Interprofessional communication in healthcare: An integrative review.

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Importance Use of harmful and/or unnecessary medications in older adults is prevalent. This can lead to avoidable harms such as adverse drug reactions, falls, hospitalization, and mortality. Primary care physicians report that patient resistance to discontinuing medication use is a significant barrier to deprescribing. Objective To describe the attitudes of older adults toward deprescribing and to determine whether individual characteristics are associated with these attitudes. Design, Setting, and Participants For this population-based survey study of US Medicare beneficiaries 65 years and older, data were obtained from the Medication Attitudes module fielded through in-person interviews in round 6 of the National Health and Aging Trends Study (weighted response rate of round 6 was 88.5%). The questions in this module were drawn from the Patients’ Attitudes Towards Deprescribing questionnaire and its revised version. The Medication Attitudes module was fielded to a random one-third (n = 2124) of the National Health and Aging Trends Study participants (weighted response rate of this module was 94.8%). Main Outcomes and Measures Responses to 2 statements (“If my doctor said it was possible, I would be willing to stop one or more of my regular medicines” and “I would like to reduce the number of medicines I am taking”) were the main outcomes of interest. Results Of the 1981 Medicare beneficiaries included in the study, 1149 (55.2%, weighted) were women, and the majority (n = 715 [54.6%, weighted]) were 65 to 74 years old. A total of 1752 (92.0%, weighted) older adults reported being willing to stop taking 1 or more of their medicines if their physician said it was possible, and 1241 (66.6%, weighted) older adults wanted to reduce the number of medicines that they were taking. Older adults taking 6 or more medications had greater odds than those taking fewer than 6 medications of being willing to stop taking 1 or more of their medicines (adjusted odds ratio, 2.90; 95% CI, 1.74-4.82) and wanting to reduce the number of medicines that they were taking (adjusted odds ratio, 2.31; 95% CI, 1.71-3.13). Conclusions and Relevance Physicians considering deprescribing as part of comprehensive, patient-centered care should be reassured that a majority of older Americans are open to having 1 or more of their medicines deprescribed if their physician says it is possible, and more than two-thirds want to reduce the number of medicines that they are taking.

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Assessment of Attitudes Toward Deprescribing in Older Medicare Beneficiaries in the United States.

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Assessment For Learning In Higher Education

The Internet of Things (IoT) is a newly emerging term for the new generation of the Internet which allows understanding between interconnected devices. IoT acts as an assistant in healthcare and plays an extremely important role in wide scopes of medicinal services observing applications. Through determining the pattern of parameters that are observed, the character of the disease can be expected. Health specialists and technicians have developed a great system with low-cost healthcare monitoring for people suffering from many diseases using common techniques such as wearable devices, wireless channels, and other remote devices. Network-related sensors, either worn on the body or in living environments, collect rich information to assess the physical and mental state of the patient. This work focuses on scanning the existing e-health (electronic healthcare) monitoring system using integrated systems. The main goal of the e-health monitoring system is to offer the patient a prescription automatically according to his or her condition. The doctor can check patient health continuously without physical interaction. The study aims to explore the uses of IoT applications in the medical sector, and its role in raising the level of medical care services in health institutions. Also, the study will address the applications of IoT in the medical field and the extent of its use to enrich traditional methods in various health fields and to determine the extent of the ability of IoT to improve the quality of health services provided. The study relies on a descriptive research approach through an analysis of the literature published in this field. The results of the study refer to the application of IoT in the health institutions, it will help to obtain accurate diagnoses for patients, which will reflect on the quality of service provided to the patient. It will also reduce periodic patient reviews to the hospital by relying on IoT applications for remote diagnosis. Also, an application in health institutions will contribute to providing data correct for the diseases that patients suffer from, and hence employing them in preparing scientific research to obtain more accurate results. This paper introduces the review of the Internet-based healthcare monitoring system (HCMS) and the general outlines on opportunities and challenges of the patient’s Internet-based patient health monitoring system.

An Overview of Patient’s Health Status Monitoring System Based on Internet of Things (IoT)

The influence of mobile health applications on patient - healthcare provider relationships: A systematic, narrative review.

The use of multiple medicines, known as polypharmacy, poses a risk of harm that is greatest in older adults with multimorbidity. Deprescribing aims to improve health outcomes through ceasing medicines that are no longer necessary or appropriate due to changing clinical circumstances and patient priorities. General practitioners (GPs) and consultant pharmacists (CPs) are well positioned to facilitate deprescribing in primary care in partnership with older adults who present with inappropriate polypharmacy. In this article, we explore GPs' and CPs' views about inappropriate polypharmacy, the reasoning they apply to deprescribing in primary care, and identify factors that support or inhibit this process. Using focus group methodology and the Framework Method for thematic analysis, two major themes were discerned from the data-working through uncertainty and risk perception as a frame of reference. The findings provide important insights when devising methods for advancing and supporting deprescribing in primary care.

Negotiating "Unmeasurable Harm and Benefit": Perspectives of General Practitioners and Consultant Pharmacists on Deprescribing in the Primary Care Setting.

As for many health professionals, distance presents an enormous challenge to pharmacists working in rural and remote Australia. Previous studies have identified issues relating to the size of the rural and remote pharmacist workforce, and a number of national initiatives have been implemented to promote the recruitment and retention of pharmacists in rural and remote locations. The aim of this study was to explore and describe the current rural and remote pharmacy workforce, and to identify barriers and drivers influencing rural and remote pharmacy practice. A mixed-methods approach was used, which comprised a qualitative national consultation and a quantitative rural and remote pharmacist workforce survey. Semi-structured interviews (n=83) and focus groups (n=15, 143 participants) were conducted throughout Australia in 2009 with stakeholders with an interest in rural and remote pharmacy, practising rural/remote pharmacists and pharmacy educators, and as well as with peak pharmacy organizations, to explore the issues associated with rural/remote practice. Based on the findings of the qualitative work a 45-item survey was developed to further explore the relevance of the issues identified in the qualitative consultation. All registered Australian pharmacists practising in non-urban locations (RRMA 3-7, n=3,300) were identified and invited to participate in the study, with a response rate of 23.4%. The main themes identified from the qualitative consultation were the impact of national increases in the pharmacist workforce on rural/remote practice; the role of the regional pharmacy schools in contributing to the rural/remote workforce; and the perceptions of differences in pharmacist roles in rural/remote practice. The survey indicated that pharmacists practising in rural and remote locations were older than the national average (55.8 years versus 40 years). Differences in their professional role were seen in different pharmacy sectors, with hospital pharmacists spending significantly more time on the delivery of professional services and education and teaching, but less time on medication supply than community pharmacists. Rural/remote pharmacists were generally found to be satisfied with their current role. The main 'satisfiers' reported were task variety, customer appreciation, use of advanced skills, appropriate remuneration, happiness in their work location, sound relationships with other pharmacists, a happy team and relationships with other health professionals. This study described the distribution, roles and factors affecting rural and remote pharmacy practice. While the results presented provide an extensive overview of the rural/remote workforce, a comparable national study comparing rural/remote and urban pharmacists would further contribute to this discussion. Knowledge on why pharmacists chose to work in a particular geographical location, or why pharmacists chose to leave a location would further enrich our knowledge on what drives and sustains the rural/remote pharmacist workforce.

https://espace.library.uq.edu.au/view/UQ:350044/UQ350044_OA.pdf

A national study into the rural and remote pharmacist workforce

Background Multiple barriers and facilitators to the uptake of cognitive services in pharmacy practice have been identified. Pharmacists' attitudes and attributes have been described as barriers and facilitators in relation to the uptake of extended pharmacy services, in addition to those of a more systemic nature. Objectives To systematically scope and review the literature describing pharmacists' attitudes and attributes in relation to the implementation of cognitive services or role extension and to critically analyze and discuss their relevance as barriers or facilitators. Method A scoping review of the literature on attitudes and attributes of pharmacists in relation to pharmacy practice was performed, including 47 articles on attitudes and 12 on attributes, forming the basis for a critical analysis within theoretical frameworks. Results Pharmacists' attitudes toward role extensions and new pharmacy service models are generally positive and their personal attributes and personality traits appear favorable for roles as health professionals. Pharmacists perceived a number of barriers to the uptake of extended roles. Conclusion Pharmacists' attributes, including personality traits, and attitudes favor the implementation of cognitive and patient-focused health care services and should not be regarded as major barriers to the uptake of extended pharmacy practice roles. Framing their attitudes and attributes within the theories of planned behavior and personality trait theories indicates that individual motivation needs to be underscored by systemic support for pharmacy practice change to succeed on a wide scale.

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Attitudes and attributes of pharmacists in relation to practice change – A scoping review and discussion

Background Interprofessional communication skills are important for pharmacists to build collaborative relationships with other health professionals, integrate into healthcare teams, maximise their effectiveness in patient care in addressing complex care needs and meet the demands of health care reforms Objective This qualitative study explores clinical pharmacists’ experiences and reflections after completing a learning and practice module which introduced them to a framework for successful interprofessional communication Setting The postgraduate clinical pharmacy program at The University of Queensland and the clinical pharmacy practice environments of forty-eight hospital and seven community based pharmacists Method A learning and practice module outlining a framework for successful interprofessional communication was designed and integrated into a postgraduate clinical pharmacy program Enrolled pharmacists applied newly learnt communication skills in pro-actively initiated, clinical discussions with a health professional in their practice environment They provided written reflections on their experiences which were analysed using thematic analysis Main outcome Pharmacists’ perceptions of the impact of applying the communication framework during their interaction with a health professional in their practice setting Results Themes which emerged from reflections described pharmacists’ confidence and capabilities to successfully conduct a clinical discussion with a health professional after initial apprehension and nervousness about the scheduled interaction The application of the communication framework enhanced their perception of their professional identity, credibility and ability to build a collaborative working relationship with other health professionals Conclusions Pharmacists perceived that a learning and practice module for successful interprofessional practice integrated into a postgraduate clinical pharmacy program enhanced their interprofessional communication skills The development of pro-active, interprofessional communication skills has the potential to increase interprofessional collaboration and pharmacists’ personal role satisfaction Pharmacists also observed it added value to their professional contribution in health care teams when addressing the demands of increasingly complex health care needs and reforms

Karen Luetsch

Papers

The influence of mobile health applications on patient - healthcare provider relationships: A systematic, narrative review.

Negotiating "Unmeasurable Harm and Benefit": Perspectives of General Practitioners and Consultant Pharmacists on Deprescribing in the Primary Care Setting.

A national study into the rural and remote pharmacist workforce

Attitudes and attributes of pharmacists in relation to practice change – A scoping review and discussion

Interprofessional communication training: benefits to practicing pharmacists