Simon White

Background Healthcare delivery in the UK is shifting towards community-based, preventative, and population-focused care. Community pharmacy is well placed to support this transition. The importance of community pharmacy has been highlighted by national policies alongside the need for strong research foundations within this setting. Despite major changes in community pharmacy and its easy accessibility to wide and diverse communities, research engagement remains limited. Evidence on the barriers to community pharmacy research engagement and how to overcome these is scarce. This project aims to co-develop a toolkit to enhance research engagement in community pharmacy and to widely disseminate findings to key stakeholders to support implementation. Protocol This study will use a Community of Practice (CoP) framework and will draw on the principles of Implementation Mapping (IM). The CoP will include key stakeholders to support the co-development of the research engagement toolkit. Stakeholders will include patients/public members and representatives from pharmacy, primary and secondary care, academia, commissioning, and research delivery professionals. Five meetings will be held online with the CoP (n = up to 15). Meetings will be recorded, transcribed verbatim and thematically analysed to identify common, emerging themes., to support the toolkit co-development. A separate patient and public advisory group will also be established to provide guidance and assistance across the duration of the study. The CoP and patient and public advisory group will advise on the most appropriate dissemination routes to reach the widest audience so that our recommendations help to build community pharmacy research. Discussion Despite its central role in the healthcare system, and its easy accessibility to wider and diverse communities, community pharmacy engagement in research is still limited. A collaborative CoP stakeholder group would better identify how to overcome barriers and to co-develop a toolkit to enhance research engagement and build research capacity, thus supporting greater participation in research.

Background Opioids offer limited long-term benefits and carry significant risks. We developed the PROMPPT intervention to address challenges in implementing effective person-centred review and safe opioid tapering in UK primary care. PROMPPT comprises a primary care review, led by clinical pharmacists working in general practices as part of the multidisciplinary team, and an associated training package. This trial will evaluate (1) the effectiveness of PROMPPT in supporting people with persistent non-cancer pain to safely reduce opioids, where appropriate, without increasing pain/pain-related interference, and (2) cost-effectiveness compared with usual primary care. Methods Design and setting: cluster randomised controlled trial, with internal pilot, in 38 general practices across England. Participants: patients ≥18 years prescribed one or more opioids ≥6 months for persistent pain who consent to participate in a questionnaire study. Exclusions: acute pain, cancer pain, end-of-life care, dementia, severe mental illness or otherwise vulnerable, and current substance misuse treatment. Practices are randomly allocated (1:1) to either: invite participants for a PROMPPT review with a trained practice pharmacist, and follow-up as needed, or continue usual primary care review for patients who are prescribed opioids. Co-primary outcomes, measured at 12 months, are (1) reduction in self-reported opioid use (≥25% reduction in daily morphine equivalent dose from their baseline) and (2) non-inferiority of the Brief Pain Inventory total score. The trial includes an economic evaluation (within trial and longer-term cost-utility analyses) and a mixed methods process evaluation. Analysis of consultation audio-recordings, case report forms (including an intervention delivery template), acceptability questionnaires and semi-structured interviews will explore how PROMPPT was delivered and received, and how context affected implementation and outcomes. Conclusion The PROMPPT trial will assess whether review by trained clinical pharmacists working in general practices can support safe opioid reduction without compromising pain management and quality of life. Trial registration ISRCTN 45616481, 13/05/2022 https://doi.org/10.1186/ISRCTN45616481

Background Healthcare delivery in the UK is shifting towards community-based, preventative, and population-focused care. Community pharmacy is well placed to support this transition. The importance of community pharmacy has been highlighted by national policies alongside the need for strong research foundations within this setting. Despite major changes in community pharmacy and its easy accessibility to wide and diverse communities, research engagement remains limited. Evidence on the barriers to community pharmacy research engagement and how to overcome these is scarce. This project aims to co-develop a toolkit to enhance research engagement in community pharmacy and to widely disseminate findings to key stakeholders to support implementation. Protocol This study will use a Community of Practice (CoP) framework and will draw on the principles of Implementation Mapping (IM). The CoP will include key stakeholders to support the co-development of the research engagement toolkit. Stakeholders will include patients/public members and representatives from pharmacy, primary and secondary care, academia, commissioning, and research delivery professionals. Five meetings will be held online with the CoP (n = up to 15). Meetings will be recorded, transcribed verbatim and thematically analysed to identify common, emerging themes., to support the toolkit co-development. A separate patient and public advisory group will also be established to provide guidance and assistance across the duration of the study. The CoP and patient and public advisory group will advise on the most appropriate dissemination routes to reach the widest audience so that our recommendations help to build community pharmacy research. Discussion Despite its central role in the healthcare system, and its easy accessibility to wider and diverse communities, community pharmacy engagement in research is still limited. A collaborative CoP stakeholder group would help better how to overcome barriers and to co-develop a toolkit to enhance research engagement and build research capacity, thus supporting greater participation in research.

Background Opioids offer limited long-term benefits and carry significant risks. We developed the PROMPPT intervention to address challenges in implementing effective person-centred review and safe opioid tapering in UK primary care. PROMPPT comprises a primary care review, led by clinical pharmacists working in general practices as part of the multidisciplinary team, and an associated training package. This trial will evaluate (1) the effectiveness of PROMPPT in supporting people with persistent non-cancer pain to safely reduce opioids, where appropriate, without increasing pain/pain-related interference, and (2) cost-effectiveness compared with usual primary care. Methods Design and setting: cluster randomised controlled trial, with internal pilot, in 38 general practices across England. Participants: patients ≥18 years prescribed one or more opioids ≥6 months for persistent pain who consent to participate in a questionnaire study. Exclusions: acute pain, cancer pain, end-of-life care, dementia, severe mental illness or otherwise vulnerable, and current substance misuse treatment. Practices are randomly allocated (1:1) to either: invite participants for a PROMPPT review with a trained practice pharmacist, and follow-up as needed, or continue usual primary care review for patients who are prescribed opioids. Co-primary outcomes, measured at 12 months, are (1) reduction in self-reported opioid use (≥25% reduction in daily morphine equivalent dose from their baseline) and (2) non-inferiority of the Brief Pain Inventory total score. The trial includes an economic evaluation (within trial and longer-term cost-utility analyses) and a mixed methods process evaluation. Analysis of consultation audio-recordings, case report forms (including an intervention delivery template), acceptability questionnaires and semi-structured interviews will explore how PROMPPT was delivered and received, and how context affected implementation and outcomes. Conclusion The PROMPPT trial will assess whether review by trained clinical pharmacists working in general practices can support safe opioid reduction without compromising pain management and quality of life. Trial registration ISRCTN 45616481, 13/05/2022 https://doi.org/10.1186/ISRCTN45616481

Background and Aims: Healthcare research is an essential driver of evidence‐based practice, leading to improved service delivery and outcomes. Despite being integral to pharmacy (e.g., in driving safe and effective use of medicines), research engagement is relatively low. This service evaluation study aimed to assess pharmacy professionals' research engagement inclusive of capacity (opportunity and time) and ability (skills and knowledge), and to explore potential barriers and facilitators to research engagement. Methods: The study was conducted at a single Mental Health and Community Trust in the UK between February and June in 2024. Data were collected in two phases: phase 1: an online survey assessed current research engagement, and phase 2: virtual individual interviews and a focus group explored in‐depth views on research engagement. All practising pharmacists and pharmacy technicians were eligible to participate and were invited via email through a senior pharmacist. Quantitative data were descriptively analysed, and qualitative data were audio‐recorded, transcribed and thematically analysed. As a service evaluation, no ethical approval was required. Results: Of the 62 invited pharmacy professionals, 32 responded (52%, n = 20 pharmacists). Around 47% ( n = 15) reported prior involvement in research activity/training. Most viewed research as relevant (63%, n = 20) and extremely valuable (72%, n = 23) to practice, and 47% ( n = 15) expressed interest in engaging in future research. However, few expressed having confidence across a range of research skills. Seven interviews and one focus group were conducted. Three main themes were identified: research‐related views and experience, barriers to research engagement, and strategies to improve research engagement. Conclusion: Overall, positive views on research were reflected. Current research involvement rate is low, as is the confidence in applying research to practice. Several barriers were identified, which require addressing to enhance research activity. Organisations therefore should assess research capacity and ability of their staff to identify encountered barriers to enhance research engagement.

Background Opioids offer limited long-term benefits and carry significant risks. We developed the PROMPPT intervention to address challenges in implementing effective person-centred review and safe opioid tapering in UK primary care. PROMPPT comprises a primary care review, led by clinical pharmacists working in general practices as part of the multidisciplinary team, and an associated training package. This trial will evaluate (1) the effectiveness of PROMPPT in supporting people with persistent non-cancer pain to safely reduce opioids, where appropriate, without increasing pain/pain-related interference, and (2) cost-effectiveness compared with usual primary care. Methods Design and setting: cluster randomised controlled trial, with internal pilot, in 38 general practices across England. Participants: patients ≥18 years prescribed one or more opioids ≥6 months for persistent pain who consent to participate in a questionnaire study. Exclusions: acute pain, cancer pain, end-of-life care, dementia, severe mental illness or otherwise vulnerable, and current substance misuse treatment. Practices are randomly allocated (1:1) to either: invite participants for a PROMPPT review with a trained practice pharmacist, and follow-up as needed, or continue usual primary care review for patients who are prescribed opioids. Co-primary outcomes, measured at 12 months, are (1) reduction in self-reported opioid use (≥25% reduction in daily morphine equivalent dose from their baseline) and (2) non-inferiority of the Brief Pain Inventory total score. The trial includes an economic evaluation (within trial and longer-term cost-utility analyses) and a mixed methods process evaluation. Analysis of consultation audio-recordings, case report forms (including an intervention delivery template), acceptability questionnaires and semi-structured interviews will explore how PROMPPT was delivered and received, and how context affected implementation and outcomes. Conclusion The PROMPPT trial will assess whether review by trained clinical pharmacists working in general practices can support safe opioid reduction without compromising pain management and quality of life. Trial registration ISRCTN 45616481, 13/05/2022 https://doi.org/10.1186/ISRCTN45616481

Background: Often, people living with persistent non-cancer pain are prescribed opioids long term, despite a lack of evidence for their long-term effectiveness and safety. This study informed the design of a new practice pharmacist-led review (the PROMPPT review) for people prescribed opioids for persistent pain in UK primary care. Aim: To explore the perspectives of pharmacists working in UK general practice regarding the proposed PROMPPT review, and to identify barriers to and facilitators of its delivery in practice, including supporting opioid deprescribing where appropriate. Design & setting: Multi-method qualitative study conducted with pharmacists working in primary care, who were recruited via professional networks predominantly in the East Midlands and West Midlands, UK. Method: Pharmacists with experience of consulting in primary care participated in semi-structured interviews ( n = 13) and two focus groups ( n = 16) to explore attitudes to, beliefs about, and experiences of the proposed PROMPPT review for people living with persistent pain. The Theoretical Domains Framework (TDF) provided a framework for data collection and thematic analysis. Facilitators and barriers were mapped to components of the Capability Opportunity Motivation — Behaviour (COM-B) model. Results: In total, 16 facilitators and barriers relating to the delivery of the PROMPPT review were identified across 10 domains of the TDF. Factors included access to evidence-based patient-facing resources, receiving professional colleagues’ peer support, and having a therapeutic alliance with patients. These mapped to the COM-B model components as follows: capability (knowledge, skills), opportunity (environmental context and resources, social influences), and motivation (social or professional role and identity, beliefs about capabilities, beliefs about consequences, intentions, goals, emotions). Conclusion: This study provides theoretically based evidence of factors influencing pharmacists’ delivery of the proposed PROMPPT review in relation to pharmacist capability, motivation, and opportunity. This work informed the co-design of both the intervention and the pharmacist training package.

Objectives: To assess the feasibility of a guideline-informed model of care for osteoarthritis in primary healthcare and community pharmacy settings in the West African context. Methods: The 4-phase mixed-methods programme of research undertaken in Southwest Nigeria, West Africa. Phases 1–2 involved contextual adaptation of guideline-informed care—Joint Implementation of Guidelines for OSteoArthritis in West-Africa (JIGSAW-A): (1) focus groups (n=4) with patients, community pharmacists and healthcare professionals (HCPs) to identify patient preferences and support needs of HCPs; (2) stakeholders resource contextualisation/codesign (ie, osteoarthritis guidebook in local languages, HCPs training/support package). Iterative codesign workshops (n=3) using participatory approaches, model osteoarthritis consultation simulations and consensus agreement. Phase 3: following training and a 12-week pilot implementation period, patient-reported quality of care was assessed by the OsteoArthritis Quality Indicator questionnaire (modified 9-item scale 0%–100%, 100%=best), and implementation of the JIGSAW-A model of care was evaluated using the Reach-Effectiveness-Adoption-Implementation-Maintenance framework. Patient and HCP interviews explored barriers and facilitators, usefulness and acceptability. In phase 4, recommendations for further scale-up and wider implementation of integrated osteoarthritis care were specified. Results: Phases 1–2 highlight the burden and impact of everyday living with joint pain and misinformation which affects help-seeking. Participants expressed the need for a broad information and education campaign and access to self-management support, which informed iterative contextualisation of osteoarthritis care and patient information resources used to support pilot implementation in phase 3. Over 12 weeks, 12 HCPs (community pharmacies, physiotherapists and doctors) were involved in evaluation across nine sites. Of 369 patient consultations that were reported, high rates of quality indicator achievement were found for self-management advice (97%), topical analgesic use (89%) and exercise recommendations (87%). Compliance with full patient assessment in line with the protocol was poor (17%). Conclusions: We found that evidence-based care for osteoarthritis, involving community pharmacies (as a usual first point of call) and other primary care clinicians, is feasible and may improve aspects of care in low-resource settings. Further research is needed to ascertain long-term sustainability and cost-effectiveness.

Background: Stakeholder involvement is a core element of the Medical Research Council (MRC) framework for developing and evaluating complex interventions, but approaches to involve stakeholders are not well‐reported. We outline how stakeholders contributed to co‐designing a Proactive clinical Review of patients taking Opioid Medicines long‐term for persistent Pain led by Pharmacists working in primary care Teams (the PROMPPT intervention—a review and pharmacist training package). Methods: We brought key stakeholders together to co‐design the PROMPPT intervention using a person‐based approach, alongside evidence from best practice guidance. We established a community of practice comprising three complementary groups: a patient advisory group, a pharmacist advisory group and a mixed stakeholder group. Patient stakeholders were identified from an existing patient involvement group. Professional stakeholders were identified using networks and social media. The three groups met in iterative workshops with predefined aims. We offered reimbursement for the stakeholders' time. Outcomes: The patient advisory group ( n = 10), pharmacist advisory group ( n = 6) and mixed stakeholder group ( n = 16) each met for 2 or 3 workshops between April 2019 and February 2020. Stakeholders had expertise, often cross‐cutting, in lived experience, persistent pain, opioids, delivering primary healthcare and/or promoting behaviour change. Patient stakeholders provided their perspectives of consulting about their pain and opioids. Pharmacist stakeholders provided their perspectives on how pain reviews were happening in practice and on considerations for training (e.g., vignettes and experiential learning were considered important). The mixed stakeholder group provided a breadth of views highlighting current practice, including the value of engaging the wider GP practice team, issues around clinical responsibility for prescribing and the fact that international clinical guidance was not always relevant to UK primary care. Conclusions: By understanding the context of the PROMPPT intervention, stakeholders worked to develop a new pharmacist‐led primary care review ahead of feasibility testing. We make recommendations for future developers of complex interventions. Patient and Public Contribution: Patient stakeholders, including a lay co‐applicant (C.S.) supported by a PPI support worker (A.H.), helped develop and refine the intervention. C.S. and A.H. read and contributed to the initial manuscript and approved the final manuscript.