In my previous blog I told you about how we finally started our research project.
In this blog I'll write about the biggest problem we ran into: enrolling patients.
If you don't work with them, there is something you should know about pharmacists. A substantial proportion of them are in it just for the patients. They actually go into work every day to make someone else better. I, for example, cannot claim to be that selfless. Many have an appetite for change and new models of care.
But (there's always a but) pharmacists who work in the community or high street are handicapped by how much they can do by the pharmacy contract. This is basically what NHS England has decided to pay for and how much. Right now, many pharmacies would not survive if they did not dispense medicines, it is by far and away the biggest source of income for many pharmacies and is why pharmacies are very similar with the only defining feature being how quickly they can dispense your medicines. I personally think that this is a sad state of affairs considering how many skills we have that go underused...
So what does this have to do with our research?
Unfortunately, some of our trial pharmacists have found it difficult to enrol more than a handful of patients even though our research concept is very simple:
The pharmacist identifies a patient that may benefit, they offer the service, patient says yes, the pharmacist gets them to fill out a baseline questionnaire, patient gets translated labels and, finally, patient gets followed up with another survey after a month or so.
So what are the barriers to enrolling patients and data collection? (All personal opinions)
- The whole process is extra to what pharmacists already do. But, as I've told you before, pharmacists are under a huge (self-imposed) pressure to dispense as quickly as possible. We're asking them to slow down their entire workflow and interrupt their established procedure, which has been ingrained over years and years of practice.
- In addition, I believe that they may be reluctant to offer this service to all patients. If it is too successful, I think pharmacists may not cope with the demand.
- From speaking with a couple of our trial pharmacists, I have learned that they only use the software when the pharmacy team totally fails to communicate with the patient; ie a last resort. The problem with this methodology is that it assumes the verbal support the pharmacy team provide at the point of care is sufficient. However, patients forget 40-80% of what they hear immediately and the pharmacy team won't be in the patient's home when they take their medicines.
- The last barrier, ironically, is patient communication. Our trial pharmacists have told us that explaining the new service AND the academic project AND the surveys is too complicated when they don't share a language with the patient. Of course we have written and translated an introduction to the project but patients' desire to read this stuff in the pharmacy is lacking to say the least.
So, it's been difficult to collect the surveys. What we have collected is overwhelmingly positive and it seems as though patients really like having translated labels.
I also feel that we have found one reason behind the lack of research in UK pharmacies even if they want to contribute: no time.
Our solution to this problem was to increase the number of languages and the number of pharmacies enrolled so that each pharmacy can give us fewer surveys and we can still hit data collection targets. We also, set up a patient education session in Bengali for patients with high blood pressure in one pharmacy. They were asked to bring in their medicines and we enrolled them onto the project. We also suggested pre-labelling some amoxicillin with translated labels so it would be ready to go as soon as the patient was identified. We suggested recommending it to patients when they requested repeat prescriptions.
These solutions have increased the patient tally and we are edging closer and closer to the data collection targets. With any luck (which is a skill) the numbers will be sufficient to power the study. It would be interesting to see how the situation will change over the coming months as pharmacists continue to adopt new clinical services (recent example).