Chronic obstructive pulmonary disease (COPD) is a common respiratory condition that has a significant impact on society. Acute exacerbations of COPD (AECOPDs) are characterised by a rapid worsening of symptoms, often triggered by respiratory infections, environmental pollutants and smoking. These exacerbations accelerate disease progression and increase mortality risk while contributing to a high burden on healthcare resources. The management of AECOPDs relies on pharmacological treatments, including bronchodilators, corticosteroids and antibiotics, which must be tailored to the individual patient due to the heterogeneous nature of exacerbations. Current guidelines from the Global Initiative for Chronic Obstructive Lung Disease (GOLD) and the National Institute for Health and Care Excellence (NICE) provide frameworks for treatment but highlight the ongoing challenges in managing AECOPDs effectively. Further research is essential to enhance understanding and optimise therapeutic strategies, ultimately improving outcomes for patients living with COPD.

Chronic obstructive pulmonary disease (COPD) is a progressive, largely irreversible respiratory condition that has a significant impact on the UK healthcare system. Despite effective treatments, optimal COPD management requires a holistic, patient-centred approach, with self-management playing a crucial role. This article explores self-management interventions, including tailored education, medication adherence support, symptom monitoring and written action plans. Nurses are well positioned to assess health literacy and address barriers to adherence through personalised, non-judgemental strategies. Interventions also encompass lifestyle modification, such as smoking cessation, physical activity, nutrition and psychological support. Emerging digital tools offer new opportunities for enhancing patient engagement. Recognising the heterogenous nature of COPD, interventions must be individualised to each patient's experience. Nurses' ongoing contact with patients enables them to deliver meaningful, tailored support, ultimately improving self-efficacy and health outcomes while reducing healthcare burden.

Respiratory conditions such as asthma and chronic obstructive pulmonary disease are significant public health challenges. Despite effective treatments, the rising mortality rates indicate a need for improved approaches in the management of these conditions. Patient adherence, which is known to be a key factor in treatment success, has been identified as low in these patient populations. Strategies to improve adherence include patient-centred interventions targeting knowledge of the treatment of their condition, ensuring that the most appropriate inhaler device is prescribed for an individual patient, and that all patients are followed up as recommended. Ultimately, this aims to improve patient outcomes in respiratory care.

OBJECTIVE:Identify facilitators and barriers to successful medicines management for people with dementia (PwD) in primary care from the perspectives of community-dwelling PwD and carers.METHODS:Semi-structured interviews conducted with PwD and carers in Northern Ireland. The 14-domain Theoretical Domains Framework guided data collection and analysis. Interviews explored participants' experiences and perceptions of medicines management. PwD also completed the Beliefs about Medicines Questionnaire indicating their level of agreement with statements about medicines. Qualitative data were analysed using the framework method and content analysis. Quantitative data were analysed descriptively.RESULTS:Eighteen PwD and 15 carers were interviewed. PwD believed they were competent with medicines management ('beliefs about capabilities'). Most PwD reported having strategies to prompt them to take their medicines ('memory, attention and decision processes'). Carers played an important role in supporting PwD with medicines management ('social influences') and monitoring adherence ('behavioural regulation') and anticipated having to take on a greater role as patients' cognitive impairment worsened ('beliefs about consequences'). Participants highlighted assistance provided by community pharmacies with medicines acquisition and delivery ('environmental context and resources') and placed great trust in primary healthcare professionals ('social influences'). PwD had positive attitudes towards medication and believed strongly in the necessity of their medicines.CONCLUSIONS:This is the first study to use a theoretical approach to explore medicines management for community-dwelling PwD. The findings provide new insights into the critical role of carers in facilitating optimal medicines management and will inform future intervention development, in which carers' needs assessment and involvement will be key.

Background People with dementia (PwD) face unique challenges with medicines management, yet little is known about these challenges from the perspectives of primary healthcare professionals, particularly general practitioners (GPs) and community pharmacists. Few medicines management interventions have been developed which are aimed at community-dwelling PwD. This study sought to develop an intervention to improve medicines management for PwD in primary care using a theory-informed approach. Methods Semi-structured interviews were conducted with GPs (n = 15) and community pharmacists (n = 15) to explore participants' views and experiences of medicines management for PwD, and their perceptions of barriers and facilitators to successful medicines management for PwD. The 14-domain Theoretical Domains Framework was the underpinning theoretical guide, allowing key theoretical domains to be identified and mapped to behaviour change techniques (BCTs) which are considered the 'active ingredients' of an intervention. Draft interventions were developed to operationalise selected BCTs and were presented to GPs and community pharmacists during task groups. Final selection of an intervention for feasibility testing was guided by feedback provided during these task groups and through application of the APEASE (Affordability, Practicability, Effectiveness/cost-effectiveness, Acceptability, Side-effects/safety, Equity) criteria. Results Participants expressed a number of concerns about medicines management for PwD, particularly monitoring adherence to medication regimens and conducting medication review. Two draft interventions comprising selected BCTs ('Modelling or demonstration of behaviour'; 'Salience of consequences'; 'Health consequences'; 'Social and environmental consequences'; 'Action planning'; Social support or encouragement', 'Self-monitoring of behaviour') were developed, each targeting GPs and community pharmacists. Following the task groups and discussions within the research team, the community pharmacy-based intervention was selected for future feasibility testing. The intervention will target community pharmacists to conduct a medication review (incorporating an adherence check) with a PwD, delivered as an online video demonstrating key behaviours. The video will include feedback emphasising positive outcomes of performing the behaviours. Action planning and a quick reference guide will be used as complementary intervention components. Conclusions A community pharmacist-based intervention has been developed targeting medicines management for PwD in primary care using a systematic, theory-informed approach. Future work will determine the usability and acceptability of implementing this intervention in clinical practice.

General practice pharmacists can have an important contribution to safe and effective pharmacotherapy. Clinical pharmacy services provided by general practice pharmacists have demonstrated a reduction in the number of drug therapy problems and improvement in intermediate outcomes such as blood pressure, cholesterol and blood glucose. So far, evidence on the effectiveness in terms of clinical outcomes such as morbidity or mortality is lacking. Hence, the aim of this study was to evaluate the effect of general practice pharmacists on medication-related hospitalisations. Design: A multicentre, pragmatic, controlled intervention study with pre-post comparison (2013 versus June 2014–May 2015) comparing general practice pharmacist-led care (intervention) with two current models of pharmaceutical care (usual care and usual care plus). Setting: Twenty-five general practices in the Netherlands Participants: Patients at high risk of medication problems, defined as being aged 65 years or older and using five or more chronic medications Intervention and controls: For the intervention group, ten specially trained pharmacists were employed in general practices to take integral responsibility for the pharmaceutical care. They provided a broad range of services both on patient level (e.g., clinical medication review) and practice level (e.g., quality improvement projects). In the control groups, pharmaceutical care was provided ‘as usual’ by general practitioners collaborating with a community pharmacist and ‘as usual plus’ where community pharmacists had an additional training in performing medication reviews. Assessment of medication-related hospitalisations: multistep and case-by-case by an expert panel of all acute hospital admissions, based on a modified version of the algorithm by Kramer et al. Analysis: a Poisson mixed model with adjusted rate ratios The preliminary results showed that overall, 822 possible medication-related hospitalisations were identified among 11,281 high-risk patients during the intervention period. After adjustment for clustering and adjustment for potential confounders, the mean rates of medication-related hospitalisations were lower in the intervention and usual care plus group than in the usual care group. As a result, the adjusted rate ratio of medication-related hospitalisations was significantly lower in the intervention group compared to usual care. No difference was found between the intervention group and the usual care plus group. General practice pharmacists play a vital role in improving medication safety by reducing medication-related hospitalisations compared with usual care. Interestingly, outcomes in intervention and usual care plus practices did not differ. This is probably related to the fact that the usual care plus practices were already highly integrated care settings. Since the researchers chose not to randomise, the comparison is at risk of bias, even though the results were corrected for baseline differences. The hospitalisations were also possibly medication-related, including various levels of certainty about the causality. To assess definite causality (if possible), data including interviews with involved doctors, pharmacists and patients would have been necessary. To conclude, high-risk patients will benefit most from integrated pharmaceutical care and further implementation of general practice pharmacists should be promoted.

The recently published ‘Achieving Excellence in Pharmaceutical Care: a Strategy for Scotland’ urges community pharmacy (CP) to make itself the ‘first port of call’ for healthcare advice. The aim of this research is to explore the Scottish general public's awareness of CP services and their openness to consider CP their ‘first port of call’ for healthcare advice.

BACKGROUND:people with dementia (PWD), and their carers, face challenges with medicines management activities. As interventions to support medicines management for PWD are developed, consideration must be given to the outcomes chosen to measure their effectiveness. A Core Outcome Set (COS) is a minimum set of outcomes to be measured in all trials in a particular clinical area, which seeks to reduce heterogeneity of outcome reporting across trials.OBJECTIVE:to develop a COS for trials assessing the effectiveness of medicines management interventions for PWD in primary care.METHODS:a comprehensive list of outcomes was compiled through a systematic review and semi-structured interviews with PWD (n = 18), their carers (n = 15), community pharmacists (n = 15) and general practitioners (n = 15). These outcomes were rated by a Delphi panel (n = 52) on a nine-point Likert scale from 1 (limited importance) to 9 (critical) during three sequential rounds of questionnaire distribution. The Delphi panel comprised participants with expertise in dementia and medicines management, including academics and healthcare professionals. An outcome was eligible for inclusion in the COS if ≥70% of participants rated it critical and <15% of participants rated it of limited importance.RESULTS:twenty-nine outcomes identified from the systematic review and stakeholder interviews were presented to the Delphi panel. Consensus was reached on 21 outcomes, of which the 7 most highly rated were recommended for inclusion in the COS.CONCLUSION:this study used robust methodology to develop a COS for medicines management interventions for PWD. Future work should identify the most appropriate tools to measure these outcomes.

The importance of optimising medicines management for people with dementia has been emphasised through research and policy. However, evidence is currently lacking regarding how to achieve this in this patient population. The aim was to assess the effectiveness of medicines management interventions for people with dementia living in their own home or a care home, with or without nursing care. A systematic literature search was conducted in February 2016 across six electronic databases and three trial registries. Inclusion criteria were randomised controlled trials of medicines management (prescribing, dispensing, adherence, and/or review) interventions for people with dementia living in their own homes or care homes, with or without nursing. An assessment of quality was conducted for all studies, using the Cochrane tool for assessing the risk of bias. All outcomes were considered using a narrative approach. Overall, 1365 articles were identified, with three studies eligible for inclusion (n = 475 participants). The studies were heterogeneous both in terms of intervention components, setting, and outcomes used. Aspects of medicines management targeted included medication review, adherence, and administration. Improvements in psychotropic prescribing were observed; however, the interventions had limited effects on other outcomes such as wellbeing, falls and dementia severity. This review highlights the limited number of studies examining medicines management interventions for people with dementia. Of the work that has been conducted to date, emphasis has been placed on psychotropic drug use. Future research must target community-dwelling dementia patients and take a holistic approach to medicines management.

In this so-called ‘post-truth era’, the importance of robust evidence has assumed more significance than ever. Healthcare needs to be informed by rigorous research that can underpin practice and healthcare delivery and ultimately improve outcomes for patients. But in the development and implementation of studies that will generate the necessary evidence, what outcomes should be measured? A cursory overview of studies performed in any given area reveals a huge number of outcomes being measured, making evidence synthesis and assessing the overall effectiveness of interventions very difficult. For example, Beuscart et al. undertook a systematic review of trials in medication review in older people, reporting that 327 different outcomes were identified in 47 published studies. There was marked heterogeneity in the outcomes used, with adverse events and patient-related outcomes poorly evaluated. In another field of research, more than 25 000 outcomes had appeared only once or twice in oncology trials. Therefore, in an effort to overcome the issues of range and heterogeneity within outcome selection, the Core Outcome Measures in Effectiveness Trials (COMET) Initiative was established (http://comet-initiative.org/). COMET advocates for the development and application of agreed standardised sets of outcomes known as ‘core outcome sets’ (COSs). A COS represents the minimum that should be measured and reported in all trials of a specific condition or field of research. The COMET website maintains a database of all ongoing and published COS studies to minimise duplication and share examples of good practice. Recently added COS projects include ‘Development of an International Core Outcome Set for Best Care for the Dying Person’, and ‘Development of a provide core domain set for polymyalgia rheumatica’ (http://comet-initiative.org/). Guidance has been provided to help researchers develop a COS in any given area. The essential steps are as follows: (1) establishing the scope of the COS, (2) identifying the existing knowledge, (3) stakeholder involvement and (4) a consensus exercise. Scope refers to the specific area of health or health care to which the COS will apply. It should also consider the health condition, populations and types of interventions covered by the COS. For example, in the case of medicines use in older people, the scope may include all older people or only those who reside in care homes. Furthermore, the focus may include all medications, or only those used in the management of dementia. Identifying existing knowledge requires some form of literature search to establish what outcomes have been measured and reported in previous studies in the area. COS developers will often consult systematic reviews in the area of the COS or may undertake a systematic review to allow them to compile a list of outcomes for potential inclusion in a COS. The third step in COS development is the involvement of key stakeholders. This may include patients and the public, healthcare professionals, regulators, industry representatives and researchers. This list of stakeholders is not exhaustive, and their involvement should be informed by the scope of the COS in question. Stakeholder views, elicited through interviews or focus groups on what should be included in a COS, are essential to ensure that the outcomes selected are meaningful, not just from a clinical and scientific standpoint, but also from a patient’s perspective. Identifying and accessing key patient and public stakeholders can be particularly challenging, but liaising with support groups, patient advocacy groups and/or charities may be a helpful strategy. The fourth and final step in COS development is an exercise, whereby stakeholder views are sought using a consensus method to condense the outcomes suggested in the preceding stages into the final COS. There is no single preferred consensus method, although the Delphi technique has been widely used. This technique is a long-established method that facilitates informed decision-making by obtaining consensus from a range of opinions in areas of research where there is limited information. The Delphi technique can be applied through face-to-face stakeholder panel meetings led by a facilitator or via the completion of questionnaires distributed by post or online, or using a combination of a questionnaire

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