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BackgroundNon-steroidal anti-inflammatory drugs (NSAIDs) are a common cause of renal damage, especially when taken together with angiotensin-converting enzyme inhibitors (ACE-i) or angiotensin II receptor blockers (ARBs) plus a diuretic — a combination known as the “triple whammy.” New Zealand patients are at high risk of the “triple whammy” because they can easily purchase NSAIDs without a prescription and in nonpharmacy retail settings (eg, the supermarket), there is no legal requirement to include patient information sheets with medication, and direct-to-consumer drug advertising is permitted. A patient information package has been developed for those at greatest risk of the “triple whammy,” consisting of a printable PDF and an interactive online learning activity. This information package aims to inform patients about their elevated risk of harm from NSAIDS and discourage use of NSAIDs. A randomized control trial was planned to assess the effect of the information package. ObjectiveThis study aims to pilot the trial procedures for recruiting patients and providing patient information online and to assess the acceptability of the patient information package. MethodsA two-armed randomized feasibility trial will be undertaken in Northland, New Zealand. We will recruit 50 patients who are at least 18 years old from those who have signed up to receive email alerts through their general practice. Patients eligible for this study have been prescribed an ACE-i or ARB plus a diuretic in the past 3 months. They will be randomly allocated to 2 study arms. The intervention arm will receive access to an information package plus usual care; the control arm will receive usual care alone. Online surveys will be used to assess NSAID knowledge and NSAID use at baseline and after 2 weeks for both arms. The intervention arm will also evaluate the information package in an additional survey based on Normalization Process Theory (NPT) concepts. We will report the number and proportion of participants who are eligible and consent to participate in the trial. Response and drop-out rates will be reported for each trial arm. The numbers of patients who interact with the education package will be reported together with the patient evaluation of it. ResultsFunding has been obtained from the Health Research Council of New Zealand (HRC 18-031). The University of Otago Human Research Ethics Committee (H21/016) has approved this trial. Consultation has been undertaken with The Ngai Tahu research consultation committee. The trial commenced on April 12, 2021. ConclusionsThis feasibility trial will test the study processes prior to commencing a randomized controlled trial and will determine the acceptability of the patient information package. We anticipate this work will provide useful information for other researchers attempting similar work. International Registered Report Identifier (IRRID)PRR1-10.2196/29161

Background: Community pharmacies in New Zealand have varying ownership and operational structures. Unlike independent pharmacies, corporate and hybrid pharmacies do not charge prescription copayments. Objectives: This research aimed to determine whether people receiving free prescriptions from corporate and hybrid pharmacies (via copayment waiver) have greater medication adherence than the users of independent pharmacies. Methods: A nationwide, retrospective, observational study linked 1 year of dispensing data (1/05/2022 to 30/04/2023) from the Pharmaceutical Collection to patient enrollment data using a National Health Index number to identify demographics of different pharmacy-type users. People were assigned to a particular type of pharmacy if they collected at least 70% of their prescriptions from there; if they did not meet this threshold, they were defined as mixed users. People were classified as adherent if dispensing data showed they collected their supply of medication to cover at least 80% of the study period. Results: The sample captured 218,080 people taking at least 1 diabetes medication, with a total of 360,079 unique medications being included in the analysis. The majority, 156,893, used independent pharmacies. The type of pharmacy used was shown to be a significant predictor of adherence. Corporate and hybrid pharmacy users were 0.90 (95% CI 0.88 to 0.93) and 0.93 (95% CI 0.90 to 0.96) times as likely be adherent than the users of independent pharmacies. Mail order pharmacy users were the most likely to be adherent, whereas mixed pharmacy users were the least likely to be adherent. Conclusions: Our findings suggest that prescription copayments provided by corporate and hybrid pharmacies are not the most significant barrier to medication adherence. Further research may identify more efficient ways of improving medication adherence than removing prescription copayments for all. [ABSTRACT FROM AUTHOR]

Objectives: To determine how often general practitioners (GPs) and pharmacists recommend patients obtain information about their medicines via websites and to explore factors that might improve the delivery of written information about medicines to patients. Design: Cross-sectional surveys. Setting: GPs and community pharmacists in New Zealand primary care. Method: Questionnaires were developed and sent to a sample of pharmacists and GPs. Data were collected using SurveyMonkey® and analysed to examine views about websites and leaflets informing patients about medicines. Results: In total, 143 GPs and 126 pharmacists responded. GPs and pharmacists did not routinely direct patients to medicine information websites. Most commonly, GPs did not provide medicine information leaflets due to time constraints and concerns about possibly confusing information. Both professions thought leaflets might cause patients to worry about side-effects. Pharmacists mainly withheld leaflets because the medicine has been taken previously or because leaflet indications differed to prescribed use. A summary leaflet, if available, would be the preferred option for improving leaflet provision. Conclusion: Providing digital medicine information is uncommon in New Zealand. Summarised, relevant information tailored to patient requirements might facilitate the provision of medicines information at the point of care.

Background: Discussing medicines with patients is the responsibility of prescribers and pharmacists. However, it is not well known whether patients are given the information they want or whether information provision continues when medicines are taken long-term. Objective: To determine how often general practitioners (GPs) and pharmacists provide verbal information to patients about their medicines, and compare the information given with what patients want to know. Design: Cross-sectional surveys. Setting: New Zealand primary healthcare. Method: Two questionnaires were developed and sent to a sample of pharmacists and GPs, and chi-squared analysis was carried out. Open responses were analysed qualitatively to detect further ideas. Results: A total of 119 pharmacists and 150 GPs responded. For new medicines, significantly more GPs than pharmacists reported giving verbal information all of the time. Significantly more GPs than pharmacists reported discussing most counselling points all or most of the time. Pharmacists were more likely than GPs to discuss counselling points only when requested to by patients. For repeat medicines, significantly more GPs than pharmacists were likely to consider counselling points very important. Conclusion: Patients may not be receiving the information they want to know about their medicines, and there may be an overall lack of verbal communication about medicines with patients. Some information will only be discussed if the patient actively requests it; the likelihood of this increases with repeat medicines. The use of counselling aids and tools, such as a medicine information leaflet, could help healthcare providers provide patients with the information they need.

Aim: This study sought to determine the factors influencing successful implementation of non‐medical prescribing (NMP). Data sources: EMBASE, Medline, CINAHL and reference lists were searched from January 2010 to November 2020. Study Selection: Umbrella review and narrative synthesis of results were utilised. The retrieved reviews underwent title screening, abstract review, full‐text screening and assessment for inclusion. To guarantee the precision of the search results, Participants, Intervention, Control, and Outcomes (PICO) elements were recorded for each study. Studies were included if they were systematic reviews, published in English, published from January 2010 to November 2020, and discussed barriers and/or facilitators to NMP implementation. Results: Of the 193 studies identified, eight were eligible for inclusion. Most of the reviews (62%) were published in 2017–2018. The majority of the reviews (62%) were focused on the United Kingdom. Three reviews discussed nurse prescribing, two reviews focused on pharmacist prescribing, and three reviews investigated NMP generally. Data were compiled into the Consolidated Framework for Implementation Research to evaluate the factors that influence the success or failure of NMP implementation. Conclusion: Implementation of NMP is a complex process which requires fulfilment of all its elements. The success of NMP can be directly related to the extent of the whole system engagement and support, and available funding. [ABSTRACT FROM AUTHOR]

Background: Pre-exposure prophylaxis (PrEP) for human immunodeficiency virus (HIV) is a highly effective way to reduce virus transmission. There have been increasing calls to improve access to PrEP in Canada. One way to improve access is by having more prescribers available. The objective of this study was to determine target users' acceptance of a PrEP-prescribing service by pharmacists in Nova Scotia. Methods: A triangulation, mixed-methods study was conducted consisting of an online survey and qualitative interviews underpinned by the Theoretical Framework of Acceptability (TFA) constructs (affective attitude, burden, ethicality, intervention coherence, opportunity cost, perceived effectiveness and self-efficacy). Participants were those eligible for PrEP in Nova Scotia (men who have sex with men or transgender women, persons who inject drugs and HIV-negative individuals in serodiscordant relationships). Descriptive statistics and ordinal logistic regression were used to analyze survey data. Interview data were deductively coded according to each TFA construct and then inductively coded to determine themes within each construct. Results: A total of 148 responses were captured by the survey, and 15 participants were interviewed. Participants supported pharmacists' prescribing PrEP across all TFA constructs from both survey and interview data. Identified concerns related to pharmacists' abilities to order and view lab results, pharmacists' knowledge and skills for sexual health and the potential for experiencing stigma within pharmacy settings. Conclusion: A pharmacist-led PrEP-prescribing service is acceptable to eligible populations in Nova Scotia. The feasibility of PrEP prescribing by pharmacists should be pursued as an intervention to increase access to PrEP. [ABSTRACT FROM AUTHOR]

Background: Pre-exposure prophylaxis (PrEP) for human immunodeficiency virus (HIV) prevention is highly effective. Pharmacists can increase PrEP accessibility through pharmacist prescribing. This study aimed to determine pharmacists' acceptance of a pharmacist PrEP prescribing service in Nova Scotia. Methods: A triangulation mixed methods study consisting of an online survey and qualitative interviews was conducted with Nova Scotia community pharmacists. The survey questionnaire and qualitative interview guide were underpinned by the 7 constructs of the Theoretical Framework of Acceptability (affective attitude, burden, ethicality, opportunity costs, intervention coherence, perceived effectiveness and self-efficacy). Survey data were analyzed descriptively and with ordinal logistic regression to determine associations between variables. Interview transcripts were deductively coded according to the same constructs and then inductively coded to identify themes within each construct. Results: A total of 214 community pharmacists completed the survey, and 19 completed the interview. Pharmacists were positive about PrEP prescribing in the constructs of affective attitude (improved access), ethicality (benefits communities), intervention coherence (practice alignment) and self-efficacy (role). Pharmacists expressed concerns about burden (increased workload), opportunity costs (time to provide the service) and perceived effectiveness (education/training, public awareness, laboratory test ordering and reimbursement). Conclusion: A PrEP prescribing service has mixed acceptability to Nova Scotia pharmacists yet represents a model of service delivery to increase PrEP access to underserved populations. Future service development must consider pharmacists' workload, education and training as well as factors relating to laboratory test ordering and reimbursement. [ABSTRACT FROM AUTHOR]