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    The Effectiveness of Pharmacist Interventions in Improving Asthma Control and Quality of Life in Patients with Difficult Asthma

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    DPharm (4.639Mb)
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    Publication date
    2014
    Author
    Capstick, Toby G.D.
    Supervisor
    Blenkinsopp, Alison
    Morgan, Julie D.
    Silcock, Jonathan
    Clifton, I.J.
    Keyword
    Asthma; Pharmacist interventions; Pharmacist prescribing; Quality of life; Asthma control; Hospital pharmacists; Community pharmacists; Care transitions
    Rights
    Creative Commons License
    The University of Bradford theses are licenced under a Creative Commons Licence.
    Institution
    University of Bradford
    Department
    School of Pharmacy, Faculty of Life Sciences
    Awarded
    2014
    
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    Abstract
    Despite national guidelines, the management of difficult asthma remains suboptimal, and there may be opportunities for pharmacists to improve asthma outcomes. This six-month prospective, randomised, open study investigated the effects of pharmaceutical care across primary and secondary care on difficult asthma. Fifty-two patients attending a hospital difficult asthma clinic were randomised (1:1) to receive usual medical care (UC), or pharmacist interventions (PI) comprising asthma review, education, and medicines optimisation from a hospital advanced clinical pharmacist, plus follow-up targeted Medicines Use Review (t-MUR) from community pharmacists. Forty-seven patients completed the study. More interventions were performed in the PI group at baseline (total 79 vs. 34, p<0.001), but only six patients received a t-MUR. At six-months, PI were non-inferior to UC for all outcomes. The primary outcome measure was Juniper’s Asthma Control Questionnaire score and reduced (improved) from a median (IQ) score of 2.86 (2.25, 3.25) and 3.00 (1.96, 3.71) in the PI and UC groups respectively to 2.57 (1.75, 3.67) and 2.29 (1.50, 3.50). At baseline, 58.8%, 46.9% and 17.6% of patients had optimal inhaler technique using Accuhalers, Turbohalers or pMDIs; education improved technique but this was not maintained at six-months. Adherence rates <80% were observed in 57.5% of patients at baseline, and was improved in the PI group at six-months (10/20 PI vs. 3/21 UC had adherence rates of 80-120%, p=0.020). This study demonstrates that the management of difficult asthma by specialist pharmacists is as effective as usual medical care. Future research should investigate whether pharmacist-led follow-up produces further improvements.
    URI
    http://hdl.handle.net/10454/13962
    Type
    Thesis
    Qualification name
    DPharm
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      Community pharmacists’ experience and perceptions of the New Medicines Service (NMS)

      Lucas, Beverley J.; Blenkinsopp, Alison (2015-12)
      Objectives The New Medicines Service (NMS) is provided by community pharmacists in England to support patient adherence after the initiation of a new treatment. It is provided as part of the National Health Service (NHS) pharmacy contractual framework and involves a three-stage process: patient engagement, intervention and follow-up. The study aims to explore community pharmacists’ experiences and perceptions of NMS within one area of the United Kingdom. Methods In-depth semi-structured telephone interviews were conducted with 14 community pharmacists. Interviews were audio-recorded, independently transcribed and thematically analysed. Key findings Pharmacists gave a mixed response to the operationalisation, ranging from positive opportunities for improving adherence and enhancement of practice to difficulties in terms of its administration. Pharmacists generallywelcomed opportunities to utilise their professional expertise to achieve better patient engagement and for pharmacy practice to develop as a patient resource. There was a perceived need for better publicity about the service. Different levels of collaborative working were reported. Some pharmacists were working closely with local general practices most were not. Collaboration with nurses in the management of long-term conditions was rarely reported but desired by pharmacists. Where relationships with general practitioners (GPs) and nurses were established, NMS was an opportunity for further collaboration; however, others reported a lack of feedback and recognition of their role. Conclusions Community pharmacists perceived the NMS service as beneficial to patients by providing additional advice and reassurance, but perceptions of its operationalisation were mixed.Overall, our findings indicate that NMS provides an opportunity for patient benefit and the development of contemporary pharmacy practice, but better collaboration with GPs and practice nurses could enhance the service.
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      Pharmacist joint-working with general practices: evaluating the Sheffield Primary Care Pharmacy Programme. A mixed- methods study

      Marques, Iuri; Gray, N.J.; Tsoneva, J.; Magirr, P.; Blenkinsopp, Alison (2018)
      Background: The NHS in the UK supports pharmacists’ deployment into general practices. This article reports on the implementation and impact of the Primary Care Pharmacy Programme (PCPP). The programme is a care delivery model that was undertaken at scale across a city in which community pharmacists (CPs) were matched with general practices and performed clinical duties for one half-day per week. Aim: To investigate (a) challenges of integration of CPs in general practices, and (b) the perceived impact on care delivery and community pharmacy practice. Design & setting: This mixed-methods study was conducted with CPs, community pharmacy employers (CPEs), scheme commissioners (SCs), and patients in Sheffield. Method: Semi-structured interviews (n = 22) took place with CPs (n = 12), CPEs (n = 2), SCs (n = 3), and patients (n = 5). A cross-sectional survey of PCPP pharmacists (n = 47, 66%) was also used. A descriptive analysis of patient feedback forms was undertaken and a database of pharmacist activities was created. Results: Eighty-six of 88 practices deployed a pharmacist. Although community pharmacy contracting and backfill arrangements were sometimes complicated, timely deployment was achieved. Development of closer relationships appeared to facilitate extension of initially agreed roles, including transition from ‘backroom’ to patient-facing clinical work. CPs gained understanding of GP processes and patients’ primary care pathway, allowing them to follow up work at the community pharmacy in a more timely way, positively impacting on patients’ and healthcare professionals’ perceived delivery of care. Conclusion: The PCPP scheme was the first of its kind to achieve almost universal uptake by GPs throughout a large city. The study findings reveal the potential for CP–GP joint-working in increasing perceived positive care delivery and reducing fragmented care, and can inform future implementation at scale and at practice level.
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      Time for management training? Investigating the support for the continuous professional development of critical management skills amongst community and hospital pharmacists

      Breen, Liz; Roberts, Leanne; Mathew, Dimble; Tariq, Zara; Arif, Izbah; Mubin, Forhad; Aziz, Fessur (2016-04)
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