Medicines optimisation for young people with juvenile arthritis and other long-term conditions:system-level barriers to engagement

To explore the views of pharmacy and rheumatology stakeholders about system-related barriers to medicines optimisation activities with young people with long-term conditions. A three-phase consensus-building study comprising (1) focus groups with community and hospital pharmacists; (2) semi-structured telephone interviews with lay and professional adolescent rheumatology stakeholders and pharmacy policymakers, and (3) multidisciplinary discussion groups with community and hospital pharmacists and rheumatology staff. Qualitative verbatim transcripts from phases 1 and 2 were subjected to framework analysis. Themes from phase 1 underpinned a briefing for phase 2 interviewees. Themes from phases 1 and 2 generated elements of good pharmacy practice and current/future pharmacy roles for ranking in phase 3. Results from phase 3 prioritisation and ranking exercises were captured on self-completion data collection forms, entered into an Excel spreadsheet and subjected to descriptive statistical analysis. Institutional ethical approval was given by Aston University Health and Life Sciences Research Ethics Committee. Four focus groups were conducted with 18 pharmacists across England, Scotland and Wales (7 hospital, 10 community and 1 community/public health). Fifteen stakeholders took part in telephone interviews (3 pharmacist commissioners; 2 pharmacist policymakers; 2 pharmacy staff members (1 community and 1 hospital); 4 rheumatologists; 1 specialist nurse, and 3 lay juvenile arthritis advocates). Twenty-five participants took part in three discussion groups in adolescent rheumatology centres across England and Scotland (9 community pharmacists; 4 hospital pharmacists; 6 rheumatologists; 5 specialist nurses, and 1 physiotherapist). In all phases of the study, system-level issues were acknowledged as barriers to more engagement with young people and families. Community pharmacists in the focus groups reported that opportunities for engaging with young people were low if parents collected prescriptions alone, which was agreed by other stakeholders. Moreover, institutional/company prescription collection policies – an activity largely disallowed for a young person under 16 without an accompanying parent - were identified by hospital and community pharmacists as barriers to open discussion and engagement. Few community pharmacists reported using Medicines Use Review (England/Wales) or Chronic Medication Service (Scotland) as a medicines optimisation activity with young people; many were unsure about consent procedures. Despite these limitations, rheumatology stakeholders ranked highly the potential of pharmacists empowering young people with general health care skills, such as repeat prescription ordering. The pharmacy profession lacks vision for its role in the care of young people with long-term conditions. Pharmacists and rheumatology stakeholders identified system-level barriers to more engagement with young people who take medicines regularly. We acknowledge that the modest number of participants may have had a specific interest and thus bias for the topic, but this underscores their frank admission of the challenges. Professional guidance and policy, practice frameworks and institutional/company policies must promote flexibility for pharmacy staff to recognise and empower young people who are able to give consent and take responsibility for medicines activities. This will increase mutual confidence and trust, and foster pharmacy’s role in teaching general health care skills. In this way, pharmacists will be able to build long-term relationships with young people and families.

Managing the multiplicities of graduate level education! Are Master’s students’ expectations matched by their experiences?

With rapid increases in student fees reflecting moves towards a QUASI Market model of Higher Education in the UK and across much of the Western World[1], many universities find themselves having to meet progressively higher levels of student expectations[2]. This is particularly the case at undergraduate level, where increases in fees over the past decade have far exceeded inflation. Yet with so much attention on ‘consumer savvy’ undergraduates, the question of whether Master’s level students’ expectations are matched by their experiences is one which remains largely unanswered. Grounded in an empirically grounded approach to learning and teaching developed by the paper authors[3], this paper sets out to being to answer this question. In doing so it makes a distinctive contribution to debates about graduate level engineering education and concludes with a number of recommendations. Discussion: The ‘MSc: Managing Expectations’ Project analyses the expectations and experiences of Graduate level Engineering Management Students over a two year period. Focusingon the ‘student experience’, three main concepts are identified as being particular relevant to enhancing learning [3]: Relationships: Variety: Synergy. Relationships: Based on empirical research, the significance of Relationships within the academic environment is discussed with particular attention being paid to the value of students’ social and academic support networks, including academic tutoring. Variety: Grounded in a statistical analysis of ‘engagement data’ together with survey and interview findings, the concept of variety critically examines students’ perspectives and experiencesof different approaches to learning and teaching. Synergy: Possibly the most important concept discussed within this paper, the need for constructively aligned curriculum is extended to reflect the students’ apriori knowledge and experienceas well as employer and societal demands and expectations. The conclusion brings the different concepts within the discussion together, providing a set of practical recommendations for colleagues working both at graduate and undergraduate level. References 1.Gibbs, P. (2001) "Higher education as a market: a problem or solution?." Studies in Higher Education 26. 1. pp. 85-94. 2.Tricker, T., (2005) Student Expectations-How do we measure up. University of Sheffield. Available from: http://www.persons.org.uk/tricker%20paper.pdf Accessed 9/10/14 3.Clark, R. & Andrews, J. (2014). Relationships, Variety & Synergy [RVS]: The Vital Ingredients for Scholarship in Engineering Education? A Case-Study. European Journal of Engineering Education. 39.6. pp. 585-600.