scholarly journals Development of an antimicrobial stewardship implementation model involving collaboration between general practitioners and pharmacists: GPPAS study in Australian primary care

2021 ◽  
Vol 22 ◽  
Author(s):  
Sajal K. Saha ◽  
David C.M. Kong ◽  
Karin Thursky ◽  
Danielle Mazza
Keyword(s):  
Primary Care ◽  
General Practitioners ◽  
Antimicrobial Stewardship ◽  
Systems Engineering ◽  
Qualitative Interviews ◽  
Community Pharmacists ◽  
Feasibility Assessment ◽  
Implementation Model ◽  
Mrc Framework ◽  
Normalization Process

Abstract Background: Rising antimicrobial resistance (AMR) in primary care is a growing concern and a threat to community health. The rise of AMR can be slowed down if general practitioners (GPs) and community pharmacists (CPs) could work as a team to implement antimicrobial stewardship (AMS) programs for optimal use of antimicrobial(s). However, the evidence supporting a GP pharmacist collaborative AMS implementation model (GPPAS) in primary care remains limited. Aim: With an aim to design a GPPAS model in Australia, this paper outlines how this model will be developed. Methods: This exploratory study undertakes a systematic review, a scoping review, nationwide surveys, and qualitative interviews to design the model. Medical Research Council (MRC) framework and Normalization Process Theory are utilized as guides. Reviews will identify the list of effective GPPAS interventions. Two AMS surveys and paired interviews of GPs and CPs across Australia will explore their convergent and divergent views about the GPPAS interventions, attitudes towards collaboration in AMS and the perceived challenges of implementing GPPAS interventions. Systems Engineering Initiative for Patient Safety (SEIPS 2.0) model and factor analyses will guide the structure of GPPAS model through identifying the determinants of GPPAS uptake. The implementable GPPAS strategies will be selected based on empirical feasibility assessment by AMS stakeholders using the APEASE (Affordability, Practicability, Effectiveness and cost-effectiveness, Acceptability, Side-effects and safety, Equity) criteria. Discussion: The GPPAS model might have potential implications to inform how to better involve GPs and CPs in AMS, and, to improve collaborative services to optimize antimicrobial use and reduce AMR in primary care.

scholarly journals Divergent and Convergent Attitudes and Views of General Practitioners and Community Pharmacists to Collaboratively Implement Antimicrobial Stewardship Programs in Australia: A Nationwide Study

Antibiotics ◽  
2021 ◽  
Vol 10 (1) ◽  
pp. 47
Author(s):  
Sajal K. Saha ◽  
David C. M. Kong ◽  
Karin Thursky ◽  
Danielle Mazza
Keyword(s):  
Primary Care ◽  
General Practitioners ◽  
Antimicrobial Stewardship ◽  
Point Of Care ◽  
Community Pharmacists ◽  
System Structure ◽  
Collaborative Group ◽  
Chi Square ◽  
Information Leaflets ◽  
Point Of Care Tests

Setting up an interprofessional team for antimicrobial stewardship (AMS) to improve the quality and safety of antimicrobial use in primary care is essential but challenging. This study aimed to investigate the convergent and divergent attitudes and views of general practitioners (GPs) and community pharmacists (CPs) about AMS implementation and their perceived challenges of collaboration to design a GP–pharmacist collaborative AMS (GPPAS) model. Nationwide surveys of GPs and CPs across Australia were conducted January-October 2019. Chi square statistics and a theoretical framework were used for comparative analyses of quantitative and qualitative data, respectively. In total, 999 participants responded to the surveys with 15.4% (n = 386) response rates for GPs and 30.7% (n = 613) for CPs. GPs and CPs were aware about AMS however their interprofessional perceptions varied to the benefits of AMS programs. CPs indicated that they would need AMS training; significantly higher than GPs (GP vs. CP; 46.4% vs. 76.5%; p < 0.0001). GPs’ use of the Therapeutic Guideline Antibiotic was much higher than CPs (83.2% vs. 45.5%; p < 0.0001). No interprofessional difference was found in the very-limited use of patient information leaflets (p < 0.1162) and point-of-care tests (p < 0.7848). While CPs were more willing (p < 0.0001) to collaborate with GPs, both groups were convergent in views that policies that support GP–CP collaboration are needed to implement GPPAS strategies. GP–pharmacist collaborative group meetings (54.9% vs. 82.5%) and antimicrobial audit (46.1% vs. 86.5%) models were inter-professionally supported to optimise antimicrobial therapy, but an attitudinal divergence was significant (p < 0.001). The challenges towards GP–CP collaboration in AMS were identified by both at personal, logistical and organisational environment level. There are opportunities for GP–CP collaboration to improve AMS in Australian primary care. However, strengthening GP–pharmacy collaborative system structure and practice agreements is a priority to improve interprofessional trust, competencies, and communications for AMS and to establish a GPPAS model in future.

scholarly journals Electronic transmission of prescriptions in primary care: transformation, timing and teamwork

2021 ◽  
Vol 13 (4) ◽  
pp. 340
Author(s):  
Chloë Campbell ◽  
Caroline Morris ◽  
Lynn McBain
Keyword(s):  
Primary Care ◽  
New Zealand ◽  
General Practitioners ◽  
Community Pharmacists ◽  
Unintended Consequences ◽  
Structured Interviews ◽  
Interprofessional Communication ◽  
Potential Benefits ◽  
Handwritten Signature ◽  
Purposive Sample

ABSTRACTINTRODUCTIONDuring the coronavirus disease 2019 (COVID-19) pandemic lockdown in New Zealand in March 2020, there was a rapid shift to virtual consultations in primary care. This change was supported by system adjustments to enable electronic transmission of prescriptions without a handwritten signature if they met certain security criteria. International research suggests potential for unintended consequences with such changes, so it is important to understand the effect on professional practice in New Zealand general practice and community pharmacy.AIMThe purpose of this study was to undertake a preliminary exploration of the experiences of New Zealand general practitioners and community pharmacists when prescriptions are transmitted electronically directly from prescriber to pharmacy.METHODSSemi-structured interviews with a purposive sample of four pharmacists and four general practitioners gathered qualitative data about their experiences of the shift to electronic transmission of prescriptions. Participants’ perceptions of effect on professional workflow, interprofessional interactions between general practitioners and pharmacists, and interactions with patients were explored. Interviews were audio-recorded, and the data analysed thematically using an inductive approach.RESULTSFour themes were identified: workflow transformation; mixed impact on interactions with patients; juggling timing and expectations; and new avenues for interprofessional communication (with some cul-de-sacs).DISCUSSIONBoth general practitioners and pharmacists experienced transformational changes to workflow. This was positive for general practitioners due to saved time and increased work flexibility. Pharmacists noted potential benefits but also some challenges. To fully reap teamwork benefits, more work is needed on managing the timing issues and patient expectations, and to refine the new modes of communication between health-care practitioners.

scholarly journals Perceptions, Current Practices and Interventions of Community Pharmacists Regarding Antimicrobial Stewardship: A Qualitative Study in France

2021 ◽  
Author(s):  
Claire Durand ◽  
Aude Chappuis ◽  
Eric Douriez ◽  
Frédérique Poulain ◽  
Raheelah Ahmad ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Antimicrobial Resistance ◽  
Community Health ◽  
Antimicrobial Stewardship ◽  
Thematic Analysis ◽  
Community Pharmacists ◽  
Antibiotic Use ◽  
Antibiotic Prescribing ◽  
Community Health Care

Abstract Background: Community health care accounts for the vast majority of antibiotic use in Europe. Given the threat of antimicrobial resistance (AMR), there is an urgent need to develop new antimicrobial stewardship (AMS) interventions in primary care that could involve different health care providers including community pharmacists. This study aimed to explore the perceptions, currents practices and interventions of community pharmacists regarding antimicrobial stewardship.Methods: Semi-structured qualitative interviews were conducted with community pharmacists in France. Participants were recruited through a professional organization of community pharmacists combined with a snowballing technique. Interviews were audio recorded, transcribed and analyzed using thematic analysis. The Consolidated Framework for Implementation Research was used while developing the interview guide and carrying out thematic analysis.Results: Sixteen community pharmacists participated. All the respondents had good awareness about antimicrobial resistance and believed community pharmacists had an important role in tackling AMR. Some barriers to community pharmacists’ participation in AMS were identified such as difficult interactions with prescribers, lack of time and lack of access to patient medical records and diagnosis. Increased patient education, audits and feedback of antibiotic prescribing, increased point-of-care testing and delayed prescribing were interventions suggested by the pharmacists to improve antibiotic use in primary care. Strategies cited by participants to facilitate the implementation of such interventions are increased pharmacist-general practitioner collaboration, specialized training, clinical decision support tools as well as financial incentives. Conclusions: This study suggests that community pharmacists could play a greater role in infection management and AMS interventions. Further interprofessional collaboration is needed to optimize antibiotic prescribing and utilization in community health care.

The perspectives of parents, general practitioners, and community pharmacists about treating an ill child in primary care: a comparative study

2019 ◽  
Vol 179 (1) ◽  
pp. 111-119 ◽  
Author(s):  
Sigrid Verhelst ◽  
Pauline De Bruyne ◽  
Myriam Van Winckel ◽  
Koen Boussery ◽  
Eline Tommelein
Keyword(s):  
Primary Care ◽  
Comparative Study ◽  
General Practitioners ◽  
Community Pharmacists

scholarly journals Pharmacist-Physician Interprofessional Collaboration to Promote Early Detection of Cognitive Impairment: Increasing Diagnosis Rate

2021 ◽  
Vol 12 ◽  
Author(s):  
Hernán Ramos ◽  
Juan Pardo ◽  
Rafael Sánchez ◽  
Esteve Puchades ◽  
Jordi Pérez-Tur ◽  
...  
Keyword(s):  
Primary Care ◽  
Cognitive Impairment ◽  
Early Detection ◽  
Clinical Diagnosis ◽  
General Practitioners ◽  
Interprofessional Collaboration ◽  
Community Pharmacists ◽  
Cognitive Test ◽  
Community Pharmacies

The increased pressure on primary care makes it important for other health care providers, such as community pharmacists, to collaborate with general practitioners in activities related to chronic disease care. Therefore, the objective of the present project was to develop a protocol of action that allows close pharmacist-physician collaboration to carry out a coordinated action for very early detection of cognitive impairment (CI).Methods: A comparative study to promote early detection of CI was conducted in 19 community pharmacies divided into two groups: one group with interprofessional collaboration (IPC) and one group without interprofessional collaboration (NonIPC). IPC was defined as an interactive procedure involving all pharmacists, general practitioners and neurologists. A total of 281 subjects with subjective memory complaints were recruited. Three tests were used in the community pharmacies to detect possible CI: Memory Impairment Screening, Short Portable Mental State Questionnaire, and Semantic Verbal Fluency. Individuals with at least one positive cognitive test compatible with CI, were referred to primary care, and when appropriate, to the neurology service. Finally, we evaluated the differences in clinical and diagnostic follow-up in both groups after six months.Results: The NonIPC study group included 38 subjects compatible with CI referred to primary care (27.54%). Ten were further referred to a neurology department (7.25%) and four of them (2.90%) obtained a confirmed clinical diagnosis of CI. In contrast, in the IPC group, 46 subjects (32.17%) showed results compatible with CI and were referred to primary care. Of these, 21 (14.68%) were subsequently referred to a neurology service, while the remaining 25 were followed up by primary care. Nineteen individuals out of those referred to a neurology service obtained a confirmed clinical diagnosis of CI (13.29%). The percentage of subjects in the NonIPC group referred to neurology and the percentage of subjects diagnosed with CI, was significantly lower in comparison to the IPC group (p-value = 0.0233; p-value = 0.0007, respectively).Conclusions: The creation of IPC teams involving community pharmacists, general practitioners, and neurologists allow for increased detection of patients with CI or undiagnosed dementia and facilitates their clinical follow-up. This opens the possibility of diagnosis in patients in the very early stages of dementia, which can have positive implications to improve the prognosis and delay the evolution of the disease.

scholarly journals General practitioners’ views and experiences in caring for patients after sepsis: a qualitative interview study

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e040533
Author(s):  
Sabine Gehrke-Beck ◽  
Jochen Gensichen ◽  
Katrina M Turner ◽  
Christoph Heintze ◽  
Konrad FR Schmidt
Keyword(s):  
Primary Care ◽  
Critical Illness ◽  
General Practitioners ◽  
Continuity Of Care ◽  
Controlled Trial ◽  
Qualitative Interviews ◽  
Daily Practice ◽  
Training Programme ◽  
Qualitative Interview Study

BackgroundPatients surviving critical illnesses, such as sepsis, often suffer from long-term complications. After discharge from hospital, most patients are treated in primary care. Little is known how general practitioners (GPs) perform critical illness aftercare and how it can be improved. Within a randomised controlled trial, an outreach training programme has been developed and applied.ObjectivesThe aim of this study is to describe GPs’ views and experiences of caring for postsepsis patients and of participating a specific outreach training.DesignSemistructured qualitative interviews.Setting14 primary care practices in the metropolitan area of Berlin, Germany.Participants14 GPs who had participated in a structured sepsis aftercare programme in primary care.ResultsThemes identified in sepsis aftercare were: continuity of care and good relationship with patients, GP’s experiences during their patient’s critical illness and impact of persisting symptoms. An outreach education as part of the intervention was considered by the GPs to be acceptable, helpful to improve knowledge of the management of postintensive care complications and useful for sepsis aftercare in daily practice.ConclusionsGPs provide continuity of care to patients surviving sepsis. Better communication at the intensive care unit–GP interface and training in management of long-term complications of sepsis may be helpful to improve sepsis aftercare.Trial registration numberISRCTN61744782.

scholarly journals Self-care of Canterbury general practitioners, nurse practitioners, practice nurses and community pharmacists

2017 ◽  
Vol 9 (4) ◽  
pp. 286 ◽  
Author(s):  
Caroline Christie ◽  
Susan Bidwell ◽  
Andrea Copeland ◽  
Ben Hudson
Keyword(s):  
Primary Care ◽  
Health Professional ◽  
Pastoral Care ◽  
General Practitioners ◽  
Nurse Practitioners ◽  
Self Care ◽  
Community Pharmacists ◽  
Care Programme ◽  
Practice Nurses ◽  
Professional Groups

ABSTRACT INTRODUCTION Pastoral care is recognised as an important aspect of a mature primary care network. Pegasus Health is now in its 25th year and has had a formal Pastoral Care Programme for doctors since 2009. AIM This study aimed to collect local data on the self-care of Canterbury (Christchurch, New Zealand) general practitioners (GPs), nurse practitioners (NPs), practice nurses (PNs) and community pharmacists (CPs). METHODS The survey was open to all participants in the Pegasus Small Group Education Programme in Canterbury. From a survey circulated to approximately 1100 primary care professionals, 504 responses were collected either electronically or as hard copies. RESULTS The themes that emerged were similar among all the health professional groups. A significant proportion of health professionals took minimal annual leave and even more worked while ill. CPs were the group with the highest rates in both these areas. Reasons given for this focused largely on a lack of locum cover. DISCUSSION Locum cover is a significant issue in Canterbury for all health professional groups in the study. The issue of locums is now being reviewed in Canterbury partly as a result of this study. Consideration is also being given to how the Pastoral Care Programme can be made more widely available.

scholarly journals General Practitioners and Community Pharmacists’ Collaboration in Primary Care: Small Steps for a Major Change

2021 ◽  
Vol 21 (2) ◽  
Author(s):  
Amber Damiaens ◽  
Jessica Fraeyman ◽  
Sarah Fakroune ◽  
Caroline Hutsebaut ◽  
Sandrine Roussel ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practitioners ◽  
Community Pharmacists ◽  
Major Change

scholarly journals General practitioners’ views on use of patient reported outcome measures in primary care: a cross-sectional survey and qualitative study

2019 ◽  
Author(s):  
Grace M Turner ◽  
Ian Litchfield ◽  
Sam Finnikin ◽  
Olalekan Lee Aiyegbusi ◽  
Melanie Calvert
Keyword(s):  
Primary Care ◽  
General Practitioners ◽  
Outcome Measures ◽  
Qualitative Interviews ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Patient Reported ◽  
Clinical Systems

Abstract Background Patient reported outcome measures (PROMs) are increasingly used to assess impact of disease and treatment on quality of life and symptoms; however, their use in primary care is fragmented. We aimed to understand the current use of PROMs in primary care, barriers and facilitators, and how their use might be optimised. Methods Cross-sectional survey and semi-structured interviews among general practitioners (GPs) in England. GPs’ opinions were explored using an electronic, self-completed questionnaire disseminated to 100 GPs via an online doctors’ community and semi-structured qualitative interviews with 25 GPs. Results Most GPs surveyed (77/100; 77%) reported using one or more PROM, primarily to aid clinical management (n=66) or as screening/diagnostic tools (n=62). Qualitative interviews highlighted challenges in identifying and selecting PROMs; however, some GPs valued PROMs for shared decision making and to direct patient discussions. The interviews identified key barriers to PROM use including: time constraints; insufficient knowledge; lack of integration into clinical systems; and PROMs being mandated without consultation or explanation. Evidence of the benefit of PROMs is required to promote uptake and use of PROMs in primary care. Conclusion Implementation of PROMs in primary care requires integration with clinical systems, a bottom-up approach to PROM selection and system design involving meaningful consultation with patients and primary care clinicians and training/support for use.

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