Healthcare Improvement Scotland

Cardio-oncology remains a speciality dominated by cardiologists despite the importance of doctors from other specialties, such as oncology and haematology, for managing the cardiovascular health of patients living with cancer. A major reason for this is a distinct lack of cardio-oncology training opportunities for the noncardiology trainee. This is because of several factors, including a lack of awareness of cardio-oncology as a specialty. We propose a cardio-oncology training programme that involves early exposure to cardio-oncology as a specialty and provides the noncardiologist with a good understanding of cardiological investigations and treatment in the context of cancer treatment. Future work should elucidate additional barriers to cardio-oncology training as well as identifying programmes that have integrated cross-disciplinary cardio-oncology content to inform future curriculum development. Future work should also focus on establishing pilot cardio-oncology training programmes for the noncardiologist.

This study aimed to explore the reflections of student and newly qualified pharmacists (NQPs) surrounding community pharmacy culture around substance dependency. This study explored professionalism and professional identity formation, and the possibility that a fragmented professional identity may impact behaviours and the provision of compassionate care. Qualitative study: semi-structured interviews were conducted with student and exploring stigma within community pharmacy environments in relation to people with substance dependency, the community pharmacy culture and their own ideas of professionalism and their professional identity formation. Interviews were undertaken by six pharmacy student researchers, under the supervision of two experienced researchers. Community pharmacies across Scotland. Twenty-eight participants were recruited, including undergraduates based at Scottish Schools of Pharmacy (n = 20); Foundation Year Pharmacy students (n = 2) and NQPs (n = 6). Recruitment utilised university networks and social media platforms. Interviews were conducted between September and November 2023 on Microsoft Teams®, each lasting 17-60 minutes. Data underwent inductive thematic analysis via NVivo® through data familiarisation, initial coding, theme searching, reviewing and defining and reporting. Stigmatisation of people with substance dependency attending a pharmacy was a prominent observation. This included negative stereotyping, adverse treatment because of judgements made about substance use and structural stigma relating to barriers to accessing care. Positive care provision in pharmacies was evident. Pharmacy staff who were empathetic, respectful, professional and who formed long-term relationships with people with substance dependency were valuable role models for students and influenced their professional identify formation. Students appreciated the exposure to practice and the opportunity to make judgements that would mould the type of pharmacist they aspired to become. A number of participants reported that their university course poorly prepared them for the reality of supporting people with substance dependency. Pharmacy practice in Scotland appears to be characterised by stigma and lack of professionalism towards people with substance dependency, although there are examples of compassionate care. Observing staff in practice allowed participants of this study to develop their own professional identity and attitudes, yet there is a need to better prepare students in undergraduate curricula.

Advice on how to see yourself as a leader in your clinical area, regardless of your role or position in the hierarchy

ABSTRACTObjectiveTo explore patients' perceptions and attitudes towards patient guidelines (PGs) and to identify specific factors related to PG content, design, presentation, and management that may influence patients' use or adoption of PGs.MethodsAn exploratory sequential mixed‐methods design was employed. Initial semi‐structured interviews were conducted with a diverse group of individuals, including people with diabetes or oncology, and clinicians. These interviews were analysed through directed content analysis. Findings from the qualitative study were used to develop a questionnaire. The questionnaire was circulated to patients with diabetes and cancer and asked them to report their awareness, attitudes, and the PG‐related factors influencing their use and adoption of PGs.ResultsIn total, 25 participants were interviewed qualitatively, and 400 participated in the quantitative survey. Analysis of interviews yielded three themes: perception of PGs, attitude towards PGs, and key PG attributes influencing patients' use or adoption of PG. Qualitative findings indicated limited awareness of PGs, supported quantitatively by only 26.5% of patients being aware of PGs. Attitudes varied, with 73.0% expressing an overall positive attitude towards PG, but only 17.3% preferred PGs for evidence‐based answers and 32.3% favoured them for decision support, citing concerns that general recommendations may not meet individual needs. Participants suggested tailoring recommendations based on subgroups considering age, comorbidity, and weight, explaining why treatments work or don't work in different populations. Eight PG attributes influencing their use or adoption were found: accessibility, identifiability, attractiveness, credibility, usability, timeliness, relevance and simplicity. Lack of credibility was the most frequently mentioned hindrance, with 34.8% identifying unverifiable information as a barrier. Further qualitative and quantitative analyses revealed that medical staff were trusted sources for conveying PGs to patients.Conclusions and Practice ImplicationsThis study underscores the necessity for PGs to acknowledge individual differences and provide recommendations that are more tailored considering age, comorbidities, weight, and other factors influencing decision‐making, ensuring that they address patients' specific needs and support informed decision‐making. Additionally, there was a significant need to improve the dissemination of PGs, using medical staff as key channels to improve patients' use or adoption of PGs.Patient or Public ContributionIn this study, patients were actively involved in several stages. During the development of the interview guide, feedback from two patients, alongside one patient guidelines (PGs) developer and three clinicians, was incorporated to ensure the guide's relevance and comprehensiveness. Patients' insights were integral to refining the interview questions, ensuring they were appropriate and effective. Additionally, the survey questionnaire was pre‐tested among 20 patients using the Think‐Aloud method, which led to significant revisions for better comprehension and response quality. These steps highlight the essential role of patients in shaping the data collection instruments and enhancing the overall quality and relevance of the study.

In 2017, the WHO introduced the AWaRe (Access, Watch and Reserve) classification of antibiotics to support antibiotic stewardship (AMS) at local, national and global levels. We assessed the categorization of each of the antibiotics for systemic use for antimicrobial stewardship and quality improvement practice across primary and secondary care in the UK, proposing a nationally adapted UK-AWaRe classification. A four-stage modified Delphi survey was conducted to review the AWaRe classifications in light of antibiotic resistance profiles, antibiotic use and stewardship practice in the UK. Recommendations were iteratively discussed and consensus reached on how to adapt the WHO AWaRe list. Implications of the proposed new categorization for possible antibiotic usage targets were assessed using England national antibiotic consumption data as a case study. Sixty-one experts across the four UK nations participated in the modified Delphi process. Consensus was most easily reached, with least between-expert variation, for Access antibiotics. Seventeen antibiotics differed in categorization when comparing proposed adapted UK-AWaRe classification and the 2023 WHO AWaRe classification. Through the focus group discussions, the importance of clear messaging was highlighted for the proposed move of first-generation cephalosporins into the Access category, a step-change from the 2019 England AWaRe classification, where all cephalosporins were in the Watch category. From the case study analysis of national data in England, Access antibiotics accounted for >60% of human antibiotic use between 2018 and 2022, 69.7% when using the WHO 2023 classification and 63.7% with the proposed UK-adapted 2024 classification. An adapted UK-AWaRe list has been suggested through a consensus-reaching process. This will support national AMS and antibiotic usage targets of the UK antimicrobial resistance 2024-29 national action plan.

ObjectiveTo identify the challenges and key learning and development needs of First Contact Physiotherapists (FCPs) providing fitness for work and sickness absence certification from Occupational Health physiotherpists' viewpoints.DesignAn online modified version of the Nominal Group Technique.ParticipantsA convenience sample of 21 expert occupational health physiotherapists as participants whose substantive job role was within a public or private UK based occupational health provider.Main MeasureConsensus on each competency was defined a priori as an agreement of more than 60%.ResultsNine items ultimately reached the required 60% threshold consensus level from the Occupational Health expert group for Question 1 on the challenges involved in providing fitness for work and sickness absence certification. Of these items, five reached full consensus; two of which (‘Time’ and ‘Lack of knowledge’) were deemed the most important items. For Question 2 on the learning and development needs, six items reached full consensus from the group (100% of participants that ranked an item) and two of these items (‘Work conversations’ and ‘Training in Occupational Health topics’) both reached full consensus from the group and were deemed the most important items.ConclusionMost employees in the UK do not have access to Occupational Health services. Fit Notes can be an important vehicle to provide work-related, fitness for work and sickness absence advice to help prevent long-term sickness absence. This study provides insights into some barriers and educational development needs of FCPs in primary care, as judged by an expert Occupational Health physiotherapy group.