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International Journal of Pharmacy Practice, 2021, Vol. 29, No. S1 i5
services, service users were a similar age (mean 68years), but
were taking more medications (mean 3.6 versus 2.8), were
more often female (64.1% versus 54.2%), had higher educa-
tional attainment, and had higher GP visitrates.
Controlling for other factors, the following were associated
with a high likelihood of availing of pharmacy services: female
gender (odds ratio (OR) 1.32, 95%CI 1.14–1.52), third level edu-
cation (OR 1.85, 95%CI 1.51–2.27), higher rates of GP visits,
private health insurance (OR 1.29, 95%CI 1.07–1.56), higher
number of medications, loneliness, and a diagnosed respiratory
condition (OR 1.42, 95% CI 1.14–1.74). The relationship be-
tween these factors and requesting medicines advice were similar.
Conclusion: A high proportion of middle-aged and older
adults visit community pharmacy and a quarter avail of speci-
ed pharmacy services. Despite advances in the services offered
in pharmacies, medicines advice remains at the core of pharma-
cists’ practice. Those on multiple medications, who may derive
greater benet from such services, are more likely to avail of
them. Number of GP visits was also associated with service use,
suggesting patients may avail of pharmacy services as a com-
plement, rather than a substitute, to visiting their GP. Services
were more often used by people who are lonely, and pharma-
cists should consider interventions to support these people.
PATIENT AND HEALTHCARE PRACTITIONER
PERSPECTIVES
USING THE WORKING MODEL OF ADJUSTMENT TO
CHRONIC ILLNESS TO EXPLAIN THE BURDEN OF RE-
CURRENT URINARY TRACT INFECTION: A SURVEY-
BASED STUDY
K.Maxwell1, L.Roberts2, M.Kramer3 and K.Finlay4, 1.
University of Buckingham, Buckingham, UK. 2. Oxford
University Hospitals, Oxford, UK. 3. Live UTI Free. 4.
University of Reading, Reading, UK.
Introduction: The treatment of recurrent urinary tract infec-
tion (RUTI) with antibiotics is causing concern as patients are
often prescribed an inappropriate course of antibiotics, and the
recurrence rate remains at 30–44% following treatment (1).
Overprescription of antibiotics can also cause antimicrobial re-
sistance. Given the current lack of adequate clinical guidelines for
RUTI treatment, it is necessary for this population to adjust to
living with a chronic condition, and research suggests that RUTI
may be associated with poor mental health and a lower quality
of life. Thus, there is a need for a more interdisciplinary approach
to understanding RUTI, to inform additional treatment options.
Aim: The current study aimed to use the Working Model
of Adjustment to Chronic Illness (WMACI) (see Figure 1)to
explore the personal, physical and social burden of RUTI (2).
Methods: A cross-sectional survey was employed, which was
informed by existing questionnaires and reviewed by experts
including pain specialists (n=6). 5,078 participants accessed
liveutifree.com to seek information regarding their condition
and completed the Live UTI Free survey. Participants provided
information on their experiences with RUTI (recurrence rate,
symptoms, pain intensity, triggers and comorbidity) and the as-
sociated burden. Binomial logistic regressions were conducted
to assess the effect of RUTI characteristics on the likelihood of
experiencing personal, physical and social burden.
Results: RUTI predicted greater likelihood of personal burden
(enjoyment of life; enjoyment of favourite activities; mental
health) (R²=18.8 – 20.8, p=<.001), physical burden (sleep;
activities of daily living; maintaining a healthy lifestyle; sexual
behaviour) (R² = 21.1 – 35.9, p = <.001), and social burden
(normal work; nances; relationships with friends and family;
relationships with partners) (R²=17.0 - 25.8, p=<.001), with
the burden associated with sexual behaviour showing the lar-
gest amount of variance. Rate of recurrence, symptom burden,
pain intensity, and having an additional diagnosis of Interstitial
Cystitis (IC) were most predictive of participant burden.
Conclusion: RUTI was associated with all areas of burden.
Some factors, including pain intensity and having an add-
itional diagnosis of IC, affected a majority of areas. Predicted
burden from having an additional diagnosis of IC may be a
result of lack of clarity between the two diagnoses, which have
shared symptom indicators and rely on urine culture testing,
which has been demonstrated to be inaccurate. Misdiagnosis,
or a dual diagnosis, may consequently contribute to burden.
The WMACI was used to suggest how burden can lead to
poor illness adjustment. Limitations of the study were that it
did not explore the possibility of misdiagnosis and its impact,
or investigate the effects of SES and country-level differences.
However, the ndings of the study have important clinical im-
plications, as patients worldwide who are suffering with RUTI
are required to manage signicant burden that is associated
with the condition, and this is an important issue which needs
to be addressed in primary care settings. An interdisciplinary
approach in primary care settings is recommended, which ac-
knowledges the psychosocial burden that persists when treat-
ment fails to resolve physical symptoms.
Figure 1: The Working Model of Adjustment to Chronic
Illness
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i6 International Journal of Pharmacy Practice, 2021, Vol. 29, No. S1
References
1. Gupta K, Trautner BW. Diagnosis and management of re-
current urinary tract infections in non-pregnant women.
BMJ (Online). 2013; 346:f3140.
2. Moss-Morris R.Adjusting to chronic illness: Time for a unied
theory. British Journal of Health Psychology. 2013; 681–686.
AN EXPLORATION OF COMMUNITY PHARMACISTS’
EXPERIENCE, KNOWLEDGE AND PERSPECTIVES OF
FRAILTY AND MEDICINES OPTIMISATION IN FRAIL
OLDER PEOPLE: A QUALITATIVE STUDY
L.Faulkner, C.M.Hughes and H.E.Barry, Primary Care
Research Group, School of Pharmacy, Queen’s University
Belfast, Belfast, UK
Introduction: Frailty is a heightened state of vulnerability
due to an accumulation of age-related defects in separate
physiological systems (1). Frailty is becoming increasingly
common, with up to 50% of older adults being diagnosed
with mild, moderate or severe frailty (35%, 12% and 3%
respectively) (2). Community pharmacists may often be
the primary healthcare professional with whom frail older
people have most frequent contact due to their convenience
and accessibility. Therefore, it is hypothesised that commu-
nity pharmacists could play a wider role in frailty identica-
tion and medicines optimisation for frail older people.
Aim: To explore community pharmacists’ knowledge of frailty
and its assessment, their experiences and contact with frail older
patients in the community pharmacy setting, and their percep-
tions of their role in optimising medicines for frail older people.
Methods: Two strategies were used to recruit community phar-
macists registered in Northern Ireland (NI). Community pharma-
cists were recruited through the Pharmacy Forum NI bi-monthly
newsletter and the School of Pharmacy Undergraduate Placement
Network, followed by snowballing. The interview topic guide
was developed based on the published literature, current frailty
guidelines and through discussion within the research team; it
was piloted with four pharmacists. Semi-structured interviews
commenced in March 2020. Due to the Covid-19 pandemic,
face-to-face interviews were logistically not possible, therefore
telephone interviews were conducted at a time convenient to par-
ticipants. All interviews were recorded, transcribed verbatim and
analysed using inductive thematic analysis.
Table 1. Characteristics of interview participants and the
community pharmacies in which they worked(n=14)
Participant characteristics n (%)
Female 9 (64.3)
Male 5 (35.7)
Time qualied in years n (%)
<5
5 to 9
10 to 15
>15
4 (28.6)
1 (7.1)
5 (35.7)
4 (28.6)
Location of pharmacy n (%)
Urban
Suburban
Rural
7 (50)
4 (28.6)
3 (21.4)
Size of pharmacy n (%)
Independent
Small/medium chain
Large chain
5 (35.7)
2 (14.3)
7 (50)
Results: To date, 14 interviews have been conducted,
lasting between 24 and 72 minutes. Apart from one inter-
view, all were conducted over the telephone. Participant char-
acteristics are summarised in Table 1. Analysis of interview
transcripts is ongoing. Findings to date have highlighted the
key role community pharmacists feel they play in assisting
frail older patients with their medicines (especially during
the current pandemic). Many saw themselves as a ‘point of
contact’ for frail older people and highlighted the holistic ap-
proaches they used to care of such patients: “It’s easier to get
in contact with us than other healthcare professionals and we
tend to be the rst port of call really” [CP2]. Interviews high-
lighted a lack of pharmacist knowledge surrounding frailty
as a condition and its assessment, with participants primarily
focusing on the physical aspects of frailty (e.g. weight loss,
weakness) when observing or ‘informally assessing’ patients.
None of the participants reported formally assessing their
patients using validated frailty tools or checklists: “It’s not
something that I’ve ever thought about. We don’t have any
tools readily available to us that I know of and certainly
nothing that would be standardised” [CP1].
Conclusion: This study has highlighted that community
pharmacists felt they could contribute to optimising medi-
cines for frail older people. However, the ndings emphasise
the need for more formal training for community pharma-
cists about the clinical aspects of frailty, frailty assessment
and future interventions to address the medicines-related
issues they have encountered with this patient population.
References
1. Shaw RL, Gwyther H, Holland C, Bujnowska M, Kurpas
D, Cano A, et al. Understanding frailty: meanings and
beliefs about screening and prevention across key stake-
holder groups in Europe. Ageing & Society. 2018;38(6):
1223–1252.
2. Hollinghurst J, Fry R, Akbari A, Clegg A, Lyons RA,
Watkins A, et al. External validation of the electronic
Frailty Index using the population of Wales within the
Secure Anonymised Information Linkage Databank. Age
and Ageing. 2019;48(6): 922–926.
A QUALITATIVE STUDY EXPLORING PATIENT
SUGGESTIONS FOR THE DESIGN, FUNCTIONALITY
AND IMPLEMENTATION OF DIGITAL HEALTH
TECHNOLOGIES BEFORE AND AFTER BARIATRIC
SURGERY.
A.Robinson1,2, A.K.Husband1,2, R.D.Slight2,3 and
S.P.Slight1,2,3,4,5, 1. School of Pharmacy, Newcastle
University, UK. 2. Population Health Sciences Institute,
Newcastle University, UK. 3. Newcastle upon Tyne
Hospitals NHS Foundation Trust, UK. 4. The Centre for
Patient Safety Research and Practice, Division of General
Internal Medicine and Primary Care, Brigham and Women’s
Hospital, USA. 5. Harvard Medical School, Boston, USA.
Introduction: Health behaviour changes made
during the pre-operative period can positively impact on
post-operative outcomes and the success of bariatric sur-
gery.(1) Digital technologies present an opportunity to
support patients with this. Currently, little is known about
the optimal design or delivery of digital technologies for
this patient cohort. In order to develop useful and effective
digital strategies for this unique patient cohort, it is im-
portant to rst understand how bariatric surgery patients
want to be supported.(2)
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