scholarly journals Modelling vaccination capacity at mass vaccination hubs and general practice clinics

2021 ◽  
Author(s):  
Mark Hanly ◽  
Tim Churches ◽  
Oisín Fitzgerald ◽  
Ian Caterson ◽  
Chandini Raina MacIntyre ◽  
...  
Keyword(s):  
Network Models ◽  
Mass Vaccination ◽  
Community Pharmacies ◽  
Stress Tests ◽  
Web Based ◽  
Vaccination Programs ◽  
Delivery Modes ◽  
Small Practice ◽  
General Practices ◽  
Service Times

AbstractCOVID-19 population vaccination programs are underway globally. In Australia, the federal government has entered into three agreements for the supply of vaccines, with roll-out beginning for the highest priority groups in February 2021. Expansion of the vaccination program throughout February and March failed to meet government targets and this has been attributed to international supply issues. However, Australia has local capacity to manufacture one million doses of the AstraZeneca vaccine weekly and once fully operational this will greatly increase the national vaccination capacity. Under current plans, these vaccine doses will be distributed primarily through a network of general practices, to be joined in later phases by community pharmacies. It remains unclear whether these small distribution venues have the logistical capacity to administer vaccines at the rate they will become available. To inform this discussion, we applied stochastic queue network models to estimate the capacity of vaccination sites based on assumptions about appointment schedules, service times and available staff numbers. We specified distinct queueing models for two delivery modes: (i) mass vaccination hubs located in hospitals or sports arenas and (ii) smaller clinics situated in general practices or community pharmacies. Based on our assumed service times, the potential daily throughput for an eight hour clinic at a mass vaccination hub ranged from around 500 vaccinations for a relatively small hub to 1,400 vaccinations a day for a relatively large hub. For GP vaccination clinics, the estimated daily throughput ranged from about 100 vaccinations a day for a relatively small practice to almost 300 a day for a relatively large practice. Stress tests showed that for both delivery modes, sites with higher staff numbers were more robust to system pressures, such as increased arrivals or staff absences, and mass vaccination sites were more robust that GP clinics. Our analysis is accompanied by an interactive web-based queue simulation applet, which allows users to explore queue performance under their own assumptions regarding appointments, service times and staff availability. Different vaccine delivery modes offer distinct benefits and may be particularly appealing to specific population segments. A combination of expanded mass vaccination hubs and expanded GP vaccination is likely to achieve mass vaccination faster than either mode alone.

Effectiveness of a web-based medication adherence tool with patient centered communication: Results of a clustered randomized controlled trial (Preprint)

2019 ◽  
Author(s):  
Jan van Lieshout ◽  
Joyca Lacroix ◽  
Aart van Halteren ◽  
Martina Teichert
Keyword(s):  
Randomized Controlled Trial ◽  
Medication Adherence ◽  
Controlled Trial ◽  
Intervention Group ◽  
Control Group ◽  
Community Pharmacies ◽  
Web Based ◽  
Randomized Controlled ◽  
Tailored Interventions ◽  
Increased Risk

BACKGROUND Growing numbers of people use medication for chronic conditions; non-adherence is common, leading to poor disease control. A newly developed web-based tool to identify an increased risk for non-adherence with related potential individual barriers might facilitate tailored interventions and improve adherence. OBJECTIVE To assess the effectiveness of the newly developed tool to improve medication adherence. METHODS A cluster randomized controlled trial assessed the effectiveness of this adherence tool in patients initiating cardiovascular or oral blood glucose lowering medication. Participants were included in community pharmacies. They completed an online questionnaire comprising an assessments of their risk for medication non-adherence and subsequently of barriers to adherence. In pharmacies belonging to the intervention group, individual barriers displayed in a graphical profile on a tablet were discussed by pharmacists and patients at high non-adherence risk in face to face meetings and shared with their general practitioners and practice nurses. Tailored interventions were initiated by the healthcare providers. Barriers of control patients were not presented or discussed and these patients received usual care. The primary outcome was the difference in medication adherence at 8 months follow-up between patients with an increased non-adherence risk from intervention and control group, calculated from dispensing data. RESULTS Data from 492 participants in 15 community pharmacies were available for analyses (intervention 253, 7 pharmacies; control 239, 8 pharmacies). The intervention had no effect on medication adherence (-0.01; 95%CI -0.59 – 0.57; P= .96), neither in the post hoc per protocol analysis (0.19; 95%CI -0.50 – 0.89; P=.58). CONCLUSIONS This study showed no effectiveness of a risk stratification and tailored intervention addressing personal barriers for medication adherence. Various potential explanations for lack of effect were identified. These explanations relate for instance to high medication adherence in the control group, study power and fidelity. Process evaluation should elicit possible improvements and inform the redesign of intervention and implementation. CLINICALTRIAL The Netherlands National Trial Register: NTR5186. Date: May 18, 2015 (http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=5186)

scholarly journals Exploring the independent prescribing role of the community pharmacists in Wales

2021 ◽  
Vol 29 (Supplement_1) ◽  
pp. i35-i35
Author(s):  
S S Alghamdi ◽  
R Deslandes ◽  
S White ◽  
K Hodson ◽  
A Mackridge ◽  
...  
Keyword(s):  
Community Pharmacy ◽  
Community Pharmacists ◽  
Community Pharmacies ◽  
Committee Report ◽  
Independent Prescribing ◽  
General Practices ◽  
The Government ◽  
Clinical Records ◽  
The Impact

Abstract Introduction Since 2019, the role of independent pharmacist prescribers (IPPs) in primary care has extended to community pharmacies in Wales [1]. This was in response to a Welsh Pharmaceutical Committee report in 2019 that outlined a plan to include an IPP in each community pharmacy in Wales by 2030. This aimed to relieve pressure on general practices, enhance patient care and reduce referral and admission rates to secondary care [2]. As funding was provided by the Government, the number of community pharmacists completing the independent prescribing course increased and many have implemented their prescribing role. Aim To explore the views of community IPPs regarding their prescribing role within community pharmacies in Wales. Methods Semi-structured face-to-face and telephone interviews were conducted with community IPPs from all seven health boards (HBs) in Wales. Ethical approval was obtained from the School of Pharmacy and Pharmaceutical Sciences at Cardiff University and the School of Pharmacy and Bioengineering at Keele University. Purposive sampling was used to identify potential participants. Gatekeepers (HB community pharmacy leads and directors of IPP courses in Wales) sent invitation emails, participant information sheet and consent form to potential participants. Written consent was obtained. Interviews were audio-recorded and transcribed ad verbatim. Thematic analysis was used to analyse the data. Results Thirteen community IPPs across Wales participated. Six themes were identified, including the utilisation of their role as community IPPs, their experiences with their independent prescribing training, motivation to obtain their prescribing qualification and utilise it, the impact, barriers and facilitators to implement and utilise their role. Participants practised as IPPs in the management of minor ailments and some other conditions, such as respiratory and sexual health. The course and training for community IPPs was helpful, but there was a need to focus more on therapeutic and clinical examination skills. The main impact of the role was that it helped to improve communication between community pharmacies and general practices and relieved some pressure on general practices. The main barriers were the lack of appropriate funding by the Government to develop the role, lack of access to patients’ medical records, lack of support and high workload. “One of the areas identified as high risk is for pharmacy prescribers is the lack of access to clinical records. How can you [as community IPPs] make any sensible decisions with half the information?” IPP6 Facilitators included that some services were already in place and the drive from the 2030 vision. Conclusion This is the first study that explored the views of community IPPs regarding their prescribing role in community pharmacies in Wales. It provided an insight into this new role that can be considered by the Welsh Government to achieve the 2030 vision for this role. A limitation to this study was that the role is still new in community pharmacies, which may affect the views of the community IPPs. Many of them have obtained their prescribing qualification but have not started to utilise it yet. Further work is needed to explore a wider population of community IPPs’ experiences as the role develops. References 1. Wickware, C. 2019. All community pharmacies in Wales to have an independent prescriber as part of long-term plan for Welsh pharmacy. Available at: https://www.pharmaceutical-journal.com/news-and-analysis/news/all-community-pharmacies. 2. Welsh Pharmaceutical Committee. 2019. Pharmacy: Delivering a Healthier Wales. Available at: https://www.rpharms.com/Portals/0/RPS%2.

scholarly journals A Web-Based and Print-Delivered Computer-Tailored Physical Activity Intervention for Older Adults: Pretest-Posttest Intervention Study Comparing Delivery Mode Preference and Attrition

10.2196/13416 ◽  
2019 ◽  
Vol 21 (8) ◽  
pp. e13416 ◽  
Author(s):  
Janet Maria Boekhout ◽  
Denise Astrid Peels ◽  
Brenda Angela Juliette Berendsen ◽  
Catherine Bolman ◽  
Lilian Lechner
Keyword(s):  
Social Support ◽  
Older Adults ◽  
Educational Attainment ◽  
Intervention Study ◽  
Delivery Mode ◽  
Web Based ◽  
Physical Impairments ◽  
Delivery Modes ◽  
Participant Characteristics ◽  
The Web

Background Web-based interventions can play an important role in promoting physical activity (PA) behavior among older adults. Although the effectiveness of these interventions is promising, they are often characterized by low reach and high attrition, which considerably hampers their potential impact on public health. Objective The aim of this study was to identify the participant characteristics associated with the preference for a Web-based or a printed delivery mode and to determine whether an association exists between delivery modes or participant characteristics and attrition in an intervention. This knowledge may enhance implementation, sustainability of participation, and effectiveness of future interventions for older adults. Methods A real-life pretest-posttest intervention study was performed (N=409) among community-living single adults who were older than 65 years, with physical impairments caused by chronic diseases. Measurements were taken at baseline and 3 months after the start of the intervention. Hierarchical logistic regression was used to assess demographic and behavioral characteristics (age, gender, body mass index, educational attainment, degree of loneliness, and PA level), as well as psychosocial characteristics (social support for PA, modeling, self-efficacy, attitude, and intention) related to delivery mode preference at baseline and attrition after 3 months. Results The printed delivery mode achieved higher participation (58.9%, 241/409) than the Web-based delivery mode (41.1%, 168/409). Participation in the Web-based delivery mode was associated with younger age (B=–0.10; SE 0.02; Exp (B)=0.91; P<.001) and higher levels of social support for PA (B=0.38; SE 0.14; Exp (B)=1.46; P=.01); attrition was associated with participation in the Web-based delivery mode (B=1.28; SE 0.28; Exp (B)=3.58; P<.001) and low educational attainment (B=–0.53; SE 0.28; Exp (B)=0.59; P=.049). Conclusions A total of 41% of the participants chose the Web-based delivery mode, thus demonstrating a potential interest of single older adults with physical impairments in Web-based delivered interventions. However, attrition was demonstrated to be higher in the Web-based delivery mode, and lower educational attainment was found to be a predictor for attrition. Characteristics predicting a preference for the printed delivery mode included being older and receiving less social support. Although Web-based delivery modes are generally less expensive and easier to distribute, it may be advisable to offer a printed delivery mode alongside a Web-based delivery mode to prevent exclusion of a large part of the target population. Trial Registration Netherlands Trial Register NTR2297; https://www.trialregister.nl/trial/2173 International Registered Report Identifier (IRRID) RR2-DOI: 10.2196/resprot.8093

scholarly journals Beyond the four walls: an exploratory survey of location, employment and roles of pharmacists in primary health care

2017 ◽  
Vol 9 (4) ◽  
pp. 297 ◽  
Author(s):  
Chloë Campbell ◽  
Rhiannon Braund ◽  
Caroline Morris
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Community Pharmacy ◽  
Patient Outcomes ◽  
Service Provision ◽  
Health Care Sector ◽  
Pharmacy Service ◽  
Community Pharmacies ◽  
Primary Health ◽  
General Practices

ABSTRACT INTRODUCTION Recognition of the need to reduce harm and optimise patient outcomes from the use of medicines is contributing to an evolution of pharmacy practice in primary health care internationally. This evolution is changing community pharmacy and leading to new models of care that enable pharmacist contribution beyond traditional realms. There is little information about the extent of these changes in New Zealand. AIM The aim of this study was to investigate emerging roles of pharmacists in primary health care. METHODS A 10-question electronic survey was used to collect quantitative data about location, employment and roles of pharmacists practising in primary health care. RESULTS There were 467 survey responses. Although most pharmacists are employed by (78%, n = 357/458) and located in (84%, n = 393/467) community pharmacies, small numbers are dispersed widely across the primary health care sector. Of the 7% (n = 31/467) working in general practices, most are employed by Primary Health Organisations or District Health Boards. Limited cognitive pharmacy service provision is evident in the sector overall, but is much greater for pharmacists spending time located within general practices. DISCUSSION The large proportion of pharmacists practising in community pharmacies emphasises the importance of the Community Pharmacy Services Agreement in facilitating increased cognitive pharmacy service provision to optimise patient outcomes. The small numbers of pharmacists located elsewhere in the primary health care sector suggest there is scope to improve collaboration and integration in these areas. Flexible funding models that promote innovation and support sustainable practice change are key.

scholarly journals B-COURSE: A WEB-BASED TOOL FOR BAYESIAN AND CAUSAL DATA ANALYSIS

2002 ◽  
Vol 11 (03) ◽  
pp. 369-387 ◽  
Author(s):  
PETRI MYLLYMÄKI ◽  
TOMI SILANDER ◽  
HENRY TIRRI ◽  
PEKKA URONEN
Keyword(s):  
Data Analysis ◽  
Bayesian Network ◽  
Network Models ◽  
Causal Modeling ◽  
Analysis Tool ◽  
Support Material ◽  
Online Data ◽  
Web Based ◽  
User Friendly ◽  
Bayesian Network Models

B-Course is a free web-based online data analysis tool, which allows the users to analyze their data for multivariate probabilistic dependencies. These dependencies are represented as Bayesian network models. In addition to this, B-Course also offers facilities for inferring certain type of causal dependencies from the data. The software uses a novel "tutorial stylerdquo; user-friendly interface which intertwines the steps in the data analysis with support material that gives an informal introduction to the Bayesian approach adopted. Although the analysis methods, modeling assumptions and restrictions are totally transparent to the user, this transparency is not achieved at the expense of analysis power: with the restrictions stated in the support material, B-Course is a powerful analysis tool exploiting several theoretically elaborate results developed recently in the fields of Bayesian and causal modeling. B-Course can be used with most web-browsers (even Lynx), and the facilities include features such as automatic missing data handling and discretization, a flexible graphical interface for probabilistic inference on the constructed Bayesian network models (for Java enabled browsers), automatic prettyHyphen;printed layout for the networks, exportation of the models, and analysis of the importance of the derived dependencies. In this paper we discuss both the theoretical design principles underlying the B-Course tool, and the pragmatic methods adopted in the implementation of the software.

scholarly journals Spatiotemporal dynamics of foot and mouth disease outbreaks in India, 2008-2016

2021 ◽  
Author(s):  
Umanga Gunasekera ◽  
Jitendra Biswal ◽  
Gustavo Machado ◽  
Rajeev Ranjan ◽  
Saravanan Subramaniam ◽  
...  
Keyword(s):  
Antibody Titer ◽  
Foot And Mouth Disease ◽  
Spatiotemporal Dynamics ◽  
Mouth Disease ◽  
Mass Vaccination ◽  
Vaccination Program ◽  
Post Vaccination ◽  
Vaccination Programs ◽  
Foot And Mouth ◽  
The Impact

Foot-and-mouth disease (FMD) is endemic in India, where circulation of serotypes O, A and Asia 1 is frequent. In the past two decades, many of the most widespread and significant FMD lineages globally have emerged from the South Asia region. Here, we provide an epidemiological assessment of the ongoing mass vaccination programs in regard to post-vaccination monitoring and outbreak occurrence. The objective of this study was to quantify the spatiotemporal dynamics of FMD outbreaks and to assess the impact of the mass vaccination program between 2008 to 2016 with available antibody titer data from the vaccination monitoring program, alongside other risk factors that facilitate FMD spread in the country. We first conducted a descriptive analysis of epidemiological outcomes of governmental vaccination programs in India, focusing on antibody titer data from >1 million animals sampled as part of pre- and post-vaccination monitoring and estimates of standardized incidence ratios calculated from reported outbreaks per state/administrative unit. The percent of animals with inferred immunological protection (based on ELISA) was highly variable across states, but there was a general increase in the overall percent of animals with inferred protection through time. In addition, the number of outbreaks in a state was negatively correlated with the percent of animals with inferred protection. Because standardized incidence ratios of outbreaks were heterogeneously distributed over the course of eight years, we analyzed the distribution of reported FMD outbreaks using a Bayesian space-time model to map high-risk areas. This model demonstrated a ~50% reduction in the relative risk of outbreaks in states that were part of the vaccination program. In addition, states that did not have an international border experienced reduced risk of FMD outbreaks. These findings help inform risk-based control strategies for India as the country progresses towards reducing reported clinical disease.

scholarly journals SARS CoV-2 Vaccines, Remdesivir and Favipiravir Might Have Led to SARS CoV-2 B.1.617 Variants: India First but We Can Intervene

2021 ◽  
Author(s):  
Mina Kelleni
Keyword(s):  
Mass Vaccination ◽  
Vaccination Programs

In the initial draft, I have made a mistake SARS COV-2 Vaccines have not shared in development of the original SARS CoV-2 B.1.617 variants in India (yet they might have shared in the evolution of the more virulent delta plus variant). I have updated the manuscript, thanks to Authorea, and in the updated versions Remdesivir, Favipiravir and Dexamethasone are suggested as potential crucial causes that led to B.1.617 variants in India and elsewhere. Moreover, SARS CoV-2 mass vaccination programs and the unfortunately anticipated Molnupiravir are suggested to share in evolution of potentially more virulent variants e.g. delta plus and the catastrophic Indian surge of mortality is also anticipated to be repeated elsewhere unless some prompt interventions are considered.

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