p1 _ HPE100 _ cover _ v2 . indd 1 09 / 03 / 2022 16:40
18 | Issue 100 | hospitalpharmacyeurope . com hospitalpharmacyeurope . com | Issue 100 | 19
14 | Issue 100 | hospitalpharmacyeurope . com hospitalpharmacyeurope . com | Issue 100 | 15
Re-register to continue receiving Hospital Pharmacy Europe
Issue 100 | hospitalpharmacyeurope . com
100 TH
ISSUE
REVIEW
INSIDE
Following the science P6
Matching staffing resource to service demand in the pharmacy P13
Optimising medication adherence and health literacy P26
Improving competencies in behaviour change support in chronic disease : the case of medication adherence
An interprofessional European competency framework , linked with behaviour change techniques from an established taxonomy , can be used to optimise medication adherence in persons living with chronic disease
Isa Brito Félix MSc Nursing Research , Innovation and Development Centre of Lisbon ( CIDNUR ), Nursing School of Lisbon , Lisbon , Portugal Marta Moreira Marques PhD Comprehensive Health Research Centre ( CHRC ), NOVA Medical School , Lisbon , Portugal Afonso Miguel Cavaco PhD Faculty of Pharmacy , University of Lisbon , Lisbon , Portugal . Mara Pereira Guerreiro PhD Nursing Research , Innovation and Development Centre of Lisbon ( CIDNUR ), Nursing School of Lisbon , Lisbon , Portugal ; Centro de Investigação Interdisciplinar Egas Moniz ( CiiEM ), Instituto Universitário Egas Moniz , Monte de Caparica , Portugal
Hospital pharmacists contribute to inpatient and outpatient medications and care through a unique expertise by , for example , medication reconciliation , management of drug-related problems and patient education . In this setting , pharmacists improve medication management at the hospital-to-home interface , supporting the patients routinely taking medication and their adherence , and contributing to better outcomes . 1
This paper presents an overview of a European competency framework for health and other professions to support behaviour change for the self-management of chronic disease , 2 and its application to medication adherence , a key behaviour in self-management . * *
The article comprises three key sections . First , it sets the scene for the need and relevance of the competency framework as a tool to create standards of practice and guide training . Second , it describes the development of the
P29 competency framework to support behaviour change in persons living with chronic disease . 2 Then , it turns to the case of supporting medication adherence , by providing examples of the application of behaviour change techniques ( BCTs ) from an established taxonomy . Using BCTs in medication adherence consultations facilitates the provision of tailored interventions by hospital pharmacists , while fostering comprehensiveness and consistency . Moreover , it renders hospital pharmacists ’ interventions more explicit .
Background Chronic diseases are a global epidemic , responsible for 40.5 million deaths in 2016 , corresponding to 71 % of deaths worldwide . 3 Changing and sustaining desirable lifestyle behaviours is key in preventing and managing chronic diseases .
Self-management is defined as tasks performed by an individual to minimise the impact of one ’ s disease , with or without the support of health professionals . 4 Tasks can
Fetal alcohol spectrum disorders
holistically be categorised under medical management ( for example , taking medication , adhering to a diet , engaging in physical activity ), role management ( for example , redefining life roles in light of a chronic disease ) and emotional management ( for example , dealing with anger and frustration ), and are related to a set of skills . 4 This definition captures the idea that self-management encompasses a variety of health behaviours in which individuals should engage .
Healthcare and other professionals are expected to support behaviour change for the self-management of chronic disease , including , for example , interventions to improve medication adherence or increase physical activity . However , effective interventions targeting a range of health behaviours are still not the norm routinely . Evidence shows that health professionals perceive a lack of confidence in their own skill set and ability to deliver behaviour change interventions , focusing seldom this aspect on consultations .
5 , 6 It appears that
perceived knowledge and skills relating to the implementation of behaviour change interventions is a global workforce problem , which is imperative to address other . settings in the UK was explored in a validation study . 12 A BCT is “ an observable , replicable , and With irreducible
expert consensus as the explicit source of the activity component of an intervention designed standard to alter or in redirect
WISN , a two-round Delphi consensus study was causal processes that regulate behaviour run ”. 7 BCTs . Hospital include pharmacy setting managers from across Great Britain goals , self-monitoring of behaviour , social responded support . etc The . ‘ activity standard ’, as identified in Stoke-on-
A seminal British guidance on individual-level Trent was health
confirmed by strong consensus of national peers behaviour change interventions recommended for its application detailing the to acute hospital inpatients and the tool
BCTs by using standardised classification was systems demonstrated , so that to be used reliably by multiple operators . interventions can be replicated and include A small techniques number shown of pharmacy managers in community and to be effective at changing behaviour .
8 This mental guideline health from settings the also responded to the study . Their National Institute for Health and Care Excellence numbers were ( NICE not ) has
large enough to generate a consensus view recommended that behaviour change practitioners pharmacy recognise
activity in these different environments , though BCTs in the interventions they are delivering the small and have amount the of data provided suggested there would be relevant skills to deliver them . 8 The BCT some Taxonomy differences ( version in the activity standard , driven by tasks
1 - BCTTv . 1 ) is the most well-known classification mandated of in BCTs the . Mental It Health Act , 13 or lower patient has gained international acceptance as a pharmaceutical valid tool for acuity . specifying the content of behaviour change The interventions study delivered .
7 , 9 on its objectives of confirming the
Notably , a recent scoping review found that activity BCTs standard remain for in-patient clinical pharmacy services in underused in self-management interventions the UK . 10 , One and reason therefore the validity of the calculator based on that might explain this shortcoming is the this poor algorithm permeation and the of transferability of the tool between behavioural science and BCTs , in particular operators , into the . The education application of the WISN approach to identifying and training of health and other professionals staffing . requirements to hospital pharmacy has proved a Train4Health ( www . train4health . eu ) is methodology a strategic which could be adapted to a variety of pharmacy partnership involving seven European institutions services . Leaders across in five
different settings , or with more specialist countries , which seeks to improve behaviour patient change needs support
, could replicate this approach to confirm their competencies for the self-management of activity chronic standard disease and . develop a standardised algorithm for The Train4Health consortium comprises identifying higher education pharmacy staff resource requirements .
institutions ( nursing , pharmacy and sports sciences ), an IT partner and the European Students ’ Union Reality . Hallmarks of practice of the Train4Health project ( 2019 -) include drawing As with on much research , the study generated further questions that remain unanswered and warrant further investigation .
The strength of the consensus with which the ‘ activity standard ’ was confirmed suggests that many hospital pharmacy services are established to deliver the same set
FIGURE 2 NHS benchmarking data 6
GETTY
TABLE 1
Comparison of workforce requirements from recent literature
Reference source
Beds / WTE pharmacist
O ’ Leary , Stuchbery and Taylor 14
19.5
( average hospital-wide , average LOS 6 days )
Onatade , Miller and Sanghera 15
18.19
( average across seven London sites )
NHS Benchmarking 6 43
12 CPWC ( 24-bed ward , LOS 6 days , 5 day service ) 22
of care tasks for their patients . However , in reality , this will simply not be possible for all patients , given the range of staffing levels available to deliver these services . NHS benchmarking data ( Figure 2 ) 6 suggest that the average number of patients reviewed by each pharmacist each day is 55 , whereas the ‘ activity standard ’, strongly confirmed by the consensus , would suggest that this number should be nearer to 17 . This lower value is supported by other studies ( see Table 1 ). 14 , 15 Patient care cannot , therefore , be equivalent . The first set of questions raised here is to what extent does the activity standard described impact positively on patient outcomes ? Is the evidence base that drives this consensus still valid ? It should be noted that in the survey of hospital pharmacy conducted by the European Association of Hospital Pharmacists in 2010 , UK hospital pharmacist staffing levels
2016 mean 2017 mean 2018 mean
Hours spend on wards per week by pharmacists per 100 beds 68.0 77.7 74.2
Patients seen by all pharmacists on wards per day per 100 beds 58.3 62.9 57.0
Hours spent on wards per week by pharmacy technicians per 100 beds 33.2 42.0 40.9
Patients seen by all pharmacy technicians on wards pr day per 100 beds 26.9 37.5 31.1
GETTY
FREE TO SUBSCRIBE REGISTER NOW were around three-times higher than in other European
TABLE 2 countries . 16 The same challenge is raised – what is the difference in impact on patient care ?
Comparative results of clinical assessments of pharmacy technicians and junior pharmacists
Clinical pharmacy – validity of the evidence base The activity standard , as confirmed by the consensus
, is largely Candidate number Total score % driven by the medicines reconciliation work stream , which is heavily evidenced-based 2 and monitored throughout the NHS . 5 CH03 33 97.06 % Medicines reconciliation , i . e . the confirmation of the complete list of medicines prescribed for and taken by a patient prior to RS09 31.5 92.65 % their admission to a new health care setting , contributes to the majority of the staff time requirement ement for the delivery
RS06 31.5 92.65 pharmaceutical care . This evidence strongly associated the Increasing the reconciliation of patients ’ medicines at transfer of care
CH08 29 85.29 % likelihood of ( particularly around admission to hospital ) with improved success patient of adherence outcomes . As staffing levels vary greatly , the same level RS08 28.5 83.29 % interventions of medicines also reconciliation cannot not be delivered consistently requires between tailoring sites and so the assumption might be that there are RS01 27 79.41 % behavioural differences change in patient outcomes which would impact on equity techniques of care . or Some its components of the task must be omitted for B602 25 73.53 % some or all patients . Which of these are relevant in terms of application to the impact on outcome presuming the patient cohorts are similar ? RS03 24.5 72.06 %
patient as In addition , much of this evidence base is 15 years old and a unique technology person advances in that time might have impacted on the CH04 24.5 72.06 %
association between medicines reconciliation and positive patient outcomes . Reasons for this may include the reduced
RS07 24 70.59 % need for the process of medicines es reconciliation as the technology has driven accuracy of data transfer between care CH02 24 67.65 % settings or technology has reduced the time it takes to complete medicines reconciliation . The activity standard
B605 23 64.75 % would need to be adjusted in both scenarios . However , the evidence base that drives this activity and its associated time B601 22 64.71 % requires refreshing to confirm the previously identified impact .
CH06 20.5 60.29 %
This is necessary if we are to continue to deliver evidencebased care at the appropriate level for our patients . The
B603 20 58.82 % staffing levels , calculated by the CPWC , driven by evidence , are more than the average seen across the UK . If adopted widely B604 19 55.88 % this increased requirement for pharmacist and pharmacy technician resource is identified at a time when there are RS05 17.5 51.47 % substantial competing employers for this workforce within the UK .
RS04 16.5 48.53 %
Pharmacy technicians
CH07 15 44.12 %
If we are unable to staff to the identified ‘ activity standard ’ with pharmacists , do we need to consider the skill mix of the CH05 12.5 36.76 % team delivering the service ? An area of practice where consensus was difficult to achieve related to the interim
Full marks 34 review of patients between admission and discharge . At present the activity standard suggests that this should be done by pharmacists . In the UK , delivery of pharmaceutical care is already supported by registered pharmacy technicians . As an ‘ in-house ’ exploration of the issue this was not subject These vocationally trained staff support many elements of the to statistical analysis , but the data is shared for illustrative medicines supply process and have developed a strong role purposes . within medicines reconciliation activities . Perhaps the role This data demonstrated that the existing clinical knowledge of the ‘ clinical ’ pharmacy technician needs to be considered of these medicines management technicians ‘ compared here ? The team at Royal Stoke University Hospital explored favourably ’ to the junior pharmacist cohort . These results were this question in an assessment of pharmacy technician clinical replicated in West Midlands study from Aston University in the skills . The team of medicines management technicians at the UK . 17 Service structures that support the extension of practice Trust were asked to review a prescription chart to identify of this workforce should be considered and the activity medicines management issues and the necessary action standard could then be adapted accordingly . required to ensure the safe use of medicines . The same
Alternatively , time could be released to care by making the prescription was used as a clinical assessment of pharmacists approach to service delivery more efficient . In the field of presenting for interview for entry grade posts . The results were continuous improvement methodology , the basis of the Toyota marked and ranked in order of success ( see Table 2 ). The ‘ Lean ’ system 18 requires the removal of ‘ waste ’; repetition of highlighted candidates were the pharmacist interviewees . activities not done to the correct standard the first time is
Sharing best practice and learning from peers is vital – and Hospital Pharmacy Europe does just this , by providing practical and applicable information that shows what others in this sector are doing across Europe and the UK .
This copy of Hospital Pharmacy Europe is sent to you free of charge and delivers the latest news , clinical articles and research . Re-register today and ensure you don ’ t miss the next issue !
Visit https :// hospitalpharmacyeurope . com / subscribeto-the-journal /