

Method: Semi-structured telephone interviews with a sample (n = 12) of pre-registration pharmacy graduates.

Key Findings: Most reported a desire to train as prescribers, largely for reasons of professional development, but acknowledged the need first to develop as pharmacists. They perceived the lack of organisational strategy, pharmacist prescribers' self-confidence and additional workload to be barriers and were aware of the value of interprofessional relationships as potential facilitators to pharmacist prescribing.

Conclusion: While participants were supportive of pharmacist prescribing, they highlighted the need first to gain experience as pharmacists and were acutely aware of barriers to prescribing implementation.
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April 2016

A cross sectional survey of the views of newly registered pharmacists in Great Britain on their potential prescribing role: a cautious approach.

Br J Clin Pharmacol 2012 Apr;73(4):656-60

School of Pharmacy and Life Sciences, Robert Gordon University Institute of Medical Sciences, University of Aberdeen, Aberdeen, UK.

What Is Already Known About This Subject: Pharmacists, along with certain other health professionals, may train and practice as supplementary or independent prescribers. The implementation and sustainability of pharmacist prescribing services throughout Britain will require a sizeable workforce. However, a survey of GB pharmacists highlighted that only a minority has taken any action to investigate prescribing training. Newly registered pharmacists may be keen to explore extended clinical roles and their engagement is likely to be key to the future success of this initiative.

What This Study Adds: Newly registered pharmacists are cautious in their approach to taking on prescribing training and roles. While almost all expressed interest in prescribing training, they acknowledged training needs in clinical examination, patient monitoring and medico-legal aspects of prescribing. Longitudinal research on a cohort of newly registered pharmacist prescribers is warranted, aiming to identify later prescribing training actions and subsequent impact on patient care. AIM To investigate newly registered pharmacists' awareness of pharmacist prescribing and views on potential future roles as prescribers.

Methods: A mailed questionnaire was sent to all 1658 pharmacists joining the Pharmacist Register in 2009.

Results: The response rate was 25.2% (n= 418). While most (86.4%) expressed interest in prescribing training, they acknowledged training needs in clinical examination, patient monitoring and medico-legal aspects of prescribing. Two thirds of respondents (66.3%) thought the current requirement of being registered as a pharmacist for 2 years prior to commencing prescribing training was appropriate.

Conclusion: Newly registered pharmacists are cautious in their approach to taking on prescribing training and roles.
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April 2012