National Health Service Community Research Articles

Specific phobias in children with moderate to severe intellectual disabilities: SPIRIT, an adaptation and feasibility study.

There is a lack of interventions for specific phobia in children and adolescents with moderate to severe intellectual disabilities. The objectives were to: (a) develop an intervention for specific phobia, together with an intervention fidelity checklist and logic model, and evaluate candidate outcome measures, together with parents/carers and clinicians; (b) describe treatment as usual; (c) model the intervention to determine the acceptability and feasibility for all stakeholders, judge the appropriateness of outcome measures, explore recruitment pathways, and examine the feasibility and acceptability of consent and associated processes; and (d) describe factors that facilitate or challenge the intervention. Phase 1a: using consensus methods, an Intervention Development Group was established who met to develop the intervention, review candidate outcome measures and contribute to the development of the intervention fidelity checklists and logic model. Phase 1b: a national online survey was conducted with parents and professionals to describe treatment as usual. Phase 2: a single-group non-randomised feasibility study was designed to model the intervention and to test intervention feasibility and acceptability, outcome measures and aspects of the research process. Phase 2: participants were recruited from National Health Service community child learning disabilities teams and special schools in England. Treatment was delivered in the child learning disabilities teams. Children aged 5-15 years with moderate to severe learning disability and specific phobia, and their parents/carers. The SPIRIT intervention comprised two half-day workshops and eight support sessions plus treatment as usual. The feasibility and acceptability of the intervention and research processes, recruitment, outcome measure completion rates and acceptability, and intervention adherence. Parents completed all of the outcome measures, with very low rates of missing data. The recruitment of sites and participants was impacted by the COVID-19 pandemic. The intervention was successfully developed and modelled with 15 participants with moderate to severe learning disabilities and their parents. The intervention was judged to be feasible and acceptable by parents/carers and therapists. Parents/carers and therapists suggested minor intervention revisions. Randomisation was not modelled within this feasibility study, although the majority of parents and therapists indicated that this would be acceptable. The SPIRIT intervention and associated study processes were judged to be feasible and acceptable. The intervention requires minor revisions. The SPIRIT intervention should be tested further within a clinical trial. Current Controlled Trials ISRCTN34766613. This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: NIHR130177) and is published in full in Health Technology Assessment; Vol. 28, No. 64. See the NIHR Funding and Awards website for further award information.

Clinicians' perspectives on remote patient management: A qualitative exploration of physiotherapists using the DiAL (Direct Access Line) programme

BackgroundIn response to the COVID-19 pandemic, face-to-face consultations within healthcare settings were suspended. Remote consultations became crucial for managing musculoskeletal conditions alongside Patient Initiated Follow-ups, leading to the development of the DiAL programme at a large National Health Service Community Trust. Previous research has focused on quantitative data, little is known about staff experiences with this programme. ObjectivesTo explore the perceptions and opinions of physiotherapy staff using DiAL, in order to highlight the benefits and challenges of this service with identification of areas for future development. DesignQualitative focus groups. MethodsTwo virtual focus groups were conducted via Microsoft Teams, involving a purposive sample of physiotherapy staff in the musculoskeletal services known to have used DiAL. Thematic analysis was conducted. ResultsTen clinicians participated in the study, generating two main themes: Clinician Autonomy and Institutional Needs. These themes encompassed several subthemes. ConclusionsClinicians reported higher job satisfaction and improved accessibility for patients, attributing these positive outcomes to the autonomy and flexibility provided by the platform. While the programme met National Health Service targets for Patient Initiated Follow-ups, there was a desire for ongoing improvements and a recognition that previous audits failed to capture all the benefits. DiAL serves as a treatment choice, supporting evidence on the advantages of remote consultations and contributing to the National Health Services’ goal of reducing its carbon footprint. There is a collective desire for the platform to continue with future recommendations including expanding its use and exploring additional audit metrics.

Attitudes of cardiac rehabilitation and stroke teams towards integration of stroke survivors into adapted cardiac rehabilitation: A focus group study

Objective To explore the attitudes and beliefs of cardiac rehabilitation and stroke teams towards adapted cardiac rehabilitation, and the broader topics of exercise, healthy lifestyles and health behaviour change, for people with mild-to-moderate severity stroke in the sub-acute phase of recovery. Design Qualitative focus group-based study. Setting Acute and community national health service trusts. Participants Stroke and cardiac rehabilitation team members. Intervention Adapted cardiac rehabilitation. Main measures Focus groups. Thematic analysis was applied to the transcribed data. Results Overall, 57 health professionals participated in 12 focus groups. Positive impacts for teams and stroke survivors were identified particularly confidence. However, there were negatives, barriers and adaptations identified. In addition, there was a lack of knowledge for cardiac rehabilitation teams in relation to stroke survivors and stroke teams in relation to cardiac rehabilitation, exercise and healthy lifestyles. Conclusions Cardiac rehabilitation and stroke staff attitudes to cardiac rehabilitation for stroke survivors showed a range of benefits, negatives, barriers and adaptations needed. Confidence and knowledge of the cardiac rehabilitation and stroke teams needs to be addressed. Registration ISRCTN65957980.

Barriers and facilitators to pressure ulcer prevention behaviours by older people living in their own homes and their lay carers: a qualitative study

ObjectiveTo identify barriers and facilitators to pressure ulcer prevention behaviours in community-dwelling older people and their lay carers.DesignTheoretically informed qualitative interviews with two-phase, deductive then inductive, thematic analysis.SettingThe study was...

Improving the understanding and management of back pain in older adults: the BOOST research programme including RCT and OPAL cohort

Improving the understanding and management of back pain in older adults: the BOOST research programme including RCT and OPAL cohort

It's all about the journey! An online museum-based recovery-oriented art psychotherapy group

ABSTRACT Background: Whilst there is evidence of the value of museums for art psychotherapy, evidence about online groups to improve mental health recovery is still scarce. The aim was to assess the impact on mental health recovery of an online museum-based recovery-oriented art psychotherapy group. Context: The group was designed to help adults under the care of a UK community mental health team with their journey of mental health recovery. Approach: The group consisted of six, weekly online sessions and used the collections of two local museums. Quantitative outcome measures and qualitative feedback were used to evaluate the group. Outcomes: Five women participated in the group, and four in the evaluation. Generic wellbeing after each session was rated 4 out of 5. Participants scored higher in the Questionnaire about the Process of Recovery (33.25 vs. 42) and a Visual Numerical Recovery Scale (3 vs. 3.25) after participating in the group. Feeling supported was what participants liked most and found most helpful, and they liked the short duration of the group least. Half found the online setting preferable to face-to-face, and all felt that the museum focus was inspirational, and enjoyed the artmaking. Participants gained a better understanding of their recovery journey and were able to express their emotions better. Conclusions: This group contributed towards participants’ mental health recovery and the museum focus was valued by them. Implications for research: The evaluation findings encourage further exploration of this way of working.

Polypharmacy as a risk factor for dementia: Scottish population‐based longitudinal record linkage study of 1 225 894 people

AbstractBackgroundPolypharmacy, the concurrent use of multiple medicines, is increasing. Population‐wide studies of its association with dementia are lacking. We examined this relationship longitudinally, at a national level.MethodWe used National Health Service community prescribing data from all adults in Scotland aged ≥50 years who received at least one drug in the first quarter of 2009. These data were linked to death records, including cause of death. We used Cox proportional hazards models to assess associations between the number of unique medicines dispensed in one quarter and mortality with any subtype of dementia over 8.5 years, in the whole sample and stratified by age.ResultThe sample contained 1,225,894 people aged ≥50 years (mean age 67.4 (SD = 10.8) years, 56.1% female, 3.8% care home residents). The mean number of drugs dispensed at baseline was 5.0 (SD = 3.7). Over 8.5 years, there were 336,244 deaths, of which 58,358 had any subtype of dementia on the death certificate.Among the whole sample, the hazard ratio (HR) for dementia mortality with each additional medicine was 1.027 (95% CI 1.024‐1.028). In people aged 50‐64 years, the HR was 1.075 (1.061‐1.089); for 65‐79 year‐olds, HR = 1.043 (1.040‐1.047) and for those aged ≥80 years, HR = 1.009 (1.006‐1.012). All models were adjusted for baseline age, gender, care home residence status and deprivation index based on postcode.ConclusionThere was higher mortality with dementia as the number of dispensed medicines increased. Age‐stratified analyses showed that the association was stronger in younger age groups, perhaps reflecting that younger people taking medication for more comorbidities had an increased risk of dying with dementia. These analyses did not allow adjustment for multimorbidity or the consideration of individual drug classes.

Prevalence and Characteristics of Persistent Symptoms in Children During the COVID-19 Pandemic: Evidence From a Household Cohort Study in England and Wales.

Prevalence and Characteristics of Persistent Symptoms in Children During the COVID-19 Pandemic: Evidence From a Household Cohort Study in England and Wales.

Extended-release pharmacotherapy for opioid use disorder (EXPO): protocol for an open-label randomised controlled trial of the effectiveness and cost-effectiveness of injectable buprenorphine versus sublingual tablet buprenorphine and oral liquid methadone

BackgroundSublingual tablet buprenorphine (BUP-SL) and oral liquid methadone (MET) are the daily, standard-of-care (SOC) opioid agonist treatment medications for opioid use disorder (OUD). A sizable proportion of the OUD treatment population is not exposed to sufficient treatment to attain the desired clinical benefit. Two promising therapeutic technologies address this deficit: long-acting injectable buprenorphine and personalised psychosocial interventions (PSI). This study will determine (A) the effectiveness and cost-effectiveness — monthly injectable, extended-release (BUP-XR) in a head-to-head comparison with BUP-SL and MET, and (B) the effectiveness of BUP-XR with adjunctive PSI versus BUP-SL and MET with PSI. Safety, retention, craving, substance use, quality-adjusted life years, social functioning, and subjective recovery from OUD will be also evaluated.MethodsThis is a pragmatic, multi-centre, open-label, parallel-group, superiority RCT, with a qualitative (mixed-methods) evaluation. The study population is adults. The setting is five National Health Service community treatment centres in England and Scotland. At each centre, participants will be randomly allocated (1:1) to BUP-XR or SOC. At the London study co-ordinating centre, there will also be allocation of participants to BUP-XR with PSI or SOC with PSI. With 24 weeks of study treatment, the primary outcome is days of abstinence from non-medical opioids during study weeks 2–24 combined with up to 12 urine drug screen tests for opioids. For 90% power (alpha, 5%; 15% inflation for attrition), 304 participants are needed for the BUP-XR versus SOC comparison. With the same planning parameters, 300 participants are needed for the BUP-XR and PSI versus SOC and PSI comparison. Statistical and health economic analysis plans will be published before data-lock on the Open Science Framework. Findings will be reported in accordance with the Consolidated Standards of Reporting Trials and Consolidated Health Economic Evaluation Reporting Standards.DiscussionThis pragmatic randomised controlled trial is the first evaluation of injectable BUP-XR versus the SOC medications BUP-SL and MET, with personalised PSI. If there is evidence for the superiority of BUP-XR over SOC medication, study findings will have substantial implications for OUD clinical practice and treatment policy in the UK and elsewhere.Trial registrationEU Clinical Trials register 2018-004460-63.

Does registered nurse involvement in improving healthcare services, influence registered nurse retention?

Registered nurses are 'critical' to population health, international responses to emergencies, epidemics and disasters. Retention of registered nurses (RNs) is an international nursing priority. In England, RNs are encouraged to be involved in improving healthcare services. This benefits quality of care, operational and financial performance. However, RN involvement in improvement may reduce RN retention. It is important to understand this relationship when developing effective RN retention strategies. The purpose of this research is to describe possible relationships between RN involvement in improving healthcare services and RN retention, using published 2018 data for National Health Service (NHS) Trusts in England. The relationship between RN involvement in improving healthcare services and RN retention was explored using a correlational design, involving secondary data from the annual NHS Staff Survey and Model Hospital. In mental health NHS Trusts in England, a statistically significant, positive correlation of 0.24 was found between RN 'ab(ility) to make suggestions for improvement' and RN retention. In mental health NHS Trusts, a statistically significant correlation of 0.278 was found between RNs 'making improvements happen' and RN retention. In acute NHS Trusts in England, a statistically significant, negative correlation of -0.15 was identified between RNs 'mak(ing) improvements happen' and RN retention. The findings suggest that RN retention factors in mental health and acute NHS Trusts differ from community and specialist NHS Trusts in England. This is an important consideration for national RN retention programmes as a single approach to RN retention may not be effective across all healthcare settings.

How much information is ‘reasonable’? A qualitative interview study of the prescribing practices of palliative care professionals

Background: Prescribing clinicians have to negotiate ambiguities around information provision and consent for medications on a daily basis, despite the availability of professional guidance. Aim: This study aims to explore some of the many factors prescribing clinicians in the United Kingdom take into account when deciding what information to give to patients about medication choices, and when. Design: In depth face-to-face interviews, utilising both a hypothetical scenario and semi-structured prompts, were conducted in order to elicit extended reflections on how clinicians individually work through such dilemmas and make decisions. Setting/participants: Ten prescribing clinicians (doctors and nurses) from a large combined team of National Health Service (NHS) secondary and community palliative care providers in England. Results: Palliative care staff regularly face choices about information provision in prescribing discussions, in particular when considering whether information might increase distress. Participants presented three overlapping framings that helped them assess the range of factors that could potentially be taken into account; (1) assessing the individual patient, (2) tailoring the provision of information and (3) jointly forming a plan. Conclusions: Information provision about medication choices and effects is a demanding, ongoing process, requiring nuanced judgements that constitute an unacknowledged yet significant aspect of clinical workload. Although current medical guidelines allow clinical discretion about information provision, this can leave individual clinicians feeling vulnerable. Further evolution of guidelines needs to establish a more sophisticated way to acknowledge professional and legal requirements, whilst also promoting professional autonomy and judgement.

Expectant parents’ perceptions of healthcare and support during COVID-19 in the UK: a thematic analysis

ABSTRACT Background In response to the COVID-19 pandemic, expectant parents experienced changes in the availability and uptake of both National Health Service (NHS) community and hospital-based healthcare. Objective To examine how COVID-19 and its societal related restrictions have impacted the provision of healthcare support for pregnant women during the COVID-19 pandemic. Method A thematic analysis using an inductive approach was undertaken using data from open-ended responses to the national COVID in Context of Pregnancy, Infancy and Parenting (CoCoPIP) Study online survey (n = 507 families). Findings The overarching theme identified was the way in which the changes to healthcare provision increased parents’ anxiety levels, and feelings of not being supported. Five sub-themes, associated with the first wave of the pandemic, were identified: (1) rushed and/or fewer antenatal appointments, (2) lack of sympathy from healthcare workers, (3) lack of face-to-face appointments, (4) requirement to attend appointments without a partner, and (5) requirement to use PPE. A sentiment analysis, that used quantitative techniques, revealed participant responses to be predominantly negative (50.1%), with a smaller proportion of positive (21.8%) and neutral (28.1%) responses found. Conclusion This study provides evidence indicating that the changes to healthcare services for pregnant women during the pandemic increased feelings of anxiety and have left women feeling inadequately supported. Our findings highlight the need for compensatory social and emotional support for new and expectant parents while COVID-19 related restrictions continue to impact on family life and society.

Health service costs of treating venous leg ulcers in the UK: evidence from a cross-sectional survey based in the north west of England

ObjectivesTo estimate and examine the direct healthcare costs of treating people with open venous leg ulcers in the UK.DesignCost-of-illness study.SettingA cross-sectional survey of nine National Health Service community locales over...

Assessment of a Nurse Led Energy Behavior Change Intervention in an NHS Community Hospital Ward

This paper investigates a nurse led, energy conservation behavioral intervention, in hospital wards of an NHS (National Health Service) community hospital (Trust). The information based intervention was adapted from “Operation TLC”, developed by environmental behavioral change charity Global Action Plan, and St Bartholomew’s Health NHS Trust, London. For this study, three identical older persons’ acute-care wards in terms of patient type, nursing levels, layout, electrical fittings (lighting & small power), elevation and orientation (one control ward and two intervention wards) were evaluated over a nine-month period. The paper demonstrates a co-dependent relationship between the quantitative data from the electricity and light monitors on the wards with the qualitative data gathered from staff comfort surveys and focus groups, and Trust policies. Our results show a 13% reduction in electricity consumption, primarily from preventing nursing staff in the intervention group from using prohibited secondary space heaters at night during the heating season and the introduction of a “quiet time” in the intervention group. During quiet time lights in the intervention group were turned off for an hour after lunch to encourage rest for patients to provide time for nursing staff to complete administrative tasks. Electricity reductions achieved during the intervention period were observed to continue into the 3-month post intervention period but at a reduced level.

Grounding clinical guidelines in service users’ experiences of endings

PurposeThe purpose of this paper is to explore service users’ experiences of the process of ending from national health service (NHS) community personality disorder services.Design/methodology/approachSemi-structured interviews were conducted with eight participants recruited from four NHS community personality disorder services.FindingsThree main themes emerged; “Service users” experiences in the context of “Reflective versus Reactive practice”, “Endings held in mind” and “What next”?Originality/valueFurther recommendations are provided for practitioners supporting individuals managing endings alongside a “readiness to end” model which may be used in clinical practice.

Are advanced clinical practice roles in England's National Health Service a remedy for workforce problems? A qualitative study of senior staff perspectives.

A major issue facing all health systems is improving population health while at the same time responding to both growing patient numbers and needs and developing and retaining the health care workforce. One policy response to workforce shortages has been the development of advanced clinical practice roles. In the context of an English national policy promoting such roles in the health service, we explored senior managers' and senior clinicians' perceptions of factors at the organization level that support or inhibit the introduction of advanced clinical practice roles. The investigation was framed by theories of the diffusion of innovation and the system of professions. We conducted a qualitative interview study of 39 senior manager and clinicians in 19 National Health Service acute, community, mental health and ambulance organizations across a metropolitan area in 2019. Small numbers of advanced clinical practice roles were reported, often in single services. Four main influences were identified in the development of advanced clinical practice roles: staff shortages (particularly of doctors in training grades) combined with rising patient demand, the desire to retain individual experienced staff, external commissioners or purchasers of services looking to shape services in line with national policy, and commissioner-funded new roles in new ambulatory care services and primary care. Three factors were reported as enabling the roles: finance for substantive posts, evidence of value of the posts, and structural support within the organization. Three factors were perceived as inhibiting developing the roles: confusion and lack of knowledge amongst clinicians and managers, the availability of finance for the roles, and a nervousness (sometimes resistance) to introducing the new roles. While the national policy was to promote advanced clinical practice roles, the evidence suggested there was and would continue to be limited implementation at the operational level. Development scenarios that introduced new monies for such roles reduced some of the inhibiting factors. However, where the introduction of roles required funding to move from one part of a service to another, and potentially from one staff group to another, the growth of these roles was and is likely to be contested. In such scenarios, research and business evidence of relative advantage will be important, as too will be supporters in powerful positions. The paucity of publicly available evidence on the effectiveness of advanced clinical practice roles across the specialties and professions in different contexts requires urgent attention.

Latent structure and factor reliability of the National Health Service Community Mental Health Service User Questionnaire

Background National Health Service use the Community Mental Health Service User Questionnaire (NHS-CMH) to assess care quality. However, its reliability and internal validity is uncertain. Aims To test the NHS-CMH structure, reliability and item-level characteristics. Methods We used data from 11,373 participants who answered the 2017 NHS-CMH survey. First, we estimated the NHS-CMH structure using Exploratory Factor Analysis (EFA) in half of the dataset. Second, we tested the best EFA-derived model with Confirmatory Factor Analysis (CFA). We tested the internal validity, construct reliability (omega – ω), explained common variance of each factor (ECV), and item thresholds. Results EFA suggested a 4-factor solution. The structure derived from the EFA was confirmed, demonstrating good reliability for the four correlated dimensions: “Relationship with Staff” (ω = 0.952, ECV = 40.1%), “Organizing Care” (ω = 0.855, ECV = 21.4%), “Medication and Treatments” (ω = 0.837, ECV = 13.3%), and “Support and Well-being” (ω = 0.928, ECV = 25.3%). A second-order model with a high-order domain of “Quality of Care” is also supported. Conclusions The NHS-CMH can be used to reliably assess four user-informed dimensions of mental health care quality. This model offers an alternative for its current use (item-level and untested sum scores analysis).

‘The silent intermediary’: a co-authored exploration of a client’s experience of art psychotherapy for C-PTSD

ABSTRACT Background This article presents a client’s (art therapee’s) conceptualisation of his experience of art psychotherapy for symptoms of complex post-traumatic stress disorder (C-PTSD). Context He was receiving treatment through a community adult mental health team within the UK National Health Service. Approach The art therapee wrote about his art psychotherapy experience, and then he and his art psychotherapist identified key themes. They related his account to art psychotherapy theory and evidence and drew out implications of his experience for art psychotherapy research. Outcomes/Conclusions The art therapee found that an art psychotherapy approach was helpful in these ways: having control; expressing without words; distancing from trauma; being creative and playful. He identified some aspects of the art psychotherapy which seem to be under-represented in art psychotherapy literature: the importance of the therapist’s acceptance of the client’s artwork for building trust; the way in which artmaking bypasses the fear of ‘telling’ about past abuse; and the therapeutic value of creativity and play for accessing positive aspects of the child self. Implications for research It would be valuable to gain information from other clients with C-PTSD about their experiences of art psychotherapy. Research into the identified under-explored aspects of art psychotherapy practice, the use of artmaking for C-PTSD symptom management and how artmaking can be integrated within other approaches to C-PTSD treatment would be useful. Plain-language summary This article describes how a client (art therapee) with symptoms of complex post-traumatic stress disorder (C-PTSD) experienced art psychotherapy. The art therapee received therapy through a UK National Health Service community adult mental health team. The therapy sessions were on a weekly basis over an 18-month period. The art therapee wrote about his art psychotherapy experience, and then he and his art psychotherapist identified some themes. They related his account to art psychotherapy theory and evidence and drew out implications of his experience for art psychotherapy research. The art therapee found that an art psychotherapy approach was helpful in four main ways. It helped him to feel in control of the therapeutic process, and enabled him to express experiences of past abuse without having to use words. It gave him a sense of distance from his traumatic experiences. Finally, it helped him to connect with his creativity. He identified some particular aspects of his experience which seem to be under-represented in art psychotherapy literature: the importance of the therapist’s acceptance of the client’s artwork for building trust; the way in which artmaking bypasses the fear of ‘telling’ about past abuse; and how creativity and playfulness in art psychotherapy sessions can enable a more positive view of oneself as a child. The authors consider that it would be valuable to gain information from other clients with C-PTSD about their experiences of art psychotherapy and to undertake research into those aspects of the client’s experience which appear not to have been explored significantly so far. Research into how artmaking can help relieve C-PTSD symptoms and how artmaking might be used within other approaches to C-PTSD treatment would also be useful.

Pharmacy professionals’ views regarding the future of NHS patient medicines helpline services: A multimethod qualitative study

Abstract Introduction Patient medicines helpline services (PMHS) have been established at some National Health Service (NHS) hospitals in England, to provide medicines-related support to recently discharged hospital patients and carers. However, findings suggest that, due to a lack of resources, considerable variation exists in the operation of PMHS, and that their access, availability, and promotion do not meet national standards regarding helpline provision (1, 2). To develop recommendations for service improvement, this qualitative study sought to examine pharmacy professionals’ views regarding the future of PMHS. Aim To examine pharmacy professionals’ perceptions of the future of PMHS, and develop recommendations for service improvement. Methods University ethics and Health Research Authority approval were obtained before commencement. Participants comprised pharmacy professionals from acute, mental health, specialist, and community NHS Trusts that provided a PMHS. Invitations to participate in an online qualitative survey and subsequent semi-structured telephone interview were sent via email to pharmacy services at all Trusts that provided a PMHS. Within the survey and the interview schedule was one question “How do you see patient medicines helplines at NHS Trusts developing in the future?” and only the data generated from this open-ended question were analysed for this study. Survey data were collected via SurveyMonkey (n=100). Individuals interested in participating in an interview contacted the research team, resulting in 34 interviews. Interviews were conducted from May-October 2018, and ranged from 16 to 53 minutes. Braun and Clarke’s inductive reflexive thematic analysis was used to analyse the data. Guidelines for enhancing the validity and trustworthiness of qualitative research were used. Results Two themes were generated from the survey and interviews. Enhancing value for service users identifies suggestions for improving the value of PMHS for service users. These include providing access methods beyond the telephone, and providing patients/carers with post-discharge follow-up calls from a pharmacist. Improving efficiency identifies that, in the future, and in line with NHS plans for efficiency and shared resources, PMHS may become centralised or provided by community pharmacies. Centralised services were considered to likely have more resources available to provide a patient medicines information service compared to hospital pharmacies. Participants often referred to the Carter report and sustainability and transformation plans, which promote the sharing of resources within regions. However, such a change was perceived to only increase efficiency if patient information can be shared between relevant healthcare settings. Conclusion PMHS are perceived by pharmacy professionals as likely to become centralised in the future (i.e., provided regionally or nationally) or provided by community pharmacies. This is dependent upon patients’ information being shared between hospitals and the centralised PMHS or pharmacies. To enhance the value of PMHS for service users, providers could establish other methods of access, such as email and video consultation. A limitation of this study is that it did not seek the perspectives of pharmacy professionals who do not provide a PMHS, other healthcare professionals, nor patients and carers. Considering the uncertainty around the future of PMHS, research should establish the best way to support all patients and carers regarding medicines following hospital discharge.

The relationship between social risk factors and latent tuberculosis infection among individuals residing in England: a cross-sectional study

ObjectiveTo investigate the relationship between social risk factors and latent tuberculosis infection (LTBI) among individuals who are eligible for LTBI screening in the United Kingdom (UK).MethodsThis cross-sectional study used data...