Development of a Tool to Support Person-Centred Medicine-Focused Consultations between Stroke Survivors and Community Pharmacists

The need for medicines support to be person centred is well recognised. Studies have highlighted sub-optimal adherence to medicines by stroke survivors even though secondary prevention is critical to preventing a repeat event. Community pharmacists are currently not integrated into the stroke care pathway but have been directed to provide medicines support to vulnerable groups of patients, including stroke survivors.

This three-phase mixed-methods study explored how person-centred care is delivered and can be optimally supported within a medicine-focused consultation between stroke survivors and community pharmacists. Guided by Interpretative Interactionism, the first phase involved semi-structured interviews with 15 stroke survivors and 16 community pharmacists. Data were thematically analysed (NVivo 10) and then mapped to the principles of person-centred care (de Silva 2014). Phase two involved the development, piloting and dissemination of a questionnaire to explore stroke survivors' experience of and perceived need for medicine support, their use of pharmacy services and their self-reported adherence. Data received from 208 completed questionnaires were evaluated (SPSSV24): online n=79 (38%)/postal n=129 (36% response rate). Phase three involved the development of a consultation tool from results from earlier phases and the literature, and preliminary evaluation of this tool from feedback received from community pharmacists who had participated in phase one interviews (n=11/69%).

This study highlights that stroke survivors often have unmet medicine support needs that could be addressed by a pharmacist. However, only one quarter of stroke survivors had received the medicine consultation services currently offered by pharmacists and many were unaware of these services. Limited contact with their pharmacist was attributed to the sequelae of their stroke and difficulties accessing community pharmacies. The need to improve pharmacists' approach to consultations with stroke survivors, and specifically to identify their individual needs, was identified. Pharmacists provided positive feedback on the consultation tool developed.

This thesis contributes to supporting community pharmacists' delivery of person-centred stroke consultations through the development of a consultation tool, although further evaluation of this is required. The availability of medicine support services offered by community pharmacists within the current NHS contract needs to be promoted. However, changes in current practice are necessary. These should include the integration of pharmacists into the multi-disciplinary care pathway for stroke, together with provision of more domiciliary-based pharmacy services.