Service Commission Research Articles

Recovery support services as part of the continuum of care for alcohol or drug use disorders.

The definition of 'recovery' has evolved beyond merely control of problem substance use to include other aspects of health and wellbeing (known as 'recovery capital') which are important to prevent relapse to problematic alcohol or other drug (AOD) use. Developing a Recovery Oriented System of Care (ROSC) requires consideration of interventions or services (Recovery Support Services, RSS) designed to build recovery capital which are often delivered alongside established treatment structures. Lived experience and its application to the process of engaging people, changing behaviour and relapse prevention is an essential part of these services. To map out the evidence base for RSS as part of guidance for commissioners of addiction services in each of the 152 local authorities in England. The authors updated the findings of a 2017 systematic review of RSS through a further rapid scoping review, aiming to map out the extent, range and nature of research under six headings: (1) Peer-based recovery support services (P-BRSS); (2) Employment support approaches; (3) Recovery housing; (4) Continuing care and recovery check-ups; (5) Recovery community centres (RCC); and (6) Recovery support services in educational settings. A systematic search of the PubMed, Embase, CINAHL, CENTRAL and PsychINFO databases was conducted. The abstracts of all articles published since 2017 were reviewed by two of the authors, and the full text versions of all relevant articles were obtained and relevant data extracted. A narrative review of the findings was then prepared, mapping them on to the ROSC continuum of care. The review was restricted to adults (over 18 years), but all substances and available outcomes were included. Four of the six forms of RSS were well supported by evidence. RCTs of interventions to increase levels of employment demonstrated large effect sizes, and continuing care interventions that extend treatment intervention into the early recovery phase have shown small but significant benefit. Peer-delivered interventions to link people to ongoing support were associated with decreased rates of relapse and re-admission, increased engagement, and increased social support for change. However, the variability in the design of these studies means that further work is required to clarify the effective components of the intervention. Studies of recovery housing have also shown positive results, including significant differences from standard care. No controlled studies exist to support RCCs or RSS in educational settings, but the complexity of these interventions and the wide range of potential outcome measures mean that other study designs may be more relevant. This monograph provides a structure to help policy makers, commissioners and service providers describe and understand an emerging field of research. Recovery Support Services (RSS) are proving to have clinical, public health and cost utility. A rational social and fiscal response to endemic alcohol or other drug challenges should therefore include the more intensive acute care clinical services linked with more extensive community-based RSS.

Diabetic foot ulcer photography study: a study within a trial to assess the reliability of two-dimensional (2D) photography for the assessment of ulcer healing in patients with diabetes-related foot ulcers—protocol paper

BackgroundThe primary endpoint in diabetes-related foot ulcer (DFU) trials is often time to healing, defined as complete re-epithelialisation with absence of drainage, requiring clinical expert assessment as the gold standard....

The missing middle service gap: Obtaining a consensus definition of the 'Missing Middle' in youth mental health.

As highlighted in Australia's Productivity Commission Inquiry into mental health, subgroups of individuals are failing to have their needs met, or are 'falling through the cracks' in the current system - a phenomenon increasingly referred to as the 'missing middle'. A barrier to devising solutions is that the term 'missing middle' is not clearly defined. Using the Delphi method, we aimed to define the term and explore acceptability. Three expert groups were recruited: carers and young people with a lived experience of mental ill-health; clinicians and service providers; researchers, policymakers and commissioners of mental health services. Using a three-stage Delphi process, we elicited definitions, refined and developed a consensus definition. Ten subthemes describing the 'missing middle' were identified, with four endorsed across all expert groups from the outset: service gap, inflexibility, inadequate service quality and duration, and social disadvantage. Additional subthemes were later endorsed. Feedback was sought on a consensus-driven definition that encompassed the original four endorsed subthemes. Findings supported a shift to a systemic focus - framing the 'missing middle' as a care gap. A consensus definition was developed, repositioning the term to a systems lens, describing a 'missing middle service gap'. The definition represents the 'missing middle' as a term to describe a gap in care where existing mental health services are not meeting the needs of individuals in a meaningful way. Research was carried out in relation to youth mental health in Australia and the definition may need to be adapted for other contexts.

European Institutional Discourse Concerning the Russian Invasion of Ukraine on the Social Network X

The outbreak at the end of February 2022 of the Russian invasion of Ukraine—and the Russian–Ukrainian hostilities that began in 2014 with the Euromaidan—has led to numerous dramatic episodes from both a humanitarian and an informative perspective. In this context, social media have been filled with rhetoric and narrative mechanisms, both from civil society organisations and from European media and institutions, in their eagerness to define their position within the dialectical battle. This research aims to address organisational communication in the European Union during the first year after the invasion, taking as its object of study the publications of four institutional bodies: European Commission, European Parliament, European Council, and European External Action Service. For this purpose, a content analysis of tweets was carried out, as well as in-depth interviews with specialised actors in institutional communication and disinformation at the EU level. Overall, the results show that the parallel narrative of the Commission, the Parliament, the Council, and the EEAS has been quite similar and lacks significant divergences, reflecting coherence and coordination in the communication strategies around the Ukrainian war, although there are interesting findings on the interaction of the institutions with the media and other civil society actors in communicating this international crisis via social media.

Arthroplasty Follow-Up Pathways: A Qualitative Study of Current Practice and Healthcare Professionals' Attitudes and Motivations for Change.

There is considerable diversity in arthroplasty follow-up pathways. This qualitative study aimed to understand healthcare professionals' practice and attitude to follow-up, their motivation for change and what evidence they considered before implementing new pathways. The main UKSAFE study enroled 38 centres providing revision procedures across the United Kingdom. A purposive sample of professional leads and service managers was identified from site contacts. Individual interviews were conducted by telephone, transcribed verbatim and analysed using a theoretical framework derived from current evidence and the data collected in our previous studies. We found that there had been a shift away from bringing patients back into the clinic for repeat follow-up assessments, but that this was not universal, and some centres had long-established care pathways that involved long-term follow-up. The way in which those services were provided might be different or have common features, but centres were likely to face common problems including large patient numbers and funding restraints. The reliability of newer prosthetics and surgical skill has influenced some changes by increasing confidence in a pathway which does not routinely provide long-term follow-up. Service commissioners also have a role to play in how follow-up care pathways are configured, but scrutiny of the ratio of new to follow-up appointments can put pressure on clinical staff to follow-up only patients with identified clinical need. Virtual clinics can provide a service to patients and use scarce resources efficiently, but NHS IT systems that would be needed to support more remote working, for example, telemedicine and plans to collect PROMS data online from patients to assist with monitoring were not advanced.

Identifying the facilitators and barriers to implementation of renal tumour biopsy in the diagnostic pathway for small renal masses.

To understand the facilitators and barriers to the implementation of renal tumour biopsy (RTB) in the diagnostic pathway for renal tumours in England. Participants consisted of patients who had a renal tumour diagnosed and/or treated at one of five tertiary centres in England, healthcare professionals involved in the direct care of patients diagnosed with renal tumours, and clinical service managers and commissioners. The study employed a mixed-methods research methodology consisting of individual interviews and an on-line survey that explored the types of facilitators and barriers individuals perceived and experienced and the frequency in which these were reported. A public dissemination event took place following the completion of data collection; to facilitate discussion of potential solutions to implementing RTB. There were 50 participant interviews (23 patients, 22 clinicians, and five health service commissioners/operations managers). The patient on-line survey received 52 responses, and the clinician survey received 22 responses. Patients most frequently reported influences in choosing whether to undergo RTB pertained to wanting to know the diagnosis of their kidney mass (40%), the advice or information provided by healthcare professionals (40%), and not wishing to delay treatment (23%). Clinicians most frequently reported barriers to recommending RTB related to their uncertainty of diagnostic accuracy (56%), availability of appointments or hospital beds (52%), concerns of risk of bleeding (44%), risk of seeding (41%), and delays in meeting national cancer pathway targets (41%). The dissemination event was attended by 18 participants (seven patients and 11 clinicians). Suggestions to improve implementation included reducing variation and promotion of standardisation of practice by a consensus statement, increasing the evidence base (clinicians) and improved communication by developing better patient aids such as videos and diagrams (patients and clinicians). Implementation of RTB may be dependent on the quality of information provided, its format and perceived reliability of the information. Increased utilisation of RTB may be improved by development of a consensus statement on the role of biopsy, with patients expressing a preference for alternative information aids such as patient videos.

Effects of Age on Teachers’ Self-Efficacy: Evidence from Secondary Schools

The study investigated the effects of age on self-efficacy among teachers in secondary schools in Kenya. The concurrent triangulation design was adopted. A sample size of 327 teacher participants was obtained using both stratified and simple random sampling techniques. The Teacher Self-Efficacy Scale (TSES) was used to collect quantitative data. In addition, semi-structured interview was used to collect qualitative data. The reliability coefficient for the TSES was α = 0.996. The Multivariate Analysis of Variance (MANOVA) was used to test the hypothesis. Qualitative data was analyzed using thematic analysis. The MANOVA results indicate that the effect of age on teachers’ self-efficacy was not significant, Wilk’s λ (6, 320) = 0.947, p = 0.498. Qualitative results reported a significant effect of age on teachers’ self-efficacy in classroom management. The Kenyan Teachers’ Service Commission should carry out periodical assessment of teachers’ self-efficacy to identify teachers that are vulnerable to low self-efficacy. Keywords: effects, age, self-efficacy, teachers, secondary schools, Kenya

Emergency department attendances and inpatient admissions due to mpox infection, England, 2022

ObjectivesIn 2022, a global outbreak of mpox was reported. In the UK, it predominantly affected gay, bisexual and men who have sex with men (GBMSM). The study objectives were to...

Adult stakeholders' perspectives on supporting or undermining the mental health of sexual and gender minoritised adolescents.

To explore adult stakeholders' perspectives on what supports or undermines the mental health of sexual and gender minoritised adolescents (SGMA) in everyday life in order to better understand how to foster supportive psychosocial environments for SGMA. Descriptive qualitative study design, using framework analysis. Semi-structured interviews were conducted remotely with 16 UK-based adult stakeholders which included parents of SGMA, health and social care professionals, community-based professionals, and professionals who commission services related to adolescent health and well-being. Nine themes were identified that represented barriers and enablers of fostering psychosocial environments that are supportive of SGMA mental health. Example barrier themes include SGMA 'facing chronic and acute safety threats and stress', 'psychological responses to social connection losses and navigating alienation', 'digital exposure and online risk and vulnerability' and 'conflicting messages, resulting divisions and adult distancing'. Example enablers include 'exploring, owning, and changing (personal) identities', 'advocating alongside adolescents whilst containing oneself as the adult in the situation' and 'personally fostering adolescents' psychological safety and inclusion'. Adult stakeholders report that SGMA are often exposed to environments hostile to key aspects of their identity which then by extension undermines their mental health. These experiences can threaten their sense of safety and evolving identity. Practitioners in particular should be aware of the stressors relating to SGMA identity and minoritisation experiences in order to develop the psychological safety and sense of inclusion needed for SGMA to trust in the relationship and the support offered.

A value approach to measuring the effect on health resource usage of specialist cardiac interventions in Wales

Objective and ApproachThe Welsh Health Specialised Services Committee wanted to demonstrate how specialised interventions reduced subsequent pressures on the health services. We analysed the variation in the cost of patient pathways for eight cardiac interventions in both planned and emergency settings. A standard cost was allocated to each health event (hospital admissions, general practitioner interactions, outpatient attendances and accident and emergency attendances). A comparison was made for each intervention relating to the condition before the intervention against costs afterwards. In addition, analysis was carried out measuring which patient's characteristics affected the likelihood that patients incurred higher post-intervention costs. Results10,480 interventions were analysed. In 9 (of the 16) intervention combinations, post-intervention costs dropped. After the implantation of a Cardiac Device, health resource usage dropped by £1,461 per annum. In addition, the likelihood of falling into a higher cost category increased depending on deprivation. For percutaneous coronary intervention (PCI) the odds ratio and 95% confidence interval was 1.34 (1.03 to 1.76) and for Cardiac Devices 2.91 (1 to 15.23). Conclusions and ImplicationsSome interventions in Cardiac realise significant post intervention savings for the health service. Deprivation affects the risk of patients falling into high post-intervention cost categories for PCI and Cardiac Devices. By using anonymised population-scale linked individual-level data, it is possible to highlight interventions that as well as benefiting patients successfully, reduce future health resource usage. This type of analysis can also highlight how deprivation is linked to increased post intervention costs.

The edentulous patient: the impact of implants on quality of life.

Edentulism (total tooth loss) can be managed with four possible options: no prosthetic replacement, conventional complete dentures, implant-retained overdentures (removable), or implant-supported bridgework (fixed). Selection of these choices is influenced by social, medical, anatomical, technical, and economic factors. The care team involved in the decision-making process (be it patients, clinicians and occasionally commissioners of services) should be aware of the different treatment options and their potential impact on the patient's quality of life (QoL). The cost effectiveness of this impact can also be evaluated. Knowledge of the life-long sequelae of edentulism will also help practitioners guide patients in their treatment planning decisions when they may be approaching an edentulous state, preparing them for the challenges that may lie ahead. This paper aims to address the impact that edentulism has on QoL and the treatment options, focusing on the patient perspective.

Service design technology as a tool for the development of the Institute of social services

The purpose of this study is to analyze the features of the service design technology in social services. The object of the research is the institutional features of social services for the population, the subject is the role and essence of service design technology as a tool for the development of the institute of social services. The author provides an analysis of the institutional features of the development of social services, examines the impact of the use of service design technologies in the provision of social services. Special attention is paid to the characteristics of innovative social service practices based on the implementation of service design technology, as well as to the analysis of the development and transformation of institutional functions of social services as a result of the widespread introduction of service design practices in the social sphere. Based on the data of the analysis of best practices of social services, the author also analyzes the processes of formation of new social institutions as a result of the implementation of the service approach in the social sphere, one of which is the institute of regional service commissioners. The main research method is the traditional analysis of documents, generalization of the research of the Institute of Social Services, experience in the implementation of service design technology, as well as analysis of its impact on the processes of transformation of social institutions. The theoretical and methodological basis of the research is the works devoted to the study of the peculiarities of the development of the institute of social services, the introduction of service design technology into the processes of service provision. The main results of this study are conclusions about the special role of service design of social services in ensuring the sustainability of public relations by balancing the implementation of public interests associated with the absence of excessive spending on social services and the interests of small groups meeting their needs at an optimal level through convenient routing and individual design of social services. The author's scientific contribution consists in analyzing the transformation of institutional functions of social services in the implementation of service design technology. The author concludes that the institutional function of social services for reproduction, distribution and exchange also changes with the implementation of the service design approach, becoming simpler and more effective, and the structure of public relations is changing under the influence of the need for new actors and institutional forms of social services with an increased role of interdepartmental interaction.

The triple optimal combination of selling format, service provision, and blockchain implementation in a platform-based supply chain

In a platform-based supply chain, an online platform can act as a reseller (R) or a marketplace (A) for the manufacturer. Under each selling format, sales services can be provided by the manufacturer (M) or the platform (I). Besides, facing the problem of counterfeits and consumer mistrust, the platform can implement blockchain as a solution (B) or not (N). The combination of selling format selection strategy, service provision strategy, and blockchain implementation strategy produces 8 models: NMR, NMA, NIR, NIA, BMR, BMA, BIR, and BIA. On this basis, we explore the interaction of the three strategies and obtain a triple optimal combination (TOC). We find that blockchain implementation is always beneficial to the manufacturer and consumers, but blockchain will only be implemented by the platform and be beneficial to society when certain conditions are met. Under the reselling format, the manufacturer always prefers to authorize services to the platform; under the agency selling format, the manufacturer decides on the service provider according to commission rates. Based on the double optimal equilibrium, we further analyze the platform’s selling format selection with the consideration of the manufacturer’s preference and draw some interesting conclusions: When the commission rate is moderate in the lower commission rate range, the TOC is the BMA model; when both the commission rate and service efficiency are higher in the lower commission rate range or when the commission rate is lower in the higher commission rate range and service efficiency is high, the TOC is the BIR model.

A mixed-methods cross-sectional study to evaluate the public acceptability of a novel pharmacy-based response service for domestic abuse and/or suicidal ideation

BackgroundDomestic abuse (DA) and suicidal ideation (SI) are prevalent and often co-occur. Numerous practical and psychosocial barriers inhibit help-seeking, including accessibility and confidentiality concerns. Early intervention and referral are essential for both DA and SI. Pharmacies are accessible and may be perceived as a discreet venue for a DA and SI response service. There is a growing body of literature about the role of community pharmacy teams in suicide prevention and assisting domestic abuse victims globally. Whilst there have been some interventions in UK pharmacies to support domestic abuse victims and encouragement of staff training in suicide prevention, there is currently no commissioned service for DA and/or SI in pharmacies in the UK. ObjectiveTo assess public acceptability of a novel response service in community pharmacy for people in danger from domestic abuse and/or suicidal ideation. MethodsData collection consisted of an online public survey running for 6 weeks and qualitative interviews with pharmacy customers. Descriptive statistics were used to present the survey results and interviews were audio recorded, transcribed verbatim and then analysed using the Framework Analysis method and NVivo 11. ResultsThe majority of 501 survey respondents and all 12 customer interview participants were supportive of offering a response service for DA and/or SI in community pharmacy. Participants emphasised the need for appropriate staff training and support. They considered it an ethical and accessible approach and the majority said that they would recommend such a service to family or friends, and use it themselves if needed. However, awareness of the service was low and marketing materials were considered insufficiently clear. ConclusionsThere is strong public support and acceptability for a response service covering both suicidal ideation and domestic abuse in community pharmacies. Further research is required to develop appropriate marketing materials.

Methods to advance health equity and social justice in healthcare: Protocol for a scoping review on the utilisation of routinely collected data.

Many areas of healthcare are impacted by a paucity of research that is translatable to clinical practice. Research utilising real-world data, such as routinely collected patient data, may be one option to efficiently create evidence to inform practice and service delivery. Such studies are also valuable for exploring (in)equity of services and outcomes, and benefit from using non-selected samples representing the diversity of the populations served in the 'real world'. This scoping review aims to identify and map the published research which utilises routinely collected clinical healthcare data. A secondary aim is to explore the extent to which this literature supports the pursuit of social justice in health, including health inequities and intersectional approaches. This review utilises Arksey and O'Malley's methodological framework for scoping reviews and draws on the recommended enhancements of this framework to promote a team-based and mixed methods approach. This includes searching electronic databases and screening papers based on a pre-specified inclusion and exclusion criteria. Data relevant to the research aims will be extracted from included papers, including the clinical/professional area of the topic, the source of data that was used, and whether it addresses elements of social justice. All screening and reviewing will be collaborative and iterative, drawing on strengths of the research team and responsive changes to challenges will be made. Quantitative data will be analysed descriptively, and conceptual content analysis will be utilised to understand qualitative data. These will be collectively synthesised in alignment to the research aims. Our findings will highlight the extent to which such research is being conducted and published, including gaps and make recommendations for future endeavours for real-world data studies. The findings from this scoping review will be relevant for practitioners and researchers, as well as health service managers, commissioners, and research funders.

Community First Responders' role in the current and future rural health and care workforce: a mixed-methods study.

Community First Responders are trained volunteers dispatched by ambulance services to potentially life-threatening emergencies such as cardiac arrest in the first vital minutes to provide care until highly skilled ambulance staff arrive. Community First Responder schemes were first introduced to support ambulance services in rural communities, where access to prehospital emergency care is more likely to be delayed. Evidence is lacking on their contribution to rural healthcare provision, how care is provided and how this might be improved. We aimed to describe Community First Responder activities, organisation, costs of provision and outcomes of care together with perceptions and views of patients, public, Community First Responders, ambulance service staff and commissioners of their current and future role including innovations in the rural health and care workforce. We used a mixed-methods design, using a lens of pragmatism and the 'actor', 'behaviour change' and 'causal pathway' framework to integrate quantitative routine and qualitative (policy, guideline and protocol documents with stakeholder interview) data from 6 of 10 English ambulance services. We identified potential innovations in Community First Responder provision and prioritised these using a modified nominal group technique. Patients and public were involved throughout the study. In 4.5 million incidents from six English regional ambulance services during 2019, pre COVID-19 pandemic, Community First Responders attended first a higher proportion of calls in rural areas (almost 4% of calls) than in urban areas (around 1.5%). They were significantly more likely to be called out to rural (vs. urban) areas and to attend older (vs. younger), white (vs. minority ethnic) people in more affluent (vs. deprived) areas with cardiorespiratory and neurological (vs. other emergency) conditions for higher-priority emergency or urgent (category 1 and 2 compared with category 3, 4 or 5) calls but did also attend lower-category calls for conditions such as falls. We examined 10 documents from seven ambulance services. Ambulance policies and protocols integrated Community First Responders into ambulance service structures to achieve the safe and effective operation of volunteers. Costs, mainly for training, equipment and support, varied widely but were not always clearly delineated. Community First Responders enabled a faster prehospital response time. There was no clear benefit in out-of-hospital cardiac arrest outcomes. A specific Community First Responder falls response reduced ambulance attendances and was potentially cost saving. We conducted semistructured interviews with 47 different stakeholders engaged in Community First Responder functions. This showed the trajectory of becoming a Community First Responder, the Community First Responder role, governance and practice, and the positive views of Community First Responders from stakeholders despite public lack of understanding of their role. Community First Responders' scope of practice varied between ambulance services and had developed into new areas. Innovations prioritised at the consensus workshop were changes in processes and structures and an expanded scope of practice supported by training, which included counselling, peer support, better communication with the control room, navigation and communication technology, and specific mandatory and standardised training for Community First Responders. Missing data and small numbers of interviews in some stakeholder groups (patients, commissioners) are sources of bias. Future research should include a robust evaluation of innovations involving Community First Responders. This trial is registered as ClinicalTrials.gov, NCT04279262. This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR127920) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 18. See the NIHR Funding and Awards website for further award information.

Human Resource Information Systems and Employee Performance at Teacher’s Service Commission in Nairobi City County, Kenya

Human Resource Information Systems and Employee Performance at Teacher’s Service Commission in Nairobi City County, Kenya

An exploration of Northern Ireland general practice pharmacists’ views on their role in general practice: a cross-sectional survey

BackgroundThere is limited research examining the views of general practice pharmacists (GPPs) on their role and their impact in general practice. The aim of this study was to explore GPPs’ views regarding this role and its potential impact within general practice in Northern Ireland (NI).MethodsA paper-based self-administered questionnaire was mailed to 319 general practices in NI in 2022, directed to the GPP who spent most time at the practice. A variety of closed and open questions were included in six sections. Responses to closed questions were analysed descriptively whilst open question responses were analysed using content analysis. To ascertain associations between variables (e.g. GPP prescribing status, working arrangements and aspects of collaboration with GPPs), Fisher’s exact test was employed with an a priori significance level of p < 0.05.Results155 responses were received equating to a response rate of 48.5%. Most participants (72.3%) were female, independent prescribers (71%), and 64.5% were currently using their independent prescriber qualification. Services that were provided by most GPPs were medication reconciliation (99.4%) and medication reviews (97.4%). The most common method of communication between GPPs and general practitioners (GPs) was face-to-face (89.0%). Telephone was the most common method of communication between GPPs, community pharmacists (97.4%) and patients (98.7%). Most GPPs (> 80%) showed positive attitudes towards collaboration with GPs and those who worked in multiple practices were more likely to agree with the Attitudes Towards Collaboration Instrument for pharmacists (ATCI-P) statements compared to those who worked in a single practice (p < 0.05). Less than 40% (36.8%) of GPPs agreed that patients were aware of the role they provided. The majority of GPPs (80.6%) expressed positive views on their impact on primary care. Analysis of the free-text comments revealed the need for more GPP patient-facing activities, GPP-specific training, and promotion of the GPP role.ConclusionThe findings indicated that GPPs had largely positive views about their role and their impact on primary care. The results may be helpful for practices and service commissioners. Further research is necessary to explore the perspectives of patients regarding the role of the GPP and to enhance patients’ awareness of the GPP.

Assessing Public Awareness, Utilization and Satisfaction with Community Pharmacy Services.

The Saudi Community pharmacy sector has been changing towards patient-centred care rather than depending solely on dispensing medications. Accordingly, pharmacies can now provide many services that they previously could not offer. The aims of this study were to identify all pharmacy services provided in a community setting and to assess public awareness and utilization of and satisfaction with these services. This was a cross-sectional study in which the authors first purposively visited community pharmacies to identify the services offered. Pharmacists were asked about pharmacy services currently provided to community. Fieldnotes were used to document pharmacists' responses. After identifying pharmacy services, a questionnaire was desgined and reviewed by experts in the field, piloted and approved by the Ethics Committee at King Faisal University, then disseminated via Google Forms. The satisfaction level with pharmacy services was assessed using a five-point Likert scale. Data were collected from 24 January 2023 to 2 March 2023. Eighteen community pharmacies offering 17 different services were visited across Alahsa Governorate. The number of participants who completed the questionnaire was 350. Of those (232 [66.3%]) were female, and the majority of the sample (80.5%) were younger than 40 years old. The majority of the participants were unaware of pharmacy services. Out of 17 services, six received a score of 50% or higher regarding participant awareness. The most utilized services were the medication dispensing service "Wasfaty" (250 [71.4%]), medication counselling provided by pharmacists (232 [66.3%]) and minor ailment service (231 [66%]). The overall satisfaction score for pharmacy services was 87.2%. The majority of the participants were unaware of the full range of available pharmacy services. There is a potential for community pharmacists to fill the capacity gap in the healthcare system since, overall, the participants rated the pharmacies' clinical services as satisfactory. Commissioners of pharmacy services may consider extending the scope of community pharmacies to include services that best utilize the expertise of clinical pharmacists.

Effects of implementation of a care bundle on rates of necrotising enterocolitis and own mother’s milk feeding in the East Midlands: protocol for a mixed methods impact and process evaluation study

IntroductionPrevention of necrotising enterocolitis (NEC) is vital for improving neonatal outcomes. Feeding own mother’s milk helps prevent NEC. Rates of own mother’s milk feeding in the East Midlands are lower...