Judith Ann Singleton

Poor mental health among students undertaking health professional training is increasingly recognised as a significant global challenge [1]. University students face a range of mental health challe...

Between January 29 and February 11, 2019, the Townsville region in Australia experienced a major flooding event. This study explored impacts on affected community pharmacies. Semi-structured phone interviews were conducted with six pharmacists who worked in affected Townsville community pharmacies during this flood. De-identified transcript data were analyzed using reflexive thematic analysis. The thematic analysis yielded six themes – “financial impact on pharmacy owners,” “engagement with Local Disaster Coordination Center (LDCC) important,” “workload pressures,” “preparedness,” “medication supply impacts,” and “communication and collaboration.” Financial impacts to owners included loss of property (two pharmacies were completely flooded), purchase or hire costs of generators when power was lost, and loss of revenue from complete or early closure of pharmacies and when patients could not pay or did not have a prescription and did not return to the pharmacy after the event. Engagement with the LDCC assisted pharmacy responsiveness. Medication supply issues were experienced by patients whose houses had flooded, or who had left their prescriptions with pharmacies that had flooded. Opioid Replacement Therapy (ORT) program patients were also impacted due to communication difficulties between them, their clinics, and their pharmacies. Increased customer numbers by those whose regular pharmacy was closed, reduced staff numbers, and austere working conditions increased workload pressures. Pharmacists collaborated to consolidate resources with those whose pharmacy had closed, working in pharmacies that were open. This research highlights a critical need for improved flood preparedness among Townsville pharmacists. Regardless, they collaborated to ensure there were minimal critical medication delays.

Objective: To explore community pharmacy consumers’ knowledge and attitudes of mental illness, support services, and community pharmacists’ role in supporting people living with mental illness (PLMI). Methods: This survey was conducted in 15 community pharmacies between June and September 2019. Participants were aged 18 years or older without prior or ongoing history of mental illness and/or with close family members with mental illness. Open-ended responses to the anonymous questionnaire were analysed using content analysis. Key findings: Majority of the 380 participants were female (57.4%) with a mean age 52.9 years and 33.7% having completed university. Most (70.3%) believed that people with mental illness had a negative image due to poor health literacy providing possible solutions of ‘awareness campaigns’, ‘education and training’, and ‘increased government funding for mental health (MH) support services’. Only 33.7% and 63.7% of participants were aware of Mental Health Week and the R U OK? Campaign, respectively. Whilst 12.4% of participants had participated in MH campaigns, only 3.4% were aware of community pharmacists-led MH educational activities. There were significant differences between adults (<65 years) and older adults (≥65 years old) with the latter reporting a more negative image for mental illness (P < 0.05) and having less exposure and engagement with MH resources (P < 0.001) and campaigns (P < 0.01). Conclusion: Despite awareness, participants reported low engagement with MH campaigns. Additionally, older adults had lower MH literacy and exposure to resources and campaigns. This study highlighted that the community lacked awareness of what pharmacists can offer to support PLMIs.

Nature-based social prescribing such as “blue prescription” promotes public health and health improvement of individuals with long-term health conditions. However, there is limited evidence explaining the relationship of contexts, mechanisms, and outcomes of implementing blue prescription programmes (BPPs) in health and social care settings that could inform policy and practice. We conducted a systematic realist review by searching PubMed, Web of Science, PsycInfo, Scopus, MEDLINE, and CINAHL for articles published in English between January 2000 and June 2022 about health and social care professionals providing referral to or prescription of blue space activities (e.g., swimming, fishing, surfing, etc.) with health-related outcomes. Components and descriptions of BPP implementation were extracted and used to develop themes of contextual factors used to develop programme theories and a logic model demonstrating the mechanisms of BPP implementation. Sixteen studies with adequate to strong quality were included from 8,619 records. After participating in BPPs referred to or prescribed by health and social care professionals, service users had improvements in their physical, cognitive (mental), social health, and proenvironmental knowledge. Service user-related contextual factors were referral information, free equipment, transportation, social support, blue space environments, and skills of service providers. Programme-related contextual factors were communication, multistakeholder collaboration, financing, and adequate service providers. Programme theories on service user enrolment, engagement, adherence, communication protocols, and programme sustainability explain the mechanisms of BPP implementation. BPPs could promote health and wellbeing if contextual factors and programme theories associated with service users’ characteristics and programme delivery are considered in the design, delivery, and evaluation of BPPs. Our study was registered with PROSPERO (CRD42020170660).

Objectives: NHS England has set itself a target of net zero emissions by 2050. Therefore, to address this gap in the literature, this study aimed to explore engagement with NHS policy on carbon reduction (including awareness of the Sustainable Development Unit [SDU] and the Coalition for Sustainable Pharmaceuticals and Medical Devices [CSPM]) in NHS hospital pharmacists in England. Methods: Semi-structured interviews were conducted with 23 pharmacists working in six NHS England hospitals across all hierarchical levels. Four interview questions elicited Yes/No responses and one generated qualitative data which were analysed by two methods – Leximancer and manual coding. Key Findings: Only five (5/23; 21.74%) had heard of the SDU and none knew its purpose. Those who did not wish to learn more about the SDU could not see its relevance to their clinical practice. Barriers identified to the inclusion of sustainability considerations in clinical decision-making were lack of knowledge of the environmental risk profiles for treatment options, lack of quality environmental evidence incorporated into clinical guidelines and lack of time to research for themselves. Many participants did not believe that environmental considerations were part of their job. Conclusions: For NHS England to successfully deliver on its target of net zero emissions by 2050, immediate action is required from all hospital staff, clinicians included. The challenge for the NHS will be engaging pharmacists and other clinicians with sustainable clinical practice and working with clinicians to reduce identified barriers. As these data were collected in 2016, further research is warranted to determine if pharmacists’ attitudes towards sustainable practice are changing.

Background Nature-based social prescribing programmes such as ‘bluespace prescription’ may promote public health and health improvement of individuals with long-term conditions. However, there is limited systematically synthesised evidence that investigates the contexts and mechanisms of Bluespace Prescription Programmes (BPPs) that could inform programme theories for policy and practice. Methods We conducted a realist review by searching six databases for articles published between January 2000 and February 2020, in English, about health and social care professionals providing referral to or prescription of blue space activities with health-related outcomes. We developed themes of contextual factors by analysing the contexts of BPPs. We used these contextual factors to develop programme theories describing the mechanisms of BPP implementation. Our study was registered with PROSPERO (CRD42020170660). Results Fifteen studies with adequate to strong quality were included from 6,736 records. Service users had improvements on their physical, mental, social health, and environmental knowledge after participating in BPPs referred to or prescribed by health and social care professionals. Patient-related contextual factors were referral information, free equipment and transportation, social support, blue space environments, and skills of service providers. Programme-related contextual factors were communication, multi-stakeholder collaboration, financing, and adequate service providers. Programme theories on patient enrolment, engagement, adherence, communication protocols, and long-term programme sustainability described the mechanisms of BPP implementation. Conclusion BPPs could support health and social care services if contextual factors and mechanisms of programme theories associated with patients and programme delivery are considered for implementation. Our findings have implications in planning, development, and implementation of similar nature-based social prescribing programmes in health and social care settings.