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Electronic adherence monitoring (EAM) is increasingly used to improve adherence. However, there is limited evidence on the effect of EAM in across chronic conditions and on patient acceptability. We aimed to assess the effect of EAM on adherence and clinical outcomes, across all ages and all chronic conditions, and examine acceptability in this systematic review and meta-analysis. A systematic search of Ovid MEDLINE, EMBASE, Social Work Abstracts, PsycINFO, International Pharmaceutical Abstracts and CINAHL databases was performed from database inception to December 31, 2020. Randomised controlled trials (RCTs) that evaluated the effect of EAM on medication adherence as part of an adherence intervention in chronic conditions were included. Study characteristics, differences in adherence and clinical outcomes between intervention and control were extracted from each study. Estimates were pooled using random-effects meta-analysis, and presented as mean differences, standardised mean differences (SMD) or risk ratios depending on the data. Differences by study-level characteristics were estimated using subgroup meta-analysis to identify intervention characteristics associated with improved adherence. Effects on adherence and clinical outcomes which could not be meta-analysed, and patient acceptability, were synthesised narratively. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline was followed, and Risk of bias (RoB) assessed using the Cochrane Collaboration's RoB tool for RCTs. The review is registered with PROSPERO CRD42017084231. Our search identified 365 studies, of which 47 studies involving 6194 patients were included. Data from 27 studies (n = 2584) were extracted for the adherence outcome. The intervention group (n = 1267) had significantly better adherence compared to control (n = 1317), (SMD = 0.93, CI:0.69 to 1.17, p<0.0001) with high heterogeneity across studies (I2 = 86%). There was a significant difference in effect according to intervention complexity (p = 0.01); EAM only improved adherence when used with a reminder and/or health provider support. Clinical outcomes were measured in 38/47 (81%) of studies; of these data from 14 studies were included in a meta-analysis of clinical outcomes for HIV, hypertension and asthma. In total, 13/47 (28%) studies assessed acceptability; patient perceptions were mixed. Patients receiving an EAM intervention had significantly better adherence than those who did not, but improved adherence did not consistently translate into clinical benefits. Acceptability data were mixed. Further research measuring effects on clinical outcomes and patient acceptability are needed.

Despite anti-inflammatory reliever (AIR) therapy now being the preferred treatment choice across all severities of asthma, many patients are still \"attached\" to their short-acting beta -agonist (SABA) reliever, believing this to be the best way to control their asthma. To encourage individuals to switch to AIR, it is important to first identify the beliefs that patients hold about AIR. The aim of this paper was to describe the initial development and validation of the BMQ-AIR , a six-item screening tool which assesses and identifies patients' treatment beliefs about switching to AIR therapy. Statements were identified from the primary literature that assessed patients' perceptions of AIR therapy and adapted from the Beliefs about Medicines Questionnaire (BMQ). Internal reliability was examined using Cronbach's alpha coefficient. Construct validity was evaluated by comparing scores on BMQ-AIR with a validated measure of medication adherence and SABA beliefs. A total of 446 participants completed the online survey. The BMQ-AIR contained two subscales with three items each. Both the Necessity and Concerns subscales demonstrated good internal reliability, with Cronbach's α-values of 0.70 and 0.69, respectively. Both subscales were negatively correlated with self-report inhaled corticosteroid adherence (Necessity: r = -0.28, < 0.0001; Concerns: r = -0.28, < 0.0001) and positively correlated with SRQ scores (Necessity: r = 0.51, < 0.0001; Concerns: r = 0.44, < 0.0001). Preliminary findings indicate that BMQ-AIR demonstrates satisfactory reliability and validity. BMQ-AIR is a promising tool that may help tailor interventions to an individual's specific beliefs and barriers to switching to better support individuals in stopping SABA and initiating AIR therapy.

Background The period immediately following hospital discharge is a time of heightened vulnerability for patients compounded by poor communication and information transfer between hospital and primary care healthcare professionals. These gaps contribute to medication-related harm, which accounts for a substantial proportion of preventable readmissions and emergency department presentations. This study explored the perspectives of consumers and healthcare professionals on discharge medicine information handover to inform the development of an intervention to improve transitions of care. Methods Qualitative methodology was used through focus group discussions in Southeast Queensland, Australia, between March–August 2024. Participants included hospital-based doctors, nurses, and pharmacists; primary care healthcare professionals (general practitioners, community pharmacists, and credentialled pharmacists); and consumers and carers with experience of post-discharge medicine management. Data were audio-recorded, transcribed verbatim, and analysed inductively using thematic analysis. Rigour was enhanced through iterative coding cycles, reflexive team discussions, and triangulation across diverse stakeholder groups. Results Seventy-five participants contributed to 12 focus groups. Three overarching themes with eight subthemes were identified. First, discharge documentation was frequently delayed, incomplete, or poorly structured, with workforce constraints and fragmented digital systems compounding these issues. Second, primary care providers often received no notification of discharge information, with inaccurate contact details and absent verification processes leading to missed or delayed follow-up. Third, patients reported insufficient or unclear medicine information at discharge, limiting their confidence in post-discharge self-management. Proposed solutions included greater pharmacist involvement in discharge planning, decoupling discharge medicine lists from discharge summaries, automated alerts to confirm receipt of information, improved use of digital health systems, and enhanced patient/carer engagement. Conclusion This study highlights persistent challenges in the transfer of medicine information at hospital discharge at system, healthcare professional, and patient levels. Participants identified practical strategies to address these gaps, including pharmacist-led interventions, digital solutions, and patient-centred discharge practices. These findings will inform the design of a multifaceted intervention to improve medicine handover and reduce 30-day hospital readmissions due to medication-related harm. Broader system investment in workforce capacity, digital integration, and patient engagement will be essential to promote safer transitions of care. Trial registration number This trial is registered with the Australian New Zealand Clinical Trials Registry: ACTRN12624000480583p, registered 19 April 2024, https://www.anzctr.org.au/ACTRN12624000480583p.aspx .

Reducing antimicrobial resistance (AMR) is a priority for public health. Inappropriate patient demand is an important driver of unnecessary antibiotic use. To develop an effective intervention to reduce inappropriate demand for antibiotics in upper respiratory tract infections (URTIs), it is important to identify patient perceptions that influence demand for, and appropriate use of antibiotics. To identify and describe the beliefs about antibiotics necessity and concerns that patients with URTIs have, in Riyadh, Saudi Arabia. An exploratory qualitative approach was used. One-to-one, face-to-face or telephone semi-structured interviews were conducted with participants recruited using purposive sampling (based on age and gender) from primary healthcare centre in Riyadh, Saudi Arabia were conducted. Only adult patients who currently experience URTIs symptoms and agreed to participate were recruited. Recruitment for interviews continued until data saturation point was reached. The interview guide explored patients' necessity beliefs and concerns about antibiotics, AMR perceptions, and expectations from URTIs consultation. Interview transcripts were coded using QSR NVivo 12 using framework analysis informed by the Necessity-Concerns Framework to identify key motivations driving antibiotic requests and consultations. the study interviewed 32 participants (44% were male, average age was 36.84). Results identified that the patients often relate their personal need for antibiotics when encountering an URTIs symptoms to the type, severity and duration of symptoms. Patients also linked antibiotics with quicker recovery, generally expressing few concerns about antibiotics mainly because of its short duration of use. However, some conveyed their concern about frequent administration of antibiotics and effect on the body's immune system function, which may make them more prone to infections in the future. Participants varied widely in their awareness of AMR; this was associated with many misconceptions, such as confusing AMR with antibiotics efficacy and tolerance. Interestingly, the interplay between necessity beliefs and concerns was observed to influence the decision to start and stop antibiotic, potentially impacting inappropriate antibiotic demand and unnecessary use. This study highlighted important beliefs and misconceptions about antibiotics and AMR in Saudi population which can be targeted in future interventions to reduce inappropriate demand for antibiotics and optimise appropriate usage.

The aim of this study was to evaluate the feasibility of a community pharmacy-delivered intervention to shift patients' beliefs about short-acting beta agonists (SABA) in asthma management. The study targeted individual beliefs about SABA and assessed actual SABA use, focusing on reducing SABA use as well as adherence to inhaled corticosteroids (ICS) as a preventive measure. This non-randomized, before-and-after feasibility study enrolled participants with asthma from four community pharmacies in Auckland, New Zealand. Eligible participants were aged 18 years and above and were prescribed a SABA for their asthma. The intervention included the SABA reliance questionnaire to determine the degree of SABA reliance, verbal discussions with pharmacists personalised according to the degree of SABA reliance identified, and referral to general practitioners as appropriate. Of the 44 patients who consented into the study, 19 were in the control group and 16 in the intervention group. Recruitment and retention were modest, with 10 control and five intervention participants completing the 90-day follow-up. Although not statistically significant, preliminary results indicated reduced SABA reliance and increased ICS adherence in the intervention group, and reduced SABA refill. Feedback showed that 78% of intervention participants found the information easy to understand, and 56% expressed intent to consult their general practitioners. Pharmacy staff found the intervention feasible but noted time constraints as a barrier to intervention delivery. The study demonstrates that a community pharmacy-delivered intervention is feasible and acceptable to both patients and pharmacists. While preliminary results show a positive effect on reducing SABA reliance and improvement of ICS adherence, the results were not statistically significant due to the small numbers recruited. This suggests a larger randomised trial is indicated. This intervention holds promise for addressing the over-reliance on SABA in asthma management and improving adherence to preventive therapies.

Background General practitioners (GP) and community pharmacists need information about hospital discharge patients’ medicines to continue their management in the community. This necessitates effective communication, collaboration, and reliable information-sharing. However, such handover is inconsistent, and whilst digital systems are in place to transfer information at transitions of care, these systems are passive and clinicians are not prompted about patients’ transitions. There are also gaps in communication between community pharmacists and GPs. These issues impact patient safety, leading to hospital readmissions and increased healthcare costs. Methods A three-phased, multi-method study design is planned to trial a multifaceted intervention to reduce 30-day hospital readmissions. Phase 1 is the co-design of the intervention with stakeholders and end-users; phase 2 is the development of the intervention; phase 3 is a stepped wedge cluster randomised controlled trial with 20 clusters (community pharmacies). Expected intervention components will be a hospital pharmacist navigator, primary care medication management review services, and a digital solution for information sharing. Phase 3 will recruit 10 patients per pharmacy cluster/month to achieve a sample size of 2200 patients powered to detect a 5% absolute reduction in unplanned readmissions from 10% in the control group to 5% in the intervention at 30 days. The randomisation and intervention will occur at the level of the patient’s nominated community pharmacy. Primary analysis will be a comparison of 30-day medication-related hospital readmissions between intervention and control clusters using a mixed effects Poisson regression model with a random effect for cluster (pharmacy) and a fixed effect for each step to account for secular trends. Trial registration This trial is registered with the Australian New Zealand Clinical Trials Registry: ACTRN12624000480583p , registered 19 April 2024.

Over-use of SABA is associated with poor asthma control and greater risk of exacerbations and death. Identifying and addressing the beliefs driving SABA over-reliance is key to reducing over-use. This study aimed to assess the utility, impact and acceptability of the Reliever Reliance Test (RRT), a brief patient self-test behaviour-change tool to identify and address SABA over-reliance. Patients with asthma who completed the RRT in Argentina were invited to an online survey exploring the acceptability of the RRT, and its impact on patients’ perceptions of SABA and intention to discuss asthma treatment with a doctor. 93 patients completed the questionnaire. The RRT classified 76/93 (82%) as medium-to-high risk of SABA over-reliance (a mindset where SABA is perceived as the most important aspect of asthma treatment), with 73% of these reporting SABA overuse (3 or more times a week). 75% intended to follow the RRT recommendations to review their asthma treatment with their doctor. The RRT is acceptable to patients and was effective at raising awareness of, identifying and addressing SABA over-reliance and encouraging patients to review their treatment with their doctor.

IntroductionA model of general practitioner (GP) and pharmacist collaboration in primary care may be an effective strategy to reduce medication-related problems and provide better support to patients after discharge. The aim of this study is to investigate whether a model of structured pharmacist and GP care reduces hospital readmissions in high-risk patients.Methods and analysisThis protocol details a stepped-wedge, cluster-randomised trial that will recruit participants over 9 months with a 12-month follow-up. There will be 14 clusters each representing a different general practice medical centre. A total of 2240 participants will be recruited from hospital who attend an enrolled medical centre, take five or more long-term medicines or whose reason for admission was related to heart failure or chronic obstructive pulmonary disease.The intervention is a multifaceted service, involving a pharmacist integrated into a medical centre to assist patients after hospitalisation. Participants will meet with the practice pharmacist and their GP after discharge to review and reconcile their medicines and discuss changes made in hospital. The pharmacist will follow-up with the participant and liaise with other health professionals involved in the participant’s care. The control will be usual care, which usually involves a patient self-organising a visit to their GP after hospital discharge.The primary outcome is the rate of unplanned, all-cause hospital readmissions over 12 months, which will be analysed using a mixed effects Poisson regression model with a random effect for cluster and a fixed effect to account for any temporal trend. A cost analysis will be undertaken to compare the healthcare costs associated with the intervention to those of usual care.Ethics and disseminationThe study has received ethical approval (HREC/16/QRBW/410). The study findings will be disseminated through peer-reviewed publications, conferences and reports to key stakeholders.Trial registration numberACTRN12616001627448

IntroductionSerotonin syndrome (SS) is an iatrogenic, potentially life-threatening, condition associated with a number of non-specific symptoms for which there is no objective diagnostic test. The use of serotonergic medications in Palliative Care is common and therefore the risk of SS is potentially higher in this patient population, however the incidence of SS is unknown, and it may be under-recognised. Our aim was to explore the experiences of Palliative Care clinicians in diagnosing and managing SS. MethodsRecruitment was conducted through convenience sampling of specialist Palliative Care clinicians who were members of a regional professional network (the Eastern Region Palliative Medicine Development Group). Three focus groups were conducted concurrently in November 2022 (two in-person and one virtually) with a total of 16 participants, using a topic guide relating to: their clinical experiences of SS, the challenges of recognising SS, and suggestions for improving clinical practice with regards to SS. The audio recordings of these discussions were transcribed verbatim and analysed using reflexive thematic analysis in an inductive latent approach. ResultsOf the 16 participants, 94% were Palliative Care Consultants and 6% were Specialty Doctors in Palliative Care, with specialist clinical experience in Palliative Care ranging from 5 to 30 years (mean 17.1 years). Analysis generated four initial themes: (1) ‘SS is unfamiliar’, (2) ‘Diagnosis of SS is easy to miss’, (3) ‘Diagnosis of SS is prompted by triggers’, and (4) ‘The importance of SS diagnosis lacks clarity’. ConclusionThe diagnosis and management of SS in Palliative Care are characterised by ambiguity. This qualitative research suggests that recognition of SS is challenging and requires purposeful consideration. As a result, it may be being overlooked, particularly in less severe cases. Suggestions to improve this include promoting a higher index of suspicion of SS, and encouraging pharmacovigilance.