BACKGROUND:Trust between healthcare providers is important in facilitating collaborative practices, especially in primary care, where disciplines collaborate across communities to deliver patient-centred care. OBJECTIVE:To identify the facilitators and barriers that influence trust in interprofessional partnerships within primary care settings. METHODS:We searched PubMed, PsycInfo, Embase, and CINAHL using key words to identify articles published up to 16 August 2023. Facilitators and barriers to trust were mapped onto the Consolidated Framework for Implementation Research (CFIR). Quality assessment utilized the Mixed Methods Appraisal Tool (MMAT). RESULTS:From 5750 screened articles, 11 studies were included. Sixteen facilitators and seven barriers were identified. Facilitators included co-location, familiarity, competence, professional identities, and effective communication. Barriers included perceived conflicts of interest, lack of familiarity, and transgressions of professional boundaries. Trust was often unbalanced, with a perception among non-medical healthcare professionals that they need to earn trust from medical healthcare professionals. CONCLUSIONS:Formation and nurturing of interprofessional trust is the foundation for building strong partnerships between healthcare professionals that promote collaborative practice in primary care. Future research should include non-English and grey literature and focus on the unequal trust dynamics.

Second-generation antipsychotics are highly effective in controlling symptoms if taken as prescribed. However, poor medication adherence results in patients continuing to experience psychotic episodes and metabolic disturbances that can cause them to develop abnormal lipid levels, weight gain, and diabetes. Understanding the underlying modulators that impact follow-up appointments and metabolic monitoring is critical. Semi-structured interviews were conducted with patients and their treating psychiatrists across four sites in South India. Narrative data were thematically analyzed, informed by an inductive approach. Patient-reported barriers included medication side effects, lack of awareness about metabolic monitoring, and financial constraints. Psychiatrists reported both patient and resource barriers that impact their provision of care. This study has shed light on key barriers impacting the provision of care and subsequently health outcomes for patients living with severe mental illness to inform strategies that target barriers for both patients and psychiatrists.

Pediatric-specific networks have emerged over the past decade as Medicaid payment models have shifted away from fee-for-service, which rewards volume of service delivery, towards more value-based payments that incentivize improved health outcomes. More recently, growing recognition that health care alone is insufficient to produce health has resulted in the Centers for Medicare and Medicaid Services advancing value-based payment models that allow greater flexibility for networks to address the “social determinants of health” – those social and economic conditions which significantly influence health outcomes. Although pediatricians have long advocated for understanding and addressing social health needs, pediatric networks must now determine their role in managing or mitigating the impact of these complex factors on the health of their attributed populations. Pediatric networks can implement basic screening and referral processes to address social health needs, invest network resources in direct service provision, and/or leverage the network's expertise in child health to influence upstream changes in health policy. This article presents some questions that pediatric networks can use to explore their potential role in managing social health needs.

Digital Interprofessional Learning Client Documentation (D-IPL Client Docs) is an initiative designed to develop student interprofessional communication skills through electronic record writing and a virtual simulation (VS) or live virtual simulation (LVS) case conference. The aims of the study were to (a) identify whether D-IPL Client Docs supports student learning in the affective domain and (b) compare the learning outcomes for students participating in the VS versus the LVS case conference. Data were drawn from 83 Bachelor of Social Work students who had participated with other health professional students in the D-IPL Client Docs activities. The reflective journals submitted by this cohort of social work students were analyzed qualitatively and quantitatively using the Griffith University Affective Learning Scale. Qualitative analyses revealed that the activities enabled students in both groups to learn about themselves, their roles, and the roles of others, and the benefits of interprofessional collaboration in optimizing client outcomes. Quantitatively, the VS mode appeared to be more effective in supporting students to develop higher order affective learning; however, the effect size was small. Future studies should involve a larger sample size and include students from various professions to ascertain the transferability of findings.

Background:Pharmacists in many countries have long been involved in some aspect of assisted dying. Since 2016, when Canada enacted legislation permitting medical assistance in dying (MAiD), the number of patients seeking the procedure has increased yearly. Despite the global nature of pharmacists' involvement, little is known about how they experience MAiD practice.Objective:To study how pharmacists experience the practice of caring for patients who seek MAiD.Methods:This qualitative study used semistructured interviews with pharmacists who had cared for patients seeking MAiD. Interviews, conducted between June 2019 and October 2020, were audio-recorded and transcribed verbatim. Data were examined using a modified framework analysis approach. Data were coded and sorted using Quirkos and Microsoft Excel software. Themes were defined through an iterative process involving constant comparison.Results:Nineteen hospital pharmacists representing a range of practice settings in Alberta participated in the study. The experience of caring for patients seeking assistance in dying brought to light 3 themes: finding a place in the process, serving in a caring role, and bearing emotional burdens. Pharmacists' experiences were personal, relational, emotional, and dynamic.Conclusions:Each of the pharmacists experienced MAiD practice in a unique way. Although their roles in MAiD were primarily medication-focused, their experiences highlighted the centrality of patient choices, autonomy, and needs. The results of this study will inform pharmacists (including those not yet engaged in MAiD practice) about the role, and will also be valuable for pharmacy organizations and educators seeking to support pharmacists and the profession, as well as policy-makers seeking to expand pharmacists' roles in MAiD.

BACKGROUND:Worldwide, pharmacy practice is changing to include new roles and responsibilities. Laws enabling the implementation of assisted dying are expanding in international jurisdictions. Pharmacy practice in assisted dying is subsequently expanding. However, studies of how pharmacists experience their practice when engaged in assisted dying are absent. To progress research into the lived experiences of pharmacists practicing in assisted dying, the development of an inquiry framework to guide such research is the first step.OBJECTIVE:The objective was to develop a theoretical framework of inquiry for use in subsequent continuing research which may explore the actual experience of pharmacy practice in assisted dying.METHODS:Perspectives were gathered from expert and senior pharmacists who were anticipating the imminent implementation of assisted dying practice. Analysis focused on understanding what aspects of practice experience were important to them. Interview-conversations centred on the question: If you had the chance to talk to experienced pharmacist practitioners who have been involved in the practice of assisted dying, what aspects regarding their experiences, would you like to know about? A conventional approach to qualitative content analysis was utilized to analyze the data.RESULTS:Findings summarized questions posed by pharmacists contemplating the implementation of assisted dying practice. These perspectives formed the foundation of a theoretical inquiry framework constituted by 8 inter-related dimensional range-continuums. Each range-continuum, designed to explore the lived experiences of pharmacists in practice, is defined. Examples of how the inquiry dimensions will be used to inform future exploratory research are offered within the framework.CONCLUSIONS:The theoretical inquiry framework will be used to develop knowledge for pharmacists contemplating participation (or not) in assisted dying practice. It is timely to progress research that reveals the informed experiences of pharmacists that are actually practicing in this area. The framework may be adapted for researching pharmacists' experience in other practice areas and contexts.

BACKGROUND:The COVID-19 pandemic has caused changes that disrupted the status quo of society. As a result, the level of conflict in community pharmacy has increased significantly. With existing conflict research more focused on the management of conflict, it is important to direct attention towards understanding the nature of conflict. This understanding will allow for informed resources to be developed to guide practice, decreasing the occurrence of and negative effects of conflict.OBJECTIVE:This research explored experiences of pharmacists working in community pharmacies, to identify the occurrence and nature of conflicts which may have been motivated by changes resulting directly or indirectly from the COVID-19 pandemic, to provide directions for future research into the nature of conflict.METHOD:Person-to-person semi-structured telephone interviews were conducted. Transcripts were analysed using inductive reasoning to identify themes.RESULTS:Thirteen pharmacists agreed to participate in this study and 9 were interviewed. Analysis revealed 7 themes that described the causes, contributors, management, outcome, and essence of experienced conflict. A model that incorporated existing theory and themes derived from this study was developed to facilitate understanding of the nature of conflict in community pharmacy during the COVID-19 pandemic.CONCLUSION:Conflict in community pharmacy settings follows a defined model with multiple interrelated themes. Guidance from this model may assist pharmacists in reducing occurrences of dysfunctional conflicts during their practice.

Background: While medication is an integral part of the effective management of COPD, more than 50% of people living with COPD do not adhere to their prescribed medications.The drivers underpinning this observed behaviour are poorly understood.As pharmacists generally have the final interaction with patients prior to their use of medications, their perspectives may offer insights about patients' medication use that may improve our understanding of this complex issue.Objective: This study explored pharmacists' experiences of providing care for patients living with COPD to gain insight about factors that impact their medication-taking behaviour.Methods: Fourteen pharmacists who worked in practice settings across the South-East Queensland region of Australia participated in interviews between March 2019 and January 2020.Interviews were audio-recorded, transcribed verbatim, and thematically analysed.Results: Two overarching themes were identified which modulated medication-taking behaviour.Barriers comprised patient-related factors including, financial constraints, poor inhaler technique, and inaccurate beliefs; alongside pharmacist-related factors such as a lack of COPD-specific training and time constraints.Factors that promote adherence included patient education and monitoring and collaborative relationships between key stakeholders.Conclusions: Medication non-adherence is common.While pharmacists expressed a desire to better support their patients, practical strategies to overcome the challenges that they face in clinical settings are lacking.Future research should focus on exploring ways to engage patients at the pharmacy level thereby enhancing the provision of services that would optimise medication adherence.

BACKGROUND:While medication is an integral component of the effective management of COPD, contemporary studies report that more than half of all people who are prescribed medication for the management of their COPD do not adhere to therapy. Enhancing medication adherence and improving health outcomes for those living with COPD are among the key challenges for the global health community. This systematic review aims to identify the rate of nonadherence among people who are prescribed controller medication for the management of their COPD, and identifies the barriers and facilitators that influence their medication use behavior.METHODS:A systematic search of medical databases (ie, MEDLINE, CINHAL, and EMBASE) was conducted using key words to identify literature in the English language, published between January 2003 and December 2019. Included studies were assessed for quality using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist.RESULTS:A total of 1,474 studies were identified from the initial database search, of which 38 met the inclusion criteria. Of these 38 studies, 37 reported on rates of nonadherence (ranging from 22% to 93%), 30 reported on barriers to adherence, 24 reported on enablers to adherence, and 16 reported on both. The majority (33) of the studies were conducted in high-income nations. The quality of articles ranged from 47% to 90%. Medication-taking behavior was reported to be influenced by several factors such as subjects' beliefs about medication, their experiences of and satisfaction with medication effectiveness, their concerns regarding medication side effects, their personal circumstances, habits and health status, and their relationships with health care providers.CONCLUSIONS:Adherence to COPD medication was generally low, with the majority of studies identifying the presence of depression and subjects' concern about the harmful effects of the medicine as barriers to adherence. Variability exists on the reported rates of nonadherence, possibly due to different measures utilized to assess adherence. Future research in low-income nations is needed.

Purpose: Human capabilities in medicine, including communication skills, are increasingly important within the complex, challenging and dynamic landscape of healthcare. Supporting medical students to manage unavoidable role-related stressors adaptively may help mitigate the anguish that is too commonly reported among the profession. We developed a model, "MaRIS", underpinned by contemplative pedagogy, to support medical students to enhance their human capabilities, across all three domains of Bloom's taxonomy, and their personal resilience. It is the first to integrate Mindfulness, affective Reflection, Impactive experiences and a Supportive environment into medical curriculum design. Here, we describe the theoretical basis underpinning MaRIS and present a preliminary study to evaluate its impact on students' subjectively-rated capabilities.Materials and Methods: A questionnaire capturing self-ratings of competence, empathy and resilience, as well as impressions of their experiences, was administered to foundation year medical students before (T0), during (T1) and after delivery (T2).Results: Fifty-five students completed the survey at all time points. Mean scores for all domains increased significantly from T0 to T1 and from T0 to T2. Free-text comments suggest learning impact across the cognitive, psychomotor and affective domains.Conclusions: MaRIS appears to facilitate medical students' establishment of the foundations for building the human capabilities and personal resilience required for professional practice.

Background: The scope and roles of pharmacists worldwide are undergoing dramatic change. Patient-focused care aimed at caring for people that seek medical assistance in dying is among the newest roles. While pharmacists have been involved in medically assisted dying in some international jurisdictions for over two decades, little is known about their actual lived experiences. Objective: To map the literature concerning pharmacy practice in the assisted dying domain to clarify apparent research gaps. Methods: A mapping review was preformed following a systematic search of Medline, CINAHL and IPA to locate academic papers and reports relating to pharmacists' involvement in assisted dying published between 1990 and 2019. Searches included articles in English, French, and Dutch. References and citations of articles were searched to identify additional articles. Results: A total of 43 articles were selected, including commentaries (n = 26), reports (n = 2), a scoping literature review (n = 1), and empirical studies (n = 14). Most commentaries centered on pharmacists' roles, ethico-legal and moral challenges, and educational concerns in relation to participation. Of the 14 empirical studies, 12 studies were designed around surveys that focused on pharmacists' attitudes, and opinions concerning assisted dying. Other methodologies included thematic analysis of moral dilemmas, experimental design identifying attitudes to sedation at end of life, and analysis of documents such as guidelines, position statements, and standards of practice. Two studies utilized a qualitative research approach. A significant gap was found with respect to research exploring the actual experience of pharmacists' practice in medically assisted dying. Conclusion: There is an absence of studies exploring pharmacists' actual experiences in assisted dying practice. Research involving pharmacists that participate in legally sanctioned assisted dying will facilitate a meaningful understanding of the lived experience of pharmacy practice in this domain.

Objectives Reclassification of medicines from prescription to non-prescription increases timely access to treatment, promotes self-management of minor ailments and relieves healthcare system burden. Previous research identified that Australia lagged behind the United Kingdom and New Zealand in medicines reclassification. This study aimed to identify Australian pharmacists' opinions on the current state of medicines reclassification; the prescription medicines consumers requested without prescription; the medicines pharmacists believed should and should not be considered for reclassification; and perceived barriers to reclassification. Methods A 2016 national online survey that sought pharmacists' opinions on the state of reclassification, perceived barriers to reclassification and readiness of the profession for further reclassification. Pharmacists' comments were invited through open-ended questions. Key findings Two hundred and thirty-five valid surveys were completed. Respondents practised in community, hospital, consultant and academic contexts, and the majority were female (58.7%, n = 138). More than two thirds (70.66%, n = 166) of pharmacists reported receiving daily or weekly requests for non-prescription access to prescription medicines. The majority of pharmacists (71.7%) agreed that the Australian pharmacy profession is ready for further medicines reclassification, guided by patient safety, harm minimisation and medication continuance. The most prominent barrier to further reclassification was opposition from other healthcare professionals. Conclusions Australian pharmacists believe that their profession has the capacity to safely and effectively manage a wider range of non-prescription medicines through increased reclassification in the contexts of patient safety and risk mitigation. This study has contributed to the global conversation on non-prescription medicines access, providing momentum for practice and policy change.

BACKGROUND:Non-adherence to prescribed medicines is linked to adverse health outcomes in people living with chronic health conditions (CHCs). Multiple factors are known to contribute to non-adherence to medicines including polypharmacy, demographic features and disease and health systems. Both non-prescription and prescription medicines contribute to polypharmacy; however, there is limited data on the influence of non-prescription medicines to non-adherence.AIM:Therefore, the aim of the study was to investigate the influence of non-prescription medicines to non-adherence in an Australian population.METHODS:Data from the 2016 National Survey of a random sample of Australian adult residents were utilised in this study to investigate factors associated with non-adherence. Descriptive statistics, χ2 , regression and generalised linear models were used to assess the relationships between variables of interest. Narrative response and comments were used to provide further insight.RESULTS:This study recruited 1217 participants to explore factors associated with non-adherence to medicines. Weak but statistically significant correlations were identified showing the number of CHCs, patient's age, number of prescription medicines, number of non-prescription medicines and total number of medicines associated with non-adherence.DISCUSSION:The findings suggest that people living with CHCs and taking multiple medicines, including non-prescription medicines, are likely to be non-adherent to prescription medicines. This study shows the possible involvement of non-prescription medicines in contributing to non-adherence in an Australian population and suggests that future studies with a broader demographic are warranted.

The new Appendix M category added to the Standard for Uniform Scheduling of Medicines and Poisons (SUSMP) from February this year offers optimism that additional medicines might be considered for down-scheduling from S4 to S3. What do pharmacists think of the potential down-scheduling of specific S4 medicines? A team of Griffith University academics have been researching pharmacists to build a picture of the profession's views. Here the researchers - Denise Hope, Amary Mey, Fiona Kelly and Michelle King - summarise their findings and overview the potential implications.

Despite the life-preserving benefits of antiretroviral therapy (ART), some people living with HIV (PLHIV) delay, decline or diverge from recommended treatment while paradoxically being willing to use potentially dangerous substances, such as recreational drugs (RD) and complementary medicines (CM). During 2016 and 2017, interviews were conducted with 40 PLHIV, in Australia to understand drivers underpinning treatment decisions. While many believed ART to be effective, they expressed concerns about long-term effects, frustration over perceived lack of autonomy in treatment decisions and financial, emotional and physical burdens of HIV care. In contrast, they ascribed a sense of self-control over the use of RD and CM, along with multiple professed benefits. The perceived burden of ART emerged as a motivator for deviating from recommended treatment, while positive views towards RD and CM appear to justify use. This study may serve as guidance for the development of future strategies to address barriers to treatment uptake and adherence and subsequently health outcomes for PLHIV in Australia and elsewhere.

Introduction: Despite the risks involved, the use of drugs for recreational purposes is prevalent and generally well accepted. However, there is sparse research to explore the drivers of this phenomenon. Method: Semi-structured interviews were conducted with lay field observers of the recreational drug scene. The data were analyzed using ground theory to provide a framework for understanding motivators underpinning recreational drug use. Two ascribed benefits underpinned recreational drug use: 1) improved social connectedness and 2) enhanced performance. This paper reports on the relationship between drug use and performance enhancement. Results: Recreational drugs were used with the aim of enhancing performance in a number of ways, including to improve endurance, appearance, confidence, and personality. The majority of participants reported that drug taking offers personal and social benefits that outweighed the risks. Discussion and conclusions: In contrast to much of the literature, this study found that people perceived recreational drug use to have a range of positive effects that they wanted to take advantage of. This important finding adds to our understanding of the pulling power of drugs. Ultimately, the study highlights a need to rethink the preoccupation in drug strategies with negative physical, mental, and social outcomes as this would seem to be disconnected from actual experience and may result in a credibility gap for prevention education.

This article was migrated. The article was marked as recommended. BackgroundAssessment of health students' attainment of cognitive and psychomotor learning outcomes is achieved through the application of well-established methods. However, for learning in the affective domain, which, in the health professions, is closely associated with the development of 'professionalism', assessment remains challenging as there is a dearth of validated, reliable and practical tools available. The aim of this study was to develop and test the reliability of an instrument assess for evidence of affective learning in the reflective journals of health professional students who have participated in emotionally-impactive learning experiences.MethodBased on the findings of our earlier published work on the assessment of affective learning (Rogers, Mey & Chan, 2017), we developed a practical tool known as the Griffith University Affective Learning Scale (GUALS). We trained a pool of learning facilitators in the assessment of affective learning and the use of the instrument. Two facilitators, in parallel, independently graded each of the daily journals of 26 medical students undertaking a week-long immersive simulation activity. Assessors were asked to rate the highest level of affective learning evident in each journal. Statistical analysis explored score distribution, means and inter-rater differences.ResultsOne hundred and twenty-five journal entries (five from each of 25 students - one selected student had missing journals and was thus excluded from the analysis) were rated by a total of seven trained facilitators. Scores were normally distributed, with a mean of 4.23 (SD = 1.10) on a seven-point scale. Inter-rater absolute score concordance was seen for 45.6% of the journals, with a mean inter-rater difference of 0.56 points, maximum difference of 2.00 points and intraclass correlation coefficient of 0.86 (95% Cl: 0.80 - 0.90).ConclusionsGUALS, when utilised by trained assessors, appears to be a reliable tool to assess for evidence of affective learning in medical students' journals related to emotionally-impactive simulated clinical experiences. Further research should explore its utilisation in relation to other learning experiences such as real clinical setting encounters, as well as with students from other health professions and in other settings where the assessment of affective learning is important.

OBJECTIVES:Availability of medicines without prescription can increase consumers' timely access to treatment and promote self-management of minor ailments and adherence to long-term medications. Globally, access to relevant medicines has improved through increased reclassification of medicines from prescription to non-prescription availability. However, Australian reclassification lags behind countries with comparable health systems, and the factors influencing this are poorly understood.METHODS:Semi-structured interviews were conducted during May 2015 to explore the perspectives of Australian pharmacists and support staff on future reclassification. Interview responses were transcribed verbatim, and the data were analysed thematically, primarily informed by the general inductive approach.RESULTS:Participants identified a broad range of medicines as candidates for future reclassification by applying risk versus benefit judgements, assessing any medicines with potential for misuse and hazardous medicines as unsuitable. Key drivers for change in classification were underpinned by participants' desire to support consumers' management of minor ailments and adherence for those on long-term therapy. Barriers to reclassification were identified by pharmacy staff as internal, negatively impacting pharmacists' readiness for reclassification and external, negatively impacting the overall progress of change.CONCLUSIONS:While the research provided valuable insights to inform the ongoing discussion on future reclassification, a larger, more representative sample is needed to confirm these findings.