Background Residents in care homes are often very frail, have complex medicine regimens and are at high risk of adverse drug events. It has been recommended that one healthcare professional should assume responsibility for their medicines management. We propose that this could be a pharmacist independent prescriber (PIP). This feasibility study aimed to test and refine the service specification and proposed study processes to inform the design and outcome measures of a definitive randomised controlled trial to examine the clinical and cost effectiveness of PIPs working in care homes compared to usual care. Specific objectives included testing processes for participant identification, recruitment and consent and assessing retention rates; determining suitability of outcome measures and data collection processes from care homes and GP practices to inform selection of a primary outcome measure; assessing service and research acceptability; and testing and refining the service specification. Methods Mixed methods (routine data, questionnaires and focus groups/interviews) were used in this non-randomised open feasibility study of a 3-month PIP intervention in care homes for older people. Data were collected at baseline and 3 months. One PIP, trained in service delivery, one GP practice and up to three care homes were recruited at each of four UK locations. For ten eligible residents (≥ 65 years, on at least one regular medication) in each home, the PIP undertook management of medicines, repeat prescription authorisation, referral to other healthcare professionals and staff training. Outcomes (falls, medications, resident’s quality of life and activities of daily living, mental state and adverse events) were described at baseline and follow-up and assessed for inclusion in the main study. Participants’ views post-intervention were captured in audio-recorded focus groups and semi-structured interviews. Transcripts were thematically analysed. Results Across the four locations, 44 GP practices and 16 PIPs expressed interest in taking part; all care homes invited agreed to take part. Two thirds of residents approached consented to participate (53/86). Forty residents were recruited (mean age 84 years; 61% (24) were female), and 38 participants remained at 3 months (two died). All GP practices, PIPs and care homes were retained. The number of falls per participating resident was selected as the primary outcome, following assessment of the different outcome measures against predetermined criteria. The chosen secondary outcomes/outcome measures include total falls, drug burden index (DBI), hospitalisations, mortality, activities of daily living (Barthel (proxy)) and quality of life (ED-5Q-5 L (face-to-face and proxy)) and selected items from the STOPP/START guidance that could be assessed without need for clinical judgement. No adverse drug events were reported. The PIP service was generally well received by the majority of stakeholders (care home st...

Community pharmacy services delivered remotely using tele-technology are feasible and acceptable. A larger study should be undertaken to confirm the potential of the TPRSS to reduce health inequalities in rural areas.

Objectives Limited awareness of cancer symptoms results in patient delay in seeking help and contributes to delay in diagnosis. Few UK studies have investigated the potential for community pharmacists to facilitate earlier detection of cancer. This study aimed to investigate what actions patients take to manage their early cancer symptoms, to identify the extent of current community pharmacy involvement and to consider the potential role for community pharmacists to facilitate appropriate management and appraisal of potential early cancer symptoms. Methods Patients diagnosed with lung, colorectal or gastro‐oesophageal cancer in the preceding 12 months were identified during clinic visits by consultants. Semi‐structured interviews were conducted, audio‐recorded, transcribed and thematically analysed, using the Framework Approach. Key findings Twenty‐five consenting patients were interviewed: two‐thirds were male and more than half had lung cancer. Although all had experienced potential cancer symptoms prior to diagnosis, most underestimated seriousness and misattributed causation. Symptoms were managed by lifestyle changes and self‐selecting medicines from local shops, supermarkets and pharmacies but without engaging with the pharmacist. Conclusions For symptom management, participants self‐selected medicines from community pharmacies, but pharmacy staff were rarely involved. Involving community pharmacists or their staff at the point of sale of these medicines might have facilitated earlier cancer diagnosis. Further research is needed to quantify how many patients with symptoms suggestive of cancer present in community pharmacies to understand if a pharmacist's role in facilitating symptom management and appraisal of potential cancer symptoms would be acceptable and effective, before developing any interventions.

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