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Care Homes Independent Pharmacist Prescribing Study (CHIPPS)

This South Norfolk CCG sponsored University of East Anglia study is a 5-year, NIHR-funded research programme, which proposes that a suitable model for appropriate medicines management in care homes is a Pharmacist Independent Prescriber (PIP), who would assume responsibility for repeat prescriptions’ monitoring and authorising and overall management of medicines in the care home.

Experiences from a non‐randomised feasibility study. The aim of this study was to inform the definitive Randomised Controlled Trial (RCT). The results show that PIPS are valued by GPs, care home staff and residents but there are difficulties meeting care home staff and GPs due to service pressures, and the Pharmaceutical Care Plans are time consuming to complete. An abstract from oral presentation is published and can be accessed through International Journal of Pharmacy Practice .

GP views on the potential role for pharmacist independent prescribers (PIPs) within care homes. This study aimed to determine GPs’ views on the utility and acceptability of PIPs. Focus groups and interviews involving 28 GPs were carried out in England, Scotland and Northern Ireland. Whilst GPs were largely supportive of PIPs assuming responsibility for repeat prescription management, there were concerns regarding the initiation of medication, and perceived implications for GP workload. An article was published in International Journal of Pharmacy Practice.

Development of a core outcome set for effectiveness trials aimed at optimising prescribing in older adults in care homes. Prescribing medicines for older adults in care homes is known to be sub-optimal. The aim of this study was to develop a core outcome set (COS), a list of outcomes which should be measured and reported, as a minimum, for all effectiveness trials involving optimising prescribing in care homes. Widespread adoption of this COS will facilitate evidence synthesis between trials. The full open access publication can be accessed from Trials.

Not just a ‘tick box exercise’ – meaningful public involvement in research. A long standing Public and Patient Involvement in Research (PPIRes) member Kate Massey gave her account on being a lay member on the management group of CHIPPS Programme and how the Public Involvement (PI) has been regarded as an integral element of the CHIPPS programme, where PI members have had ‘an effective equal partnership…, felt empowered and valued’ by the study team in an article free to read in International Journal of Pharmacy Practice .

The Care Home Independent Prescribing Pharmacist Study (CHIPPS)—a non-randomised feasibility study of independent pharmacist prescribing in care homes. Mixed methods (routine data, questionnaires and focus groups/interviews) were used in this non-randomised open feasibility study of a 3-month PIP intervention in care homes for older people. Across the four locations, 44 GP practices and 16 PIPs expressed interest in taking part; all care homes invited agreed to take part. The study has shown that implementing a PIP service in care homes is feasible and acceptable to care home residents, staff and clinicians. Findings have informed refinements to the service specification, PIP training, recruitment to the future RCT and the choice of outcomes and outcome measures. Full publication can be accessed via BMC. The full RCT with internal pilot started in February 2016 and results are expected to be available in mid late 2020.

GoalPlan: The Goal-setting in care planning for people with multimorbidity

The study aim was to explore the feasibility of adding goal setting to the care planning process in primary care for people with more than one long term condition. ‘Goal-setting is the sharing of realistic health and well-being goals by physicians and patients, and is rooted in an understanding of patient’s priorities and preferences’. This cluster randomised trial involved 6 practices (5 in Norfolk and 1 in Suffolk), 11 GPs and 52 patients. The intervention involved GP training with goal-setting role-play and the delivery of goal-setting consultations for patients with 6 month follow up.

The trial results published in BMJ Open have shown that goal setting was acceptable to patients, who wanted more continuity of care to follow up their goals. GPs liked setting goals and felt it helped care be more patient -centred and highlighted the importance of training.

A 2nd paper published in British Journal of General Practice summarised in-depth qualitative analysis of GPs consultations setting goals with patients living with multimurbidity. The interviews with 22 patients and 5 GPs revealed four main themes around the goal setting process: patient preparedness and engagement; eliciting and legitimising goals; collaborative action planning; and GP engagement. Goal setting required time and energy from both parties. GPs had an important role in listening and bearing witness to their patients’ goals.

Tele-First: telephone triage as an alternative to face-to-face contact in general practice

The aim of this study was to evaluate a ‘telephone first’ approach where patients wanting to see their GP were asked to speak to them on the phone before being given an appointment. 147 practices adopting this approach were compared with 10% random samples of other GPs in England in GP Patient Survey scores and secondary care utilisation. The study involved practice manager survey in ‘telephone first’ practices, analysis of practice data and patient surveys conducted in 20 practices using the ‘telephone first’ approach, interviews with 43 patients and 49 primary care staff. 150 participants from 4 practices in CRN Eastern took part in the study. The telephone first approach showed that many problems can be dealt with a GP on the phone. The new telephone first approach resulted in more phone calls, fewer face to face consultations, and, on average, more time spent consulting. The approach does not suit all patients or practices and is not a solution for appointment demand. There was wide variation between individual practices, including large increases and large decreases in workload after adoption of the telephone first approach. There was no evidence that the telephone first approach would reduce costs of secondary care. Access to BMJ online full publication here.