Literature Collection

AIM: This developmental study tested the feasibility of training pharmacy staff on the psychologically informed environments (PIE) approach to improve the delivery of care. BACKGROUND: Community pharmacies provide key services to people who use drugs (PWUD) through needle exchange services, medication-assisted treatment and naloxone distribution. PWUD often have trauma backgrounds, and an approach that has been demonstrated to work well in the homeless sector is PIEs. METHODS: Bespoke training was provided by clinical psychologists and assessed by questionnaire. Staff interviews explored changes made following PIE training to adapt the delivery of care. Changes in attitude of staff following training were assessed by questionnaire. Peer researchers interviewed patient/client on observed changes and experiences in participating pharmacies. Staff interviews were conducted six months after training to determine what changes, if any, staff had implemented. Normalisation process theory (NPT) provided a framework for assessing change. FINDINGS: Three pharmacies (16 staff) participated. Training evaluation was positive; all participants rated training structure and delivery as 'very good' or 'excellent'. There was no statistically significant change in attitudes. COVID-19 lockdowns restricted follow-up data collection. Staff interviews revealed training had encouraged staff to reflect on their practice and communication and consider potentially discriminatory practice. PIE informed communication skills were applied to manage COVID-19 changes. Staff across pharmacies noted mental health challenges for patients. Five patients were interviewed but COVID-19 delays in data collection meant changes in delivery of care were difficult to recall. However, they did reflect on interactions with pharmacy staff generally. Across staff and patient interviews, there was possible conflation of practice changes due to COVID-19 and the training. However, the study found that training pharmacy teams in PIE was feasible, well received, and further development is recommended. There was evidence of the four NPT domains to support change (coherence, cognitive participation, collective action and reflexive monitoring).

BACKGROUND: Fentanyl test strips (FTS) are a harm reduction method for people to test their drugs for fentanyl. Ideal points for FTS distribution have not been identified. Many people who use drugs have frequent contact with the Emergency Department (ED). We piloted FTS distribution in two urban hospital EDs. METHODS: Between June-December 2021 in Philadelphia, PA, patients with past 30-day drug use completed a survey about drug use, fentanyl attitudes, and FTS; then offered FTS and a brief training. Survey data were analyzed using SPSS for bivariate statistics. RESULTS: Patients (n = 135) were primarily White (68.1%) and male (72.6%). Participants regularly interacted with substance use (57.8%) and benefits coordination (49.6%) services. The most common drugs used were heroin/fentanyl (68.9%), crack cocaine (45.2%) and cannabis (40.0%). Most (98.5%) had heard of fentanyl though few (18.5%) had ever used FTS. Across most drug types, participants were concerned about fentanyl. All accepted FTS training and distribution. Few (9.6%) were somewhat or very concerned about having FTS if stopped by police and this number varied by race (7.6% of White people were somewhat or very concerned, compared to 12.8% of Black people). Most participants were already engaged in risk reduction practices. DISCUSSION: FTS are a widely desired harm reduction tool to facilitate informed decision-making, and non-harm reduction locations are potentially feasible and acceptable distribution sites. Given regular contact with EDs and social services across the sample, FTS should be offered at non-harm reduction locations that come into frequent contact with people who use drugs.

Patient-centred care is the foundation for safe and high-quality care that enhances patient health outcomes, with multidisciplinary team-based care (MTBC) being a key enabling factor. MTBC is an integrated approach in care provision involving health professionals with different skillsets working in collaboration. Shared goals, clarity of roles, mutual trust, effective communication, and the evaluation of team functions are important for MTBC success. No reviews were identified on the system or cross-organisational approaches that support MTBC in primary care settings. A scoping review was conducted between October and December 2024 to identify international innovations in operationalising MTBC in primary care and the factors that impact its success. The databases searched were CINAHL, ProQuest Central, PubMed, Scopus, and Web of Science, in October 2024. The search terms were informed by two central concepts: MTBC (concept 1) and primary care (concept 2). Concepts of design (concept 3) and factors (concept 4) were added to refine the scope of the search. Following the Arksey and O'Malley framework, the scoping review included 58 articles on data extraction, and confirmed 14 key success factors and 14 barriers that could affect the implementation and adoption of MTBC. The strengths of MTBC in the primary care setting are summarised by six themes: patient-centred benefits, teamwork and collaboration, decision-making and clinical care, communication and coordination, improved access and performance management, and supportive infrastructure. This review further confirms six core benefits and 11 core components of the MTBC model, providing important guidance for MTBC development. A multidisciplinary team-based care model was designed to deliver comprehensive patient-centred care by integrating expertise from various disciplines. By integrating the key elements identified in this review into a specific primary care context, successful implementation of an adaptable MTBC model may lead to improved service delivery and outcomes in primary care.