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Table 3 Qualitative examples of stakeholder perceptions of the intervention

From: Process evaluation for the Care Homes Independent Pharmacist Prescriber Study (CHIPPS)

  PIP GP Care homes
Resident quality of life ‘It was just pushing it a bit further, looking at the patient as a whole, and being able to do a little bit more and involved the families … made me be more thorough as a prescriber and a pharmacist’ PIP 22
‘A lady was finding it very hard to swallow medication and I was able to get her medications changed. Some of them were de-prescribed and some of them were changed into a form, a more dispersible form and she was much happier with that’ PIP 1
‘I don’t have as much time to go round every single one unless it is doing a Care Plan. The Pharmacist looked at them and thought ‘well they have been on this stuff for a long time’ liaised with the staff and said ‘look do you think we might be able to reduce it?’ You know ‘what’s their behavioural, you know their behaviour like?’ and then we have trialled reductions of things and the same with anti-depressants and things as well’ GP16 ‘A lady she didn’t particularly like the texture and the taste of the chalky Ad Cal tablets so PIP changed her tablet and that was a good positive experience for her because she was engaged’ CHM 1
‘We are having good conversations it is not just somebody instructing on us what they think should be done … you are having that dialogue and explaining about your resident and the Pharmacist has taken that into the background of the resident’s care needs and what the difficulties have been … it has been a positive impact’ CHM 12–03
Increased safety ‘Some patients were on meds and they hadn’t been necessarily reviewed, so they were then reviewed, so I’d like to think that the quality was better … hopefully the patient care was better’ PIP 2 ‘From a safety and medicine waste point of view things have much improved. Care home teams greatly appreciated time taken looking at repeat meds, ensuring they are up to date, have good instructions’ GP 3
‘It brings another layer of safety to prescribing in a care home, because we all know that that can be a little bit, not unsafe, but it can be challenging, partly because there are so many residents with poly pharmacy’ GP11
‘Just a safety blanket’ CHM 14–02
‘PIP did ensure that the bloods were taken so that we were getting a true thyroid reading for the dosage. Diabetics as well, we did have urine testing and extra blood tests done on a couple of them’ CHM 6
Improved medication systems ‘Stock can go out of date and then it is disposed of and wasted … less of that is happening now’ PIP 8
‘We have a two-way conversation now. When medicines change, we tell the pharmacy so they know to expect the change’ PIP 9
  ‘It is meant to be on repeat prescription, you’ve got to go through the rigmarole of phoning the doctor, they’ve got to phone you back, that can take ages, and it’s just a bit of a waste of their time but now the PIP will make sure that it goes on the repeat prescriptions, so there’s never an issue for the next cycle, and things don’t get missed’ CHM 14–02
Impact on workload ‘I would have liked to use the training materials for the care home staff, although they were all very experienced and one of the homes was a nursing home with trained nursing staff. I may still do so if the opportunity arises or if they feel it would be beneficial’ PIP 4 ‘I want it back! It was very helpful for me; it did take some of the workload off the weekly visits that were all about medication’ GP 16 ‘It made ordering easier, a little bit simpler, put the MAR charts into place a bit better, in respect of the things that were on there that were no longer needed they were taken off and things that maybe some of the residents didn’t need’ CHS 19
Professional development ‘Really rewarding, as a pharmacy professional and especially as a Pharmacist Independent, I can really use my skills to benefit the Care Home residents directly’ PIP 16
‘I have the confidence to go in and use the training … I feel confident in their prescriptions that everything has been well looked after, so I would be confident to continue to reauthorize the issue’
  ‘The care home nurses assessment are also being taken as a valuable tool as well,, and the nurses are liaising with the PIP, to prescribe what they think is needed, I think it’s a win, win situation, the nurses are feeling valued, and the PIP as well’ CHM 21–02
‘I can’t even remember that far back but I think we already had training, allocated training, delivered by our Community Pharmacist in place anyway so I maybe did turn it down if we were offered it’ CHM 1
Dissatisfaction with intervention ‘I think the CHIPPS probably works best if you are actually familiar with the surgery’ PIP 19
‘I found the pharmaceutical care plan quite cumbersome and I didn’t find it intuitive, I’ve done medication reviews and pharmaceutical plans for quite a few years, and the ones I’ve used a lot more simplistic, Yes it was very comprehensive, there was a lot of information stored on it, for a working document for a pharmacist, it would be alright, but for presenting to a GP it wouldn’t be any use’ PIP 11
‘Occasionally PIP would pick up something that I would have to then address and very often when you try and get blood tests on these patients, they don’t like it and refuse to let the District Nurses near them so it just adds, those little contacts add up and I feel at the end of it I had achieved nothing’ GP 19
‘It was very useful when there was some communication between the PIP and myself, the negative would be it just didn’t happen enough’ GP 6
‘She was helpful when here but did not attend every week’ CHM 6
‘I don’t know that it actually happened umm the residents in question that actually agreed to sign up for it their medication was never really appropriate for review so that is perhaps why it never happened’
CHM 18–02