Primary Care Pharmacy Research Articles

Creating an inclusive workforce in 2024: Are pharmacy teams across England committed to embedding equality, diversity, and inclusion?

Abstract Introduction The Pharmacy Workforce Race Equality Standard (PWRES) published in 2023 provided evidence of the varied experiences that registered pharmacy professionals in NHS trusts face, particularly in relation to gender and ethnicity.1 Following this, the Inclusive Pharmacy Practice delivery group at NHS England set out to raise awareness of the data and to support regions in developing action plans to drive improvements in equality, diversity and inclusion (EDI) within pharmacy teams. Aim The aim of this study was to identify current initiatives within NHS providers that promote EDI within the pharmacy workforce with a view to enabling the sharing of good practice, and identifying implementation barriers. Methods A questionnaire was created by the Chief Pharmaceutical Officer’s Clinical Fellows and distributed by the 6 regional chief pharmacists within NHS England to their networks. The questionnaire was also promoted in regional pharmacy leadership meetings. Responses were collected between 1st February and 31st May 2024. Data was collected on an Excel spreadsheet. London was excluded from data collection as a similar questionnaire was distributed in 2023. No ethical approval was needed for non-sensitive anonymised data. Results There were 77 responses: 75% (n = 58) from hospital trusts, 13% (n = 10) from integrated care boards and the remaining 9 responses included the Local Pharmaceutical Committee, Hospice and Mental Health Trust. 86% of respondents (n = 66) indicated that their organisation has EDI initiatives in place. These have been summarised into six key themes: 1) EDI network/steering group (n = 44), 2) action plan (n = 14), 3) EDI training/accreditation (n =14), 4) reverse/reciprocal mentoring (n = 11), 5) awareness days (n = 10) and 6) inclusive recruitment practices (n = 10). In contrast, only half of respondents indicated that their team had EDI initiatives. The impact of any initiatives was measured by feedback from staff (e.g. Internal staff survey, NHS staff survey, focus groups, open staff forums) and regular staff demographic data collection. 55% of respondents (n = 36) indicated that recruitment panel members received compulsory EDI training for interviews and 54% of respondents (n = 35) received mandatory recruitment training. Barriers and challenges identified with implementing EDI initiatives included organisational change, workforce capacity, competing priorities and staff apathy. Discussion The survey results highlight a strong commitment to EDI initiatives at an organisational level, with most organisations having established EDI frameworks. However, the lower prevalence of EDI initiatives within individual pharmacy teams suggests a gap in implementation. This discrepancy indicates a need for better dissemination and integration of EDI practices within pharmacy team settings. There is evidence of varied practice in terms of EDI training requirements of interview panellists, and these variations are opportunities where improvements can be made in terms of IPP. The survey was only sent to the managed NHS sector and is not reflective of primary care or community pharmacy. One of the next steps is for regions to use the results of the questionnaire in combination with the PWRES data to develop and implement local action plans to address these issues. Reference 1. NHS England. Pharmacy Workforce Race Equality Standard Report 2023. [Accessed 4th June 2024]. Available from https://www.england.nhs.uk/long-read/pharmacy-workforce-race-equality-standard-report/

Qualitative study exploring perceptions and experiences of Pharmacy technicians’ professional identity in NHS Scotland

Abstract Introduction Pharmacy technicians worldwide share workplace challenges including: job role; scope of practice; level of pharmacist’ supervision; and education1. In the USA, Canada and many European countries, pharmacy technicians require national or state registration2. In the UK, Pharmacy technicians became registered professionals in 2011, as a means of improving patient safety through compliance with General Pharmaceutical Council (GPhC) standards. There are approximately 2,500 pharmacy technicians and 5,500 pharmacists registered with the GPhC in Scotland3. Given the importance of professional identity, and the lack of research exploring pharmacy technicians’ professional affiliation, we explored the perspectives and experiences of pharmacy technicians’ professionalism across Scotland. Aim To explore pharmacy technicians’ perceptions and experiences of their professional status and professional identity. Methods Following West of Scotland Research and Ethics Service Scientific Officer’s approval, Pharmacy technicians from all fourteen Scottish territorial health boards were invited by email using snowball sampling technique to provide a national representation. A draft semi-structured interview was piloted on four pharmacy technicians. Between May and August 2023, 36 pharmacy technicians were recruited: 23 from acute services; mental health (n=1); rehabilitation hospitals (n=1); primary care (n=8); and community pharmacy (n=3). Twenty two participants were interviewed in person and 14 on line. Interviews lasted between 17-91 minutes, were audio recorded, transcribed verbatim and accuracy checked, then analysed thematically using a framework approach and NVivo software. Three researchers analysed data including initial coding, categorisation, and theme generation. Any disagreements were discussed and addressed within the research team. Results Seven themes emerged from the data describing pharmacy technicians: feeling stuck in the shadow of pharmacists; underrepresented in policy and practice; and marginalised, undervalued and underpaid. There was frustration at the lack of awareness of pharmacy technician roles amongst the wider healthcare team. Primary care pharmacy technicians were thought to have more opportunities than secondary care colleagues. There was a pervasive feeling that pharmacy technicians were increasingly squeezed between pharmacists and support workers and a lack of confidence and feeling unsupported in the delivery of clinical roles. Pharmacy technicians acknowledged that they may not have used their initiative to take new opportunities, but did not feel they had sufficient clinical and educational opportunities. Catalysts to professional development were recognised including pharmacy technician led management and leadership, readiness to undertake traditional pharmacist roles and the potential positive impact of strengthened professional identity. Interviewees described the absence of a structured, funded career framework, and lack of post-registration higher-level professional qualification as inhibiting increased responsibility and scope of practice. Discussion/Conclusion Professional registration does not appear to have strengthened pharmacy technicians’ professional identity. There is a pervasive lack of development opportunities impacting negatively on pharmacy technicians and therefore, service delivery across Scotland. A review of defined roles is required. A lack of previous qualitative evaluation limits comparisons with the perceptions and experiences of pharmacy technicians worldwide. Findings offer a starting point to inform practice and policy. Further research could explore pharmacy technicians’ perceptions of the potential impact of the emerging career framework on developing roles and responsibilities. Keywords: Pharmacy technician, Professional identity

Health-seeking behaviour and patient-related factors associated with the time to TB treatment initiation in four African countries: a cross-sectional survey

IntroductionIn 2022, tuberculosis (TB) was the second-leading cause of global deaths from a single infectious agent. Delays in initiating TB treatment can lead to increased morbidity and mortality. We describe...

A theoretical explanation of naloxone provision among primary care physicians and community pharmacists in Tennessee

BackgroundIncreasing access to naloxone reduces opioid-related morbidity and mortality. Primary care and community pharmacy settings are critical access points, yet limited theoretical research has examined naloxone prescribing and dispensing behaviors. ObjectivesTo determine if the theory of planned behavior (TPB) combined with theoretical constructs from communication science explains intentions to co-prescribe and discuss co-dispensing naloxone among primary care physicians and community pharmacists, respectively. MethodsThis cross-sectional study surveyed cohorts of licensed primary care physicians and community pharmacists in Tennessee in 2017. Intentions were measured using profession-specific case vignettes, whereby they were asked given 10 similar patients, how many times (0–10) would they co-prescribe or discuss co-dispensing naloxone. Bivariate and multivariable analyses were used. ResultsThe analytic sample included 295 physicians (response rate = 15.6 %) and 423 pharmacists (response rate = 19.4 %). Approximately 65 % of physicians reported never intending to co-prescribe naloxone (0 out of 10 patients), while 47 % of pharmacists reported never intending to discuss co-dispensing. All TPB constructs—attitudes (AOR = 1.32, CI = 1.16–1.50), subjective norms (AOR = 1.17, CI = 1.06–1.30), and perceived behavioral control (AOR 1.16, CI = 1.02–1.33)—were associated with an increased likelihood of pharmacists always (versus never) discussing co-dispensing. Similarly, two TPB constructs—attitudes (AOR = 1.41, CI = 1.19–1.68) and subjective norms (AOR = 1.22, CI = 1.08–1.39)—were associated with an increased likelihood of physicians always co-prescribing. Among physicians only, one communication construct—self-perceived communication competence (AOR = 1.19, CI = 1.01–1.41)—was associated with an increased likelihood of always co-prescribing. ConclusionFindings support the value of theory, particularly TPB, in explaining primary care physician intentions to co-prescribe and community pharmacist intentions to discuss co-dispensing naloxone.

Effectiveness of an Aerosol Inhalation Monitor in an Ambulatory Primary Care Pharmacy Clinic.

Background: Poor inhaler technique can worsen respiratory disease. An Aerosol Inhalation Monitor (AIM) may provide insight into a patient's capability of utilizing inhaled medications. Objective: The purpose of this quality assessment was to determine if the addition of the Vitalograph AIM device by ambulatory care pharmacists within an outpatient primary care clinic improves patient's disease control through changes in pharmacotherapy. Methods: This was a retrospective, longitudinal, quality assessment review. Pharmacists met with patients for initial and follow-up appointments. A chronic obstructive pulmonary disease (COPD) Assessment Test (CAT) or Asthma Control Test (ACT) and AIM assessment were performed and pharmacotherapy was subsequently adjusted. The primary endpoint was the change in initial to last recorded ACT and CAT score and was analyzed by Wilcoxon sign-rank test. Results: Twenty asthma and 17 COPD patients were included; 13 asthma and 13 COPD patients were included in the primary and secondary endpoint analysis. Initial median (interquartile range [IQR]) ACT score was 17 (14-23), first follow-up was 20 (18-24), and last recorded score was 22 (18-23). Initial median (IQR) CAT score was 17 (12-22), first follow-up score was 14 (6-20), and last recorded score was 11 (6-19). There was no statistical difference between initial CAT or ACT to first follow-up or last recorded CAT or ACT. Most patients continued their current inhaler regimen. Conclusions: This review demonstrates the positive effect pharmacists can have on respiratory disease management. The improvement in ACT and CAT scores suggests a positive, clinically significant outcome. Future research should evaluate pharmacist's effect on asthma and COPD readmission rates.

Development of new training programmes for Thai community pharmacists using the theory of training needs analysis

Development of new training programmes for Thai community pharmacists using the theory of training needs analysis

Integrating community-based partnerships for enhanced health outcomes: A collaborative model with healthcare providers, clinics, and pharmacies across the USA

The Community Health Enhancement Initiative represents a significant advancement in the field of public health within the United States, targeting the improvement of health outcomes through a comprehensive, collaborative approach. This initiative, in partnership with an array of healthcare entities including renowned hospitals (e.g., Cleveland Clinic, Mayo Clinic, Johns Hopkins Hospital), federally qualified community health centers (e.g., Henry J. Austin Health Center, Chase Brexton Health Care), primary care practices (e.g., Kaiser Permanente, Geisinger Health System, Providence Medical Group), specialized clinics (e.g., Dana-Farber Cancer Institute, Cleveland Clinic Heart and Vascular Institute), and pharmacies with healthcare services (e.g., CVS Health, Walgreens, Rite Aid), aims to revolutionize community health services across the nation. This paper delves into the strategic framework of the initiative, which is designed to foster health literacy, disease prevention, and wellness in diverse American communities. It examines how the collaborative model not only leverages the strengths of various healthcare providers to offer comprehensive care but also actively involves communities in their health management through educational workshops and accessible services. By bridging the gap between healthcare providers and the public, the initiative seeks to build a more health-literate society that is better equipped to manage and prevent diseases. Furthermore, the paper evaluates the impact of this nationwide initiative on public health metrics, showcasing evidence-based outcomes and the potential for scalability in different regions. The initiative's alignment with national health objectives, its innovative use of partnerships to extend healthcare access, and its emphasis on health literacy as a pivotal component of community well-being underscore its relevance and importance to the broader health policy landscape in the U.S. In addition, the research addresses the challenges and opportunities presented by this model, including the integration of technology in healthcare delivery, the sustainability of partnerships, and the continuous engagement of communities. It concludes with policy recommendations for enhancing the initiative's effectiveness and potential for replication, contributing to the ongoing discourse on improving public health infrastructure and outcomes across the United States.

People and sites as community resources for preventing and managing chronic health conditions: A conceptual analysis.

The prevention and management of chronic non-communicable diseases (NCDs) require community-based efforts-especially as their burden grows, and recognition of the need for engaging diverse stakeholders in care grows. The aim of this conceptual analysis was to categorise existing community resources (people and sites) used to support such efforts, the mechanisms by which they work, and the conditions that constrain their effectiveness. We developed an initial framework for categorising community resources. We then used a sample of the literature- 24 studies from 12 countries-to refine and enrich the framework. We identified seven categories of sites ('where': House, Meeting place, Community health centre, Primary health care centre, Mobile clinic, Pharmacy, and Hospital) and ten categories of people ('who': Community Health Worker, Nurse/Midwife, Health educator, Physician, Primary Health Care Worker, Peer Group, Navigator, Pharmacist, Cultural Advisor, Family caregiver). We identified eight mechanisms through which those resources improve NCD prevention and management: Context specific engagement, Personalised and integrated care, Community health worker led knowledge dissemination, Social support through family and/or friends, Extending the reach of the health system, Social support through peer groups, Task shifting, and Training of health workforce. We identified two broad categories of constraints on these mechanisms: (i) health system barriers such as inadequate workforce, training, coordination and engagement; and (ii) socio-economic, political, and cultural barriers to care. The conceptual categories (of people and sites as resources, the mechanisms through which they work and the contextual constraints on their effectiveness) identified in this analysis may be useful in further analysing current approaches in NCD efforts using community resources, in informing the development of community-based efforts, and in exploring the commonalities and transferable insights between different locations or settings around the world and between different efforts to prevent and manage NCDs within communities.

Measuring and Improving Adherence in Primary Health Care – best practices from Medical and Diagnostic Center in Siedlce, Poland

Adherence is defined as patient compliance with agreed treatment recommendation in order to achieve a therapeutic result. It could be described as combination of three behaviors: compliance, persistence and concordance. “Compliance” is the extent to which a person’s behavior is consistent with the medical advice. In practice, this means following the doctor’s recommendations. “Persistence” means systematic and persistent application of therapy. Finally, “Concordance” is the collaboration between the patient and the doctor in the choice of therapy. Adherence is therefore based on: acceptance of the agreed therapy, adherence to its principles and systematic adherence to the recommendations.
 In order to reproduce all three of those components, Medical and Diagnostic Center (MDC) in Siedlce, Poland has developed four dimensions to measure adherence in:
 -intake of medication,
 -registration for and appearance on compulsory medical visits,
 -degree to which patient evaluates the importance of taking medication for their health,
 -patient’s active participation in caring for their health. 
 First two dimensions measure patient’s compliance and persistence. The issues therefore concern both the fact that certain measures are taken and their regularity. Two other domains consider patient’s concordance. Importantly, fourth dimension focuses on patient role in their health. It assumes that the patient, who is responsible for his or her health, should not only follow the rules of adherence by participating passively in the treatment process, but should also play an active role: they should maintain adequate nutrition, exercise regularly, restrict the use of stimulants or quit smoking. Patients should also be transparent with their doctors about the medicines they are taking. 
 Adherence of patients in MDC is evaluated by means of patient interview with open-ended questions, but also by verifying data on patient’s weight, filling out prescriptions and registration for compulsory medical visits, including carrying out of preventive check-ups. This is thanks to connected IT system between primary care facilities and pharmacies. 
 Studies in European countries show that about half of chronically ill patients have problems adhering to prescribed treatment. Encouraging patients to monitor their behaviors, empowering them in making informed decisions around their heath and holding them accountable are key strategies to minimize non-adherence and ensure effectiveness of therapy. 

Evaluating the role of primary care pharmacy technicians in antimicrobial stewardship (AMS) and acne management using TARGET resources.

Inappropriate antibiotic prescribing is accelerating antimicrobial resistance (AMR) (Antibiotic resistant infections and associated deaths increase https://www.gov.uk/government/news/antibiotic-resistant-infections-and-associated-deaths-increase). Pharmacy professionals (pharmacists and pharmacy technicians) promote good antibiotic prescribing practice. The traditional role of pharmacy technicians in supporting pharmacists and patients has expanded alongside the clinical expansion of pharmacist roles. (Boughen M, Fenn T. Practice, skill mix and education: the evolving role of pharmacy technicians in Great Britain. Pharmacy (Basel) 2020; 8(2): 50. doi:10.3390/pharmacy8020050) This paper focuses on the opinion of pharmacy technicians and their role in the review of acne management and the evaluation of the UKHSA TARGET acne 'How to…' review resources. To explore the impact of the TARGET resources on the capability, opportunity and motivation of pharmacy technicians in general practice in managing patients with acne.To evaluate the usefulness of the acne 'How to…' review resources. A primarily quantitative study using an electronic survey asking UK-based pharmacy technicians to rate their agreement on a five-point Likert scale with 21 predefined statements, themed on the COM-B model and usefulness of the TARGET resources for acne. The survey found that capability and opportunity in managing acne in the group familiar with TARGET resources was higher than the group not familiar with TARGET resources. Scores for motivation in both groups were high; pharmacy technicians have the motivation to undertake infection management roles, whether or not they are familiar with the TARGET toolkit.The acne 'How to…' review resources were overall rated as useful in supporting the review of patients with acne. The TARGET materials are effective resources that helps to upskill pharmacy technicians in the area of AMS, increasing capability and opportunity in the management of acne.

Changes in Attitudes to Medical Care among Pharmacy Pharmacists before and after the COVID-19 Pandemic: A Questionnaire Survey

The coronavirus disease 2019 (COVID-19) pandemic has had a major negative effect on the number of patients visiting pharmacies in Japan. The decrease in pharmacy visits during the pandemic compared with the pre-pandemic period may have increased the likelihood of adverse health outcomes; thus, it is important that pharmacy pharmacists take measures to prevent health disadvantages. In this study, we distributed a questionnaire survey to 104 pharmacy pharmacists (mainly in Kagoshima and Kumamoto Prefectures), and investigated changes in the extent of implementation and perceptions of measures considered necessary to protect patients' health between the pre-pandemic and pandemic period. The results showed that the proportions of respondents "sharing patient information between primary care doctors and pharmacy pharmacists" and conducting "follow-up after prescribing medications mainly via telephone" increased between the pre-pandemic period and September 2022. The perceived necessity of the above two measures, as well as "online medication instructions" and "a prescription refill system," increased during the same period. However, the proportion of respondents who perceived "0410 correspondence," which was introduced during the pandemic, as a necessity did not change. Moreover, many pharmacists indicated that, at their own discretion, they continued to correspond with patients in relation to the above, and to respond to specific requests during normal daily practice. Our results could help community-based pharmacists tackle serious public health problems, such as COVID-19.

Evaluation of simvastatin and CYP3A4-inhibitor interactions in an inpatient population

Abstract Introduction The maximum recommended dose for simvastatin in conjunction with the CYP3A4 inhibitors amiodarone, amlodipine, diltiazem, or verapamil is 20 mg/day.1 Studies have reported on the extent of potentially harmful simvastatin interactions which can increase the risk of myopathy.2 A project in a local primary care setting had identified that 42 (14%) of 305 patients prescribed simvastatin and one of these CYP3A4 inhibitors were receiving the unlicensed dose of simvastatin 40mg. We wanted to investigate if there were similar concerns for hospital inpatients. Aim The aim of this evaluation was to ascertain whether patients were prescribed simvastatin 40mg with one of the named interacting drugs during their hospital admission and whether any action was taken for patients on such a combination. Methods A search was undertaken of patients prescribed simvastatin 40mg with amiodarone, amlodipine, diltiazem, or verapamil using the electronic prescribing system (EPS) (Careflow Medicines Management) between January to October 2022. Relevant data were extracted from the EPS and discharge summaries were searched for any additional information, in particular for any notes made by the prescriber or pharmacy team that they had recognised and acted on this combination. Data were collated and analysed using Microsoft Excel. As this project falls under the definition of a service evaluation, according to UK NHS Research Ethics Committees, formal ethical approval was not required. This project was registered on the hospital’s clinical audit database. Results Fifty-six patients (mean age 78, range 59-94, 50% female) were prescribed a combination of interest during their admission. A further 13 who died in hospital were excluded. Thirty (54%) patients were admitted on this combination. Simvastatin 40mg appeared with amlodipine in 77% (n=43) of instances, diltiazem in 11% (n=6), amiodarone in 11% (n=6), and verapamil in 1% (n=1). Thirty-one (55%) of 56 patients were discharged on this combination, and 6 had no discharge information. Of the 19 (34%) not discharged on the combination, six were due to proactive pharmacy intervention, whilst remaining instances were due to other clinical reasons. Discussion/Conclusion We observed a possible lack of knowledge of these potentially hazardous interactions with some inpatients commenced on the combination, and just over half of the cohort discharged on such a combination. Such in-hospital prescribing of interacting drugs and lack of pharmacy team clinical check could be due to unawareness of the MHRA alert. Though our EPS has the functionality of triggering alerts to notify prescribers of interactions, only level 4 warnings are flagged and the interactions we examined, as a level 3 warning, remain suppressed and not easily visible to the prescriber. Our results will be shared with hospital and primary care pharmacy teams, as this is an area of prescribing that the Care Quality Commission may review when inspecting general practices.3 This evaluation will be repeated. Recognised limitations of this single centre, retrospective study include: we did not look at interactions between simvastatin and other medicines, nor interactions with other statins; we did not investigate whether these patients were suffering from muscle-related adverse events.

Improving frequency and appropriateness of direct oral anticoagulant (DOAC) prescribing for af through integrated pharmacy-led care

Abstract Background Anticoagulants for stroke-risk reduction in atrial fibrillation (AF) are underutilised and international literature shows 10-25% of patients on a direct oral anticoagulant (DOAC) for AF are prescribed an inappropriate dose, increasing the risk of stroke and bleeding. NHS England targets are for 90% high-risk AF patients to be prescribed anticoagulation by 2029. Purpose A new pharmacy-led integrated care model was developed to improve the frequency and quality of prescribing and monitoring of DOACs for AF in line with national guidance. This abstract describes the results when this model of care was rolled out across a large UK city. Methods The integrated model of care was designed to provide a multi-pronged approach and empower primary care pharmacy teams to prescribe and manage DOACs for AF. The model includes an education and training programme, a weekly specialist-run virtual clinical discussion service, a 48-hour turn around advice and guidance service and a clinical tool that identifies and makes recommendations for patients on an unlicensed dose of a DOAC. Results 16,594 patients are included on the city’s AF register. From April-November 2022, an additional 1,339 (8%) patients were anticoagulated. An increase from 76.3% to 84.3% of patients on the AF register. Dosing as per manufacturers Summary of Product Characteristics (SmPC) improved for all DOACs. In April 2022 an incorrect dose was prescribed for 10%, 15% and 12% of patients respectively on apixaban, edoxaban and rivaroxaban. In November 2022 incorrect dosing reduced across the board to 7%, 8% and 7% of patients respectively. 914 patients prescribed an inappropriate dose had their dose adjusted to meet SmPC recommendations based on relevant characteristics (renal function, age, weight, serum creatinine, interacting medicines). Monitoring according to local guidelines also increased. Experience of staff was overwhelmingly positive and demonstrated growth in knowledge, skills, and activity amongst primary care pharmacy teams. Rapid access to specialist support allowed patients to be managed close to home. Conclusions This integrated care model improves frequency and appropriateness of DOAC prescribing for patients with AF. The model results in incorrect dosing lower than any described in international literature. The service model is sustainable and scalable, grows cross-sector clinical leadership and develops relationships between primary and secondary care. The next steps are to roll this model out across a large region.

Implementation of an e-Interconsultation system between a Hospital Pharmacy Service and Primary Care Pharmacy Units in a health area

PurposeTo present the requirements, development, structure and results of an electronic interconsultation platform (e-Interconsultation) for communication between primary and hospital care. MethodA working group was created and set out its purposes, working schedule, software requirements, the structure of the electronic platform, validation procedure, and its implementation. Once the software had been developed and validated and training sessions were conducted, the electronic platform was launched in June 2015. ResultsAfter 1 year of operation, a total of 321 electronic interconsultations had been made, 110 of which were referrals from hospital care to primary care in addition to 211 from primary to hospital care. The validation of prescriptions and the need for drug monitoring in primary care are among main reasons for consultation. ConclusionsThe e-Interconsultation platform is a valid, efficient and user-friendly mean of consultation or patient referrals between both healthcare levels.

Assessment of adherence to treatment with injectable extended-release antipsychotics within a pharmacotherapeutic follow-up program

ObjectiveTo describe an injectable extended-release antipsychotic pharmacotherapeutic follow-up program and to assess adherence among patients included in the program. MethodA coordinated program is described involving hospital and primary care pharmacy, which included electronic prescription, reviewing, and dispensing of injectable antipsychotic agents in mental health and primary health care centers. Adherence to treatment was assessed in a 1-month prospective observational cross-sectional study which included all patients under treatment with injectable extended-release antipsychotics in a health area of more than 500,000 inhabitants. The variables collected were: medication administered, frequency of administration, administration center, and whether or not the patient attended the center. Patients were considered to have adhered to treatment if they had attended their appointments within a margin of ± 7 days. ResultsA total of 919 patients and 1,073 appointments were included. Eleven mental health units and 40 primary health care centers participated in data collection. In 95.7 % (1,027) of cases, the patients attended the appointment. No differences were found in adherence between drugs or administration frequency. However, differences were found between mental health units and primary health care centers. Patient adherence was slightly higher in mental health units (97.6% vs 91.1%; P < 0.001). ConclusionsThe high adherence rate shows that the described follow-up program is effective. Further long-term studies are needed to confirm this trend.

P06 Stewardship potential—the hidden burden of antibiotic prophylaxis in primary care

Abstract Background This study aimed to decrease unnecessary long-term antimicrobial use in primary care by identifying and highlighting patients with long-term or repeated exposure to antibiotics to GP teams for review. The broad spectrum antimicrobial co-amoxiclav was targeted following data showing rising DDD per prescription in our Health Board. Methods Community antibiotic prescribing from the national Prescribing Information System (PIS) was searched for NHS Lothian (126 GP practices) using DDD to identify patients. Long courses of co-amoxiclav were defined as ≥63 DDD. Ninety-eight patients were identified with high antimicrobial usage and a data collection form was sent to the Primary Care Pharmacy teams to voluntarily collate data for each patient. Results The data collection form had a 97% response rate. Of the 94 patients with full data 62 (66%) patients had co-amoxiclav initiated due to secondary care specialist advice and 26 (28%) had been initiated by primary care. Forty-four patients (47%) were aged 65 or over, putting them at high risk of Clostridioides difficile. Forty-one patients had multiple courses of co-amoxiclav and 39 patients were prescribed co-amoxiclav as prophylaxis; of these 59% were for urinary tract infection (UTI). Thirty-four of 94 patients (36%) had been on prophylaxis for over 5 years with 9 patients on co-amoxiclav for over 20 years. Of note in 39 of 94 patients no microbiology samples were available and where samples were available (n=55), narrower spectrum options were available in 38 patients (69%) and 17 patients (31%) had samples showing resistance to co-amoxiclav. Following this intervention to highlight use, the number of patients on long-term courses or prophylaxis with co-amoxiclav reduced by 70% in the following year. Conclusions Patients on long-term antibiotics are priorities for antimicrobial stewardship interventions. This work demonstrated that ongoing appropriateness and efficacy of long-term antibiotic courses were not routinely reviewed. Using pharmacy data proved an effective method to highlight patients and ultimately reduce patient antibiotic exposure. UTI prophylaxis was the majority patient group in this study and interventions to review and decrease long-term UTI prophylaxis in our Board using this method are underway.

Pharmacy professionals’ perceptions of educational supervision in primary care through the lens of Proctor’s model

BackgroundEducational supervision plays a vital role in postgraduate medical education and more recently in pharmacy and advanced clinical practitioner training in England. Proctor’s three-function model of clinical supervision (consisting of formative, restorative, and normative functions) is assumed to apply to educational supervision, but this has not been tested empirically. The aim of this study was to establish perceptions of the purpose of educational supervision from the perspective of primary care pharmacy professionals enrolled on a national training pathway in England.MethodsUsing a mixed methods design, data were collected using a validated 25-item online survey and respondents were invited to add comments explaining their responses. The survey was sent to all 902 learners enrolled on a postgraduate training pathway for pharmacy professionals working in primary care. Principal components analysis (PCA) was used to interpret patterns in the survey data, and framework analysis of qualitative free text comments was used to identify themes and aid interpretation of quantitative findings.ResultsOne hundred eighty-seven pharmacy professionals responded (response rate 20.7%). PCA extracted three factors explaining 71.5% of the total variance. Factor 1 corresponded with survey items linked to the formative function of Proctor’s model, while factor 2 corresponded with survey items linked to the restorative function. No items corresponded with the normative function. Framework analysis of qualitative free-text comments identified two themes: learning support, which corresponded with factor 1; and personal support, which corresponded with factor 2.ConclusionsThis study identified that pharmacy professionals perceived educational supervision to perform two functions, formative (educational) and restorative (pastoral), but did not perceive it to perform a normative (surveillance) function. Educational supervision has the potential to support allied health professionals advancing their roles and we suggest the need for more research to develop models of effective educational supervision which can inform practice.

Incorporating Social Vulnerability Variables in Measures to Quantify Access to Opportunities

This study quantifies access to travel opportunities to understand what societal factors are linked with local access and to identify communities with reduced access. We introduce a method to compare accessibility across all census tracts in the United States that can be used across geographically diverse communities ranging from sparsely to densely populated areas. This study considers six key opportunities which we consider essential for all communities (grocery stores, public schools, daycares, primary care doctors, pharmacies, and parks), and six additional destinations which can be viewed as a social safety net (homeless shelters, women’s shelters, food pantries, libraries, vocational schools, and banks). We quantify accessibility to these opportunities within a 15 min walk, transit trip, bicycle ride, and automobile drive for every census tract in the United States, and observe a decrease in vehicle miles traveled and vehicle ownership in tracts with increased walkability. Through analysis at the census tract level, this study incorporates variables of social vulnerability with these cumulative opportunity metrics to better understand diminished accessibility as attributed to social and racial inequities. As example findings, we find decreased access to financial services in communities with high minority and limited English speaking populations, no apparent change in access for childcare in communities with high percentages of single-parent families, and potentially increased or decreased access to women’s healthcare resources for Black women depending on the travel mode.

A cross-sectional study on substandard and falsified medicines (fake or counterfeit drugs) in UK pharmacies during the COVID-19 pandemic

ABSTRACT Background Failure of the Falsified Medicines Directive (FMD) in the UK could mean that substandard and falsified medicines (SFs) enter the supply chain. Does this risk patients’ health? Readiness to implement FMD, and prevalence of SFs vs. regulator detection were assessed. Research design and methods A total of 12,040 primary care pharmacies across England were invited (April 2021–March 2022). Respondent postcodes were used to extract deprivation scores. Information request was placed with the medicine’s agency. Survey findings were used to calculate probability and power of a simulated trial. Results A total of 208 participants responded: Of the seven who identified SFs, all but one reported it; 61% were ready to implement FMD, 74.1% had adequate resources, 54.8% expected improved patient safety, and 17.8% had ever reported SFs. SFs were prevalent in deprived areas. Bayesian simulation shows 438 (p = 0.030) incidences with a 3% probability of SFs prevalence. The agency identified 15,238 SFs units in the supply chain (2019 and 2020). Results are credible, reliable, and generalisable, with corroborated longitudinal persistence. Conclusions FMD or equivalent processes need to be urgently reinstated. Deprived children may be more affected. Pharmacists are worried about liability. All health consultations should assess safety, and effectiveness of medicines. Findings should inform policy, systems planning, surveillance, and evaluations.

503 Barriers and facilitators to the development of pharmacy workforce digital skills– a qualitative study

Abstract Introduction The NHS Long Term Plan envisions a health and social care system that is patient-centred, equitable and safe, with staff who feel supported and enabled to do their work. Digitalisation is seen as essential to successful delivery of this, and its use to support medicines related activity continues to grow. Pharmacy staff need the necessary knowledge and skills to feel confident, competent and capable to use digital systems for patient benefit (1). However, development of Pharmacy workforce digital skills, and innovation with technology, continues to be a challenge (2). Aim This project aimed to, • define the barriers and facilitators faced by pharmacy staff, across an Integrated Care Provider, when developing digital skills. • create recommendations to enable pharmacy staff to develop the digital skills required to work with, and fully realise the potential of, digital systems in healthcare. Methods Senior pharmacy leadership staff from primary care, community pharmacy, mental health and secondary care, and front-line pharmacy staff from mental health and secondary care, participated in online focus groups and semi-structured interviews. Front-line pharmacy staff from Community Pharmacy and Primary Care did not participate in the focus groups and interviews. Their input was gathered through completion of a questionnaire. Thematic analysis was used to analyse the data. Results Pharmacists, Pharmacy Technicians and Pharmacy Assistants/Support Workers were recruited to the study. Seven themes were identified from the combined data set. These were, 1) Digital Knowledge and Skill Development, 2) Supporting staff with change, 3) Enabling Innovation, 4) Risks of poor digital skill development, 5) Technology as a barrier, 6) Leadership, and 7) Across the health care system. The themes informed a set of recommendations. One of the stronger themes identified by nearly all participants related to ‘supporting staff with change’. Participants described the scale and pace, resistance to and fear of change, and having to learn new skills and processes as a consequence of digital system implementation. Some participants observed variation in practice and changes in professional identity as they adapted and adopted digital systems. Some participants described themselves, and members of staff they managed, as having a fixed ‘can’t do’ mindset when faced with technology. Some participants recognised the potential with digital yet felt constrained by their roles and the restrictions set by digital system configuration. Discussion/Conclusion The changes that occur in response to digital systems affect staff in multiple ways. Some effort is made in response to this through creation of a standard process for system use in clinical practice, but this is often months after digital system implementation. It is suggested that implementation is no longer considered and managed as a single moment in time, but is an iterative change process that incorporates alternative change models and tools to those currently used. This may improve staff adaptability, system use, digital skill development, innovation and realisation of health technology benefits. A weakness of the study is limited participantion from front-line Community and Primary Care pharmacy staff.