439 Design and feasibility testing of IDC-VI: a theory-informed intervention to support medication dispensing and counselling for patients with vision impairment
Authors: Kentab B Y , Barry H E , Al-Aqeel S A , Hughes C M 
Published: April 2023

Abstract

Introduction
Pharmaceutical services for visually impaired (VI) individuals are lacking, both worldwide and in Saudi Arabia (SA). Little evidence exists for effective pharmaceutical interventions to support medicines optimisation in this population (1). The Medical Research Council advocates theory-based intervention development and feasibility testing before full implementation. A feasibility study ‘asks whether something can be done, should we proceed with it, and if so, how’.

Aim
To design and test the feasibility of IDC-VI (Intervention for Dispensing and Counselling for the Visually Impaired).

Methods
Phase 1 focused on developing the intervention. Using the theoretical domains framework (TDF) (2), 26 hospital/community pharmacists in SA were interviewed about their dispensing/counselling behaviour with a view to developing an intervention. The research team identified nine key TDF domains and selected eight behaviour change techniques (BCTs) to include in the intervention which could potentially enhance the pharmacist’s knowledge, skills and help them monitor their behaviour. The BCTs were operationalised to produce an intervention package including a training session for pharmacists, behaviour goal setting and review sheets, a checklist with 25 steps to follow during dispensing/counselling (e.g., Ask “What is the best method to provide information about medications to you and/or your caregiver?”), sample patient scenarios, and an intervention record and manual. Phase 2 tested the feasibility of the intervention and study procedures (recruitment, data collection) at two hospital outpatient pharmacies. Two pharmacists, recruited through the pharmacy supervisor, were trained and provided with all intervention materials. Pharmacists were asked to implement the intervention with VI adult patients taking ≥3 medicines. Due to difficulties in identifying patients prior to attending the pharmacy, records of those requesting refills for out-of-stock medicines were used to recruit patients. Outcomes focused on the feasibility of recruitment, and collecting data on pharmacists’ experience and patients’ medicines/medical conditions. Pharmacists and patients provided feedback through interviews and telephone-administered questionnaires, respectively. Descriptive statistics and thematic analysis were used to analyse data.

Results
Two pharmacists implemented the IDC-VI with five patients. The patient recruitment process was practical at the time, but not feasible for a future study as the pharmacy stopped collecting records of those requesting out-of-stock medications. Data on pharmacists’ experience and patients’ clinical data were easily collected via interviews or extracted from medical/pharmacy records, respectively. The dispensing/counselling process took 15-30 minutes. Both pharmacists thought the intervention was useful, but were concerned about its acceptability/practicability, due to heavy workload and time constraints at the pharmacy. Shortening the dispensing/counselling checklist was suggested to improve acceptability. Three patients reported that the service had somewhat influenced how they took their medications due to the additional information obtained. Two patients reported very little or no influence at all.

Conclusion
The IDC-VI used a novel approach in developing and testing an intervention targeting pharmaceutical care services to VI patients. It was potentially feasible. Numbers completing the study were small, although the final sample was inclusive in terms of age, gender, and visual impairment levels. Amendments are required before testing the intervention in a larger pilot trial.

References
1. Kentab BY, Barry HE, Al-Aqeel SA, Hughes CM. A systematic review of pharmacists' interventions to support medicines optimisation in patients with visual impairment. Int J Clin Pharm. 2019;41(6):1400-7.
2. Cane J, Richardson M, Johnston M, Ladha R, Michie S. From lists of behaviour change techniques (BCTs) to structured hierarchies: comparison of two methods of developing a hierarchy of BCTs. Br J Health Psychol. 2015;20(1):130-50.