Background:

With advancing age comes the increasing prevalence of frailty and increased risk of adverse outcomes (e.g. hospitalisation). Internationally, models of Comprehensive Geriatric Assessment (CGA) delivery in primary care/community settings vary, and effectiveness is uncertain. CGA is a complex intervention and improving the effectiveness and efficiency of it first requires exploration of how individual components may work and how the intervention can be strengthened.

Aims:

To explore how to enhance current CGA, the conditions needed to implement enhanced CGA and the outcomes that older people, families, health and care professionals identify as important.

Methods:

A qualitative study using semi-structured interviews with older people and healthcare practitioners working in non-hospital settings with older people in the UK. Data were analysed using an abductive analysis approach. Findings were shared with our stakeholder group involving older people, family members, health and social work professionals.



Results:

Twenty-seven people participated including 14 older people and 13 healthcare professionals. We identified limitations in current CGA: the lack of information sharing between different healthcare professionals who are delivering the CGA; communication between older people and their healthcare professionals; and follow-up after conducting the CGA. There was variation in participant perceptions on the provision of digital and remote assessment. However, we found that introducing remote assessment and a designated comprehensive care coordinator might be a viable solution to address the gaps in the current delivery of CGA.

Conclusions:

The study identified potential challenges in the implementation of enhanced CGA. However, the participants suggested possible solutions that can be used to overcome these challenges, which aligned with feedback from relevant stakeholders. The next stage of this research will involve using these findings, alongside existing evidence and key stakeholder engagement, to develop and refine a model of enhanced CGA that can then be assessed for feasibility and acceptability.

AbstractThis is the protocol for a Campbell systematic review. The objectives are as follows: identify available systematic reviews and randomised controlled trials on interventions targeting health or social needs of the people aged over 80; identify qualitative studies relating to the experiences of people aged over 80 of interventions that target their health or social needs; identify areas where systematic reviews are needed; identify gaps in evidence where further primary research is needed; assess equity considerations (using the PROGRESS plus criteria) in available systematic reviews, randomised trials and qualitative studies of identified interventions; assess gaps and evidence related to health equity.

This study aimed to assessasthma management in a sample of adult patients in general practice. A retrospective case-note review was conducted,involving 27 asthma patients in general practice inEngland. The Asthma Quality Improvement tool informed the development of thedata collection tool. The data were analysed statistically by theresearcher using frequencies testing, using descriptive statistics.Twenty-one participants out of 27 were reviewed in the general practice in the last12-months by their healthcare practitioner. All the components of an asthmareview were assessed and recorded except the inhaler technique for 11participants and 66.7% were classed as having poorly-controlled asthma symptoms.Although the small sample size affected the generalisability ofthe findings, reviewing the medical records of each participant allowed theresearcher to highlight issues with asthma management in the sample. This studyfound that asthma care in the participants requires improvement and highlightedareas that could be targeted to enhance asthma care. Asthma care could beenhanced by focusing on increasing asthma patients’ engagement with their annualasthma reviews, enhancing the provision of the asthma action plan and followinga consistent approach for inhaler-technique check and recording of asthmareview components. Finally, conducting multiple checks of asthma patients’medical records might help to identify patients who need a review and supportthem to enhance their management of their asthma.

BACKGROUND: Asthma poses a public health concern, with an estimated 235 million people currently living with the condition globally. The provision of evidence-based, patient-centred services for adult asthma patients in community pharmacy which involves collaboration across the multidisciplinary team could improve their asthma control. OBJECTIVES: a literature review was conducted to examine the evidence of asthma management in community pharmacy setting. METHODS: Five databases were searched to identify relevant articles published before February 2021. Screening of the potential studies was performed to remove articles that did not comply with the inclusion criteria. Relevant data from all included studies was collected using a data extraction form to ensure consistency throughout the review. RESULTS: Twenty studies were included in the review; all were conducted in community pharmacy settings in the period of 2001-2020, in different countries. The studies included randomised controlled trials, controlled trials and observational studies. Several successful community pharmacy-based services that were provided to asthma patients to improve their asthma management were highlighted in this review. These interventions consisted of one or more components and included: patient education, inhaler technique improvement, patient counselling, self-management plans, development and provision of asthma action plans and referral to other health care practitioners. None of the studies involved medication or dosage changes by community pharmacy. CONCLUSIONS: the evidence discussed in this review showed that community pharmacists are well-placed to deliver services to asthma patients and many studies were conducted in the community pharmacy to improve asthma control in adult patients. However, further research could be conducted to explore further opportunities for community pharmacy to enhance asthma patients management of their condition.

A qualitative approach was adopted to explore the current management and control of asthma and to identify opportunities for improvement. Seventeen stakeholders of varying backgrounds and experience were face-to-face or telephone interviewed. Thematic analysis of the interview transcripts was performed and resulted in seven key themes, that based around asthma control improvement. The overall findings of the study revealed that although asthma management is sub-optimal, there is potential for improvement.