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Article ; Online: Reducing medication errors and transitions of care.

Cardwell, Karen

2020 Volume 49, Issue 4, Page(s) 537–539

MeSH term(s)	Aged ; Aged, 80 and over ; Humans ; Medication Errors ; Patient Transfer ; Polypharmacy
Language	English
Publishing date	2020-05-30
Publishing country	England
Document type	Journal Article ; Comment
ZDB-ID	186788-x
ISSN	1468-2834 ; 0002-0729
ISSN (online)	1468-2834
ISSN	0002-0729
DOI	10.1093/ageing/afaa065
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Article ; Online: The effectiveness and cost of integrating pharmacists within general practice to optimize prescribing and health outcomes in primary care patients with polypharmacy: a systematic review.

Croke, Aisling / Cardwell, Karen / Clyne, Barbara / Moriarty, Frank / McCullagh, Laura / Smith, Susan M

BMC primary care

2023 Volume 24, Issue 1, Page(s) 41

Abstract: Background: Polypharmacy and associated potentially inappropriate prescribing (PIP) place a considerable burden on patients and represent a challenge for general practitioners (GPs). Integration of pharmacists within general practice (herein 'pharmacist ...

Abstract	Background: Polypharmacy and associated potentially inappropriate prescribing (PIP) place a considerable burden on patients and represent a challenge for general practitioners (GPs). Integration of pharmacists within general practice (herein 'pharmacist integration') may improve medications management and patient outcomes. This systematic review assessed the effectiveness and costs of pharmacist integration. Methods: A systematic search of ten databases from inception to January 2021 was conducted. Studies that evaluated the effectiveness or cost of pharmacist integration were included. Eligible interventions were those that targeted medications optimization compared to usual GP care without pharmacist integration (herein 'usual care'). Primary outcomes were PIP (as measured by PIP screening tools) and number of prescribed medications. Secondary outcomes included health-related quality of life, health service utilization, clinical outcomes, and costs. Randomised controlled trials (RCTs), non-RCTs, interrupted-time-series, controlled before-after trials and health-economic studies were included. Screening and risk of bias using Cochrane EPOC criteria were conducted by two reviewers independently. A narrative synthesis and meta-analysis of outcomes where possible, were conducted; the certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation approach. Results: In total, 23 studies (28 full text articles) met the inclusion criteria. In ten of 11 studies, pharmacist integration probably reduced PIP in comparison to usual care (moderate certainty evidence). A meta-analysis of number of medications in seven studies reported a mean difference of -0.80 [-1.17, -0.43], which indicated pharmacist integration probably reduced number of medicines (moderate certainty evidence). It was uncertain whether pharmacist integration improved health-related quality of life because the certainty of evidence was very low. Twelve health-economic studies were included; three investigated cost effectiveness. The outcome measured differed across studies limiting comparisons and making it difficult to make conclusions on cost effectiveness. Conclusions: Pharmacist integration probably reduced PIP and number of medications however, there was no clear effect on other patient outcomes; and while interventions in a small number of studies appeared to be cost-effective, further robust, well-designed cluster RCTs with economic evaluations are required to determine cost-effectiveness of pharmacist integration. Trial registration: CRD42019139679.
MeSH term(s)	Humans ; General Practice ; Outcome Assessment, Health Care ; Pharmacists ; Polypharmacy ; Primary Health Care
Language	English
Publishing date	2023-02-06
Publishing country	England
Document type	Journal Article ; Systematic Review ; Research Support, Non-U.S. Gov't
ISSN	2731-4553
ISSN (online)	2731-4553
DOI	10.1186/s12875-022-01952-z
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Article ; Online: Clinical pharmacists working within family practice: what is the evidence?

Cardwell, Karen / Smith, Susan M

Family practice

2018 Volume 35, Issue 2, Page(s) 120–121

MeSH term(s)	Community Pharmacy Services/organization & administration ; Delivery of Health Care, Integrated/organization & administration ; Family Practice/organization & administration ; Health Services Research ; Humans ; Interprofessional Relations ; Pharmacy Research ; Professional Role
Language	English
Publishing date	2018-02-08
Publishing country	England
Document type	Editorial ; Research Support, Non-U.S. Gov't
ZDB-ID	605939-9
ISSN	1460-2229 ; 0263-2136
ISSN (online)	1460-2229
ISSN	0263-2136
DOI	10.1093/fampra/cmy003
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Article ; Online: The effectiveness and cost of integrating pharmacists within general practice to optimize prescribing and health outcomes in primary care patients with polypharmacy

Aisling Croke / Karen Cardwell / Barbara Clyne / Frank Moriarty / Laura McCullagh / Susan M. Smith

BMC Primary Care, Vol 24, Iss 1, Pp 1-

a systematic review

2023 Volume 30

Abstract: Abstract Background Polypharmacy and associated potentially inappropriate prescribing (PIP) place a considerable burden on patients and represent a challenge for general practitioners (GPs). Integration of pharmacists within general practice (herein ‘ ... ...

Abstract	Abstract Background Polypharmacy and associated potentially inappropriate prescribing (PIP) place a considerable burden on patients and represent a challenge for general practitioners (GPs). Integration of pharmacists within general practice (herein ‘pharmacist integration’) may improve medications management and patient outcomes. This systematic review assessed the effectiveness and costs of pharmacist integration. Methods A systematic search of ten databases from inception to January 2021 was conducted. Studies that evaluated the effectiveness or cost of pharmacist integration were included. Eligible interventions were those that targeted medications optimization compared to usual GP care without pharmacist integration (herein ‘usual care’). Primary outcomes were PIP (as measured by PIP screening tools) and number of prescribed medications. Secondary outcomes included health-related quality of life, health service utilization, clinical outcomes, and costs. Randomised controlled trials (RCTs), non-RCTs, interrupted-time-series, controlled before-after trials and health-economic studies were included. Screening and risk of bias using Cochrane EPOC criteria were conducted by two reviewers independently. A narrative synthesis and meta-analysis of outcomes where possible, were conducted; the certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation approach. Results In total, 23 studies (28 full text articles) met the inclusion criteria. In ten of 11 studies, pharmacist integration probably reduced PIP in comparison to usual care (moderate certainty evidence). A meta-analysis of number of medications in seven studies reported a mean difference of -0.80 [-1.17, -0.43], which indicated pharmacist integration probably reduced number of medicines (moderate certainty evidence). It was uncertain whether pharmacist integration improved health-related quality of life because the certainty of evidence was very low. Twelve health-economic studies were included; three ...
Keywords	Polypharmacy ; Potentially inappropriate prescribing ; Primary care ; Systematic review ; Clinical pharmacist ; Medication review ; Medicine (General) ; R5-920
Subject code	150
Language	English
Publishing date	2023-02-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Towards conceptual convergence

Odessa McKenna / Afolasade Fakolade / Katherine Cardwell / Nigèle Langlois / Karen Jiang / Lara A. Pilutti

Health Expectations, Vol 25, Iss 1, Pp 4-

A systematic review of psychological resilience in family caregivers of persons living with chronic neurological conditions

2022 Volume 37

Abstract: Abstract Background The demand for family caregiving in persons with chronic neurological conditions (CNCs) is increasing. Psychological resilience may empower and protect caregivers in their role. Thus, a synthesis of resilience evidence within this ... ...

Abstract	Abstract Background The demand for family caregiving in persons with chronic neurological conditions (CNCs) is increasing. Psychological resilience may empower and protect caregivers in their role. Thus, a synthesis of resilience evidence within this specific population is warranted. Aim In this systematic review we aimed to: (1) examine the origins and conceptualizations of resilience; (2) summarize current resilience measurement tools; and (3) synthesize correlates, predictors and outcomes of resilience in family caregivers of persons with CNCs. Design We sourced English articles published up to July 2020 across five databases using search terms involving CNCs, family caregivers and resilience. Results A total of 50 studies were retained. Nearly half (44%) of the studies used trait‐based resilience definitions, while about one third (36%) used process‐based definitions. Twelve different resilience scales were used, revealing mostly moderate to high‐resilience levels. Findings confirmed that resilience is related to multiple indicators of healthy functioning (e.g., quality of life, social support, positive coping), as it buffers against negative outcomes of burden and distress. Discordance relating to the interaction between resilience and demographic, sociocultural and environmental factors was apparent. Conclusions Incongruity remains with respect to how resilience is defined and assessed, despite consistent definitional concepts of healthy adaptation and equilibrium. The array of implications of resilience for well‐being confirms the potential for resilience to be leveraged within caregiver health promotion initiatives via policy and practice. Patient or Public Contribution The findings may inform future recommendations for researchers and practitioners to develop high‐quality resilience‐building interventions and programmes to better mobilize and support this vulnerable group.
Keywords	chronic neurological conditions ; dementia ; family caregivers ; resilience ; systematic review ; Medicine (General) ; R5-920 ; Public aspects of medicine ; RA1-1270
Subject code	360
Language	English
Publishing date	2022-02-01T00:00:00Z
Publisher	Wiley
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Towards conceptual convergence: A systematic review of psychological resilience in family caregivers of persons living with chronic neurological conditions.

McKenna, Odessa / Fakolade, Afolasade / Cardwell, Katherine / Langlois, Nigèle / Jiang, Karen / Pilutti, Lara A

Health expectations : an international journal of public participation in health care and health policy

2021 Volume 25, Issue 1, Page(s) 4–37

Abstract: Background: The demand for family caregiving in persons with chronic neurological conditions (CNCs) is increasing. Psychological resilience may empower and protect caregivers in their role. Thus, a synthesis of resilience evidence within this specific ... ...

Abstract	Background: The demand for family caregiving in persons with chronic neurological conditions (CNCs) is increasing. Psychological resilience may empower and protect caregivers in their role. Thus, a synthesis of resilience evidence within this specific population is warranted. Aim: In this systematic review we aimed to: (1) examine the origins and conceptualizations of resilience; (2) summarize current resilience measurement tools; and (3) synthesize correlates, predictors and outcomes of resilience in family caregivers of persons with CNCs. Design: We sourced English articles published up to July 2020 across five databases using search terms involving CNCs, family caregivers and resilience. Results: A total of 50 studies were retained. Nearly half (44%) of the studies used trait-based resilience definitions, while about one third (36%) used process-based definitions. Twelve different resilience scales were used, revealing mostly moderate to high-resilience levels. Findings confirmed that resilience is related to multiple indicators of healthy functioning (e.g., quality of life, social support, positive coping), as it buffers against negative outcomes of burden and distress. Discordance relating to the interaction between resilience and demographic, sociocultural and environmental factors was apparent. Conclusions: Incongruity remains with respect to how resilience is defined and assessed, despite consistent definitional concepts of healthy adaptation and equilibrium. The array of implications of resilience for well-being confirms the potential for resilience to be leveraged within caregiver health promotion initiatives via policy and practice. Patient or public contribution: The findings may inform future recommendations for researchers and practitioners to develop high-quality resilience-building interventions and programmes to better mobilize and support this vulnerable group.
MeSH term(s)	Adaptation, Psychological ; Caregivers/psychology ; Humans ; Quality of Life ; Resilience, Psychological ; Social Support
Language	English
Publishing date	2021-10-22
Publishing country	England
Document type	Journal Article ; Review ; Systematic Review
ZDB-ID	2119434-8
ISSN	1369-7625 ; 1369-6513
ISSN (online)	1369-7625
ISSN	1369-6513
DOI	10.1111/hex.13374
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Zs.A 5896: Show issues

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Article ; Online: The effectiveness of integrating clinical pharmacists within general practice to optimise prescribing and health outcomes in primary care patients with polypharmacy: A protocol for a systematic review.

Croke, Aisling / James, Oscar / Clyne, Barbara / Moriarty, Frank / Cardwell, Karen / Smith, Susan M

HRB open research

2020 Volume 2, Page(s) 32

Abstract: Introduction: ...

Abstract	Introduction:
Language	English
Publishing date	2020-03-12
Publishing country	Ireland
Document type	Journal Article
ISSN	2515-4826
ISSN (online)	2515-4826
DOI	10.12688/hrbopenres.12966.2
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Article ; Online: Community pharmacists' views of using a screening tool to structure medicines use reviews for older people: findings from qualitative interviews.

Cardwell, Karen / Hughes, Carmel M / Ryan, Cristín

International journal of clinical pharmacy

2018 Volume 40, Issue 5, Page(s) 1086–1095

Abstract: Background The Medicines use review (MUR) service, provided by community pharmacists, seeks to optimise patients' use of medicines. There is limited evidence on the clinical effectiveness of this service. Structuring MURs to include an assessment of ... ...

Abstract	Background The Medicines use review (MUR) service, provided by community pharmacists, seeks to optimise patients' use of medicines. There is limited evidence on the clinical effectiveness of this service. Structuring MURs to include an assessment of prescribing appropriateness, facilitated by a validated prescribing screening tool, has the capacity to enhance this service. Objective To explore community pharmacists' views on the facilitators and barriers towards the utilisation of a screening tool as a guide to conducting structured MURs. Setting Community Pharmacy, Northern Ireland. Method Using the 14 domain Theoretical Domains Framework (TDF), semi-structured interviews were conducted with community pharmacists. Interviews were digitally recorded, transcribed verbatim and analysed using the Framework method. Main Outcome Measure Pharmacists' views towards utilisation of a screening tool as a guide to conducting structured MURs. Results Based on the analysis of 15 interviews, 11 TDF domains ('Knowledge', 'Skills', 'Social and professional role and identity', 'Beliefs about capabilities', 'Beliefs about consequences', 'Reinforcement', 'Goals', 'Memory, attention and decision process', 'Environmental context and resources', 'Social influences', 'Behavioural regulation') were deemed relevant. Facilitators included: knowledge of patients, clinical knowledge, perceived professional role, patients' clinical outcomes, influence of peers. Barriers included: prioritisation of other clinical activities, inability to access patients' clinical information, perceived alienation from the primary healthcare team and staffing issues. Conclusions Using the TDF, key facilitators and barriers were identified in the use of a screening tool as a guide to conducting MURs. These findings may assist in further development of MURs as a means to optimise patients' medicines use.
MeSH term(s)	Aged ; Attitude of Health Personnel ; Community Pharmacy Services/standards ; Drug Utilization Review/methods ; Drug Utilization Review/standards ; Female ; Health Knowledge, Attitudes, Practice ; Humans ; Male ; Pharmacists/psychology ; Pharmacists/standards ; Qualitative Research
Language	English
Publishing date	2018-05-23
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	2601204-2
ISSN	2210-7711 ; 2210-7703 ; 0928-1231
ISSN (online)	2210-7711
ISSN	2210-7703 ; 0928-1231
DOI	10.1007/s11096-018-0659-z
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Article ; Online: Veteran Caretaker Perspectives of the Need for Childcare Assistance During Health Care Appointments.

Shepherd-Banigan, Megan / Cannedy, Shay / Rodriguez, Adriana / Burns, Madison / Woolson, Sandra / Hamilton, Alison / Quiroz, Ismael / Matthews, Hanh / Garber-Cardwell, Diane / Byrd, Kaileigh G / Brown, Adrian / Goldstein, Karen M

Women's health issues : official publication of the Jacobs Institute of Women's Health

2023 Volume 34, Issue 1, Page(s) 98–106

Abstract: Purpose: In 2020, Congress passed legislation to establish the national Veterans Child Care Assistance Program (VCAP) targeting eligible veterans receiving care through the Veterans Health Administration (VA). This needs assessment describes the ... ...

Abstract	Purpose: In 2020, Congress passed legislation to establish the national Veterans Child Care Assistance Program (VCAP) targeting eligible veterans receiving care through the Veterans Health Administration (VA). This needs assessment describes the childcare needs of veteran caretakers of young children and explores the implications of inadequate childcare on health care engagement. Methods: Survey data were collected from 2,000 VA users with dependent children; data were analyzed using standard descriptive statistics. Qualitative data were collected from 19 veterans through focus groups and analyzed using rapid thematic analysis. Findings: More than 75% of veterans surveyed indicated that they required childcare assistance during health care appointments and 73% reported barriers to finding childcare. Prominent barriers included the high cost of childcare and not having a trusted source of childcare. Nearly 58% of survey respondents reported missed or canceled VA health care appointments due to childcare challenges. Furthermore, 35% of surveyed veterans reported that their children had accompanied them to an appointment in the past year. Among these veterans, 59% brought their children into the exam room. Focus group participants discussed how having children present during their health care appointments hampered communication with health care providers. Conclusions: Veterans report that lack of childcare keeps them from attending and remaining focused on the provider during their health care visits, which could compromise quality of care. As one of the only health systems in the United States that will offer childcare assistance, VCAP presents an opportunity to improve health care access and quality by reducing missed appointments and suboptimal care.
MeSH term(s)	Humans ; United States ; Child ; Child, Preschool ; Veterans ; Child Care ; United States Department of Veterans Affairs ; Health Services Accessibility ; Needs Assessment
Language	English
Publishing date	2023-10-12
Publishing country	United States
Document type	Journal Article
ZDB-ID	1085396-0
ISSN	1878-4321 ; 1049-3867
ISSN (online)	1878-4321
ISSN	1049-3867
DOI	10.1016/j.whi.2023.08.005
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Article ; Online: Pharmacists in general practice: a qualitative process evaluation of the General Practice Pharmacist (GPP) study.

James, Oscar / Cardwell, Karen / Moriarty, Frank / Smith, Susan M / Clyne, Barbara

Family practice

2020 Volume 37, Issue 5, Page(s) 711–718

Abstract: Background: There is some evidence to suggest that pharmacists integrated into primary care improves patient outcomes and prescribing quality. Despite this growing evidence, there is a lack of detail about the context of the role.: Objective: To ... ...

Abstract	Background: There is some evidence to suggest that pharmacists integrated into primary care improves patient outcomes and prescribing quality. Despite this growing evidence, there is a lack of detail about the context of the role. Objective: To explore the implementation of The General Practice Pharmacist (GPP) intervention (pharmacists integrating into general practice within a non-randomized pilot study in Ireland), the experiences of study participants and lessons for future implementation. Design and setting: Process evaluation with a descriptive qualitative approach conducted in four purposively selected GP practices. Methods: A process evaluation with a descriptive qualitative approach was conducted in four purposively selected GP practices. Semi-structured interviews were conducted, transcribed verbatim and analysed using a thematic analysis. Results: Twenty-three participants (three pharmacists, four GPs, four patients, four practice nurses, four practice managers and four practice administrators) were interviewed. Themes reported include day-to-day practicalities (incorporating location and space, systems and procedures and pharmacists' tasks), relationships and communication (incorporating GP/pharmacist mode of communication, mutual trust and respect, relationship with other practice staff and with patients) and role perception (incorporating shared goals, professional rewards, scope of practice and logistics). Conclusions: Pharmacists working within the general practice team have potential to improve prescribing quality. This process evaluation found that a pharmacist joining the general practice team was well accepted by the GP and practice staff and effective interprofessional relationships were described. Patients were less clear of the overall benefits. Important barriers (such as funding, infrastructure and workload) and facilitators (such as teamwork and integration) to the intervention were identified which will be incorporated into a pilot cluster randomized controlled trial.
MeSH term(s)	Attitude of Health Personnel ; Family Practice ; General Practice ; Humans ; Pharmacists ; Pilot Projects ; Primary Health Care ; Professional Role
Language	English
Publishing date	2020-04-06
Publishing country	England
Document type	Clinical Trial ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	605939-9
ISSN	1460-2229 ; 0263-2136
ISSN (online)	1460-2229
ISSN	0263-2136
DOI	10.1093/fampra/cmaa044
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