Publications by authors named "Zachariah Nazar"

19 Publications

  • Page 1 of 1

A study to investigate the implementation process and fidelity of a hospital to community pharmacy transfer of care intervention.

PLoS One 2021 28;16(12):e0260951. Epub 2021 Dec 28.

School of Pharmacy, Newcastle University, Newcastle upon Tyne, United Kingdom.

Background: Hospital to community pharmacy transfer of care medicines-related interventions for inpatients discharged home aim to improve continuity of care and patient outcomes. One such intervention has been provided for seven years within a region in England. This study reports upon the implementation process and fidelity of this intervention.

Methods: The process evaluation guidance issued by the Medical Research Council has informed this study. A logic model to describe the intervention and causal assumptions was developed from preliminary semi-structured interviews with project team members. Further semi-structured interviews were undertaken with intervention providers from hospital and community pharmacy, and with patient and public representatives. These aimed to investigate intervention implementation process and fidelity. The Consolidated Framework for Implementation Research and the Consolidated Framework for Intervention Fidelity informed interview topic guides and underpinned the thematic framework analysis using a combined inductive and deductive approach.

Results: Themes provided information about intervention fidelity and implementation that were mapped across the sub processes of implementation: planning, execution, reflection and evaluation, and engagement. Interviewees described factors such as lack of training, awareness, clarity on the service specification, governance and monitoring and information and feedback which caused significant issues with the process of intervention implementation and suboptimal intervention fidelity.

Conclusions: This provides in-depth insight into the implementation process and fidelity of a ToC intervention, and the extant barriers and facilitators. The findings offer learning to inform the design and implementation of similar interventions, contribute to the evidence base about barriers and facilitators to such interventions and provides in-depth description of the implementation and mechanisms of impact which have the potential to influence clinical and economic outcome evaluation.
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January 2022

Patient activation and patient-reported outcomes of men from a community pharmacy lifestyle intervention after prostate cancer treatment.

Support Care Cancer 2022 Jan 21;30(1):347-358. Epub 2021 Jul 21.

School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK.

Purpose: To report patient activation, which is the knowledge, skills, and confidence in self-managing health conditions, and patient-reported outcomes of men after prostate cancer treatment from a community pharmacy lifestyle intervention.

Methods: The 3-month lifestyle intervention was delivered to 116 men in nine community pharmacies in the UK. Patient Activation Measure (PAM) was assessed at baseline, 3 and 6 months. Prostate cancer-related function and quality of life were assessed using the European Prostate Cancer Index Composite (EPIC-26) and EuroQOL 5-dimension 5-level (EQ5D-5L) questionnaires at baseline and 6 months. Lifestyle assessments included Mediterranean Diet Adherence Screener (MEDAS) at baseline, 3 and 6 months and Godin Leisure Time Exercise Questionnaire (GLTEQ) at baseline and 3 months.

Results: PAM score increased from 62 [95% CI 59-65] at baseline to 66 [64-69] after the intervention (p = 0.001) and remained higher at 6 months (p = 0.008). Scores for all the EPIC-26 domains (urinary, bowel and hormonal) were high at both assessments, indicating good function (between 74 [70-78] and 89 [86-91]), except sexual domain, where scores were much lower (21 [17-25] at baseline, increasing to 24 [20-28] at 6 months (p = 0.012)). In EQ5D-5L, 3% of men [1-9] reported self-care problems, while 50% [41-60] reported pain and discomfort, and no significant changes over time. Men who received androgen deprivation therapy, compared with those who did not, reported higher (better) urinary incontinence scores (p < 0.001), but lower (worse) scores in the urinary irritative/obstructive (p = 0.003), bowel (p < 0.001) and hormonal (p < 0.001) domains. Poor sexual function was common across all age groups irrespective of prostate cancer treatment.

Conclusions: The intervention led to significant improvements in patient activation, exercise and diet. Community pharmacy could deliver effective services to address sexual dysfunction, pain and discomfort which are common after prostate cancer.
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January 2022

Using Assessment Design Decision Framework in understanding the impact of rapid transition to remote education on student assessment in health-related colleges: A qualitative study.

PLoS One 2021 9;16(7):e0254444. Epub 2021 Jul 9.

Pharmaceutical Sciences Department, College of Pharmacy, QU Health, Qatar University, Doha, Qatar.

Maintaining integrity and validity with online assessment is a significant issue that is well documented. Overt policies encouraging educators to adopt e-Learning and implement digital services coupled with the dramatic change in the education system in response to the challenges posed by COVID-19, has furthered the demand for evidence-based approaches for the planning and delivery of assessments. This study employed the Assessment Design Decision Framework (ADDF), a theoretical model that considers key aspects of assessment design, to retrospectively investigate from a multi-stakeholder perspective the assessments implemented following the rapid transition to remote learning during the COVID-19 pandemic. One-to-one semi-structured interviews were conducted with faculty and students from the Colleges of Pharmacy, Medicine and Health Sciences. After inductive and deductive thematic analysis three major themes were identified. These reflected on the impact of sudden transition on assessment design and assessment plan; changing assessment environment; and faculty-student assessment related interactions which included feedback. The use of a comprehensive validated framework such as ADDF, to plan assessments can improve validity and credibility of assessments. The strengths of this study lie in the innovative adoption of the ADDF to evaluate assessment design decisions from both an educator and student perspective. Further, the data yielded from this study offers novel validation of the use of ADDF in circumstances necessitating rapid transition, and additionally identifies a need for greater emphasis to be attributed to the significance of timeliness of the various activities that are advocated within the framework.
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July 2021

A theoretically informed, mixed-methods study of pharmacists' aspirations and readiness to implement pharmacist prescribing.

Int J Clin Pharm 2021 Dec 14;43(6):1638-1650. Epub 2021 Jun 14.

Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar.

Background Studies have highlighted advancing clinical pharmacy practice in Qatar. Objective To explore pharmacists' aspirations and readiness to implement pharmacist prescribing. Setting Hamad Medical Corporation (HMC), the main provider of secondary and tertiary care. Method A sequential explanatory mixed-methods design. Questionnaire items were derived from the Consolidated Framework of Implementation Research (CFIR), in domains of: awareness/support; readiness; implementation; and facilitators and barriers. Following piloting, all pharmacists (n = 554) were invited to participate. Questionnaire data were analysed using descriptive and inferential statistics with principal component analysis of attitudinal items. Focus groups were recorded, transcribed and analysed using the Framework Approach. Main outcome measure Aspirations and readiness to implement pharmacist prescribing. Results The response rate was 62.8% (n = 348), with respondents highly supportive of implementation in Qatar (median 4, scale 0-5, extremely supportive). The majority (64.9%, n = 226) considered themselves ready, particularly those more senior (p < 0.05) and classifying themselves innovative (p < 0.01). Outpatient (72.9%, n = 221 agreeing) and inpatient (71.1%, n = 218 agreeing) HMC settings were those perceived as being most ready. PCA identified 2 components, with 'personal attributes' being more positive than 'prescribing support'. Facilitators were access to records, organizational/management support and the practice environment, with physician resistance and scope of practice as barriers. Focus groups provided explanation, with themes in CFIR domains of innovation characteristics, characteristics of individuals and the inner setting. Conclusion HMC pharmacists largely aspire, and consider themselves ready, to be prescribers with inpatient and outpatient settings most ready. CFIR domains and constructs identified as facilitators and barriers should be focus for implementation.
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December 2021

A rapid review and narrative synthesis of hospital to community pharmacy transfer of care services in England.

Int J Pharm Pract 2021 Mar;29(2):96-105

Pharmacy Department, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.

Objectives: A new discharge medicines service in England has been proposed for rollout in July 2020. This study aims to appraise the evidence for hospital to community pharmacy referral services in England. A rapid review methodology was adopted, findings were synthesised and reported narratively. The PubMed search engine was used and specific pharmacy journals were searched in March 2020. Studies published since 2012, reporting on transfer of care (ToC) services provided from hospitals and community pharmacies in England were included. Study data analysed included clinical outcomes; findings relating to implementation, staff and patient perceptions and experiences. Studies were assessed for risk of bias using a critical appraisal checklist.

Key Findings: Ten studies met the inclusion criteria. The ToC services varied in relation to patients targeted, mode of referral, and post-discharge service provided. There were some conservative observations that ToC services were associated with reduced hospital readmission rates, however other outcomes were less well substantiated. Pharmacy staff were generally supportive of these services for patient benefit, however, patient engagement and accessibility issues have been reported.

Summary: There is some emerging evidence that hospital to community pharmacy referral services are associated with reduced hospital readmission. Service delivery reported in these studies highlights barriers and facilitators to patient recruitment, engagement and follow-up and limitations on recording and measuring meaningful outcomes. Future work is recommended to take advantage of the implementation and delivery of the national service that includes the analysis of patient data at scale to substantiate evidence in this area.
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March 2021

Adopting a systems thinking approach to investigate the implementation and provision of a pharmacist-led post-discharge domiciliary medicines review service.

Res Social Adm Pharm 2021 04 5;17(4):808-815. Epub 2020 Aug 5.

Clinical Pharmacy and Practice Department, College of Pharmacy, QU Health, Qatar. Electronic address:

Background: Intervention planners need to be sufficiently cognisant of the health system landscape to facilitate embedding, adoption and diffusion of new services. Pharmacist-led transfer of care initiatives from hospital to community have been developed to address a health system flaw: patient hospital readmissions. A hospital in England partnered with a chain of community pharmacies establishing a domiciliary pharmacist medicines use review service (DMRS) for discharged patients to reduce hospital readmissions.

Objectives: We adopt a systems thinking approach to understand the adoption and diffusion of the service by investigating the perceptions of hospital and community pharmacy staff. The experience of a role swap between these settings is investigated to probe further system factors influencing service provision.

Methods: Semi-structured interviews informed by a conceptual model for the diffusion, dissemination and implementation of innovations, were conducted with hospital and community pharmacy staff between Oct-Dec 2016. Interviews were audio-recorded with consent, transcribed verbatim and a combination of inductive and deductive thematic analysis was used.

Results: Four each of hospital and community pharmacy staff were interviewed and four hospital staff were interviewed after the role swap. Staff indicated barriers and facilitators thematically related to organisational and individual-level components of a conceptual model about service diffusion and implementation. The role swap appeared to address the lack of a feedback loop, which was limiting engagement of hospital staff. The role swap led to improved trust and shared goals between the healthcare sectors and increased appreciation and self-efficacy of the hospital staff role.

Conclusions: A systems thinking lens offered the opportunity to investigate the wider healthcare system within which the DMRS was being provided. The role swap aligned to the principles of participatory design of an intervention to facilitate successful adoption and diffusion and contribute to more insightful evaluation about the process and context of service implementation.
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April 2021

Maternal and perinatal outcomes and pharmacological management of Covid-19 infection in pregnancy: a systematic review protocol.

Syst Rev 2020 07 18;9(1):161. Epub 2020 Jul 18.

Pharmacy Executive Office, Hamad Medical Corporation, Doha, Qatar.

Background: Over 4.2 million confirmed cases and more than 285,000 deaths, COVID-19 pandemic continues to harm significant number of people worldwide. Several studies have reported the impact of COVID-19 in general population; however, there is scarcity of information related to pharmacological management and maternal and perinatal outcomes during the pandemic. Altered physiological, anatomical, and immunological response during pregnancy makes it more susceptible to infections. Furthermore, during pregnancy, a woman undergoes multiple interactions with the health care system that increases her chance of getting infected; therefore, managing pregnant population presents a unique challenge.

Research Questions: This systematic review seeks to answer the following questions in relation to COVID-19: What are the different clinical characteristics presented in maternal and perinatal population? What are the different maternal and perinatal outcome measures reported? What are the distinct therapeutic interventions reported to treat COVID-19? Is it safe to use "medications" used in the treatment of COVID-19 during antenatal, perinatal, postnatal, and breastfeeding?

Method: The search will follow a comprehensive, sequential three step search strategy. Several databases relevant to COVID-19 and its impact on pregnancy including Medline, CINAHL, and LitCovid will be searched from the inception of the disease until the completion of data collection. The quality of this search strategy will be assessed using Peer Review of Electronic Search Strategies Evidence-Based Checklist (PRESS EBC). An eligibility form will be developed for a transparent screening and inclusion/exclusion of studies. All studies will be sent to RefWorks, and abstraction will be independently performed by two researchers. Risk of bias will be assessed using Cochrane Risk of Bias tool for randomized controlled trials, Newcastle-Ottawa Quality Assessment Scale for non-randomized studies, and for case reports, Murad et al. tool will be used. Decision to conduct meta-analysis will be based on several factors including homogeneity and outcome measures reported; otherwise, a narrative synthesis will be deemed appropriate.

Discussion: This systematic review will summarize the existing data on effect of COVID-19 on maternal and perinatal population. Furthermore, to the best of our knowledge, this is the first systematic review addressing therapeutic management and safety of medicines to treat COVID-19 during pregnancy and breastfeeding.

Systematic Review Registration: This systematic review has been registered and published with Prospero ( CRD42020172773 ).
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July 2020

A service evaluation and stakeholder perspectives of an innovative digital minor illness referral service from NHS 111 to community pharmacy.

PLoS One 2020 19;15(3):e0230343. Epub 2020 Mar 19.

School of Pharmacy, Newcastle University, Newcastle upon Tyne, United Kingdom.

Introduction: The management of minor conditions represents a significant burden for urgent and emergency care services and reduces the capacity to provide specialist care for higher acuity healthcare need. A pilot Digital Minor Illness Service (DMIRS) was commenced in the North East of England in December 2017 to feasibility test the NHS 111 referral to community pharmacy for patients presenting with minor conditions.

Objectives: A formative evaluation of the service activity data and qualitative investigation of stakeholders involved in the service design, management, delivery and use, aims to present and investigate the service outcomes.

Method: Routine service activity data was evaluated during Jan-Dec 2018 to investigate the demographics of patients included in the service; the presenting conditions; and how those referrals were managed by community pharmacies. Semi-structured interviews with NHS 111 call handlers, project team members, community pharmacists and patients were undertaken to investigate the design, management, implementation and delivery of the service.

Results: 13,246 NHS 111 patient calls were referred to community pharmacy during the evaluative period. The most common presenting conditions were acute pain (n = 1144, 8.6%) and cough (n = 887, 6.7%). A large volume of complaints (47.1%, 6233) were resolved in community pharmacy. Stakeholders explained the structured approach to service design, organisation and implementation facilitated successful delivery and management. Patients reported positive experiences with accessing care via DMIRS.

Conclusions: DMIRS demonstrated that patients could be referred to community pharmacy for the management of minor conditions, shifting a burden away from urgent and emergency care. The service data provides key information for further optimisation of service design, and stakeholder training and awareness. The service was acceptable and valued by patients. Evidence from the DMIRS pilot has been utilised to inform recent national healthcare policy and practice around the management of minor conditions within the urgent and emergency care setting.
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June 2020

Exploring the experiences and preparedness of humanitarian pharmacists in responding to an emergency-response situation.

Res Social Adm Pharm 2020 01 31;16(1):90-95. Epub 2019 Mar 31.

Newcastle University, King George VI Building, Newcastle upon Tyne, NE1 7RU United Kingdom. Electronic address:

Background: Pharmacists are more frequently being deployed along with other members of the multi-disciplinary team in order to provide humanitarian aid. This team will need to work collaboratively to overcome challenges such as constraints in access to medication, medical supplies and medical records. Recent literature reports on the role of the pharmacist across all facets of care continuing to evolve into clinical areas to support patient care. To date there is a deficiency in description and understanding of the preparedness and contribution of pharmacists within a humanitarian capacity.

Objective: This study aims to investigate the preparedness of pharmacists working in the humanitarian field and to explore pharmacists' experiences including the challenges they face in an emergency response situation.

Methods: An interview topic guide was developed and informed by a review of the literature and one-to-one in-depth semi-structured telephonic interviews were conducted with pharmacists involved in the humanitarian field based in England. Interviews were audio recorded and were transcribed verbatim. A member of the research team conducted the data analysis (FS) consistent with the Braun and Clarke approach, the authors (ZN and HN) provided advice and input throughout the analysis process.

Results: Twelve pharmacists participated in this study, nine of whom had deployment experience; interviews took place between October 2017 and April 2018. Data analysis identified four descriptive themes (training and preparation; skills required; challenges/barriers; professional development) and numerous sub-themes.

Conclusions: This study resonates with research investigating experiences of other healthcare professionals, which report the need for more tailored and appropriate training to improve preparedness for deployment. Pharmacists also suggest specific skills and knowledge facilitate adaptability and innovate working which areas of humanitarian need require. The pharmacists did not report any psychological burden or trauma from their experiences in emergency response, which requires further study to ensure this aspect of preparation, debriefing and support is not neglected.
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January 2020

A systematic review of the outcome data supporting the Healthy Living Pharmacy concept and lessons from its implementation.

PLoS One 2019 12;14(3):e0213607. Epub 2019 Mar 12.

School of Pharmacy and Biomedical Science, University of Portsmouth, Portsmouth, United Kingdom.

Background: The Healthy Living Pharmacy (HLP) project, launched in England, UK in 2009 was a novel approach of introducing public health services within community pharmacy to tackle local health inequalities. A national roll-out followed a reported successful pilot; subsequent local evaluations ensued.

Objectives: To summarise reported outcomes and investigate contextual factors that indicate the presence, absence and maturity of implementation determinants, thus offering useful lessons to stakeholders in implementing future initiatives to achieve successful outcomes.

Methods: A systematic review was conducted to identify all publications reporting on the HLP project. All HLP articles and conference abstracts were considered for inclusion and were assessed for methodological quality. The Consolidated Framework for Implementation Research (CFIR) was utilised to identify potential implementation determinants reported. Each article was then analysed to identify reported economic, humanistic or clinical outcomes.

Results: The review included six peer-reviewed journal articles and 12 conference abstracts. Joanna Briggs Institute Qualitative Assessment and Review Instrument indicated deficiencies in methodological quality. Through adoption of the CFIR framework, the implementation determinants relevant to the implementation of HLP into community pharmacy were identified. A resonating issue emerged in that the absence of adopting an evidence-based implementation process limited the ability to capture meaningful outcome data. This resulted in a lack of evidence to support sustainability and the failure to address many of the well cited barriers, e.g. lack of awareness amongst patients, public and other healthcare professionals, and weak support for future investment in resource for training and dissemination.

Conclusions: Healthcare systems are increasingly called on to adopt evidence-based interventions that improve quality, control costs, and maximize value, thus offering opportunity to accelerate the implementation of clinical pharmacy services and programs aimed at improving patient care. Interventions, such as the HLP project require focused efforts on implementation and evaluation of those implementation efforts to produce effective and lasting changes in complex health care systems.
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December 2019

A study to investigate the impact of a blended learning teaching approach to teach pharmacy law.

Int J Pharm Pract 2019 Jun 13;27(3):303-310. Epub 2018 Dec 13.

School of Pharmacy, Newcastle University, Newcastle upon Tyne, UK.

Objective: To describe the implementation and assess the effect of a blended learning approach to teach pharmacy law.

Methods: Twenty didactic pharmacy law lectures were redeveloped to 9 h of flipped classroom sessions. Presession online videos delivered factual content created in-house. In-class activities explored the application and nuances of law through simulated cases. Stage 2 Pharmacy undergraduate students (n = 69) were administered the Community of Inquiry Survey, measuring the social, teaching and cognitive presence of online learning experiences across 34 items on a Likert scale 1-5 (1 = 'strongly agree', to 5 = 'strongly disagree'). Four focus groups were undertaken and analysed thematically to explore student perceptions. Performance at the final summative law examination was recorded and compared to that of two previous cohorts given traditional, didactic teaching.

Key Findings: Fifty-three students (76.8% response) completed the survey. The mean ranking was 3.6 ± 0.7, 3.6 ± 0.6 and 3.3 ± 0.7 for teaching, social and cognitive presence, and most positively rated statements related to material design and organization. All students passed the summative law examination performing not significantly different to the previous cohorts. Focus group discussions demonstrated that students liked the online and interactive case-study materials, but wanted more direction and preferred smaller group sessions. Students had mixed feelings about needing an online social component.

Conclusions: Blended learning transformed the pharmacy law teaching from didactic to an interactive learning experience. The student feedback was generally mixed, but offered many recommendations to optimize the design and format of the course. Examination performance appeared to be unaffected by the change in teaching style.
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June 2019

Community pharmacy minor ailment services: Pharmacy stakeholder perspectives on the factors affecting sustainability.

Res Social Adm Pharm 2019 03 14;15(3):292-302. Epub 2018 May 14.

School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, PO1 2DT, UK.

Background: Self-care advice and management of minor ailments have long been provided in community pharmacies across England. However, formal pharmacy minor ailment service provision is geographically variable and has yet to gain recognition and political support as a valued sustainable service for nationwide adoption and commissioning.

Objective: To investigate the sustainability potential of pharmacy minor ailment services from the perspective of community pharmacy stakeholders within the North East of England.

Methods: A mixed methods approach was adopted to survey and interview stakeholders from the North East of England who commission; provide; and/or represent groups influencing the design, delivery and investment in community pharmacy clinical and public health services. The 40-item Programme Sustainability Assessment Tool, a validated instrument to assess a public health programme's capacity for sustainability across eight domains, was administered to fifty-three stakeholders, identified from a pharmacy minor ailments showcase event. The same stakeholders were invited for a semi-structured interview to explore issues further. Interviews were audio-recorded, transcribed verbatim, and underwent framework analysis.

Results: Forty-two (79.2% response rate) stakeholders representing commissioning, provider and influencing (e.g. Local Professional Network) organisations completed the assessment tool. Pharmacy minor ailment services were rated as unsustainable across the majority of the domains. Elements within the domain 'Partnerships' demonstrated potential for sustainability. Stakeholder interviews provided detailed explanation for the low scoring sustainability domains, highlighting the multifaceted challenges threatening these services.

Conclusion: The Programme Sustainability Assessment Tool allowed stakeholders to evaluate the potential of pharmacy minor ailment services in England. Follow-up interviews highlighted that initial design and implementation of services was poorly conceived and lacked evidence, thereby impeding the services' sustainability. There are many challenges facing a widespread provision of pharmacy ailment services, but it is clear the profession needs to be clear on the service objectives to secure future interest and investment.
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March 2019

Consensus methodology to determine minor ailments appropriate to be directed for management within community pharmacy.

Res Social Adm Pharm 2018 11 4;14(11):1027-1042. Epub 2018 Jan 4.

School of Pharmacy, Sir James Spence Institute Building, Newcastle University, Newcastle-upon-Tyne, UK.

Background: National Health Service (NHS) 111, a medical helpline for urgent care used within the England and Scotland, receives significant numbers of patient calls yearly for a range of clinical conditions. Some are considered high acuity and mainly directed to urgent and emergency care. Low acuity conditions are also directed to these costly, overburdened services. Community pharmacy is a recognised setting for effective low acuity condition management and could offer an alternative.

Objective: To design and evaluate a new NHS111 pathway re-directing patients with low acuity conditions to community pharmacy.

Methods: Two consensus development stakeholder workshops were undertaken. A "low acuity" condition was defined as one that can be clinically assessed by a community pharmacist and requires a treatment and/or advice available within a community pharmacy. Retrospective NHS111 patient data (February-August 2016) from the North East of England and access to the NHS Pathways clinical decision support software were available to stakeholders. The NHS111 data demonstrated the volume of patient calls for these conditions that could have been redirected to community pharmacy.

Results: Stakeholders reached consensus that 64 low acuity conditions could be safely redirected to community pharmacy via NHS111. This represented approximately 35,000 patients (11.5% of total) being shifted away from the higher cost settings in the North East region alone during February-August 2016. The stakeholder group discussions provided rationale behind their classifications of conditions to ensure patient safety, the care experience and added value.

Conclusions: The resulting definitive list of low acuity conditions that could be directed to community pharmacy via NHS111 could result in a shift of workload from urgent and emergency care settings. Future work needs to evaluate the cost, clinical outcomes, patient satisfaction of a community pharmacy referral service that has the potential to improve integration of community pharmacy in the wider NHS.
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November 2018

A Consensus Approach to Investigate Undergraduate Pharmacy Students' Experience of Interprofessional Education.

Am J Pharm Educ 2017 Mar;81(2):26

Durham University, Stockton-on-Tees, United Kingdom.

To assess the development of knowledge, attitudes, and behaviors for collaborative practice among first-year pharmacy students following completion of interprofessional education. A mixed-methods strategy was employed to detect student self-reported change in knowledge, attitudes, and behaviors. Validated survey tools were used to assess student perception and attitudes. The Nominal Group Technique (NGT) was used to capture student reflections and provide peer discussion on the individual IPE sessions. The validated survey tools did not detect any change in students' attitudes and perceptions. The NGT succeeded in providing a milieu for participating students to reflect on their IPE experiences. The peer review process allowed students to compare their initial perceptions and reactions and renew their reflections on the learning experience. The NGT process has provided the opportunity to assess the student experience through the reflective process that was enriched via peer discussion. Students have demonstrated more positive attitudes and behaviors toward interprofessional working through IPE.
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March 2017

Healthy living champions network: An opportunity for community pharmacy's sustained participation in tackling local health inequalities.

Res Social Adm Pharm 2016 Nov - Dec;12(6):1010-1015. Epub 2016 Jan 7.

School of Pharmacy & Biomedical Science, University of Portsmouth, PO1 2DT, UK.

Background: Evaluations recognize healthy living champions (HLCs) as key contributors to the Health Living Pharmacy (HLP) project's success; the project has served to reduce pressure on family doctor services and clients who would have otherwise not sought professional advice have accessed HLP services.

Objectives: To investigate the impact of innovative networking opportunities in supporting HLCs to function within their role and to explore the network's potential in promoting sustained HLP participation.

Method: Twenty of Portsmouth's (England) HLCs (n = 33) agreed to participate in focus groups. Transcripts were subjected to interpretative phenomenological analysis guided by grounded theory. The transcripts were read repeatedly; recurrent themes were identified and coded manually and consensus was reached by discussion within the research team.

Findings: Network meetings provide HLCs with professional development, networking opportunities and continued encouragement. Recommendations to develop and sustain the network included the formation of a group committee and establishing of a communication facility accessible between meetings.

Conclusion: The successful Portsmouth HLP project informed the design of UK HLP projects. The current focus is to build a successful strategy to sustain the positive outcomes, building on the recognized enablers. This study contributes further lessons learned to guide health commissioners and service implementers to best support staff development, involvement and motivation through innovative practice.
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July 2017

Use of a service evaluation and lean thinking transformation to redesign an NHS 111 refer to community Pharmacy for Emergency Repeat Medication Supply Service (PERMSS).

BMJ Open 2016 08 26;6(8):e011269. Epub 2016 Aug 26.

School of Medicine, Pharmacy and Health, Durham University, Stockton-On-Tees, UK.

Objectives: To demonstrate the contribution of community pharmacy from NHS 111 referrals out of hours (OOH) for emergency supply repeat medication requests via presentation of service activity, community pharmacist feedback and lean thinking transformation.

Design: Descriptive service evaluation using routine service activity data over the pilot period; survey of community pharmacists, and service redesign through lean thinking transformation.

Setting: North East of England NHS 111 provider and accredited community pharmacies across the North East of England.

Participants: Patients calling the North East of England NHS 111 provider during OOH with emergency repeat medication supply requests.

Interventions: NHS 111 referral to community pharmacies for assessment and if appropriate, supply of emergency repeat medication.

Main Outcome Measures: Number of emergency repeat medication supply referrals, completion rates, reasons for rejections, time of request, reason for access, medication(s), pharmaceutical advice and services provided. Secondary outcomes were community pharmacist feedback and lean thinking transformation of the patient pathway.

Results: NHS 111 referred 1468 patients to 114 community pharmacies (15/12/2014-7/4/2015). Most patients presented on Saturdays, with increased activity over national holidays. Community pharmacists completed 951 (64.8%) referrals providing 2297 medications; 412 were high risk. The most common reason for rejecting referrals was no medication in stock. Community pharmacists were positive about the provision of this service. The lean thinking transformation reduced the number of non-added value steps, waits and bottlenecks in the patient pathway.

Conclusions: NHS 111 can redirect callers OOH from urgent and emergency care services to community pharmacy for management of emergency repeat medication supply. Existing IT and community pharmacy regulations allowed patients to receive a medication supply and pharmaceutical advice. Community pharmacists supported integration into the NHS OOH services. Adopting lean thinking provided a structured framework to evaluate and redesign the service with the aim to improve effectiveness and efficiency.
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August 2016

Summative service and stakeholder evaluation of an NHS-funded community Pharmacy Emergency Repeat Medication Supply Service (PERMSS).

BMJ Open 2016 Jan 19;6(1):e009736. Epub 2016 Jan 19.

School of Medicine, Pharmacy and Health, Durham University, Stockton-On-Tees, UK.

Objectives: Service and stakeholder evaluation of an NHS-funded service providing out-ofhours (OOH) emergency repeat medications to patients self-presenting at community pharmacies.

Setting: Community pharmacies across the North East of England accredited to provide this service.

Participants: Patients self-presenting to community pharmacies during OOH periods with emergency repeat medication supply requests.

Intervention: Community pharmacists assessed each request for clinical appropriateness and when suitable provide an emergency repeat medication supply, with additional pharmaceutical advice and services if required.

Primary Outcomes: Number of emergency repeat medication supplies, time of request, reason for access, medication(s), pharmaceutical advice and services provided. Secondary outcomes were community pharmacist and patient satisfaction.

Results: A total of 2485 patients were managed across 227 community pharmacies (15 December 2014 to 7 April 2015). Most patients presented on Saturdays, with increased activity over national holidays. Older age was associated with increased service use. Of the 3226 medications provided, 439 were classified as high risk. Patients found this service easy to access and were willing to access the community pharmacy in the future for medication-related issues. In the absence of this service, 50% of patients would have missed their medication(s) until they saw their doctor and a further 46% would have accessed an alternative service. The cost of National Health Service (NHS) service(s) for patients who would have accessed an alternative OOH service was estimated as 37 times that of the community pharmacy service provided. Community pharmacists were happy to provide this service despite increased consultation times and workload.

Conclusions: Community pharmacists were able to manage patients' OOH requests for emergency repeat medication and patients were happy with the service provided. Since the service cost was favourable when compared with alternative OOH services, it would be a viable option to reduce the workload on the wider NHS.
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January 2016

A systematic review of the role of community pharmacies in improving the transition from secondary to primary care.

Br J Clin Pharmacol 2015 Nov 3;80(5):936-48. Epub 2015 Oct 3.

School of Medicine, Pharmacy and Health, Durham University, Queen's Campus, Stockton, TS17 6BH.

Aim: We set out to determine the potential contribution of community pharmacists to improve the transfer of care of patients from secondary to primary care settings.

Method: We systematically reviewed the literature on interventions that involved community pharmacy post-discharge. We considered all relevant studies, including both randomized and non-randomized controlled trials, irrespective of patient population. Our primary outcome was any impact on patient and medication outcomes, while the secondary outcome was to identify intervention characteristics that influenced all reported outcomes.

Results: We retrieved 14 studies that met our inclusion criteria. There were four studies reporting outcomes relating to the identification and rectification of medication errors that were significantly improved with community pharmacy involvement. Other patient outcomes such as medication adherence and clinical control were not unanimously positively or negatively influenced via the inclusion of community pharmacy in a transfer of care post-discharge intervention. Some inconsistencies in implementation and process evaluation of interventions were found across the reviewed studies. This limited the accuracy with which true impact could be considered.

Conclusions: There is evidence that interventions including a community pharmacist can improve drug related problems after discharge. However, impact on other outcomes is not consistent. Further studies are required which include process evaluations to describe fully the context of the intervention so as to determine better any influencing factors. Also applying more stringent controls and closer adherence to protocols in both intervention and control groups would allow clearer correlations to be made between the intervention and the outcomes.
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November 2015