Amary Mey

Background: Trust between healthcare providers is important in facilitating collaborative practices, especially in primary care, where disciplines collaborate across communities to deliver patient-centred care. Objective: To identify the facilitators and barriers that influence trust in interprofessional partnerships within primary care settings. Methods: We searched PubMed, PsycInfo, Embase, and CINAHL using key words to identify articles published up to 16 August 2023. Facilitators and barriers to trust were mapped onto the Consolidated Framework for Implementation Research (CFIR). Quality assessment utilized the Mixed Methods Appraisal Tool (MMAT). Results: From 5750 screened articles, 11 studies were included. Sixteen facilitators and seven barriers were identified. Facilitators included co-location, familiarity, competence, professional identities, and effective communication. Barriers included perceived conflicts of interest, lack of familiarity, and transgressions of professional boundaries. Trust was often unbalanced, with a perception among non-medical healthcare professionals that they need to earn trust from medical healthcare professionals. Conclusions: Formation and nurturing of interprofessional trust is the foundation for building strong partnerships between healthcare professionals that promote collaborative practice in primary care. Future research should include non-English and grey literature and focus on the unequal trust dynamics.

Background: Pharmacists in many countries have long been involved in some aspect of assisted dying. Since 2016, when Canada enacted legislation permitting medical assistance in dying (MAiD), the number of patients seeking the procedure has increased yearly. Despite the global nature of pharmacists’ involvement, little is known about how they experience MAiD practice. Objective: To study how pharmacists experience the practice of caring for patients who seek MAiD. Methods: This qualitative study used semistructured interviews with pharmacists who had cared for patients seeking MAiD. Interviews, conducted between June 2019 and October 2020, were audio-recorded and transcribed verbatim. Data were examined using a modified framework analysis approach. Data were coded and sorted using Quirkos and Microsoft Excel software. Themes were defined through an iterative process involving constant comparison. Results: Nineteen hospital pharmacists representing a range of practice settings in Alberta participated in the study. The experience of caring for patients seeking assistance in dying brought to light 3 themes: finding a place in the process, serving in a caring role, and bearing emotional burdens. Pharmacists’ experiences were personal, relational, emotional, and dynamic. Conclusions: Each of the pharmacists experienced MAiD practice in a unique way. Although their roles in MAiD were primarily medication-focused, their experiences highlighted the centrality of patient choices, autonomy, and needs. The results of this study will inform pharmacists (including those not yet engaged in MAiD practice) about the role, and will also be valuable for pharmacy organizations and educators seeking to support pharmacists and the profession, as well as policy-makers seeking to expand pharmacists’ roles in MAiD. RÉSUMÉ Contexte : Les pharmaciens de nombreux pays participent depuis longtemps à certains aspects de l’aide médicale à mourir (AMM). Depuis que le Canada a adopté une loi l’autorisant en 2016, le nombre de patients qui demandent l’intervention a augmenté chaque année. Malgré la nature mondiale de l’implication des pharmaciens, on sait peu de choses sur la façon dont ils vivent la pratique de l’AMM. Objectif : Étudier comment les pharmaciens vivent la pratique de la prise en charge des patients qui sollicitent l’AMM. Méthodes : Cette étude qualitative a utilisé des entretiens semi-structurés avec des pharmaciens qui avaient pris en charge des patients ayant fait une demande d’AMM. Un enregistrement sonore des entretiens, menés entre juin 2019 et octobre 2020, a été effectué et ils ont été transcrits mot à mot. Les données ont été examinées en adoptant une approche d’analyse du cadre modifié. Les données ont été codées et triées à l’aide des logiciels Quirkos et Microsoft Excel. Les thèmes ont été définis par un processus itératif impliquant une comparaison constante. Résultats : Dix-neuf pharmaciens d’hôpitaux représentant un éventail de milieux de pratique en Alberta ont participé à l’étude. L’expérience de la prise en charge de patients cherchant à recevoir l’aide médicale à mourir a mis en lumière 3 thèmes : trouver sa place dans le processus; jouer un rôle de proche aidant; et supporter des charges émotionnelles. Les expériences des pharmaciens étaient personnelles, relationnelles, émotionnelles et dynamiques. Conclusions : Chaque pharmacien a vécu la pratique de l’AMM d’une manière unique. Bien que leurs rôles dans l’AMM étaient principalement axés sur la médication, leurs expériences ont mis en évidence la centralité des choix, de l’autonomie et des besoins des patients. Les résultats de cette étude informeront les pharmaciens (y compris ceux qui ne sont pas encore engagés dans la pratique de l’AMM) sur le rôle. Ils seront également précieux pour les organismes pharmaceutiques et les éducateurs cherchant à soutenir les pharmaciens et la profession, ainsi que pour les décideurs politiques qui cherchent à élargir les rôles de pharmaciens dans l’AMM.

Digital Interprofessional Learning Client Documentation (D-IPL Client Docs) is an initiative designed to develop student interprofessional communication skills through electronic record writing and a virtual simulation (VS) or live virtual simulation (LVS) case conference. The aims of the study were to (a) identify whether D-IPL Client Docs supports student learning in the affective domain and (b) compare the learning outcomes for students participating in the VS versus the LVS case conference. Data were drawn from 83 Bachelor of Social Work students who had participated with other health professional students in the D-IPL Client Docs activities. The reflective journals submitted by this cohort of social work students were analyzed qualitatively and quantitatively using the Griffith University Affective Learning Scale. Qualitative analyses revealed that the activities enabled students in both groups to learn about themselves, their roles, and the roles of others, and the benefits of interprofessional collaboration in optimizing client outcomes. Quantitatively, the VS mode appeared to be more effective in supporting students to develop higher order affective learning; however, the effect size was small. Future studies should involve a larger sample size and include students from various professions to ascertain the transferability of findings.

Background Non‐adherence to prescribed medicines is linked to adverse health outcomes in people living with chronic health conditions. Multiple factors are known to contribute to non‐adherence to medicines including polypharmacy, demographic features and disease and health systems. Both non‐prescription and prescription medicines contribute to polypharmacy however, there is limited data of the influence of non‐prescription medicines to non‐adherence. Aim Therefore, the aim of the study was to investigate the influence of non‐prescription medicines to non‐adherence in an Australian population. Methods Data from the 2016 National Survey of a random sample of Australian adult residents was utilized in this study to investigate factors associated with non‐adherence. Descriptive statistics, Chi‐square, regression and generalised linear models were used to assess the relationships between variables of interest. Narrative response and comments were used to provide further insight. Results This study recruited 1217 participants to explore factors associated with non‐adherence to medicines. Weak, but statistically significant correlations were identified showing the number of chronic health conditions, patient’s age, number of prescription medicines, number of non‐prescription medicines and total number of medicines were associated with non‐adherence. Discussion The findings suggest people living with chronic health conditions and taking multiple medicines, including non‐prescription medicines, are likely to be non‐adherent to prescription medicines. This study shows the possible involvement of non‐prescription medicines in contributing to non‐adherence in an Australian population and suggests that future studies with a broader demographic are warranted.

Objectives Reclassification of medicines from prescription to non‐prescription increases timely access to treatment, promotes self‐management of minor ailments and relieves healthcare system burden. Previous research identified that Australia lagged behind the United Kingdom and New Zealand in medicines reclassification. This study aimed to identify Australian pharmacists’ opinions on the current state of medicines reclassification; the prescription medicines consumers requested without prescription; the medicines pharmacists believed should and should not be considered for reclassification; and perceived barriers to reclassification. Methods A 2016 national online survey that sought pharmacists’ opinions on the state of reclassification, perceived barriers to reclassification and readiness of the profession for further reclassification. Pharmacists’ comments were invited through open‐ended questions. Key findings Two hundred and thirty‐five valid surveys were completed. Respondents practised in community, hospital, consultant and academic contexts, and the majority were female (58.7%, n = 138). More than two thirds (70.66%, n = 166) of pharmacists reported receiving daily or weekly requests for non‐prescription access to prescription medicines. The majority of pharmacists (71.7%) agreed that the Australian pharmacy profession is ready for further medicines reclassification, guided by patient safety, harm minimisation and medication continuance. The most prominent barrier to further reclassification was opposition from other healthcare professionals. Conclusions Australian pharmacists believe that their profession has the capacity to safely and effectively manage a wider range of non‐prescription medicines through increased reclassification in the contexts of patient safety and risk mitigation. This study has contributed to the global conversation on non‐prescription medicines access, providing momentum for practice and policy change.

Purpose: Human capabilities in medicine, including communication skills, are increasingly important within the complex, challenging and dynamic landscape of healthcare. Supporting medical students to manage unavoidable role-related stressors adaptively may help mitigate the anguish that is too commonly reported among the profession. We developed a model, “MaRIS”, underpinned by contemplative pedagogy, to support medical students to enhance their human capabilities, across all three domains of Bloom's taxonomy, and their personal resilience. It is the first to integrate Mindfulness, affective Reflection, Impactive experiences and a Supportive environment into medical curriculum design. Here, we describe the theoretical basis underpinning MaRIS and present a preliminary study to evaluate its impact on students' subjectively-rated capabilities. Materials and Methods: A questionnaire capturing self-ratings of competence, empathy and resilience, as well as impressions of their experiences, was administered to foundation year medical students before (T0), during (T1) and after delivery (T2). Results: Fifty-five students completed the survey at all time points. Mean scores for all domains increased significantly from T0 to T1 and from T0 to T2. Free-text comments suggest learning impact across the cognitive, psychomotor and affective domains. Conclusions: MaRIS appears to facilitate medical students' establishment of the foundations for building the human capabilities and personal resilience required for professional practice.

Objectives: Availability of medicines without prescription can increase consumers’ timely access to treatment and promote self-management of minor ailments and adherence to long-term medications. Globally, access to relevant medicines has improved through increased reclassification of medicines from prescription to non-prescription availability. However, Australian reclassification lags behind countries with comparable health systems, and the factors influencing this are poorly understood. Methods: Semi-structured interviews were conducted during May 2015 to explore the perspectives of Australian pharmacists and support staff on future reclassification. Interview responses were transcribed verbatim, and the data were analysed thematically, primarily informed by the general inductive approach. Results: Participants identified a broad range of medicines as candidates for future reclassification by applying risk versus benefit judgements, assessing any medicines with potential for misuse and hazardous medicines as unsuitable. Key drivers for change in classification were underpinned by participants’ desire to support consumers’ management of minor ailments and adherence for those on long-term therapy. Barriers to reclassification were identified by pharmacy staff as internal, negatively impacting pharmacists’ readiness for reclassification and external, negatively impacting the overall progress of change. Conclusions: While the research provided valuable insights to inform the ongoing discussion on future reclassification, a larger, more representative sample is needed to confirm these findings.

Objective. To broaden pharmacy students’ international perspectives through a teaching and learning method involving international comparison. Design. Four topics within a pharmacy law and practice course were taught in-person by collaborating faculty members representing two international perspectives (Australian and Canadian). The assessed learning objective was for students to be able to synthesize an international comparative analysis that reflected an international perspective. Assessment. Approximately 70% (n=44) of the class completed an online survey instrument that explored students’ perceptions of their own learning. Six domains of inquiry represented in the questionnaire included knowledge development, international perspective, future prospects, personal enjoyment, assessment method, and overall learning experience. Quantitative and qualitative survey results reflected students’ strong support for all statements of inquiry. Conclusions. The method involving international comparison, a classroom teaching collaboration and knowledge management using compare-contrast strategy positively influenced student perceptions in a range of ways and was effective in raising international perspectives in the pharmacy curriculum.

Objective: Overcoming language and cultural barriers is becoming ever challenging for pharmacists as the patient population grows more ethnically diverse. To evaluate the current practices used by the pharmacists for communicating with patients with limited English proficiency (LEP) and to assess pharmacists’ knowledge of, attitude toward, and satisfaction with accessing available services for supporting LEPs patients within their current practice settings. Methods: Semi-structured interviews were conducted with five pharmacists employed in pharmacies representing multiple practice settings Queensland, Australia. Thematic analysis was primarily informed by the general inductive approach. NVivo software (QSR International Pty Ltd.) was used to manage the data. Findings: Three interlinked themes emerged from the analysis of interview data: (1) Barriers to the provision of pharmaceutical care, (2) Strategies employed in dealing with LEP patients, and (3) Lack of knowledge about existing services. Pharmacists recognized their lack of skills in communicating with LEP patients to have potential negative consequences for the patient and discussed these in terms of uncertainty around eliciting patient information and the patient’s understanding of their instructions and or advice. Current strategies were inconsistent and challenging for LEP patient care. While the use of informal interpreters was common, a significant degree of uncertainty surrounded their actual competency in conveying the core message. Conclusion: The present study highlights a significant gap in the provision of pharmaceutical care in patients with LEP. Strategies are needed to facilitate quality use of medicines among this patient group.