Research methods: answering questions in practice - PowerPoint PPT Presentation

Loading...

PPT – Research methods: answering questions in practice PowerPoint presentation | free to download - id: 514161-OGYxN



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

Research methods: answering questions in practice

Description:

Research methods: answering questions in practice Dr Catherine Duggan, Director for Clinical Pharmacy [Development & Evaluation] East & South East England Specialist ... – PowerPoint PPT presentation

Number of Views:603
Avg rating:3.0/5.0
Slides: 43
Provided by: Regis240
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Research methods: answering questions in practice


1
Research methodsanswering questions in practice
  • Dr Catherine Duggan,
  • Director for Clinical Pharmacy
  • Development Evaluation
  • East South East England Specialist Services NHS

2
The presentation
  • To identify and describe the use of different
    research methods, why different methods are used
    and the benefits of one against another.

3
The presentation
  • How to start to incorporate research into the day
    job?
  • How to bridge the gap between research and
    practice?
  • How to ensure a core number of oncology
    pharmacists contribute to the research agenda?

4
Policy
5
The presentation
  • Taking some problems in practice, start to
    describe how we might tackle them from various
    perspectives, using different methods

6
Problems in practice
  1. How to reduce inconsistencies in prescribing
    between primary and secondary care?
  2. How to provide patients with the drug related
    information they need?
  3. How can we measure how effective pharmacists are
    in patient care?

7
Where to start?
  • There is no such thing as a good methodology or a
    bad methodology...
  • The key is to understand the application of the
    appropriate methodology for the question in hand

8
Qualitative vs. Quantitative approaches
  • Quantitative
  • Positivist/Experimental
  • Hypothesis-testing (top-down/deductive)
  • Common in later stages of a field of research
  • Statistical analysis often used
  • Qualitative
  • Phenomenological
  • Hypothesis-generating (bottom-up/inductive)
  • Common in early stages of a field of research
  • Statistical analysis is never used

9
Commonly used qualitative and quantitative methods
  • Qualitative
  • Interviews
  • Face to face
  • Focus groups
  • Observation studies
  • Quantitative
  • Survey
  • Postal
  • Face to face
  • Telephone
  • Randomised controlled trial
  • Parallel groups
  • Cross over

10
Problem 1
  • How can we reduce inconsistencies in prescribing
    between primary and secondary care?

11
Where to start?
  • Survey?
  • Trial?
  • Observations?
  • Interviews?

12
Where to start?
  • A survey identified unintentional discrepancies
    between supplies of prescribed drugs highest in
    supplies obtained in the community following
    discharge
  • This formed the focus of the intervention study-
    a trial

13
Consensus panel judged the CLINICAL
SIGNIFICANCE of the observed discrepancies
Medical In-patients were recruited into CONTROL
or TRIAL cohorts
TRIAL cohort discharged with information on
medicines for their community pharmacist
14
Summary Findings
15
Effectiveness of the Intervention
16
In summary,
  • Information should be provided to the community
    pharmacists for all medical patients discharged
    from hospital.

17
Problem 2
  • How to provide patients with the drug related
    information they need?

18
The background
  • 50 (?) of chronic patients do not comply with
    prescribed therapy
  • Side effects and Toxicity
  • Interactions and allergies
  • Difficult to take
  • Forgetfulness
  • Patients beliefs and behaviours

19
Concordance Move towards empowerment Expert
patients Standard information For everyone
Compliance Paternalism Professionals know
best Experts hold the key to information
Adherence Move away from paternalism Empowering
the patient Provide patients with some
information
20
  • From Compliance to Concordance...
  • Simply a move from paradigm to paradigm?
  • A shift in perspective?
  • Increased patient involvement?

21
  • Research shows us information is good

22
  • Majority of patients want more information than
    they are given
  • Patients want to obtain an explanation of their
    problem rather than tests and diagnoses
  • Patients want the full picture, presented in a
    non-alarming way, a balanced, honest assessment
    of positive and negative aspects of treatment
  • Providing information to patients leads to better
    understanding of their medication and increased
    adherence

23
  • But, a lack of understanding or information
    overload may influence the way patients view
    their prescribed drug(s) and ultimately
    influences the way they take themor dont

24
  • Many patients have poor understanding of
    terminology
  • Many patients dont understand prescription
    instructions
  • Many patients criticise failures to communicate
    the things they really want or need to know
  • Many perceive a communication gap between
    themselves and healthcare professionals

25
So
  • How do we know which patients want information
    and which patients dont?
  • How much information do they want and when?
  • Will the information affect their medicines
    taking behaviour?

26
Where to start?
  • Survey?
  • Trial?
  • Observations?
  • Interviews?

27
DESIRE for information gt worry
500 patients perceptions towards their illness
behaviours towards Rx
TRIAL cohort discharged with Information on
drugs at discharge for their Community
pharmacist
DESIRE for information gt age socioeconomics
28
Diagnosis and desire for information?
29
Info needs Anxiety Tolerance
Duggan QSHSC, 2008
30
In summary,
  • The way we provide information to patients
    affects their perceptions of their drugs and
    their medicines taking

31
Problem 3
  • How can we measure how effective pharmacists are
    in patient care?

32
Where to start?
  • Survey?
  • Trial?
  • Observations?
  • Interviews?

33
Evidence of benefit of pharmacists- UK
  • Clinical pharmacy- accepted interventions from
    ward visits
  • Clinical setting, pharmacist experience and
    available time predict rate
  • System change integration
  • Length of stay reduced by 2 days
  • Readmission rates decreased by 20
  • Fiscal benefits included an average return of
    7.50 for every 1 invested
  • System change automation
  • 34 increase in items dispensed within 2 hours
  • 16 reduction in dispensing error
  • 19 reduction in staff time for dispensing
  • Intervention studies

34
Evidence of benefit of pharmacists- US
  • Inverse association between pharmacists per 100
    beds and mortality rates
  • Inverse association between pharmacists per 100
    beds and length of stay
  • Inverse association between pharmacists per 100
    beds and rates of adverse drug reactions
  • Association between clinical pharmacy services
    and lower mortality rates
  • Association between higher numbers of clinical
    pharmacists and lower drug costs
  • Surveys, census, outcome measures

35
Evidence of benefit
W
W
W
Borja-Lopetegi, Bates, Webb 2007
W
W
W
Mortality rate Index
36
(No Transcript)
37
Why do we need to publish?Isnt it someone
elses job?
38
Pharmacy evidence gap
Research articles on health professions
education World Health Report 2006.
39
To be a consultant (level) pharmacist, one has
to demonstrate expertise across 6 clusters
including Research and Evaluation Through
publication of robust evidence, pharmacists can
contribute to science, to pharmaceutical care and
the wider research agenda.
40
Summary
  • Its imperative
  • we understand research principles
  • we undertake research from an early stage in
    career development to incorporate research into
    the day job
  • practitioners are involved in research to bridge
    the gap between research and practice
  • Make RE part of CPD to ensure a core number of
    oncology pharmacists contribute to the research
    agenda

41
Policy
42
Research methodsanswering questions in practice
  • Dr Catherine Duggan,
  • Director for Clinical Pharmacy
  • Development Evaluation
  • East South East England Specialist Services NHS
About PowerShow.com