Medicines optimisation in visually impaired patients

Abstract

Introduction
Evidence indicates that there are major gaps in pharmaceutical care service provision and limited research on interventions to optimise medication use for patients with vision impairment. The United Kingdom’s Medical Research Council (MRC) advocates a systematic approach for the development and evaluation of an intervention. The aim of this research was to develop a novel theory-based intervention to support medicines optimisation for patients with vision impairment.

Methods
This research focuses on the development and feasibility testing of the IDC-VI (Intervention for Dispensing and Counselling for the Visually Impaired). Firstly, a systematic review was undertaken to assess the types and effectiveness of interventions provided by pharmacists. Qualitative interview-based research was then conducted with pharmacists and patients/caregivers. The Theoretical Domains Framework (TDF) was utilised as the underlying theoretical lens. Pharmacists’ interviews investigated the barriers/facilitators to the provision of medication dispensing and counselling while patients’/caregivers’ interviews explored the barriers/facilitators to obtaining and taking medications. Key TDF domains were identified from both sets of interviews. The planned intervention targeted the pharmacists’ behaviour, and the key TDF domains from pharmacists’ interviews were mapped to behaviour change techniques (BCTs). Finally, BCTs were operationalised into a workable intervention which was then tested in a small feasibility study.

Results
The systematic review highlighted the paucity of pharmacist-led interventions. Findings from pharmacists’ interviews led to the identification of eight key TDF domains which were linked to eight BCTs. Interviews with patients/caregivers identified six key TDF domains. The eight BCTs formed the IDC-VI. Feasibility testing demonstrated favourable opinions from pharmacists and patients/caregivers but a number of modifications were suggested.

Discussion and conclusion
This thesis provides theory-informed insights into the determinants of patients’, caregivers’, and pharmacists’ behaviours. The IDC-VI will require a number of amendments before being tested in a larger pilot trial in preparation for a randomised controlled trial.

Thesis is embargoed until 31 July 2025.

Date of Award	Jul 2023
Original language	English
Awarding Institution	Queen's University Belfast
Sponsors	King Saud University
Supervisor	Carmel Hughes (Supervisor), Heather Barry (Supervisor) & Sinaa Al-Aqeel (Supervisor)