For weeks, we were warned of a potential coronavirus disease 2019 (COVID‐19) pandemic, 1 and on 11th March 2020, the World Health Organization announced it as a pandemic. 2 Questions continue to be ...asked about how well the health‐care systems around the world are equipped to cope. ...we expect and hope to be filled with a sense of security when we are on the brink of a pandemic. The motivation to adopt appropriate public health behaviour is high—people do not want to contract the disease, which could be fatal in some cases, nor do they want to be restricted in their movements and contacts, or be in quarantine, whether forced or self‐imposed.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Pharmacists' knowledge about the clinical and legal aspects of antibiotic supply has an impact on appropriate dispensing practice. There are limited studies evaluating community pharmacists' ...knowledge of antibiotic dispensing in low and middle-income countries, including Sri Lanka. We aimed (i) to evaluate community pharmacy staff's self-reported knowledge about antibiotics and dispensing behaviour of antibiotics without a prescription, and (ii) to identify possible factors impacting their antibiotic dispensing behaviour.
A cross-sectional survey was conducted among a random sample (n = 369) of community pharmacies across all nine provinces in Sri Lanka using a self-administered questionnaire on their antibiotic knowledge and dispensing practice. Data were analysed using descriptive and inferential statistics including; t-test, one-way ANOVA or chi-square test, and binary and multiple logistic regression.
A total of 265 pharmacy staff (210 (79%) pharmacists and 55 (21%) assistants) responded. Overall mean antibiotic knowledge score was 26.1 (SD 3.9; range 1-33, max possible score 34). The overall mean knowledge score t(263) = 2.41, p = 0.017, specific knowledge about antibiotic resistance (ABR) t(262) = 4.98, p = 0.021 and legal aspects of antibiotic dispensing χ2(1, N = 265) = 8.55, p = 0.003) were significantly higher among pharmacists than assistants. One in every three pharmacy staff reported that they dispensed antibiotics without a prescription on patient request; however the proportion was close to half when the patient was known to them. About 30% of the staff reported to have supplied antibiotics for minor infections in the week prior to the survey. However, there was no significant difference in the supply between pharmacists and assistants except for acute sore throat (12% vs 23%, respectively; p = 0.040). Those pharmacists with higher ABR knowledge were less likely to give out antibiotics without a prescription for viral infections in adults (Adj. OR = 0.73, 95% CI: 0.55-0.96; p = 0.027) and children (Adj. OR = 0.55, 95% CI: 0.38-0.80; p = 0.002). Awareness of legal aspects of antibiotic supply reduced overall dispensing (Adj. OR = 0.47, 95% CI: 0.30-0.75; p = 0.001), and specifically for bacterial infections in adults (Adj. OR = 0.45, 95% CI: 0.20-0.99; p = 0.047). Knowledge about antibiotic use and misuse reduced the likelihood of illegal dispensing for common cold (Adj. OR = 0.75, 95% CI: 0.60-0.94; p = 0.011) and acute diarrhoea (Adj. OR = 0.76, 95% CI: 0.58-0.99; p = 0.048).
Despite the law prohibiting provision, antibiotic dispensing without a prescription continues in community pharmacies in Sri Lanka. Appropriate antibiotic dispensing was associated with high levels of pharmacists' legal and clinical knowledge about antibiotics. Strategies to change the current practice are urgently needed.
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People engage in health information-seeking behavior to support health outcomes, and being able to predict such behavior can inform the development of interventions to guide effective health ...information seeking. Obtaining a comprehensive list of the predictors of health information-seeking behavior through a systematic search of the literature and exploring the interrelationship of these predictors are critical first steps in this process.
This study aims to identify significant predictors of health information-seeking behavior in the primary literature, develop a common taxonomy for these predictors, and identify the evolution of the concerned research field.
A systematic search of PsycINFO, Scopus, and PubMed was conducted for all years up to and including December 10, 2019. Quantitative studies identifying significant predictors of health information-seeking behavior were included. Information seeking was broadly defined and not restricted to any source of health information. Data extraction of significant predictors was performed by 2 authors, and network analysis was conducted to observe the relationships between predictors with time.
A total of 9549 articles were retrieved, and after the screening, 344 studies were retained for analysis. A total of 1595 significant predictors were identified. These predictors were categorized into 67 predictor categories, with the most central predictors being age, education, gender, health condition, and financial income. With time, the interrelationship of predictors in the network became denser, with the growth of new predictor grouping reaching saturation (1 new predictor identified) in the past 7 years, despite increasing publication rates.
A common taxonomy was developed to classify 67 significant predictors of health information-seeking behavior. A time-aggregated network method was developed to track the evolution of the research field, showing the maturation of new predictor terms and an increase in primary studies reporting multiple significant predictors of health information-seeking behavior. The literature has evolved with a decreased characterization of novel predictors of health information-seeking behavior. In contrast, we identified a parallel increase in the complexity of predicting health information-seeking behavior, with an increase in the literature describing multiple significant predictors.
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Background
Adherence to ADHD medication is a complex phenomenon as the decision to adhere is influenced by a range of factors. To design tailored interventions to promote adherence, it is important ...to understand the factors that influence adherence in the context of its three phases: initiation, implementation and discontinuation.
Objective
The objective of this study was to explore the phase‐specific factors that influence adherence to medication in adults who have a diagnosis of ADHD.
Methods
Three focus groups (FGs) were conducted with twenty adults with ADHD in different metropolitan areas of Sydney, Australia. FGs were transcribed verbatim and thematically analysed.
Results
Participants’ decision to initiate medication (the initiation phase) was influenced by their perceived needs (desire to improve academic and social functioning) and concerns (fear of side‐effects) about medication following a similar process as defined by the Necessity‐Concerns Framework (NCF). The balance between benefits of medication (needs) and side‐effects (concerns) continued to determine participants’ daily medication‐taking (the implementation phase) and persistence (or discontinuation) with their medication. Forgetfulness and stigma were reported as concerns negatively impacting the implementation phase, while medication cost and dependence influenced the discontinuation phase of adherence.
Conclusions
Adults’ decision to initiate, continue or discontinue medication is influenced by a range of factors; some are unique to each phase while some are common across the phases. Participants balanced the needs for the medication against their concerns in determining whether to adhere to medication at each phase. It appears that the NCF has applicability when decision making about medication is explored at the three phases of adherence.
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The global prevalence of diabetes is increasing. Medications are a recommended strategy to control hyperglycaemia. However, patient adherence can be variable, impacting health outcomes. A range of ...interventions for patients with type 2 diabetes have focused on improving treatment adherence. This review evaluates the impact of these interventions on adherence to anti-diabetic medications and focuses on the methods and tools used to measure adherence.
Medline, Embase, CINAHL, IPA, PUBmed, and PsychINFO were searched for relevant articles published in 2000-2013, using appropriate search terms.
Fifty two studies addressing adherence to anti-diabetic medications in patients with type 2 diabetes met the inclusion criteria and were reviewed. Each study was assessed for research design, method(s) used for measuring medication adherence, and impact of intervention on medication adherence and glycaemic control. Fourteen studies were published in 2000-2009 and 38 in 2010-2013. Twenty two interventions led to improvements in adherence to anti-diabetic medications, while only nine improved both medication adherence and glycaemic control. A single strategy could not be identified which would be guaranteed to improve anti-diabetic medication adherence consistently. Nonetheless, most interventions were successful in influencing one or more of the outcomes assessed, indicating the usefulness of these interventions under certain circumstances. Self-report, particularly the Summary of Diabetes Self-Care Activities questionnaire was the most commonly used tool to assess medication adherence, although other self-report tools were used in more recent studies. Overall, there was a slight increase in the number of studies that employed multiple methods to assess medication adherence in studies conducted after 2008.
The diversity of interventions and adherence measurements prevented a meta-analysis of the impact of interventions on adherence to therapy, highlighting the need for more consistency in methods in the area of adherence research. Whilst effective interventions were identified, it is not possible to conclude on an effective intervention that can be generalised to all patients with type 2 diabetes.
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Effective interprofessional collaboration is critical for sustaining high quality care in the context of the increasing burden on primary healthcare services. Despite this, there is limited ...understanding of the factors contributing to effective collaboration between general practitioners and community pharmacists. The aim of this systematic review was to identify the factors that impact on interprofessional collaboration between general practitioners (GPs) and community pharmacists (CPs). Keywords and synonyms were combined and applied to four databases (EMBASE, CINAHL, SCOPUS, and MEDLINE) to identify articles published between January 2000 to April 2017. Relevant journals and reference lists were also hand‐searched. A total of 37 articles met the eligibility criteria. Factors that posed a challenge to effective interprofessional collaboration were the perceived imbalance in hierarchy and power between the professions and a lack of understanding of each other's skills and knowledge. Experience of collaboration with the other party led to greater understanding of each other's capabilities and potential role in co‐delivering patient care. The physical environment was also identified as important, with co‐location and other resources to facilitate clear and regular communication identified as important facilitators of interprofessional collaboration. The review findings highlight a range of approaches that may positively influence interprofessional collaboration between GPs and CPS such as co‐location, co‐education to understand the professional capabilities of each group, and utilising compatible technologies to facilitate communication between the two professions.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Background:
Australia has a high proportion of migrants with an increasing migration rate from India. Type II diabetes is a long-term condition common amongst the Indian population.
Aims:
To ...investigate patients’ medication-taking behaviour and factors that influence adherence at the three phases of adherence.
Methods:
Semi-structured interviews were conducted with a convenience sample of 23 Indian migrants living in Sydney. All interviews were audio-recorded, transcribed verbatim and thematically analysed.
Results:
1) Initiation:
The majority of participants were initially prescribed oral antidiabetic medicine and only two were started on insulin. Most started taking their medicine immediately while some delayed initiating therapy due to fear of side-effects.
2) Implementation
:
Most participants reported taking their medicine as prescribed. However, some reported forgetting their medicine especially when they were in a hurry for work or were out for social events.
3) Discontinuation:
A few participants discontinued taking their medicine. Those who discontinued did so to try Ayurvedic medicine. Their trial continued for a few weeks to a few years. Those who did not receive expected results from the Ayurvedic medicine restarted their prescribed conventional medicine.
Conclusion:
A range of medication-taking behaviours were observed, ranging from delays in initiation to long-term discontinuation, and swapping of prescribed medicine with Ayurvedic medicine. This study highlights the need for tailored interventions, including education, that focus on factors that impact medication adherence from initiation to discontinuation of therapy.
Background
Patients need medication and medical condition‐related information to better self‐manage their health. Health‐care professionals (HCPs) should be able to actively provide information ...outside of one‐on‐one consultations; however, patient consent may be required.
Objective
To investigate the Australian public's preferences, and factors that may influence their preferences, towards an opt‐in versus an opt‐out approach to health communication.
Design
A cross‐sectional study using a structured questionnaire administered via Computer‐Assisted Telephone Interviewing.
Setting and participants
Participants across Australia who were adults, English‐speaking and had a long‐term medical condition.
Main outcome measures
Preferences for opt‐in vs opt‐out approach to receiving follow‐up tailored information.
Results
A total of 8683 calls were made to achieve the required sample size of 589 completed surveys. Many (346/589; 58.7%) indicated that they were interested in receiving tailored, ongoing follow‐up information from their HCP. Nearly half (n = 281; 47.7%) preferred an opt‐in service and 293/589 (49.7%) an opt‐out service for receiving follow‐up information. Reasons for preferring an opt‐in service were being in control of the information received (n = 254); able to make a decision that is best for them (n = 245); opt‐in service would save time for HCPs (n = 217); they may not want or need the information (n = 240). Many (n = 255) felt that an opt‐out service should be part of the normal duty of care of their HCP and believed (n = 267) that this approach would ensure that everyone has access to information.
Conclusions
Respondents were interested in receiving tailored information outside of consultation times. However, preferences for an opt‐in or opt‐out approach were divided.
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The prevalence of complementary medicine product (CMP) use by pregnant or breastfeeding Australian mothers is high, however, there is limited data on factors influencing women's decision-making to ...use CMPs. This study explored and described the factors influencing women's decisions take a CMP when pregnant or breastfeeding.
Qualitative in-depth interviews and focus group discussions were held with 25 pregnant and/or breastfeeding women who currently used CMPs. Participants' health literacy was assessed using a validated single-item health literacy screening question and the Newest Vital Sign. Interview and focus group discussions were audio-recorded, transcribed verbatim and thematically analysed.
Participants were a homogenous group. Most had higher education, medium to high incomes and high health literacy skills. They actively sought information from multiple sources and used a reiterative collation and assessment process. Their decision-making to take or not to take CMPs was informed by the need to establish the safety of the CMPs, as well as possible benefits or harms to their baby's or their own health that could result from taking a CMP. Their specific information needs included the desire to access comprehensive, consistent, clear, easy to understand, and evidence-based information. Women preferred to access information from reputable sources, namely, their trusted health care practitioners, and information linked to government or hospital websites and published research. A lack of comprehensive, clear, consistent, or evidence-based information often led to decisions not to take a CMP, as they felt unable to adequately establish its safety or benefits. Conversely, when the participants felt the CMPs information they collected was good quality and from reputable sources, it reassured them of the safety of the CMP in pregnancy and/or breastfeeding. If this confirmed a clear benefit to their baby or themselves, they were more likely to decide to take a CMP.
The participants' demographic profile confirms previous research concerning Australian women who use CMPs during pregnancy and lactation. Participants' high health literacy skills led them to engage in a reiterative, information-seeking and analysis process fuelled by the need to find clear information before making the decision to take, or not to take, a CMP.
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