Mariesha Jaffray

Does training in motivational interviewing for community pharmacists improve outcomes for methadone patients? A cluster randomised controlled trial

Feasibility of pharmacist delivered motivational interviewing (MI) to methadone patients has been demonstrated, but its efficacy is untested. This study aimed to determine whether pharmacists trained in MI techniques can improve methadone outcomes.

Why do patients discontinue antidepressant therapy early? A qualitative study

Abstract Background: Current guidelines for antidepressant prescribing are that treatment should be continued following the resolution of symptoms: six months after a first episode and for at least two years for those with previous episodes. Despite this, sub-optimal treatment duration still predominates. Patients have negative and positive views on antidepressants, which change throughout their treatment journey. Objectives: To explore views and experiences of patients recently initiated on antidepressants (within six months), and to consider the influences on early discontinuation. Methods: A qualitative interview study was used in four general practices in the North East of Scotland. A purposive sample of primary care patients, newly initiated on antidepressants, was interviewed to explore views and experiences with antidepressant therapy. Interviews were audio-recorded and transcribed verbatim. Thematic analysis was conducted using a consensus coding frame developed by two researchers. Results: Twenty-nine patients participated. Three main factors influencing discontinuation were identified: ownership, knowledge and support. The treatment journey was characterized by four important time points where health care intervention may be helpful. Conclusion: Health care professionals would benefit from exploring patient knowledge and views on depression and antidepressants at an early stage in treatment. Patients would welcome active involvement in treatment decision making, the provision of information and ongoing support.

Prevalence of common chronic respiratory diseases in drug misusers: a cohort study.

BACKGROUND A randomised controlled trial of substance misuse indicated that many patients who use methadone have respiratory symptoms and/or are prescribed respiratory medications. There is little research in this area. AIMS To determine the prevalence of respiratory disease and prescriptions among drug misusers. METHODS This historical cohort study of drug misusers and matched controls analysed routinely collected primary care data. The prevalence of common chronic respiratory diseases, class and number of respiratory medications were examined. RESULTS The cohort of 18,570 patients (9,285 per group) was mostly male (64%, n=11,890) and aged 31-59 years (76%, n=14,060). After adjusting for age, gender, deprivation and smoking status, the results showed that more drug misusers than controls had a diagnosis of asthma or chronic obstructive pulmonary disease (17.1% vs. 10.9%; adjusted odds ratio (OR) 1.61, 95% confidence interval (CI) 1.46 to 1.77, and 2.4% vs. 0.8%; OR 1.86, 95% CI 1.42 to 2.44, respectively) and were prescribed more chronic respiratory medications: short-acting β(2)-agonists (16.4% vs. 7.9%; OR 2.00, 95% CI 1.80 to 2.22), long-acting β(2)-agonists (1% vs. 0.4%; OR 1.93, 95% CI 1.29 to 2.89), and inhaled corticosteroids (10.6% vs. 7.6%; OR 1.49, 95% CI 1.33 to 1.67). All differences were statistically significant (p<0.001). CONCLUSIONS Drug misusers have a significantly higher prevalence of respiratory diseases and respiratory prescriptions than matched controls. Further work is needed to determine the reasons for this.

TRUMP: A Trusted Mobile Platform for Self-management of Chronic Illness in Rural Areas

Disease self-management interventions have the potential to greatly benefit both sufferers of chronic illnesses and healthcare providers in rural areas. In this paper, we discuss our vision for a trusted platform for delivering self-management interventions in rural areas of the UK and India using second-generation mobile devices, and outline the key trust and privacy challenges in realising such an infrastructure. We illustrate our discussion with an example depression intervention scenario, highlighting some progress to date, and our plans towards realising this architecture.

A pilot study of alcohol screening and brief interventions in community pharmacies

No randomized controlled trials (RCTs) of screening and brief intervention (SBI) have been conducted in the community pharmacy setting. This pilot study was designed to inform the development and implementation of a large-scale RCT. The study examined the feasibility of providing SBI in community pharmacies, including practical considerations, recruitment of pharmacists and clients, uptake, potential effectiveness, and acceptability. A cluster RCT was conducted involving 20 community pharmacies. Pharmacy customers were screened using the Fast Alcohol Screening Test (FAST) to determine eligibility. The control group received a general lifestyle leaflet, while the intervention group was offered BI from a trained pharmacist. Clients in both groups were asked to complete baseline and three- and six-month postal questionnaires of self-reported alcohol consumption and to re-take the FAST. Qualitative work included follow-up telephone interviews with clients as well as focus groups with the public and participating pharmacists. Over 1000 clients were approached, with 77.6% (n = 846) completing the FAST. Of these, 27.1% (n = 229) were eligible for inclusion (FAST score = 3), 69 of whom (30.1%) consented to participate (27 in the intervention group and 42 in the control group). Nearly twice the number of eligible clients were recruited from control versus intervention pharmacies (41.6% versus 21.2%). A range of barriers and facilitators were identified by participating pharmacists and clients regarding SBI delivery. The main barrier for pharmacists was approaching clients for screening. Delivery of SBI was acceptable to most pharmacists and staff, however, future success of SBI in this setting will depend on identifying strategies for supporting practitioners in engaging pharmacy clients for screening.

The MEDMAN project: evaluation of the medicines management training for community pharmacists

Background and Training package: A RCT was conducted to evaluate a community pharmacist-led medicines management service (MEDMAN) for patients with coronary heart disease (CHD). The aim was to evaluate training provided prior to commencement of the service. Method: Questionnaires were mailed to participating English community pharmacists at three time points to assess CHD knowledge, perceived knowledge/skills, and comfort with respect to the new service. Results: Before training (baseline; response rate 63%) pharmacists had good CHD knowledge although 50% reported needing much more knowledge. Fewer (20%) felt training in communication skills/working with GPs was needed. After training (post-training time point 1; response rate 80%), perceived knowledge and skills increased (P , 0.001). At post- training time point 2, CHD training was rated highly useful (89%), relevant (91%) and complete (74%). Pharmacists continued to feel comfortable providing the service throughout the three time points. Many (68%) undertook further training. Pharmacists’ attitudes to MEDMAN were generally positive and un-related to knowledge, skills or comfort. Conclusion: Baseline CHD knowledge was good. Future training packages should include mentoring and experiential training.