AbstractBackground: Patients often experience changes to their medicines regimen while they are in hospital, and it is healthcare policy in the UK to ensure that patients’ medicines are managed optimally after discharge from secondary care. However, research suggests that a substantial proportion of patients who have been discharged from hospital subsequently experience medicines-related problems and require support. Patient medicines helpline services (PMHS) have been set up by some National Health Service (NHS) Trusts in England, with the aim of providing medicines-related support to discharged patients. However, to date, little high-quality research has been conducted to examine the impact of PMHS upon service users and healthcare organisations.
Aims: The aim of this doctoral research was to address the following question: What is the impact of National Health Service patient medicines helpline services upon service users and healthcare organisations? In order to achieve this, the RE-AIM framework was used throughout the research. RE-AIM comprises five dimensions which are considered important for evaluating the impact of interventions (Reach, Effectiveness, Adoption, Implementation, and Maintenance).
Methods: A mixed-methods approach was adopted, and five studies were conducted. In study one, an online survey was sent to pharmacy professionals at all 226 acute, mental health, specialist, and community NHS Trusts in England in 2017. Its aim was to obtain key data concerning the provision and usage of PMHS in NHS Trusts in England. Studies two and three were systematic reviews. Study two systematically examined the available literature regarding the effectiveness of medicines information services for patients and the general public. Study three systematically examined the
available literature regarding the characteristics of users of PMHS, and the types of enquiries they make. Studies four and five were qualitative. Study four explored thirtyfour pharmacy professionals’ perceptions and experiences of providing PMHS, and its data were analysed using Framework Analysis. Study five explored forty service users’ experiences of contacting PMHS, and its data were analysed using Inductive Reflexive Thematic Analysis.
Main findings: The findings suggest that PMHS have the potential to provide timely medicines-related support to patients and carers when they are feeling vulnerable during the transition from secondary to primary care. Additionally, PMHS are perceived as effective and valued from the perspectives of pharmacy professionals who provide them, and patients and carers who use them (e.g., satisfaction ratings are excellent, and users typically rate that the advice was followed). However, the evidence regarding the effectiveness of PMHS is limited by primarily consisting of subjective experiences and perceptions (e.g., survey and interview data) rather than
hard outcomes (e.g., symptoms, disease recurrence, readmission rates). The findings also show that, despite their perceived benefits, the limited adoption, implementation, and reach of PMHS hinders their overall impact. For example, approximately only fifty percent of Trusts provide this service, and of those that do, on average only five enquiries are received per week per Trust. Additionally, the availability and promotion of extant PMHS could be improved. The limited adoption, implementation, and reach of PMHS is largely a consequence of limited resources and staffing to adequately provide this service. However, despite this, the findings suggest that once adopted, PMHS are likely to become a relatively stable service for NHS Trusts.
Conclusions: Based upon the findings of this doctoral research, practice
recommendations have been made to improve the delivery of extant PMHS, in order to provide a more valued and efficient service. This has largely focused upon improving the availability and promotion of PMHS, and for pharmacy professionals who provide a PMHS to share their learning with the wider MI community regarding ways to provide a PMHS with limited resources. However, since PMHS are currently provided suboptimally (e.g., they are only provided by half of NHS Trusts, and they are provided in a way that does not meet national standards), and since research has not been conducted to establish their cost-effectiveness, another recommendation is
for stakeholders to consider the best way to support patients with their medicines following discharge from secondary care. Thus, research recommendations from this doctoral research focus upon exploring the future of PMHS, and establishing the best way to support all patients who need help with their medicines following discharge from secondary care, which is efficient and cost-effective yet without diminishing quality and perceived value.
|Date of Award||16 Sep 2020|
|Supervisor||Abbie Jordan (Supervisor), Jenny Scott (Supervisor) & Matthew Jones (Supervisor)|