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Background: Reducing medication-related harm is a global priority; however, impetus for improvement is impeded as routine medication safety data are seldom available. Therefore, the Medication Safety Thermometer was developed within England’s National Health Service. This study aimed to explore the implementation of the tool into routine practice from users’ perspectives. Method: Fifteen semi-structured interviews were conducted with purposely sampled National Health Service staff from primary and secondary care settings. Interview data were analysed using an initial thematic analysis, and subsequent analysis using Normalisation Process Theory. Results: Secondary care staff understood that the Medication Safety Thermometer’s purpose was to measure medication safety and improvement. However, other uses were reported, such as pinpointing poor practice. Confusion about its purpose existed in primary care, despite further training, suggesting unsuitability of the tool. Decreased engagement was displayed by staff less involved with medication use, who displayed less ownership. Nonetheless, these advocates often lacked support from management and frontline levels, leading to an overall lack of engagement. Many participants reported efforts to drive scale-up of the use of the tool, for example, by securing funding, despite uncertainty around how to use data. Successful improvement was often at ward-level and went unrecognised within the wider organisation. There was mixed feedback regarding the value of the tool, often due to a perceived lack of “capacity”. However, participants demonstrated interest in learning how to use their data and unexpected applications of data were reported. Conclusion: Routine medication safety data collection is complex, but achievable and facilitates improvements. However, collected data must be analysed, understood and used for further work to achieve improvement, which often does not happen. The national roll-out of the tool has accelerated shared learning; however, a number of difficulties still exist, particularly in primary care settings, where a different approach is likely to be required. [ABSTRACT FROM AUTHOR]

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Background Pharmacy practice is evolving according to general health-care trends such as increased patient involvement and public health initiatives. In addition, pharmacists strive to find new professional roles. Clients' expectations of service encounters at pharmacies is an under-explored topic but crucial to understanding how pharmacy practice can evolve efficiently. Objective To identify and describe different normative expectations of the pharmacy encounter among pharmacy clients. Methods Q methodology, an approach to systematically explore subjectivity that retains complete patterns of responses and organizes these into factors of operant subjectivity. Setting and participants Eighty-five regular prescription medication users recruited at Swedish community pharmacies and by snowballing. Results Seven factors of operant subjectivity were identified, and organized into two groups. Factors that emphasized the physical drug product as the central object of the pharmacy encounter were labelled as independent drug shopping; logistics of drug distribution; and supply of individual's own drugs. Factors that emphasized personal support as desirable were labelled competence as individual support; individualist professional relations, just take care of me; and practical health-care and lifestyle support. Discussion and conclusions The systematic Q-methodological approach yielded valuable insights into how pharmacy clients construct their expectations for service encounters. They hold differentiating normative expectations for pharmacy services. Understanding these varying viewpoints may be important for developing and prioritizing among efficient pharmacy services. Clients' expectations do not correspond with trends that guide current pharmacy practice development. This might be a challenge for promoting or implementing services based on such trends. [ABSTRACT FROM AUTHOR]

Background. The need for effective communication and handling of secondary care information in general practices is paramount. Objective. To explore practice processes on receiving secondary care correspondence in away that integrates the information needs and perceptions of practice staff both clinical and administrative. Methods. Qualitative study using semi-structured interviews with a wide range of practice staff (n = 36) in nine practices in the Northwest of England. Analysis was based on the framework approach using N-Vivo software and involved transcription, familiarization, coding, charting, mapping and interpretation. Results. The 'information processing model' was developed to describe the six stages involved in practice processing of secondary care information. These included the amendment or updating of practice records whilst simultaneously or separately actioning secondary care recommendations, using either a 'one-step' or 'two-step' approach, respectively. Many factors were found to influence each stage and impact on the continuum of patient care. Conclusion. The primary purpose of processing secondary care information is to support patient care; this study raises the profile of information flow and usage within practices as an issue requiring further consideration. [ABSTRACT FROM AUTHOR]

Rationale, aims and objectives Extraction of prescribing data from medical records is a common, albeit flawed, research method. Yet little is known about the processes that result in those data. This study explores the creation and use of prescribing documentation in the medical record, from the perspective of the hospital doctors who both create and use it. Methods Thirty-six hospital doctors were purposively selected for qualitative interviews, giving a maximum variability sample of grades of doctors across the range of major medical specialty areas and medical teams at a large teaching hospital in England. Results The findings suggest a number of reasons why hospital doctors fail to record prescribing decisions in the medical record. There was no set standard, record keeping was not formally taught and the hurried environment of the ward gave little time for documentation. The doctors also acknowledged that there was no need for completeness, as colleagues would be able to ‘fill in the gaps’ via an inferential process. Assumptions were made and although this was not seen as ideal, it was recognized as necessary if work was to be done efficiently. Conclusion These results reinforce the suggestion that, despite the large number of potential users, the medical record is created for those with the right privileged knowledge. This has profound implications for those without that insider knowledge who are using medical records for research purposes. Funding This work was funded by a North West Regional National Health Service Postdoctoral Fellowship. [ABSTRACT FROM AUTHOR]

To investigate cognitive schemas and schema systems used by hospital doctors to influence prescribing, particularly in terms of making appropriate prescribing decisions, and to compare the numbers and content of schemas between doctors with different levels of experience.Qualitative interviews with a purposively selected sample.Seven pre-registration (PRHOs) and 5 senior house officers (SHOs) and 5 consultants from a range of medical specialties in a teaching hospital.The qualitative analysis of the themes and patterns explored during the interviews indicated that all doctors articulated schemas that influenced their behaviour. The junior doctors seemed to have simplistic schemas, with interdoctor agreement; the consultants appeared to have more sophisticated schemas, with greater individual variation. Those schemas adopted by the PRHOs (prescribing‘novices’) could be subsumed by, rather than contradicted by, those of the consultants (prescribing‘experts’), with a transitional stage demonstrated by the SHOs. The most noticeable distinction was the greater emphasis by consultants on holistic patient care and what might be seen as their separate schemas for appropriate prescribing stemmed from that premise. In contrast, junior doctors appeared to have had a single schema that encompassed both prescribing generally and appropriate prescribing.Although the design of this study was cross-sectional rather than longitudinal, the findings suggest that the acquisition and adjustment of schemas and schema systems are significant factors in the professional development of the hospital doctor from novice through to expert. It could be hypothesised that house officers possess simpler schemas as a way of coping with their job demands, which evolve in complexity as they gain experience. However, the transitional stage found with the SHOs is critical during cognitive development, with implications for the training and support available to doctors throughout their professional careers. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To systematically explore and elicit individual patient''s preferences in the management of their hypertension using Q-methodology. Methods: Using Q-methodology, 120 patients ranking 42 statements according to their agreement or disagreement when considering appropriate hypertension management. The statements were derived from an earlier qualitative study. Factor analysis of the data was undertaken using PQMethod software to determine if any patterns were discernible. Results: Ninety-two patients clustered to five factors, which all varied in the degree of involvement patients had, or wished to have, in their hypertension management. The 42 patients who loaded to factor 1 considered that appropriate antihypertensive treatment involved leaving medical decisions to their GPs and trusting their judgement in such matters. The patients (n =31) who positively loaded to factor 2 suggested that an autonomous relationship with their healthcare professional(s) was an important issue when considering treatment. Conclusion: It is concluded that this study has successfully used Q-methodology to systematically investigate people''s subjectivity and developed a novel approach to elicit the views of individual patients, as well as explore and differentiate between groups of patients. Practice implications: The formation of true partnerships between patients and healthcare professionals which will enhance individual patients’ ability to self-manage chronic disease. [Copyright &y& Elsevier]