Sara Garfield - Academia.edu (original) (raw)

Papers by Sara Garfield

BMJ open, Feb 1, 2024

Introduction The COVID-19 pandemic demonstrated how vaccine hesitancy impacts are translated nati... more Introduction The COVID-19 pandemic demonstrated how vaccine hesitancy impacts are translated nationally and internationally. A predictor of vaccine hesitancy is religious beliefs (eg, the body being sacred and should be healed by God). Additionally, the perceived content of vaccines can conflict with religious dietary restrictions. Despite the main faith organisations in the UK endorsing COVID-19 vaccination, vaccine hesitancy remains a challenge. Most faith-based research and interventions have been investigated in individual faiths, in isolation from others. Therefore, the aim of our research is to inform the development of interfaith interventions to address COVID-19 vaccine hesitancy, following the identification of potential facilitators and barriers and codesign of interfaith intervention(s). Methods and analysis We will facilitate six face-toface focus groups in London, each comprising eight participants. There will also be the option of joining an online focus group. A semistructured topic guide will include questions on experiences around interfaith, vaccine hesitancy, facilitators and barriers, and potential interfaith interventions to increase vaccine acceptance. Focus group participants will be invited to join a subsequent interfaith codesign workshop where the researchers will share the tentative findings and facilitate discussion to develop one or more interventions. Purposive sampling will be used to recruit 48 participants from different faith groups, ethnicities and backgrounds to capture diversity in the sample. Reflexive thematic analysis will guide a systematic process of constant comparison, coding data into categories and refining into overarching themes. Ethics and dissemination The University College London (UCL) Research Ethics Committee granted ethics approval (Project ID 4359.006) on 3 May 2022. Minor amendments to the study were approved on 15 May 2023 to accommodate participants' requests for online or face-to-face focus groups at a UCL venue. Informed consent is required from all participants. The findings will be disseminated in journals and to the public and key stakeholders.

International Journal of Pharmacy Practice, Apr 1, 2022

International Journal of Pharmacy Practice, Apr 1, 2023

Introduction: Pharmaceutical services for visually impaired (VI) individuals are lacking, both wo... more Introduction: Pharmaceutical services for visually impaired (VI) individuals are lacking, both worldwide and in Saudi Arabia (SA). Little evidence exists for effective pharmaceutical interventions to support medicines optimisation in this population (1). The Medical Research Council advocates theory-based intervention development and feasibility testing before full implementation. A feasibility study 'asks whether something can be done, should we proceed with it, and if so, how'. Aim: To design and test the feasibility of IDC-VI (Intervention for Dispensing and Counselling for the Visually Impaired). Methods: Phase 1 focused on developing the intervention. Using the theoretical domains framework (TDF) (2), 26 hospital/community pharmacists in SA were interviewed about their dispensing/counselling behaviour with a view to developing an intervention. The research team identified nine key TDF domains and selected eight behaviour change techniques (BCTs) to include in the intervention which could potentially enhance the pharmacist's knowledge, skills and help them monitor their behaviour. The BCTs were operationalised to produce an intervention package including a training session for pharmacists, behaviour goal setting and review sheets, a checklist with 25 steps to follow during dispensing/counselling (e.g., Ask "What is the best method to provide information about medications to you and/or your caregiver?"), sample patient scenarios, and an intervention record and manual. Phase 2 tested the feasibility of the intervention and study procedures (recruitment, data collection) at two hospital outpatient pharmacies. Two pharmacists, recruited through the pharmacy supervisor, were trained and provided with all intervention materials. Pharmacists were asked to implement the intervention with VI adult patients taking ≥3 medicines. Due to difficulties in identifying patients prior to attending the pharmacy, records of those requesting refills for out-of-stock medicines were used to recruit patients. Outcomes focused on the feasibility of recruitment, and collecting data on pharmacists' experience and patients' medicines/medical conditions. Pharmacists and patients provided feedback through interviews and telephone-administered questionnaires, respectively. Descriptive statistics and thematic analysis were used to analyse data.

Europe’s network of 140,000 community pharmacies provides easy access to medicines to the entire ... more Europe’s network of 140,000 community pharmacies provides easy access to medicines to the entire population. It should be seen as an important health care asset for the future. Primary care doctors and nurses are becoming more involved in treating people with complex needs in community settings. Community pharmacists in many parts of Europe are starting to provide extended pharmaceutical care services. As more effective medicines become available as pharmacy only products, pharmacists will play a more significant part in directly supporting self management and improving public health through preventive interventions.

PubMed, Jul 30, 2019

Distributed cognition theory posits that our cognitive tasks are so tightly coupled to the enviro... more Distributed cognition theory posits that our cognitive tasks are so tightly coupled to the environment that cognition extends into the environment, beyond the skin and the skull. It uses cognitive concepts to describe information processing across external representations, social networks and across different periods of time. Distributed cognition lends itself to exploring how people interact with technology in the workplace, issues to do with communication and coordination, how people's thinking extends into the environment and sociotechnical system architecture and performance more broadly. We provide an overview of early work that established distributed cognition theory, describe more recent work that facilitates its application, and outline how this theory has been used in health informatics. We present two use cases to show how distributed cognition can be used at the formative and summative stages of a project life cycle. In both cases, key determinants that influence performance of the sociotechnical system and/or the technology are identified. We argue that distributed cognition theory can have descriptive, rhetorical, inferential and application power. For evidence-based health informatics it can lead to design changes and hypotheses that can be tested.

Health Research Policy and Systems, Jan 20, 2021

Background: The emergence of patient and public involvement (PPI) in healthcare in the UK can be ... more Background: The emergence of patient and public involvement (PPI) in healthcare in the UK can be traced as far back as the 1970s. More recently, campaigns by harmed patients have led to a renewed focus on strengthening PPI. There is a growing awareness of the benefits of PPI in research as well as a need to address power inequities and a lack of diversity and inclusion. This review was undertaken to look at evidence for theories, barriers and enablers in PPI across health, social care and patient safety that could be used to strengthen PPI and address a perceived knowledge and theory gap with PPI in patient safety. Methods: We searched MEDLINE, EMBASE and PsycINFO from inception to August 2018, using both MeSH and free-text terms to identify published empirical literature. Protocols in PROSPERO were also searched to identify any systematic reviews in progress. The extracted information was analysed using a narrative approach, which synthesises data using a descriptive method. Results: Forty-two reviews were identified and grouped by key outcomes. Twenty-two papers mentioned theory in some form, 31 mentioned equality and diversity (although with no theory mentioned in this area), and only 19 cited equality and diversity as a barrier or enabler. Thirty-four reviews identified barriers and enablers at different organisational levels: personal/individual; attitudes; health professional; roles and expectations; knowledge, information and communication; financing and resourcing; training; general support; recruitment and representation, PPI methods and working with communities and addressing power dynamics. Conclusions: The review findings suggest that a commitment to PPI and partnership working is dependent on taking a whole system approach. This needs to consider the complex individual and organisational enablers and constraints to this process and address imbalances of power experienced by different groups. Addressing equality and diversity and use of a theory-driven approach to guide PPI are neglected areas. The long tradition of involvement across health and social care can provide considerable expertise in thinking about ways to strengthen approaches to PPI. This is especially important in patient safety, with a much newer tradition of developing PPI than other areas of healthcare.

Patient Education and Counseling, May 1, 2021

Objective: To identify concerns related to the use of medicines for adults with complex needs and... more Objective: To identify concerns related to the use of medicines for adults with complex needs and explore whether these differed between healthcare professionals and patients/carers, in order to inform development of interventions to increase medication adherence. Methods: A quantitative secondary analysis of a database of healthcare professionals' and patients'/carers' healthcare concerns, related to adults with complex needs. Categories of concerns related to medicines use were identified and concerns related to medication use coded against these. Data were analysed descriptively, and a Chi-square test conducted to test for differences in responses from healthcare professionals versus patients/carers. Results: There was a significant difference in the types of medication concern raised by healthcare professionals versus those raised by patients/carers. Patients/carers expressed more concerns about side effects and interactions; healthcare professionals identified more concerns related to patient support and carers' knowledge/training. Conclusion: Healthcare professionals had significantly different concerns about medicines to patients; this may be a potential barrier to medication adherence. Practice implications: Healthcare professionals may need to adopt an approach to non-adherence that goes beyond education and counselling and adopts a wider patient perspective. Findings suggest that a greater focus on addressing side effects and interactions may be beneficial in increasing medication adherence.

European Journal of Hospital Pharmacy, Oct 29, 2020

Objectives To evaluate patients’ views on the content and use of the ‘Five Moments for Medication... more Objectives To evaluate patients’ views on the content and use of the ‘Five Moments for Medication Safety’ materials developed as part of the WHO’s ‘Medication Without Harm’ Global Patient Safety Challenge. These comprise a booklet, flyer, infographic poster, pamphlet and mobile application. They include recommended questions for patients to ask healthcare professionals to gain a better understanding of their medication. Methods Structured interviews were conducted with members of the public who entered an outpatient pharmacy in a London teaching hospital, using a combination of open and closed questions. Qualitative data were analysed thematically. Quantitative data were analysed descriptively. χ2, Fisher’s exact, Mann-Whitney U and Kruskal-Wallis tests were used to test for associations between responses and variables such as age. Results We approached 147 people; 100 (68%) agreed to take part. Of these, 83% thought that the materials would be ‘quite’ or ‘very’ useful. Potential barriers to their use were patients being of the view that they already ask healthcare professionals about their medicines or that there would be limited time available to answer their questions during consultations. Fifty-nine per cent of participants stated that they would prefer to be given the materials in waiting areas before seeing a healthcare professional; 61% thought they should be displayed on television screens in general practice surgeries. Age was significantly associated with preference for the mobile application (χ2 test, p<0.01), with younger people preferring this format. Conclusions Patients’ views of the Five Moments for Medication Safety materials were generally positive. Our findings suggest that they should be displayed on television screens in waiting areas and given to patients prior to appointments. More advice is needed for patients on how to incorporate the questions suggested in the resources into a brief healthcare consultation.

Doctoral thesis, UCL (University College London)., 2002

Age and Ageing, 2022

Background psychotropic medication use has been shown to increase with age and has been associate... more Background psychotropic medication use has been shown to increase with age and has been associated with increased risk of falls, strokes and mortality. Various guidelines, regulations and tools have been developed to reduce inappropriate prescribing, but this remains high. In order to understand the reasons for this, we aimed to systematically review healthcare professionals’, patients’ and family caregivers’ attitudes towards the use of psychotropic medication in older people. Methods a systematic literature search was carried out from inception to September 2020 using PUBMED, EMBASE, PsycINFO and CINAHL and hand-searching of reference lists. Included studies investigated stakeholder views on psychotropic in adults over the age of 65. Findings were thematically synthesised. Results overall, there was an acceptance of long-term psychotropic medication for older people both living in the community and in residential care. While healthcare professionals were aware of guidelines for th...

Background Prescribing errors are common. It has been suggested that the severity as well as the ... more Background Prescribing errors are common. It has been suggested that the severity as well as the frequency of errors should be assessed when measuring prescribing error rates. This would provide more clinically relevant infor-mation, and allow more complete evaluation of the effec-tiveness of interventions designed to reduce errors. Objective The objective of this systematic review was to describe the tools used to assess prescribing error severity in studies reporting hospital prescribing error rates. Data Sources The following databases were searched:

and Nick Barber on behalf of the team conducting the evaluation

Section 5: Patient Safety and Quality assurance, 2020

International Journal of Pharmacy Practice, Apr 1, 2023

Improving the normalization of complex interventions: part 2validation of the NoMAD instrument fo... more Improving the normalization of complex interventions: part 2validation of the NoMAD instrument for assessing implementation work based on normalization process theory (NPT). BMC Med Res Methodol 18, 135 (2018).

Journal of Hypertension, 2022

Nonadherence to antihypertensives is prevalent and is associated with poorer health outcomes. Thi... more Nonadherence to antihypertensives is prevalent and is associated with poorer health outcomes. This study aimed to identify psychological factors associated with adherence in patients taking antihypertensives as these are potentially modifiable, and can, therefore, inform the development of effective interventions to increase adherence. PubMed, EMBASE and PsychINFO were searched to identify studies that tested for significant associations between psychological domains and adherence to antihypertensives. The domains reported were categorized according to the Theoretical Domains Framework. The quality of included studies was evaluated using the National Institute for Clinical Excellence critical appraisal of questionnaire checklist. Thirty-one studies were included. Concerns about medicines (a subdomain of ‘beliefs about consequences’) and ‘beliefs about capabilities’ consistently showed association with adherence in over five studies. Healthcare professionals should actively ask patie...

International Journal for Quality in Health Care, 2018

Quality problem or issue: A patient survey found significantly fewer patients reported they had s... more Quality problem or issue: A patient survey found significantly fewer patients reported they had selfadministered their medicines while in hospital (20% of 100 patients) than reported that they would like to (44% of 100). We aimed to make self-administration more easily available to patients who wanted it. Initial assessment: We conducted a failure, modes and effects analysis, collected baseline data on four wards and carried out observations. Choice of solution: Our initial assessment suggested that the main areas we should focus on were raising patient awareness of self-administration, changing the patient assessment process and creating a storage solution for medicines being self-administered. We developed new patient information leaflets and posters and a doctor's assessment form using Plan-Do-Study-Act cycles. We developed initial designs for a storage solution. Implementation: We piloted the new materials on three wards; the fourth withdrew due to staff shortages. Evaluation: Following collection of baseline data, we continued to collect weekly data. We found that the proportion of patients who wished to self-administer who reported that they were able to do so, significantly increased from 41% (of 155 patients) to 66% (of 118 patients) during the study, despite a period when the hospital was over capacity. Lessons learned: Raising and maintaining healthcare professionals' awareness of self-administration can greatly increase the proportion of patients who wish to self-administer who actually do so. Healthcare professionals prefer multidisciplinary input into the assessment process.

Background: There is a recognised need to build primary care medication adherence services which ... more Background: There is a recognised need to build primary care medication adherence services which are tailored to patients ’ needs. Continuous quality improvement of such services requires a regular working method of measuring adherence in order to monitor effectiveness. Self report has been considered the method of choice for clinical use; it is cheap, relatively unobtrusive and able to distinguish between intentional and unintentional nonadherence, which have different underlying causes and therefore require different interventions. A self report adherence measure used in routine clinical practice would ideally be brief, acceptable to patients, valid, reliable, have the ability to distinguish between different types of non-adherence and be able to be completed by or in conjunction with carers where necessary. Methods: We systematically reviewed the literature in order to identify self report adherence measures currently available which are suitable for primary care and evaluate the...

BMJ open, Feb 1, 2024

Introduction The COVID-19 pandemic demonstrated how vaccine hesitancy impacts are translated nati... more Introduction The COVID-19 pandemic demonstrated how vaccine hesitancy impacts are translated nationally and internationally. A predictor of vaccine hesitancy is religious beliefs (eg, the body being sacred and should be healed by God). Additionally, the perceived content of vaccines can conflict with religious dietary restrictions. Despite the main faith organisations in the UK endorsing COVID-19 vaccination, vaccine hesitancy remains a challenge. Most faith-based research and interventions have been investigated in individual faiths, in isolation from others. Therefore, the aim of our research is to inform the development of interfaith interventions to address COVID-19 vaccine hesitancy, following the identification of potential facilitators and barriers and codesign of interfaith intervention(s). Methods and analysis We will facilitate six face-toface focus groups in London, each comprising eight participants. There will also be the option of joining an online focus group. A semistructured topic guide will include questions on experiences around interfaith, vaccine hesitancy, facilitators and barriers, and potential interfaith interventions to increase vaccine acceptance. Focus group participants will be invited to join a subsequent interfaith codesign workshop where the researchers will share the tentative findings and facilitate discussion to develop one or more interventions. Purposive sampling will be used to recruit 48 participants from different faith groups, ethnicities and backgrounds to capture diversity in the sample. Reflexive thematic analysis will guide a systematic process of constant comparison, coding data into categories and refining into overarching themes. Ethics and dissemination The University College London (UCL) Research Ethics Committee granted ethics approval (Project ID 4359.006) on 3 May 2022. Minor amendments to the study were approved on 15 May 2023 to accommodate participants' requests for online or face-to-face focus groups at a UCL venue. Informed consent is required from all participants. The findings will be disseminated in journals and to the public and key stakeholders.

International Journal of Pharmacy Practice, Apr 1, 2022

International Journal of Pharmacy Practice, Apr 1, 2023

Introduction: Pharmaceutical services for visually impaired (VI) individuals are lacking, both wo... more Introduction: Pharmaceutical services for visually impaired (VI) individuals are lacking, both worldwide and in Saudi Arabia (SA). Little evidence exists for effective pharmaceutical interventions to support medicines optimisation in this population (1). The Medical Research Council advocates theory-based intervention development and feasibility testing before full implementation. A feasibility study 'asks whether something can be done, should we proceed with it, and if so, how'. Aim: To design and test the feasibility of IDC-VI (Intervention for Dispensing and Counselling for the Visually Impaired). Methods: Phase 1 focused on developing the intervention. Using the theoretical domains framework (TDF) (2), 26 hospital/community pharmacists in SA were interviewed about their dispensing/counselling behaviour with a view to developing an intervention. The research team identified nine key TDF domains and selected eight behaviour change techniques (BCTs) to include in the intervention which could potentially enhance the pharmacist's knowledge, skills and help them monitor their behaviour. The BCTs were operationalised to produce an intervention package including a training session for pharmacists, behaviour goal setting and review sheets, a checklist with 25 steps to follow during dispensing/counselling (e.g., Ask "What is the best method to provide information about medications to you and/or your caregiver?"), sample patient scenarios, and an intervention record and manual. Phase 2 tested the feasibility of the intervention and study procedures (recruitment, data collection) at two hospital outpatient pharmacies. Two pharmacists, recruited through the pharmacy supervisor, were trained and provided with all intervention materials. Pharmacists were asked to implement the intervention with VI adult patients taking ≥3 medicines. Due to difficulties in identifying patients prior to attending the pharmacy, records of those requesting refills for out-of-stock medicines were used to recruit patients. Outcomes focused on the feasibility of recruitment, and collecting data on pharmacists' experience and patients' medicines/medical conditions. Pharmacists and patients provided feedback through interviews and telephone-administered questionnaires, respectively. Descriptive statistics and thematic analysis were used to analyse data.

Europe’s network of 140,000 community pharmacies provides easy access to medicines to the entire ... more Europe’s network of 140,000 community pharmacies provides easy access to medicines to the entire population. It should be seen as an important health care asset for the future. Primary care doctors and nurses are becoming more involved in treating people with complex needs in community settings. Community pharmacists in many parts of Europe are starting to provide extended pharmaceutical care services. As more effective medicines become available as pharmacy only products, pharmacists will play a more significant part in directly supporting self management and improving public health through preventive interventions.

PubMed, Jul 30, 2019

Distributed cognition theory posits that our cognitive tasks are so tightly coupled to the enviro... more Distributed cognition theory posits that our cognitive tasks are so tightly coupled to the environment that cognition extends into the environment, beyond the skin and the skull. It uses cognitive concepts to describe information processing across external representations, social networks and across different periods of time. Distributed cognition lends itself to exploring how people interact with technology in the workplace, issues to do with communication and coordination, how people's thinking extends into the environment and sociotechnical system architecture and performance more broadly. We provide an overview of early work that established distributed cognition theory, describe more recent work that facilitates its application, and outline how this theory has been used in health informatics. We present two use cases to show how distributed cognition can be used at the formative and summative stages of a project life cycle. In both cases, key determinants that influence performance of the sociotechnical system and/or the technology are identified. We argue that distributed cognition theory can have descriptive, rhetorical, inferential and application power. For evidence-based health informatics it can lead to design changes and hypotheses that can be tested.

Health Research Policy and Systems, Jan 20, 2021

Background: The emergence of patient and public involvement (PPI) in healthcare in the UK can be ... more Background: The emergence of patient and public involvement (PPI) in healthcare in the UK can be traced as far back as the 1970s. More recently, campaigns by harmed patients have led to a renewed focus on strengthening PPI. There is a growing awareness of the benefits of PPI in research as well as a need to address power inequities and a lack of diversity and inclusion. This review was undertaken to look at evidence for theories, barriers and enablers in PPI across health, social care and patient safety that could be used to strengthen PPI and address a perceived knowledge and theory gap with PPI in patient safety. Methods: We searched MEDLINE, EMBASE and PsycINFO from inception to August 2018, using both MeSH and free-text terms to identify published empirical literature. Protocols in PROSPERO were also searched to identify any systematic reviews in progress. The extracted information was analysed using a narrative approach, which synthesises data using a descriptive method. Results: Forty-two reviews were identified and grouped by key outcomes. Twenty-two papers mentioned theory in some form, 31 mentioned equality and diversity (although with no theory mentioned in this area), and only 19 cited equality and diversity as a barrier or enabler. Thirty-four reviews identified barriers and enablers at different organisational levels: personal/individual; attitudes; health professional; roles and expectations; knowledge, information and communication; financing and resourcing; training; general support; recruitment and representation, PPI methods and working with communities and addressing power dynamics. Conclusions: The review findings suggest that a commitment to PPI and partnership working is dependent on taking a whole system approach. This needs to consider the complex individual and organisational enablers and constraints to this process and address imbalances of power experienced by different groups. Addressing equality and diversity and use of a theory-driven approach to guide PPI are neglected areas. The long tradition of involvement across health and social care can provide considerable expertise in thinking about ways to strengthen approaches to PPI. This is especially important in patient safety, with a much newer tradition of developing PPI than other areas of healthcare.

Patient Education and Counseling, May 1, 2021

Objective: To identify concerns related to the use of medicines for adults with complex needs and... more Objective: To identify concerns related to the use of medicines for adults with complex needs and explore whether these differed between healthcare professionals and patients/carers, in order to inform development of interventions to increase medication adherence. Methods: A quantitative secondary analysis of a database of healthcare professionals' and patients'/carers' healthcare concerns, related to adults with complex needs. Categories of concerns related to medicines use were identified and concerns related to medication use coded against these. Data were analysed descriptively, and a Chi-square test conducted to test for differences in responses from healthcare professionals versus patients/carers. Results: There was a significant difference in the types of medication concern raised by healthcare professionals versus those raised by patients/carers. Patients/carers expressed more concerns about side effects and interactions; healthcare professionals identified more concerns related to patient support and carers' knowledge/training. Conclusion: Healthcare professionals had significantly different concerns about medicines to patients; this may be a potential barrier to medication adherence. Practice implications: Healthcare professionals may need to adopt an approach to non-adherence that goes beyond education and counselling and adopts a wider patient perspective. Findings suggest that a greater focus on addressing side effects and interactions may be beneficial in increasing medication adherence.

European Journal of Hospital Pharmacy, Oct 29, 2020

Objectives To evaluate patients’ views on the content and use of the ‘Five Moments for Medication... more Objectives To evaluate patients’ views on the content and use of the ‘Five Moments for Medication Safety’ materials developed as part of the WHO’s ‘Medication Without Harm’ Global Patient Safety Challenge. These comprise a booklet, flyer, infographic poster, pamphlet and mobile application. They include recommended questions for patients to ask healthcare professionals to gain a better understanding of their medication. Methods Structured interviews were conducted with members of the public who entered an outpatient pharmacy in a London teaching hospital, using a combination of open and closed questions. Qualitative data were analysed thematically. Quantitative data were analysed descriptively. χ2, Fisher’s exact, Mann-Whitney U and Kruskal-Wallis tests were used to test for associations between responses and variables such as age. Results We approached 147 people; 100 (68%) agreed to take part. Of these, 83% thought that the materials would be ‘quite’ or ‘very’ useful. Potential barriers to their use were patients being of the view that they already ask healthcare professionals about their medicines or that there would be limited time available to answer their questions during consultations. Fifty-nine per cent of participants stated that they would prefer to be given the materials in waiting areas before seeing a healthcare professional; 61% thought they should be displayed on television screens in general practice surgeries. Age was significantly associated with preference for the mobile application (χ2 test, p<0.01), with younger people preferring this format. Conclusions Patients’ views of the Five Moments for Medication Safety materials were generally positive. Our findings suggest that they should be displayed on television screens in waiting areas and given to patients prior to appointments. More advice is needed for patients on how to incorporate the questions suggested in the resources into a brief healthcare consultation.

Doctoral thesis, UCL (University College London)., 2002

Age and Ageing, 2022

Background psychotropic medication use has been shown to increase with age and has been associate... more Background psychotropic medication use has been shown to increase with age and has been associated with increased risk of falls, strokes and mortality. Various guidelines, regulations and tools have been developed to reduce inappropriate prescribing, but this remains high. In order to understand the reasons for this, we aimed to systematically review healthcare professionals’, patients’ and family caregivers’ attitudes towards the use of psychotropic medication in older people. Methods a systematic literature search was carried out from inception to September 2020 using PUBMED, EMBASE, PsycINFO and CINAHL and hand-searching of reference lists. Included studies investigated stakeholder views on psychotropic in adults over the age of 65. Findings were thematically synthesised. Results overall, there was an acceptance of long-term psychotropic medication for older people both living in the community and in residential care. While healthcare professionals were aware of guidelines for th...

Background Prescribing errors are common. It has been suggested that the severity as well as the ... more Background Prescribing errors are common. It has been suggested that the severity as well as the frequency of errors should be assessed when measuring prescribing error rates. This would provide more clinically relevant infor-mation, and allow more complete evaluation of the effec-tiveness of interventions designed to reduce errors. Objective The objective of this systematic review was to describe the tools used to assess prescribing error severity in studies reporting hospital prescribing error rates. Data Sources The following databases were searched:

and Nick Barber on behalf of the team conducting the evaluation

Section 5: Patient Safety and Quality assurance, 2020

International Journal of Pharmacy Practice, Apr 1, 2023

Improving the normalization of complex interventions: part 2validation of the NoMAD instrument fo... more Improving the normalization of complex interventions: part 2validation of the NoMAD instrument for assessing implementation work based on normalization process theory (NPT). BMC Med Res Methodol 18, 135 (2018).

Journal of Hypertension, 2022

Nonadherence to antihypertensives is prevalent and is associated with poorer health outcomes. Thi... more Nonadherence to antihypertensives is prevalent and is associated with poorer health outcomes. This study aimed to identify psychological factors associated with adherence in patients taking antihypertensives as these are potentially modifiable, and can, therefore, inform the development of effective interventions to increase adherence. PubMed, EMBASE and PsychINFO were searched to identify studies that tested for significant associations between psychological domains and adherence to antihypertensives. The domains reported were categorized according to the Theoretical Domains Framework. The quality of included studies was evaluated using the National Institute for Clinical Excellence critical appraisal of questionnaire checklist. Thirty-one studies were included. Concerns about medicines (a subdomain of ‘beliefs about consequences’) and ‘beliefs about capabilities’ consistently showed association with adherence in over five studies. Healthcare professionals should actively ask patie...

International Journal for Quality in Health Care, 2018

Quality problem or issue: A patient survey found significantly fewer patients reported they had s... more Quality problem or issue: A patient survey found significantly fewer patients reported they had selfadministered their medicines while in hospital (20% of 100 patients) than reported that they would like to (44% of 100). We aimed to make self-administration more easily available to patients who wanted it. Initial assessment: We conducted a failure, modes and effects analysis, collected baseline data on four wards and carried out observations. Choice of solution: Our initial assessment suggested that the main areas we should focus on were raising patient awareness of self-administration, changing the patient assessment process and creating a storage solution for medicines being self-administered. We developed new patient information leaflets and posters and a doctor's assessment form using Plan-Do-Study-Act cycles. We developed initial designs for a storage solution. Implementation: We piloted the new materials on three wards; the fourth withdrew due to staff shortages. Evaluation: Following collection of baseline data, we continued to collect weekly data. We found that the proportion of patients who wished to self-administer who reported that they were able to do so, significantly increased from 41% (of 155 patients) to 66% (of 118 patients) during the study, despite a period when the hospital was over capacity. Lessons learned: Raising and maintaining healthcare professionals' awareness of self-administration can greatly increase the proportion of patients who wish to self-administer who actually do so. Healthcare professionals prefer multidisciplinary input into the assessment process.

Background: There is a recognised need to build primary care medication adherence services which ... more Background: There is a recognised need to build primary care medication adherence services which are tailored to patients ’ needs. Continuous quality improvement of such services requires a regular working method of measuring adherence in order to monitor effectiveness. Self report has been considered the method of choice for clinical use; it is cheap, relatively unobtrusive and able to distinguish between intentional and unintentional nonadherence, which have different underlying causes and therefore require different interventions. A self report adherence measure used in routine clinical practice would ideally be brief, acceptable to patients, valid, reliable, have the ability to distinguish between different types of non-adherence and be able to be completed by or in conjunction with carers where necessary. Methods: We systematically reviewed the literature in order to identify self report adherence measures currently available which are suitable for primary care and evaluate the...