Facilitating primary care non-antiretroviral drug prescribing in people living with HIV: The ‘THINK ARV’ initiative

Objectives: Older people living with HIV (PLWH) have higher rates of multimorbidity, polypharmacy and an associated increased risk of potential drug–drug interactions (DDIs). We describe the development, implementation and evaluation of an intervention to increase community prescribers’ access to specialist prescribing advice. Methods: Phase One: a survey evaluating General Practitioners’ (GPs’) knowledge of, and confidence detecting DDIs affecting PLWH, was circulated to eight General Practices in one UK city. Phase Two: co-production was used to develop the THINK ARV intervention for prescribers in city-wide General Practices: a dedicated mobile phone and e-mail advice service staffed by HIV specialist pharmacists. Queries were audited for 6 months pre- and post-intervention. A user-satisfaction survey was emailed to enquirers. Results: Phase One: 42 GPs responded, of whom 62% requested further support identifying DDIs among PLWH. Phase Two: the number of queries received increased from 25 (6 months before ‘THINK ARV’ launch) to 63 in the following 6 months (152% increase). 94% of the queries were specifically about DDIs. Conclusions: Increasing community prescribers’ access to specialist telephone and e-mail advice resulted in increased awareness and detection of DDIs. Similar interventions could be embedded within different healthcare settings to optimise medicines and avoid potential patient harm.

Construcción teórica de la asesoría psicopedagógica

La formación del Licenciado en Educación. Pedagogía-Psicología como asesor psicopedagógico demanda la apropiación teórica de la asesoría psicopedagógica a directivos y docentes como modo de actuación profesional, en correspondencia con el objeto de la profesión y las esferas de actuación. En la comprensión del rol de asesor psicopedagógico se manifiestan insuficiencias que limitan la configuración teórico-metodológica de este proceso profesional. En esta dirección y como respuesta a esta problemática se propone, desde un enfoque interdisciplinar, la lógica de la construcción de la asesoría psicopedagógica en pos de favorecer el dominio del modo de actuación a partir de la relación académica, laboral e investigativo. Este trabajo es resultado de investigaciones doctorales de los autores. Se emplea desde una perspectiva sistémica métodos teóricos: analítico-sintético, histórico-lógico y empíricos: observación, encuesta, entrevista y análisis documental. Los resultados expresan la dialéctica integradora del proceso de formación para la asesoría psicopedagógica y su aplicación contextualizada en situaciones educativas. PALABRAS CLAVE: construcción; asesoría psicopedagógica; modo de actuación profesional. THEORETICAL CONSTRUCTION OF PSYCHOPEDAGOGICAL ADVICE ABSTRACT The formation of the Bachelor of Education. Pedagogy-Psychology as a psychopedagogical advisor demands the theoretical appropriation of psychopedagogical advice to managers and teachers as a mode of professional action, in correspondence with the object of the profession and the spheres of action. In the understanding of the role of psychopedagogical advisor, there are inadequacies that limit the theoretical-methodological configuration of this professional process. In this direction and in response to this problem, from an interdisciplinary approach, the logic of the construction of psycho-pedagogical advice is proposed in order to favor the mastery of the mode of action based on the academic, labor and research relationship. This work is been of the authors' doctoral investigations. Theoretical methods are used from a systemic perspective: analytical-synthetic, historical-logical and empirical: observation, survey, interview and documentary analysis. The results express the integrative dialectic of the training process for psychopedagogical advice and its contextualized application in educational situations. KEYWORDS: construction; psychopedagogical advice service; way of professional behavior.

A qualitative study of clinicians’ perspectives on independent rights advice for involuntary psychiatric patients in British Columbia, Canada

Background In British Columbia (BC), Canada, clinicians are responsible for giving involuntary psychiatric patients rights information upon admission. Yet an investigation by the BC Office of the Ombudsperson found that clinicians are not always fulfilling this responsibility. The Ombudsperson recommended that the provincial government fund an independent body to give rights advice to patients. Methods To understand how clinicians feel about this recommendation, focus groups of clinicians who may give psychiatric patients rights information (n = 81) were conducted in Vancouver, BC, to probe their attitudes toward independent rights advisors. The focus group transcripts were thematically analyzed. Results Most clinicians believe that giving rights information is within their scope of practice, although some acknowledge that it poses a conflict of interest when the patient wishes to challenge the treatment team’s decisions. Participants’ chief concerns about an independent rights-advice service were that (a) patients may experience a delay in receiving their rights information, (b) integrating rights advisors into the workflow would complicate an already chaotic admission process, and (c) more patients would be counselled to challenge their hospitalization, leading to an increased administrative workload for clinical staff. However, many participants believed that independent rights advisors would be a positive addition to the admission process, both allowing clinicians to focus on treatment and serving as a source of rights-related information. Conclusions Participants were generally amenable to an independent rights-advice service, suggesting that the introduction of rights advisors need not result in an adversarial relationship between treatment team and patient, as opponents of the proposal fear. Clearly distinguishing between basic rights information and in-depth rights advice could address several of the clinicians’ concerns about the role that independent rights advisors would play in the involuntary admission process. Clinicians’ and other stakeholders’ concerns should be considered as the province develops its rights-advice service.

A telephone assessment and advice service within an ED physiotherapy clinic: a single-site quality improvement cohort study

Background In response to issues with timely access and high non-attendance rates for Emergency Department (ED) physiotherapy, a telephone assessment and advice service was evaluated as part of a quality improvement project. This telehealth option requires minimal resources, with the added benefit of allowing the healthcare professional streamline care. A primary aim was to investigate whether this service model can reduce wait times and non-attendance rates, compared to usual care. A secondary aim was to evaluate service user acceptability. Methods This was a single-site quality improvement cohort study that compares data on wait time to first physiotherapy contact, non-attendance rates and participant satisfaction between patients that opted for a service based on initial telephone assessment and advice, versus routine face-to-face appointments. 116 patients were referred for ED physiotherapy over the 3-month pilot at the ED and out-patient physiotherapy department, XMercy University Hospital, Cork, Ireland. 91 patients (78%) opted for the telephone assessment and advice service, with 40% (n=36) contacting the service. 25 patients (22%) opted for the face-to-face service. Data on wait time and non-attendance rates was gathered using the hospital data reporting system. Satisfaction data was collected on discharge using a satisfaction survey adapted from the General Practice Assessment Questionnaire. Independent-samples t-test or Mann Whitney U Test was utilised depending on the distribution of the data. For categorical data, Chi-Square tests were performed. A level of significance of p ≤ 0.05 was set for this study. Results Those that contacted the telephone assessment and advice service had a significantly reduced wait time (median 6 days; 3–8 days) compared to those that opted for usual care (median 35 days; 19–39 days) (p ≤ 0.05). There was no significant between-group differences for non-attendance rates or satisfaction. Conclusion A telephone assessment and advice service may be useful in minimising delays for advice for those referred to ED Physiotherapy for musculoskeleltal problems. This telehealth option appears to be broadly acceptable and since it can be introduced rapidly, it may be helpful in triaging referrals and minimising face-to-face consultations, in line with COVID-19 recommendations. However, a large scale randomised controlled trial is warranted to confirm these findings.

A telephone assessment and advice service within an ED Physiotherapy clinic: A single-site quality improvement cohort study

BackgroundIn response to issues with timely access and high non-attendance rates for Emergency Department (ED) physiotherapy, a telephone assessment and advice service was evaluated as part of a quality improvement project. This telehealth option requires minimal resources, with the added benefit of allowing the healthcare professional streamline care. A primary aim was to investigate whether this service model can reduce wait times and non-attendance rates, compared to usual care. A secondary aim was to evaluate service user acceptability.MethodsThis was a single-site quality improvement cohort study that compares data on wait time to first physiotherapy contact, non-attendance rates and participant satisfaction between patients that opted for a service based on initial telephone assessment and advice, versus routine face-to-face appointments. 116 patients were referred for ED physiotherapy over the 3-month pilot at the ED and out-patient physiotherapy department, X, Ireland. 91 patients (78%) opted for the telephone assessment and advice service, with 40% (n=36) contacting the service. 25 patients (22%) opted for the face-to-face service. Data on wait time and non-attendance rates was gathered using the hospital data reporting system. Satisfaction data was collected on discharge using a satisfaction survey adapted from the General Practice Assessment Questionnaire. Independent-samples t-test or Mann Whitney U Test was utilised depending on the distribution of the data. For categorical data, Chi-Square tests were performed. A level of significance of p ≤ 0.05 was set for this study.ResultsThose that contacted the telephone assessment and advice service had a significantly reduced wait time (median 6 days; 3 – 8 days) compared to those that opted for usual care (median 35 days; 19 – 39 days) (p ≤ 0.05). There was no significant between-group differences for non-attendance rates or satisfaction.ConclusionA telephone assessment and advice service may be useful in minimising delays for advice for those referred to ED Physiotherapy for musculoskeleltal problems. This telehealth option appears to be broadly acceptable and since it can be introduced rapidly, it may be helpful in triaging referrals and minimising face-to-face consultations, in line with COVID-19 recommendations. However, a large scale randomised controlled trial is warranted to confirm these findings.

A telephone assessment and advice service within an ED Physiotherapy clinic: A single-site quality improvement cohort study

.BackgroundIn response to issues with timely access for musculoskeletal physiotherapy, telephone assessment and advice services have been evaluated in primary care settings. It is unclear whether this service model can reduce non-attendance rates and wait times and for Emergency Department (ED) physiotherapy, compared to usual care. A secondary aim was to evaluate service user acceptability.MethodsThis was a single-site cohort study that compares data on non-attendance rates, wait time to first physiotherapy contact and participant satisfaction between patients that opted for a service based on initial telephone assessment and advice, versus routine face-to-face appointments. 116 patients were referred for ED physiotherapy over the 3-month pilot at the ED and out-patient physiotherapy department, X, Ireland. 91 patients (78%) opted for the telephone assessment and advice service, with 40% (n=36) contacting the service. 25 patients (22%) opted for the face-to-face service. Data on non-attendance rates and wait time was gathered using the hospital data reporting system. Satisfaction data was collected on discharge using a satisfaction survey adapted from the General Practice Assessment Questionnaire. Independent-samples t-test or Mann Whitney U Test was utilised depending on the distribution of the data. For categorical data, Chi-Square tests were performed. A level of significance of p ≤ 0.05 was set for this study.ResultsThose that contacted the telephone assessment and advice service had a significantly reduced wait time (median 6 days; 3 – 8 days) compared to those that opted for usual care (median 35 days; 19 – 39 days) (p ≤ 0.05). There was no significant between-group differences for non-attendance rates or satisfaction.ConclusionGiven the faster access to ED physiotherapy, without compromising on service user satisfaction, this telephone assessment and advice service, which can be introduced rapidly, could be helpful in triaging referrals and minimising face-to-face consultations in line with COVID-19 recommendations. However, a large scale study is warranted to confirm these findings.

An evaluation of the effectiveness of a telephone assessment and advice service within an ED Physiotherapy clinic: A single-site cohort study

BackgroundIn response to issues with timely access for musculoskeletal physiotherapy, telephone assessment and advice services have been evaluated in primary care settings. It is unclear whether this service model can reduce wait times and non-attendance rates for Emergency Department (ED) physiotherapy, compared to usual care. A secondary aim was to evaluate service user acceptability.MethodsThis was a single-site cohort study that compares data on non-attendance rates, wait time to first physiotherapy contact and participant satisfaction between patients that opted for a service based on initial telephone assessment and advice, versus routine face-to-face appointments. 116 patients were referred for ED physiotherapy over the 3-month pilot at the ED and out-patient physiotherapy department, X, Ireland. 91 patients (78%) opted for the telephone assessment and advice service, with 40% (n=36) contacting the service. 25 patients (22%) opted for the face-to-face service. Data on non-attendance rates and wait time was gathered using the hospital data reporting system. Satisfaction data was collected on discharge using a satisfaction survey adapted from the General Practice Assessment Questionnaire. Independent-samples t-test or Mann Whitney U Test was utilised depending on the distribution of the data. For categorical data, Chi-Square tests were performed. A level of significance of p ≤ 0.05 was set for this study.ResultsThose that contacted the telephone assessment and advice service had a significantly reduced wait time (median 6 days; 3 – 8 days) compared to those that opted for usual care (median 35 days; 19 – 39 days) (p ≤ 0.05). There was no significant between-group differences for non-attendance rates or satisfaction.ConclusionGiven the faster access to ED physiotherapy, without compromising on service user satisfaction, this telephone assessment and advice service, which can be introduced rapidly, could be helpful in triaging referrals and minimising face-to-face consultations in line with COVID-19 recommendations. However, a large scale study is warranted to confirm these findings.