30 results on '"Hughes, Carmel"'
Search Results
2. An exploration of Northern Ireland general practice pharmacists’ views on their role in general practice: a cross-sectional survey
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Hassan, Abrar H. F., Barry, Heather E., and Hughes, Carmel M.
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- 2024
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3. An external pilot cluster randomised controlled trial of a theory-based intervention to improve appropriate polypharmacy in older people in primary care (PolyPrime)
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Rankin, Audrey, Gorman, Ashleigh, Cole, Judith, Cadogan, Cathal A., Barry, Heather E., Agus, Ashley, Logan, Danielle, McDowell, Cliona, Molloy, Gerard J., Ryan, Cristín, Leathem, Claire, Maxwell, Marina, Brennan, Connie, Gormley, Gerard J., Ferrett, Alan, McCarthy, Pat, Fahey, Tom, and Hughes, Carmel M.
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- 2022
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4. The MultimorbiditY COllaborative Medication Review And DEcision Making (MyComrade) study: a protocol for a cross-border pilot cluster randomised controlled trial
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Hynes, Lisa, Murphy, Andrew W., Hart, Nigel, Kirwan, Collette, Mulligan, Sarah, Leathem, Claire, McQuillan, Laura, Maxwell, Marina, Carr, Emma, Walkin, Scott, McCarthy, Caroline, Bradley, Colin, Byrne, Molly, Smith, Susan M., Hughes, Carmel, Corry, Maura, Kearney, Patricia M., McCarthy, Geraldine, Cupples, Margaret, Gillespie, Paddy, Newell, John, Glynn, Liam, Alvarez-Iglesias, Alberto, and Sinnott, Carol
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- 2022
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5. Improving medicines management for people with dementia in primary care: a qualitative study of healthcare professionals to develop a theory-informed intervention
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Barry, Heather E., Bedford, Laura E., McGrattan, Máiréad, Ryan, Cristín, Passmore, A. Peter, Robinson, A. Louise, Molloy, Gerard J., Darcy, Carmel M., Buchanan, Hilary, and Hughes, Carmel M.
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- 2020
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6. Development of a core set of clinical skills for pharmacist prescribers working in general practice: A Delphi study.
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Hasan Ibrahim, Ameerah S., Barry, Heather E., Girvin, Briegeen, and Hughes, Carmel M.
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With increasing numbers of pharmacists working in general practices and undertaking patient-facing roles, it has been recognised that they must have the necessary clinical skills. However, previous studies have highlighted that practice-based pharmacists (PBPs) do not feel confident regarding their clinical skills, and it is unclear what skills are needed. To develop a core set of clinical skills (CSs) required for pharmacists who intend to practise as independent prescribers working in general practice/family medicine. Based on a previous study, 18 CSs were selected for inclusion in a three-round Delphi consensus questionnaire. These skills were rated by a Delphi panel on a 9-point Likert scale (ranging from 1 = limited importance to 9 = critical). The Delphi panel comprised designated leads of pharmacist independent prescribing programmes in each United Kingdom educational provider listed on the General Pharmaceutical Council website. A CS was included in the core set if 80% or more of participants scored between 7 and 9, and 15% or less scored between 1 and 3. Following Round 1, seven CSs met the criteria for inclusion: 'Measuring heart rate (radial pulse)', 'Assessing respiratory rate', 'Measuring blood pressure (manual, e.g. with aneroid sphygmomanometer)', 'Measuring blood pressure (automated, i.e. electronic blood pressure monitor)', 'Measuring peripheral oxygen saturation (using pulse oximeter)', 'Measuring temperature', 'Measuring Peak Expiratory Flow Rate'. After two further rounds, a further four CSs were included consisting of 'Undertaking a urinalysis', 'Respiratory examination (includes inspection, palpation, percussion and listening to breath sounds)', 'Screening for/assessment of depression and anxiety using a validated questionnaire (e.g. Patient Health Questionnaire-9 [PHQ-9] scoring)', and 'Patient assessment via National Early Warning Score (NEWS)'. No consensus was reached on nine CSs. This study has produced a core set of CSs for prescribing pharmacists. This study may contribute to standardisation of training and assessment for pharmacist prescribers working in general practice/family medicine. [ABSTRACT FROM AUTHOR]
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- 2023
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7. Enhancing deprescribing: A qualitative understanding of the complexities of pharmacist‐led deprescribing in care homes.
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Birt, Linda, Wright, David J., Blacklock, Jeanette, Bond, Christine M., Hughes, Carmel M., Alldred, David P., Holland, Richard, and Scott, Sion
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GENERAL practitioners ,HOME care services ,RESEARCH methodology ,POLYPHARMACY ,DEPRESCRIBING ,INTERVIEWING ,DISEASES ,INAPPROPRIATE prescribing (Medicine) ,PHARMACISTS ,QUALITATIVE research ,PRIMARY health care ,HEALTH attitudes ,PSYCHOSOCIAL factors ,RESEARCH funding ,CLINICAL competence ,PROFESSIONAL competence ,HOSPITAL care ,JUDGMENT sampling ,THEMATIC analysis - Abstract
The English National Overprescribing Review identified that older people often take eight or more medicines a day. The report recommended pharmacists in primary care should take responsibility for addressing polypharmacy. Overprescribing is a safety concern in care homes as approximately half of older care home residents are prescribed at least one medicine that is unnecessary or now harmful. This predisposes them to adverse outcomes including hospitalisation and mortality. Deprescribing is the planned activity of stopping or reducing a medicine that may no longer be appropriate. Deprescribing, when performed by a pharmacist, is a multidisciplinary activity requiring close communication with general practitioners (GPs) and care home staff. A recently completed trial that integrated pharmacists with prescribing rights into older peoples' care homes found significant variation in proactive deprescribing activity. The aim of the current study was to specifically explore beliefs and practices of deprescribing in care homes. A qualitative approach was adopted to examine individual, social and contextual factors that acted as enablers and barriers to pharmacist deprescribing in care homes. Semi‐structured interviews were conducted with participants of the previous study (16 pharmacists, 6 GPs and 7 care home staff from Northern Ireland, Scotland and England). Using thematic analysis, we identified two themes: (a) Structures and systems affecting deprescribing, that is the context in which deprescribing happened, including team involvement and routine practices in GP surgeries and care homes; (b) Balancing risks when deprescribing, that is the perception of individual risk and social barriers were mitigated by understanding the medical background of residents. This supported the clinical understanding that risks from overprescribing were greater than risks from deprescribing. While deprescribing can involve all health professionals in the primary care team, these results suggest the pharmacist is well placed to lead the process; by having both clinical competence and professional willingness to drive this activity forward. [ABSTRACT FROM AUTHOR]
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- 2022
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8. Interventions to improve medicines optimisation in older people with frailty in primary care: a systematic review.
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Faulkner, Lucy, Hughes, Carmel M, and Barry, Heather E
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Objectives To identify studies that delivered an intervention to frail older people to improve medicines optimisation; identify the outcomes reported in these studies; and assess the effectiveness of these interventions on chosen study outcomes. Method Eight electronic databases and four trial registries were systematically searched from the date of inception to April 2020. Inclusion criteria were randomised controlled trials and non-randomised studies of interventions to improve medicines optimisation (including administration, adherence, deprescribing, prescribing and/or medication review) in community-dwelling older people (aged ≥65 years) with a frailty diagnosis. Only studies published in English were included. A narrative synthesis was conducted, and quality was assessed using an appropriate risk of bias tool. Key findings Searches identified 601 articles; one study met the criteria for inclusion. The single eligible study used a quasi-experimental pre-test–post-test study design to evaluate the impact of a pharmacist-led, team-based medication review for 54 frail older patients living in primary care. Improvements in the total number of medications and prescribing appropriateness were observed. The study was judged to be at an overall serious risk of bias. Conclusion There is a dearth of high-quality evidence demonstrating the effectiveness of medicines optimisation interventions for older people with frailty within primary care. Due to the strong association between patients' level of frailty and adverse outcomes, it is important that future research focuses on proactive interventions which may be beneficial to this patient population. [ABSTRACT FROM AUTHOR]
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- 2022
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9. The journey to concordance for patients with hypertension: a qualitative study in primary care
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Bane, Catherine, Hughes, Carmel M., Cupples, Margaret E., and McElnay, James C.
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- 2007
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10. Process evaluation for the Care Homes Independent Pharmacist Prescriber Study (CHIPPS).
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Birt, Linda, Dalgarno, Lindsay, Wright, David J, Alharthi, Mohammed, Inch, Jackie, Spargo, Maureen, Blacklock, Jeanette, Poland, Fiona, Holland, Richard C, Alldred, David P., Hughes, Carmel M., Bond, Christine M., on behalf of the CHIPPS study team, Blyth, Annie, Watts, Laura, Daffu-O'Reilly, Amrit, and CHIPPS study team
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Background: Medicines management in care homes requires significant improvement. CHIPPS was a cluster randomised controlled trial to determine the effectiveness of integrating pharmacist independent prescribers into care homes to assume central responsibility for medicines management. This paper reports the parallel mixed-methods process evaluation.Method: Intervention arm consisted of 25 triads: Care homes (staff and up to 24 residents), General Practitioner (GP) and Pharmacist Independent Prescriber (PIP). Data sources were pharmaceutical care plans (PCPs), pharmacist activity logs, online questionnaires and semi-structured interviews. Quantitative data were analysed descriptively. Qualitative data were analysed thematically. Results were mapped to the process evaluation objectives following the Medical Research Council framework.Results: PCPs and activity logs were available from 22 PIPs. Questionnaires were returned by 16 PIPs, eight GPs, and two care home managers. Interviews were completed with 14 PIPs, eight GPs, nine care home managers, six care home staff, and one resident. All stakeholders reported some benefits from PIPs having responsibility for medicine management and identified no safety concerns. PIPs reported an increase in their knowledge and identified the value of having time to engage with care home staff and residents during reviews. The research paperwork was identified as least useful by many PIPs. PIPs conducted medication reviews on residents, recording 566 clinical interventions, many involving deprescribing; 93.8% of changes were sustained at 6 months. For 284 (50.2%) residents a medicine was stopped, and for a quarter of residents, changes involved a medicine linked to increased falls risk. Qualitative data indicated participants noted increased medication safety and improved resident quality of life. Contextual barriers to implementation were apparent in the few triads where PIP was not known previously to the GP and care home before the trial. In three triads, PIPs did not deliver the intervention.Conclusions: The intervention was generally implemented as intended, and well-received by most stakeholders. Whilst there was widespread deprescribing, contextual factors effected opportunity for PIP engagement in care homes. Implementation was most effective when communication pathways between PIP and GP had been previously well-established.Trial Registration: The definitive RCT was registered with the ISRCTN registry (registration number ISRCTN 17847169 ). [ABSTRACT FROM AUTHOR]- Published
- 2021
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11. Protocol for a process evaluation of an external pilot cluster randomised controlled trial of a theory-based intervention to improve appropriate polypharmacy in older people in primary care: the PolyPrime study.
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Rankin, Audrey, Molloy, Gerard J., Cadogan, Cathal A., Barry, Heather E., Gorman, Ashleigh, Ryan, Cristín, Ferrett, Alan, McCarthy, Pat, Gormley, Gerard J., Fahey, Tom, Hughes, Carmel M., and PolyPrime team
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ELDER care ,POLYPHARMACY ,FRAIL elderly ,OLDER patients ,OLDER people ,PRIMARY care ,DRUGSTORES ,PATIENT-centered medical homes - Abstract
Background: The PolyPrime intervention is a theory-based intervention aimed at improving appropriate polypharmacy in older people (aged ≥65 years) in primary care. The intervention consists of an online video which demonstrates how general practitioners (GPs) can prescribe appropriate polypharmacy during a consultation with an older patient and a patient recall process, whereby patients are invited to scheduled medication review consultations with GPs. The aim of the process evaluation is to further examine the implementation of the PolyPrime intervention in primary care. This will involve investigating whether the PolyPrime intervention can be delivered as intended across two healthcare systems, how acceptable the intervention is to GPs, practice staff and patients, and to identify the intervention's likely mechanisms of action.Methods: The PolyPrime study is an external pilot cluster randomised controlled trial (cRCT) which aims to recruit 12 GP practices across Northern Ireland [NI] (n=6) and the six counties in the Republic of Ireland (ROI) that border NI (n=6). Practices have been randomised to intervention or usual care. An embedded process evaluation will assess intervention fidelity (i.e. was the intervention delivered as intended), acceptability of the intervention to GPs, practice staff and patients and potential mechanisms of action (i.e. what components of the intervention were perceived to be effective). Quantitative data will be collected from data collection forms completed by GPs and practice staff and a feedback questionnaire completed by patients from intervention arm practices, which will be analysed using descriptive statistics. Qualitative data will be collected through semi-structured interviews with GPs and practice staff and audio-recordings of medication review appointments from the intervention arm practices which will be transcribed and analysed using the framework method. Quantitative and qualitative data will be triangulated to provide an overall assessment of intervention fidelity, intervention acceptability, and mechanisms of action.Discussion: This process evaluation will add to feasibility data from the pilot cRCT by providing evidence on the fidelity of implementing the intervention package across two healthcare systems, the acceptability of the intervention and potential mechanisms of action.Trial Registration: ClinicalTrials.gov ISRCTN41009897 . Registered on 19 November 2019. ClinicalTrials.gov NCT04181879 . Registered 02 December 2019. [ABSTRACT FROM AUTHOR]- Published
- 2021
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12. An external pilot cluster randomised controlled trial of a theory-based intervention to improve appropriate polypharmacy in older people in primary care (PolyPrime): study protocol.
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Rankin, Audrey, Cadogan, Cathal A., Barry, Heather E., Gardner, Evie, Agus, Ashley, Molloy, Gerard J., Gorman, Ashleigh, Ryan, Cristín, Leathem, Claire, Maxwell, Marina, Gormley, Gerard J., Ferrett, Alan, McCarthy, Pat, Fahey, Tom, and Hughes, Carmel M.
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ELDER care ,POLYPHARMACY ,OLDER people ,OLDER patients ,QUALITY of life ,SPECIALTY pharmacies ,DRUGSTORES - Abstract
Background: The use of multiple medications (polypharmacy) is a concern in older people (≥65 years) and is associated with negative health outcomes. For older populations with multimorbidity, polypharmacy is the reality and the key challenge is ensuring appropriate polypharmacy (as opposed to inappropriate polypharmacy). This external pilot cluster randomised controlled trial (cRCT) aims to further test a theory-based intervention to improve appropriate polypharmacy in older people in primary care in two jurisdictions, Northern Ireland (NI) and the Republic of Ireland (ROI). Methods: Twelve GP practices across NI (n=6) and the six counties in the ROI that border NI will be randomised to either the intervention or usual care group. Members of the research team have developed an intervention to improve appropriate polypharmacy in older people in primary care using the Theoretical Domains Framework of behaviour change. The intervention consists of two components: (1) an online video which demonstrates how a GP may prescribe appropriate polypharmacy during a consultation with an older patient and (2) a patient recall process, whereby patients are invited to scheduled medication review consultations with GPs. Ten older patients receiving polypharmacy (≥4 medications) will be recruited per GP practice (n=120). GP practices allocated to the intervention arm will be asked to watch the online video and schedule medication reviews with patients on two occasions; an initial and a 6-month follow-up appointment. GP practices allocated to the control arm will continue to provide usual care to patients. The study will assess the feasibility of recruitment, retention and study procedures including collecting data on medication appropriateness (from GP records), quality of life and health service use (i.e. hospitalisations). An embedded process evaluation will assess intervention fidelity (i.e. was the intervention delivered as intended), acceptability of the intervention and potential mechanisms of action. Discussion: This pilot cRCT will provide evidence of the feasibility of a range of study parameters such as recruitment and retention, data collection procedures and the acceptability of the intervention. Pre-specified progression criteria will also be used to determine whether or not to proceed to a definitive cRCT. Trial registration: ISRCTN, ISRCTN41009897. Registered 19 November 2019. ClinicalTrials.gov, NCT04181879. Registered 02 December 2019. [ABSTRACT FROM AUTHOR]
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- 2021
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13. Brief interventions targeting long‐term benzodiazepine and Z‐drug use in primary care: a systematic review and meta‐analysis.
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Lynch, Tom, Ryan, Cristín, Hughes, Carmel M., Presseau, Justin, Allen, Zachary M., Bradley, Colin P., and Cadogan, Cathal A.
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BENZODIAZEPINES ,BEHAVIOR modification ,COGNITIVE therapy ,CONCEPTUAL structures ,CONFIDENCE intervals ,STATISTICAL correlation ,META-analysis ,PRIMARY health care ,TRANQUILIZING drugs ,SYSTEMATIC reviews ,EVIDENCE-based medicine ,PROFESSIONAL practice ,EFFECT sizes (Statistics) ,DESCRIPTIVE statistics ,ODDS ratio - Abstract
Aims: To assess the effectiveness of brief interventions in primary care aimed at reducing or discontinuing long‐term benzodiazepine/Z‐drug (BZRA) use. Method: Systematic review of randomized controlled trials of brief interventions in primary care settings aimed at reducing or discontinuing long‐term BZRA use in adults taking BZRAs for ≥ 3 months. Four electronic databases were searched: PubMed, EMBASE, PsycINFO and CENTRAL. The primary outcome was BZRA use, classified as discontinuation or reduction by ≥ 25%. The Theoretical Domains Framework (TDF) was used to retrospectively code behavioural determinants targeted by the interventions. The Behaviour Change Technique (BCT) Taxonomy was used to identify the interventions' active components. Study‐specific estimates were pooled, where appropriate, to yield summary risk ratios (RRs) and 95% confidence intervals (CIs). Pearson's correlations were used to determine the relationship between intervention effect size and the results of both the TDF and BCT coding. Results: Eight studies were included (n = 2071 patients). Compared with usual care, intervention patients were more likely to have discontinued BZRA use at 6 months (eight studies, RR = 2.73, 95% CI = 1.84–4.06) and 12 months post‐intervention (two studies, RR = 3.41, 95% CI = 2.22–5.25). TDF domains 'knowledge', 'memory, attention and decision processes', 'environmental context and resources' and 'social influences' were identified as having been included in every intervention. Commonly identified BCTs included 'information about health consequences', 'credible source' and 'adding objects to the environment'. There was no detectable relationship between effect size and the results of either the TDF or BCT coding. Conclusion: Brief interventions delivered in primary care are more effective than usual care in reducing and discontinuing long‐term benzodiazepine/Z‐drug use. [ABSTRACT FROM AUTHOR]
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- 2020
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14. Criteria required for an acceptable point-of-care test for UTI detection: Obtaining consensus using the Delphi technique.
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Weir, Nichola-Jane M., Pattison, Sally H., Kearney, Paddy, Stafford, Bob, Gormley, Gerard J., Crockard, Martin A., Gilpin, Deirdre F., Tunney, Michael M., and Hughes, Carmel M.
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URINARY tract infections ,DELPHI method ,BACTERIAL diseases ,PRIMARY care ,MEDICAL personnel - Abstract
Background: Urinary Tract Infections (UTIs) are common bacterial infections, second only to respiratory tract infections and particularly prevalent within primary care. Conventional detection of UTIs is culture, however, return of results can take between 24 and 72 hours. The introduction of a point of care (POC) test would allow for more timely identification of UTIs, facilitating improved, targeted treatment. This study aimed to obtain consensus on the criteria required for a POC UTI test, to meet patient need within primary care. Methods: Criteria for consideration were compiled by the research team. These criteria were validated through a two-round Delphi process, utilising an expert panel of healthcare professionals from across Europe and United States of America. Using web-based questionnaires, panellists recorded their level of agreement with each criterion based on a 5-point Likert Scale, with space for comments. Using median response, interquartile range and comments provided, criteria were accepted/rejected/revised depending on pre-agreed cut-off scores. Results: The first round questionnaire presented thirty-three criteria to the panel, of which 22 were accepted. Consensus was not achieved for the remaining 11 criteria. Following response review, one criterion was removed, while after revision, the remaining 10 criteria entered the second round. Of these, four were subsequently accepted, resulting in 26 criteria considered appropriate for a POC test to detect urinary infections. Conclusion: This study generated an approved set of criteria for a POC test to detect urinary infections. Criteria acceptance and comments provided by the healthcare professionals also supports the development of a multiplex point of care UTI test. [ABSTRACT FROM AUTHOR]
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- 2018
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15. REDUCING POTENTIALLY INAPPROPRIATE PRESCRIBING FOR OLDER PEOPLE IN PRIMARY CARE: COST-EFFECTIVENESS OF THE OPTI-SCRIPT INTERVENTION.
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Gillespie, Paddy, Clyne, Barbara, Raymakers, Adam, Fahey, Tom, Hughes, Carmel M., and Smith, Susan M.
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Objectives: This study examines the cost-effectiveness of the OPTI-SCRIPT intervention on potentially inappropriate prescribing in primary care. Methods: Economic evaluation, using incremental cost-effectiveness and cost utility analyses, conducted alongside a cluster randomized controlled trial of twenty-one general practices and 196 patients, to compare a multifaceted intervention with usual practice in primary care in Ireland. Potentially inappropriate prescriptions (PIPs) were determined by a pharmacist. Incremental costs, PIPs, and quality-adjusted life-years (QALYs) at 12-month follow-up were estimated using multilevel regression. Uncertainty was explored using cost-effectiveness acceptability curves. Results: The intervention was associated with a nonsignificant mean cost increase of €407 (95 percent CIs, −357–1170), a significant mean reduction in PIPs of 0.379 (95 percent CI, 0.092–0.666), and a nonsignificant mean increase in QALYs of 0.013 (95 percent CIs, −0.016–0.042). The incremental cost per PIP avoided was €1,269 (95 percent CI, −1400–6302) and the incremental cost per QALY gained was €30,535 (95 percent CI, −334,846–289,498). The probability of the intervention being cost-effective was 0.602 at a threshold value of €45,000 per QALY gained and was at least 0.845 at threshold values of €2,500 per PIP avoided and higher. Conclusions: While the OPTI-SCRIPT intervention was effective in reducing potentially inappropriate prescribing in primary care in Ireland, our findings highlight the uncertainty with respect to its cost-effectiveness. Further studies are required to explore the health and economic implications of interventions targeting potentially inappropriate prescribing. [ABSTRACT FROM AUTHOR]
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- 2017
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16. Supporting prescribing in older people with multimorbidity and significant polypharmacy in primary care (SPPiRE): a cluster randomised controlled trial protocol and pilot.
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McCarthy, Caroline, Clyne, Barbara, Corrigan, Derek, Boland, Fiona, Wallace, Emma, Moriarty, Frank, Fahey, Tom, Hughes, Carmel, Gillespie, Paddy, and Smith, Susan M.
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OLDER people ,COMORBIDITY ,PRIMARY care ,RANDOMIZED controlled trials ,POLYPHARMACY - Abstract
Background: Multimorbidity, defined as the presence of at least two chronic conditions, becomes increasingly common in older people and is associated with poorer health outcomes and significant polypharmacy. The National Institute for Clinical Excellence (NICE) recently published a multimorbidity guideline that advises providing an individualised medication review for all people prescribed 15 or more repeat medicines. This study incorporates this guideline and aims to assess the effectiveness of a complex intervention designed to support general practitioners (GPs) to reduce potentially inappropriate prescribing and consider deprescribing in older people with multimorbidity and significant polypharmacy in Irish primary care.Methods: This study is a cluster randomised controlled trial, involving 30 general practices and 450 patients throughout Ireland. Practices will be eligible to participate if they have at least 300 patients aged 65 years and over on their patient panel and if they use either one of the two predominant practice management software systems in use in Ireland. Using a software patient finder tool, practices will identify and recruit patients aged 65 years and over, who are prescribed at least 15 repeat medicines. Once baseline data collection is complete, practices will be randomised using minimisation by an independent third party to either intervention or control. Given the nature of the intervention, it is not possible to blind participants or study personnel. GPs in intervention practices will receive login details to a website where they will access training videos and a template for conducting an individualised structured medication review, which they will undertake with each of their included patients. Control practices will deliver usual care over the 6-month study period. Primary outcome measures pertain to the individual patient level and are the proportion of patients with any PIP and the number of repeat medicines.Discussion: Disease-specific approaches in multimorbidity may be inappropriate and result in fragmented and poorly co-ordinated care. This pragmatic study is evaluating a complex intervention that is relevant across multiple conditions and addresses potential concerns around medicines safety in this vulnerable group of patients. The potential for system-wide implementation will be explored with a parallel mixed methods process evaluation.Trial Registration: ISRCTN: 12752680 , Registered 20 October 2016. [ABSTRACT FROM AUTHOR]- Published
- 2017
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17. Beliefs about prescribed medication among older patients with polypharmacy: a mixed methods study in primary care.
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Clyne, Barbara, Cooper, Janine A., Boland, Fiona, Hughes, Carmel M., Fahey, Tom, Smith, Susan M., and OPTI-SCRIPT study team
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DRUG prescribing ,OLDER patients ,POLYPHARMACY ,PRIMARY care ,RANDOMIZED controlled trials ,MEDICAL care ,MEDICAL care for older people ,HEALTH attitudes ,PATIENT education ,PATIENT satisfaction ,PHYSICIAN-patient relations ,PRIMARY health care ,STATISTICAL sampling ,QUALITATIVE research - Abstract
Background: Polypharmacy (≥5 medications) is common in older patients and is associated with adverse outcomes. Patients' beliefs about medication can influence their expectations for medication, adherence, and willingness to deprescribe. Few studies have examined beliefs about prescribed medication among older patients with polypharmacy in primary care.Aim: To explore medication-related beliefs in older patients with polypharmacy and factors that might influence beliefs.Design and Setting: A mixed methods study utilising data from a randomised controlled trial aiming to decrease potentially inappropriate prescribing in older patients (≥70 years) in Ireland.Method: Beliefs were assessed quantitatively and qualitatively. Participants completed the Beliefs about Medicines Questionnaire by indicating their degree of agreement with individual statements about medicines on a 5-point Likert scale. Semi-structured qualitative interviews were conducted with a purposive sample of participants. Interviews were transcribed verbatim and a thematic analysis conducted. Quantitative and qualitative data were analysed separately and triangulated during the interpretation stage.Results: In total, 196 patients were included (mean age 76.7 years, SD 4.9, 54% male), with a mean of 9.5 (SD 4.1) medications per patient. The majority (96.3%) believed strongly in the necessity of their medication, while 33.9% reported strong concerns. Qualitative data confirmed these coexisting positive and negative attitudes to medications and suggested the importance of patients' trust in GPs in establishing positive beliefs and potential willingness to deprescribe.Conclusion: Participants reported strong beliefs in medications with coexisting positive and negative attitudes. The doctor-patient relationship may have influenced beliefs and attitudes towards medicines, highlighting the importance of strong doctor-patient relationships, which need to be considered in the context of deprescribing. [ABSTRACT FROM AUTHOR]- Published
- 2017
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18. Evaluating the prevalence of potentially inappropriate prescribing in older adults in intermediate care facilities: a cross-sectional observational study.
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Millar, Anna, Hughes, Carmel, Ryan, Cristín, and Ryan, Cristín
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INAPPROPRIATE prescribing (Medicine) ,HEALTH of older people ,INTERMEDIATE care ,PRIMARY care ,WILCOXON signed-rank test ,HOSPITAL care ,NONPARAMETRIC statistics ,NURSING care facilities ,DISCHARGE planning ,DISEASE prevalence ,CROSS-sectional method - Abstract
Background Potentially inappropriate prescribing (PIP) [encompassing potentially inappropriate medicines (PIMs) and potential prescribing omissions (PPOs)], is prevalent amongst older adults in primary and secondary care. However, PIP prevalence in intermediate care (IC) is unknown. Objective To determine the prevalence of PIMs/PPOs and associated patient factors. Setting Three IC facilities in Northern Ireland. Method The Screening Tool of Older People's Prescriptions and the Screening Tool to Alert doctors to Right Treatment were used to identify PIP over 8 weeks. Wilcoxon signed-rank tests were performed to compare the prevalence of PIMs/PPOs at admission and discharge. Spearman's correlation coefficients were calculated to determine factors associated with PIMs/PPOs (p < 0.05 considered significant). Main outcome measure Prevalence of PIMs/PPOs. Results 74 patients [mean age 83.5(±7.4) years] were included. Discharge medication data were available for 30 (40.5%) patients. 53 (71.6%) and 22 (73.3%) patients had ≥1 PIM at admission and discharge, respectively. 45 (60.8%) and 15 (50.0%) patients had ≥1 PPO at admission and discharge, respectively. No significant difference was found in PIM/PPO prevalence at admission compared to discharge (Z = -0.36, p = 0.72; Z = -1.63, p = 0.10). Increasing comorbidity and medication regimen complexity were associated with PIMs at admission (r = 0.265, p = 0.023; r = 0.338 p = 0.003). The number of medicines was correlated with PIMs at admission (r = 0.391, p = 0.001) and discharge (r = 0.515, p = 0.004). Conclusion Whilst IC represents an ideal setting in which to review prescribing, this study found PIP to be highly prevalent in older adults in IC, with no detectably significant change in prevalence between admission to and discharge from this setting. [ABSTRACT FROM AUTHOR]
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- 2017
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19. 'Potentially inappropriate or specifically appropriate?' Qualitative evaluation of general practitioners views on prescribing, polypharmacy and potentially inappropriate prescribing in older people.
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Clyne, Barbara, Cooper, Janine A., Hughes, Carmel M., Fahey, Tom, and Smith, Susan M.
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GENERAL practitioners ,DRUG prescribing ,INTERVIEWING ,RESEARCH methodology ,PRIMARY health care ,RESEARCH funding ,PHYSICIAN practice patterns ,QUALITATIVE research ,DATA analysis ,QUANTITATIVE research ,ACQUISITION of data ,POLYPHARMACY ,INAPPROPRIATE prescribing (Medicine) - Abstract
Background: Potentially inappropriate prescribing (PIP) is common in older people in primary care, as evidenced by a significant body of quantitative research. However, relatively few qualitative studies have investigated the phenomenon of PIP and its underlying processes from the perspective of general practitioners (GPs). The aim of this paper is to explore qualitatively, GP perspectives regarding prescribing and PIP in older primary care patients. Method: Semi-structured qualitative interviews were conducted with GPs participating in a randomised controlled trial (RCT) of an intervention to decrease PIP in older patients (≥70 years) in Ireland. Interviews were conducted with GP participants (both intervention and control) from the OPTI-SCRIPT cluster RCT as part of the trial process evaluation between January and July 2013. Interviews were conducted by one interviewer and audio recorded. Interviews were transcribed verbatim and a thematic analysis was conducted. Results: Seventeen semi-structured interviews were conducted (13 male; 4 female). Three main, inter-related themes emerged (complex prescribing environment, paternalistic doctor-patient relationship, and relevance of PIP concept). Patient complexity (e.g. polypharmacy, multimorbidity), as well as prescriber complexity (e.g. multiple prescribers, poor communication, restricted autonomy) were all identified as factors contributing to a complex prescribing environment where PIP could occur, as was a paternalistic-doctor patient relationship. The concept of PIP was perceived to be of variable usefulness to GPs and the criteria to measure it may be at odds with the complex processes of prescribing for this patient population. Conclusions: Several inter-related factors contributing to the occurrence of PIP were identified, some of which may be amenable to intervention. Improvement strategies focused on improved management of polypharmacy and multimorbidity, and communication across primary and secondary care could result in substantial improvements in PIP. [ABSTRACT FROM AUTHOR]
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- 2016
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20. A process evaluation of a cluster randomised trial to reduce potentially inappropriate prescribing in older people in primary care (OPTI-SCRIPT study).
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Clyne, Barbara, Cooper, Janine A., Hughes, Carmel M., Fahey, Tom, Smith, Susan M., and OPTI-SCRIPT study team
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INAPPROPRIATE prescribing (Medicine) ,OLDER patients ,PRIMARY care ,GENERAL practitioners ,RANDOMIZED controlled trials ,THEMATIC analysis - Abstract
Background: The OPTI-SCRIPT cluster randomised controlled trial (RCT) found that a three-phase multifaceted intervention including academic detailing with a pharmacist, GP-led medicines reviews, supported by web-based pharmaceutical treatment algorithms, and tailored patient information leaflets, was effective in reducing potentially inappropriate prescribing (PIP) in Irish primary care. We report a process evaluation exploring the implementation of the intervention, the experiences of those participating in the study and lessons for future implementation.Methods: The OPTI-SCRIPT trial included 21 GP practices and 196 patients. The process evaluation used mixed methods. Quantitative data were collected from all GP practices and semi-structured interviews were conducted with GPs from intervention and control groups, and a purposive sample of patients from the intervention group. All interviews were transcribed verbatim and analysed using a thematic analysis.Results: Despite receiving a standardised academic detailing session, intervention delivery varied among GP practices. Just over 70 % of practices completed medicines review as recommended with the patient present. Only single-handed practices conducted reviews without patients present, highlighting the influence of practice characteristics and resources on variation. Medications were more likely to be completely stopped or switched to another more appropriate medication when reviews were conducted with patients present. The patient information leaflets were not used by any of the intervention practices. Both GP (32 %) and patient (40 %) recruitment rates were modest. For those who did participate, overall, the experience was positively viewed, with GPs and patients referring to the value of medication reviews to improve prescribing and reduce unnecessary medications. Lack of time in busy GP practices and remuneration were identified as organisational barriers to future implementation.Conclusions: The OPTI-SCRIPT intervention was positively viewed by both GPs and patients, both of whom valued the study's objectives. Patient information leaflets were not a successful component of the intervention. Academic detailing and medication reviews are important components in changing PIP, and having patients present during the review process seems to be a more effective approach for decreasing PIP.Trial Registration: Current controlled trials ISRCTN41694007 . Registered on 21 March 2012. [ABSTRACT FROM AUTHOR]- Published
- 2016
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21. Potentially Inappropriate Prescribing Among People with Dementia in Primary Care: A Retrospective Cross-Sectional Study Using the Enhanced Prescribing Database.
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Barry, Heather E., Cooper, Janine A., Ryan, Cristín, Passmore, A. Peter, Robinson, A. Louise, Molloy, Gerard J., Darcy, Carmel M., Buchanan, Hilary, and Hughes, Carmel M.
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TREATMENT of dementia ,PRIMARY care ,DRUG prescribing ,MEDICAL databases ,DISEASE prevalence ,PUBLIC health ,AGE distribution ,DATABASES ,DEMENTIA ,PRIMARY health care ,SEX distribution ,INDEPENDENT living ,CROSS-sectional method ,RETROSPECTIVE studies ,POLYPHARMACY ,INAPPROPRIATE prescribing (Medicine) - Abstract
Background: Little is known about prescribing appropriateness for community-dwelling people with dementia (PWD).Objective: To estimate potentially inappropriate prescribing (PIP) prevalence among PWD in primary care in Northern Ireland, and to investigate associations between PIP, polypharmacy, age, and gender.Methods: A retrospective cross-sectional study was conducted, using data from the Enhanced Prescribing Database. Patients were eligible if a medicine indicated for dementia management was dispensed to them during 1 January 2013-31 December 2013. Polypharmacy was indicated by use of ≥4 repeat medications from different drug groups. A subset of the Screening Tool of Older Persons Potentially Inappropriate Prescriptions (STOPP) criteria, comprising 36 indicators, was applied to the dataset. Overall prevalence of PIP and the prevalence per each STOPP criterion was calculated as a proportion of all eligible persons in the dataset. Logistic regression was used to investigate associations between PIP, polypharmacy, age, and gender.Results: The study population comprised 6826 patients. Polypharmacy was observed in 81.5% (n = 5564) of patients. PIP prevalence during the study period was 64.4% (95% CI 63.2- 65.5; n = 4393). The most common instance of PIP was the use of anticholinergic/antimuscarinic medications (25.2%; 95% CI 24.2-26.2; n = 1718). In multivariable analyses, both polypharmacy and gender (being female) were associated with PIP, with odds ratios of 7.6 (95% CI 6.6-8.7) and 1.3 (95% CI 1.2-1.4), respectively. No association was observed between PIP and age, after adjustments for gender and polypharmacy.Conclusion: This study identified a high prevalence of PIP in community-dwelling PWD. Future interventions may need to focus on certain therapeutic categories and polypharmacy. [ABSTRACT FROM AUTHOR]- Published
- 2016
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22. GPs' and community pharmacists' opinions on medication management at transitions of care in Ireland.
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Redmond, Patrick, Carroll, Hailey, Grimes, Tamasine, Galvin, Rose, McDonnell, Ronan, Boland, Fiona, McDowell, Ronald, Hughes, Carmel, and Fahey, Tom
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PHARMACISTS ,MEDICATION therapy management ,MEDICATION reconciliation ,PRIMARY care ,ERROR analysis in mathematics - Abstract
Objective: The aim of this study was to survey GPs and community pharmacists (CPs) in Ireland regarding current practices of medication management, specifically medication reconciliation, communication between health care providers and medication errors as patients transition in care.Methods: A national cross-sectional survey was distributed electronically to 2364 GPs, 311 GP Registrars and 2382 CPs. Multivariable associations comparing GPs to CPs were generated and content analysis of free text responses was undertaken.Results: There was an overall response rate of 17.7% (897 respondents-554 GPs/Registrars and 343 CPs). More than 90% of GPs and CPs were positive about the effects of medication reconciliation on medication safety and adherence. Sixty per cent of GPs reported having no formal system of medication reconciliation. Communication between GPs and CPs was identified as good/very good by >90% of GPs and CPs. The majority (>80%) of both groups could clearly recall prescribing errors, following a transition of care, they had witnessed in the previous 6 months. Free text content analysis corroborated the positive relationship between GPs and CPs, a frustration with secondary care communication, with many examples given of prescribing errors.Conclusions: While there is enthusiasm for the benefits of medication reconciliation there are limited formal structures in primary care to support it. Challenges in relation to systems that support inter-professional communication and reduce medication errors are features of the primary/secondary care transition. There is a need for an improved medication management system. Future research should focus on the identified barriers in implementing medication reconciliation and systems that can improve it. [ABSTRACT FROM AUTHOR]- Published
- 2016
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23. Improving appropriate polypharmacy for older people in primary care: selecting components of an evidence-based intervention to target prescribing and dispensing.
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Cadogan, Cathal A., Ryan, Cristín, Francis, Jill J., Gormley, Gerard J., Passmore, Peter, Kerse, Ngaire, and Hughes, Carmel M.
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POLYPHARMACY ,PRIMARY care ,EVIDENCE-based medicine ,SYSTEMATIC reviews ,PHARMACISTS ,ATTITUDE (Psychology) ,CLINICAL competence ,ECOLOGY ,HEALTH attitudes ,MEDICAL personnel ,GENERAL practitioners ,PRIMARY health care ,PSYCHOLOGY ,QUALITY assurance ,SELF-efficacy ,THEORY ,OCCUPATIONAL roles ,SOCIAL support ,SOCIAL context - Abstract
Background: The use of multiple medicines (polypharmacy) is increasingly common in older people. Ensuring that patients receive the most appropriate combinations of medications (appropriate polypharmacy) is a significant challenge. The quality of evidence to support the effectiveness of interventions to improve appropriate polypharmacy is low. Systematic identification of mediators of behaviour change, using the Theoretical Domains Framework (TDF), provides a theoretically robust evidence base to inform intervention design. This study aimed to (1) identify key theoretical domains that were perceived to influence the prescribing and dispensing of appropriate polypharmacy to older patients by general practitioners (GPs) and community pharmacists, and (2) map domains to associated behaviour change techniques (BCTs) to include as components of an intervention to improve appropriate polypharmacy in older people in primary care.Methods: Semi-structured interviews were conducted with members of each healthcare professional (HCP) group using tailored topic guides based on TDF version 1 (12 domains). Questions covering each domain explored HCPs' perceptions of barriers and facilitators to ensuring the prescribing and dispensing of appropriate polypharmacy to older people. Interviews were audio-recorded and transcribed verbatim. Data analysis involved the framework method and content analysis. Key domains were identified and mapped to BCTs based on established methods and discussion within the research team.Results: Thirty HCPs were interviewed (15 GPs, 15 pharmacists). Eight key domains were identified, perceived to influence prescribing and dispensing of appropriate polypharmacy: 'Skills', 'Beliefs about capabilities', 'Beliefs about consequences', 'Environmental context and resources', 'Memory, attention and decision processes', 'Social/professional role and identity', 'Social influences' and 'Behavioural regulation'. Following mapping, four BCTs were selected for inclusion in an intervention for GPs or pharmacists: 'Action planning', 'Prompts/cues', 'Modelling or demonstrating of behaviour' and 'Salience of consequences'. An additional BCT ('Social support or encouragement') was selected for inclusion in a community pharmacy-based intervention in order to address barriers relating to interprofessional working that were encountered by pharmacists.Conclusions: Selected BCTs will be operationalised in a theory-based intervention to improve appropriate polypharmacy for older people, to be delivered in GP practice and community pharmacy settings. Future research will involve development and feasibility testing of this intervention. [ABSTRACT FROM AUTHOR]- Published
- 2015
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24. Effectiveness of a Multifaceted Intervention for Potentially Inappropriate Prescribing in Older Patients in Primary Care: A Cluster-Randomized Controlled Trial (OPTI-SCRIPT Study).
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Clyne, Barbara, Smith, Susan M., Hughes, Carmel M., Boland, Fiona, Bradley, Marie C., Cooper, Janine A., Fahey, Tom, and OPTI-SCRIPT study team
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DRUG prescribing ,PRIMARY care ,HOSPITAL care ,CLUSTER analysis (Statistics) ,MEDICAL statistics ,ALGORITHMS ,DRUG therapy ,COMPARATIVE studies ,RESEARCH methodology ,MEDICAL care ,MEDICAL cooperation ,COMPUTERS in medicine ,PRIMARY health care ,REGRESSION analysis ,RESEARCH ,PROTON pump inhibitors ,EVALUATION research ,RANDOMIZED controlled trials ,EVALUATION of human services programs ,INAPPROPRIATE prescribing (Medicine) ,PREVENTION - Abstract
Purpose: Potentially inappropriate prescribing (PIP) is common in older people and can result in increased morbidity, adverse drug events, and hospitalizations. The OPTI-SCRIPT study (Optimizing Prescribing for Older People in Primary Care, a cluster-randomized controlled trial) tested the effectiveness of a multifaceted intervention for reducing PIP in primary care.Methods: We conducted a cluster-randomized controlled trial among 21 general practitioner practices and 196 patients with PIP. Intervention participants received a complex, multifaceted intervention incorporating academic detailing; review of medicines with web-based pharmaceutical treatment algorithms that provide recommended alternative-treatment options; and tailored patient information leaflets. Control practices delivered usual care and received simple, patient-level PIP feedback. Primary outcomes were the proportion of patients with PIP and the mean number of potentially inappropriate prescriptions. We performed intention-to-treat analysis using random-effects regression.Results: All 21 practices and 190 patients were followed. At intervention completion, patients in the intervention group had significantly lower odds of having PIP than patients in the control group (adjusted odds ratio = 0.32; 95% CI, 0.15-0.70; P = .02). The mean number of PIP drugs in the intervention group was 0.70, compared with 1.18 in the control group (P = .02). The intervention group was almost one-third less likely than the control group to have PIP drugs at intervention completion, but this difference was not significant (incidence rate ratio = 0.71; 95% CI, 0.50-1.02; P = .49). The intervention was effective in reducing proton pump inhibitor prescribing (adjusted odds ratio = 0.30; 95% CI, 0.14-0.68; P = .04).Conclusions: The OPTI-SCRIPT intervention incorporating academic detailing with a pharmacist, and a review of medicines with web-based pharmaceutical treatment algorithms, was effective in reducing PIP, particularly in modifying prescribing of proton pump inhibitors, the most commonly occurring PIP drugs nationally. [ABSTRACT FROM AUTHOR]- Published
- 2015
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25. The relationship between BMI and the prescription of anti-obesity medication according to social factors: a population cross sectional study.
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Patterson, Lynsey, Kee, Frank, Hughes, Carmel, and O'Reilly, Dermot
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ANTIOBESITY agents ,BODY mass index ,PUBLIC health ,PRIMARY care ,CROSS-sectional method - Abstract
Background Obesity is a global public health problem. There are a range of treatments available with varying short and long term success rates. One option is the use of anti-obesity medication the prescription of which has increased dramatically in recent years. Despite this, little is known about the individual and GP practice factors that influence the prescription of antiobesity medication. Methods Multi-level logistic regression analysis was used to investigate factors associated with the prescription of anti-obesity medication in Northern Ireland using a population primary care prescribing database (~1.5 million people aged 16+ years) during 2009/10. Results While 25.0% of people are obese, only 1.3% (2.1% of females, 0.6% of males) received antiobesity medication. The relationship between medication rates and age differed by gender (P < 0.001) with prescriptions higher in younger females and older males. Prescribing of anti-obesity medication reflected obesity prevalence across urban/rural areas and deprivation. There was an unexplained two-fold difference, between the 25
th and 75th percentile, in the GP practice prescription of anti-obesity medication. Conclusions There is evidence of relative under-prescribing in males compared to females despite a similar prevalence of obesity. While the prevalence (and presumably the health consequences) of obesity worsens with age, younger females are more likely to be prescribed anti-obesity medication. This suggests an element of patient demand. Educational material to improve the understanding of the role of anti-obesity medication, for patients and practitioners, is recommended. But further study is needed to understand the factors responsible for the variation in prescribing between GP practices. [ABSTRACT FROM AUTHOR]- Published
- 2014
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26. Addressing potentially inappropriate prescribing in older patients: development and pilot study of an intervention in primary care (the OPTI-SCRIPT study).
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Clyne, Barbara, Bradley, Marie C., Hughes, Carmel M., Clear, Daniel, McDonnell, Ronan, Williams, David, Fahey, Tom, and Smith, Susan M.
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DRUG prescribing ,PRIMARY care ,HOSPITAL care ,MORTALITY ,GENERAL practitioners - Abstract
Background: Potentially inappropriate prescribing (PIP) in older people is common in primary care and can result in increased morbidity, adverse drug events, hospitalizations and mortality. The prevalence of PIP in Ireland is estimated at 36% with an associated expenditure of over €45 million in 2007. The aim of this paper is to describe the application of the Medical Research Council (MRC) framework to the development of an intervention to decrease PIP in Irish primary care. Methods: The MRC framework for the design and evaluation of complex interventions guided the development of the study intervention. In the development stage, literature was reviewed and combined with information obtained from experts in the field using a consensus based methodology and patient cases to define the main components of the intervention. In the pilot stage, five GPs tested the proposed intervention. Qualitative interviews were conducted with the GPs to inform the development and implementation of the intervention for the main randomised controlled trial. Results: The literature review identified PIP criteria for inclusion in the study and two initial intervention components - academic detailing and medicines review supported by therapeutic treatment algorithms. Through patient case studies and a focus group with a group of 8 GPs, these components were refined and a third component of the intervention identified - patient information leaflets. The intervention was tested in a pilot study. In total, eight medicine reviews were conducted across five GP practices. These reviews addressed ten instances of PIP, nine of which were addressed in the form of either a dose reduction or a discontinuation of a targeted medication. Qualitative interviews highlighted that GPs were receptive to the intervention but patient preference and time needed both to prepare for and conduct the medicines review, emerged as potential barriers. Findings from the pilot study allowed further refinement to produce the finalised intervention of academic detailing with a pharmacist, medicines review with web-based therapeutic treatment algorithms and tailored patient information leaflets. Conclusions: The MRC framework was used in the development of the OPTI-SCRIPT intervention to decrease the level of PIP in primary care in Ireland. Its application ensured that the intervention was developed using the best available evidence, was acceptable to GPs and feasible to deliver in the clinical setting. The effectiveness of this intervention is currently being tested in a pragmatic cluster randomised controlled trial. Trial registration: Current controlled trials ISRCTN41694007 [ABSTRACT FROM AUTHOR]
- Published
- 2013
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27. Effectiveness of medicines review with web-based pharmaceutical treatment algorithms in reducing potentially inappropriate prescribing in older people in primary care: a cluster randomized trial (OPTI-SCRIPT study protocol).
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Clyne, Barbara, Bradley, Marie C., Smith, Susan M., Hughes, Carmel M., Motterlini, Nicola, Clear, Daniel, McDonnell, Ronan, Williams, David, and Fahey, Tom
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PRIMARY care ,RANDOMIZED controlled trials ,MEDICAL care for older people ,HOSPITAL care ,ALGORITHMS - Abstract
Background: Potentially inappropriate prescribing in older people is common in primary care and can result in increased morbidity, adverse drug events, hospitalizations and mortality. In Ireland, 36% of those aged 70 years or over received at least one potentially inappropriate medication, with an associated expenditure of over €45 million. The main objective of this study is to determine the effectiveness and acceptability of a complex, multifaceted intervention in reducing the level of potentially inappropriate prescribing in primary care. Methods/design: This study is a pragmatic cluster randomized controlled trial, conducted in primary care (OPTISCRIPT trial), involving 22 practices (clusters) and 220 patients. Practices will be allocated to intervention or control arms using minimization, with intervention participants receiving a complex multifaceted intervention incorporating academic detailing, medicines review with web-based pharmaceutical treatment algorithms that provide recommended alternative treatment options, and tailored patient information leaflets. Control practices will deliver usual care and receive simple patient-level feedback on potentially inappropriate prescribing. Routinely collected national prescribing data will also be analyzed for nonparticipating practices, acting as a contemporary national control. The primary outcomes are the proportion of participant patients with potentially inappropriate prescribing and the mean number of potentially inappropriate prescriptions per patient. In addition, economic and qualitative evaluations will be conducted. Discussion: This study will establish the effectiveness of a multifaceted intervention in reducing potentially inappropriate prescribing in older people in Irish primary care that is generalizable to countries with similar prescribing challenges. [ABSTRACT FROM AUTHOR]
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- 2013
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28. Psychotropic prescribing in Catalonia: results from an epidemiological study.
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Rubio-Valera, Maria, Fernández, Ana, Luciano, Juan V, Hughes, Carmel M, Pinto-Meza, Alejandra, Moreno-Küstner, Berta, Palao, Diego J, Haro, Josep Maria, and Serrano-Blanco, Antoni
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PSYCHIATRIC drugs ,DRUG prescribing ,MENTAL illness treatment ,PRIMARY care ,EPIDEMIOLOGY ,CROSS-sectional method - Abstract
Background. Mental disorders (MDs) are mainly treated in primary care (PC), where psychotropic drug (PSD) prescribing is highly prevalent. Prescription of PSD is associated with clinical and non-clinical factors.Purpose. To describe the patterns of PSD prescribing over a 12-month period and to determine the factors associated with this in a PC population.Methods. Cross-sectional study. Data were collected on 3815 patients, via patient interview, on sociodemographics and MDs [Diagnostic and Statistical Manual of Mental Disorders (DSM-IV criteria)]. Computerized records provided data on PSD prescribing. Multilevel logistic regressions assessed the factors that influence prescribing.Results. Thirty-four per cent of PC patients were prescribed PSDs >12 months, with anxiolytics being the most commonly prescribed (22%). Fifty-three per cent of patients with any MD in this 12-month period were prescribed PSDs; however, 25% of patients without any of these disorders were also prescribed these medications. Higher rates of prescribing were associated with female gender, older age, presence of MD, being a househusband/housewife, consulting about psychological problems, increasing number of consultations and higher self-perceived disability. PSDs were less likely to be prescribed to patients born outside Spain and those consulting about physical conditions. PSD prescribing was higher in patients previously married and antipsychotic prescribing was higher in patients never married. No statistically significant associations were found between PSD prescription and education.Conclusions. PSD prescribing rates are high in Catalonia and are associated with a number of clinical and non-clinical factors. A significant proportion of patients are receiving these drugs in the absence of MD. These findings need to be considered when prescribing in PC. [ABSTRACT FROM PUBLISHER]
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- 2012
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29. Medicines optimisation for frail older people in primary care : an exploration of community pharmacists' experiences, knowledge and perspectives
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Faulkner, Lucy, Barry, Heather, and Hughes, Carmel
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Frailty ,medicines optimisation ,community pharmacy ,qualitative research ,quantitative research ,Older people ,primary care ,Systematic Review - Abstract
The aim of this thesis was to identify the current evidence base for medicines optimisation interventions for frail older patients in primary care, and to explore the role of community pharmacists in optimising medicines use for frail older people using a mixed-methods approach. A systematic review was conducted to identify medicines optimisation interventions for community-dwelling frail older patients. Community pharmacists' knowledge of frailty, experiences with frail older patients, and perspectives of frailty and medicines optimisation were explored through semi-structured interviews(n=15), followed by a questionnaire distributed to all registered community pharmacy premises in Northern Ireland (n=528). Comparative analyses were conducted for a sub-set of questionnaire items included in a questionnaire administered to Canadian pharmacists. Finally, an educational resource package for community pharmacists about frailty was developed and evaluated. The systematic review identified a lack of medicines optimisation interventions delivered to frail older patients in primary care; only one study met the inclusion criteria for this review. However, this study did highlight the potential role that community pharmacists could play in delivering interventions to this patient population. Interviews conducted with community pharmacists identified that community pharmacists lacked knowledge about frailty. This finding was also supported by data from questionnaire respondents and similar gaps in knowledge were observed with Canadian community pharmacists. Positive feedback was obtained regarding the educational resource. The research presented in this thesis has identified a lack of high-quality evidence for medicines optimisation interventions for frail older people in primary care. Whilst community pharmacists are ideally placed to deliver such interventions, gaps in their knowledge about frailty must be addressed. Further research is therefore needed to address these knowledged eficits and to develop and evaluate medicines optimisation interventions. The views of other relevant key stakeholders, including frail older patients, their family members, and carers, should also inform future work.
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- 2022
30. A quantitative and qualitative analysis of potentially inappropriate prescribing in older adults
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Baxter, Sarah, Hughes, Carmel, and O'Reilly, Dermot
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618.97 ,polypharmacy ,potentially inappropriate prescribing ,older people ,practice-based pharmacists ,screening tools for potentially inappropriate prescribing ,care homes ,primary care ,multiple medicines ,multimorbidity - Abstract
Introduction: Globally, population demographics are changing due to ageing. As people age, the prevalence of long-term conditions increases which gives rise to multimorbidity. Polypharmacy naturally accompanies multimorbidity and has many negative outcomes associated with it. When polypharmacy is prescribed appropriately, it is beneficial for the patient, leading to improved therapeutic outcomes. However, when polypharmacy is not prescribed appropriately, it can lead to potentially inappropriate prescribing (PIP). PIP occurs when the risk of an adverse event outweighs the intended clinical benefit of a medicine or when clinically indicated medicines are omitted. The overall aim of the research presented in this thesis was to explore potentially inappropriate prescribing (PIP) using a mixed methods approach. Methods: Both quantitative and qualitative methodology was used across the three studies contained in this thesis. The first study comprised a systematic review of the tools used to assess PIP in older adults (aged 365 years) who were receiving polypharmacy and aimed to identify the most appropriate tool for use in research based on a set of criteria deemed to be the key attributes that a tool to assess PIP should possess. The second study was quantitative in nature, using a unique linkage between the Enhanced Prescribing Database (EPD) and the Northern Ireland Longitudinal Study (NILS) to establish the prevalence of polypharmacy (dispensing of 4 or more medicines) and PIP in older adults living in Northern Ireland. In addition, this study determined the predictors for polypharmacy and PIP in both community-dwelling and care home residents and subsequently determined the relationship between polypharmacy, PIP and mortality in the two populations. Finally, a qualitative study, using a topic guide based on the Theoretical Domains Framework (TDF), was undertaken with pharmacists based in GP practices. Semi-structured interviews were conducted with practice-based pharmacists (PBPs) to explore the barriers and facilitators towards managing appropriate polypharmacy in older adults in primary care. Results: Based on the findings from the systematic review, the Screening Tool Of People’s Prescriptions (STOPP)/Screening Tool to Alert Right Treatment (START) criteria were determined to be the most appropriate tool to measure PIP in older adults who are receiving polypharmacy. Subsequently, in the second study in this thesis, a subset of the STOPP criteria were used to determine the prevalence of PIP in older adults, the factors associated with PIP and the relationship with mortality. This study revealed that both polypharmacy and PIP was highly prevalent among community-dwelling and care home residents, with the prevalence in the latter significantly higher even after adjustments for health. The majority of predictors for pharmacy and PIP were health-related factors with some residual associations remaining for socio-demographic factors e.g. female gender. Examples of PIP relating to the gastrointestinal (GI), central nervous system (CNS) and indication of medication categories were the most commonly encountered in both community-dwelling and care home residents. In community-dwelling population there was a modest association observed between polypharmacy, PIP and mortality, whereas in the care home population this relationship was not as clear. The qualitative study revealed that all TDF domains except ‘Emotion’ and ‘Nature of behaviours’, were either a barrier, facilitator or both, in managing appropriate polypharmacy in older adults. Pharmacists acknowledged their good professional relationships with GPs acted as a facilitator to managing appropriate polypharmacy, in addition to their clinical knowledge. Discussion and conclusion: The work contained in this thesis has added to the growing body of evidence on the use of screening tools to identify and assess PIP. Application of the screening tool highlighted the high prevalence of polypharmacy and PIP among older adults (aged 65 years or older). A particular concern was the high levels of both polypharmacy and PIP in care homes suggesting that there could be a prescribing culture within care homes in NI. Although pharmacists working in GP practices is a relatively new role in NI, they could contribute to a strategy to ensure polypharmacy is prescribed appropriately.
- Published
- 2020
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