The development and testing of a novel Cognitive Behavioural Therapy (CBT)-based intervention to support medicines-related consultations for healthcare professionals

Abstract

Introduction The cost to healthcare of wasted medicines has been estimated at around £300million per annum (1). In response to this figure and efforts to increase medicines management performance across pharmacy and patient outcomes, the practice of ‘medicines optimisation’ has developed into a key aspect of patient care. In particular, concerns exist around whether patients are deriving the optimum benefit from their medications and the extent to which adherence ‘drops off’ at varying intervals after prescription and collection. In order to tackle medicines adherence and waste, a multi-disciplinary approach must be applied to ensure patients who are prescribed a new medicine take it as intended, experience no problems and receive as much information as they feel they need from healthcare professionals (HCP’s). Adapting Cognitive Behavioural Therapy (CBT)-based techniques to medicines-related consultations has proven effective in supporting medicines adherence in previous studies (2). Collectively, findings demonstrate scope for improving the way HCP’s communicate with patients around starting a new medication and monitoring ongoing use. Aim The study aim was to adapt an existing, Royal College of General Practitioners accredited ’10-minute CBT’ training package to be suitable for wider use by a range of healthcare professionals (HCP’s) (i.e. Practice Nurses, Community Pharmacists, Hospital Pharmacists and General Practitioners). Methods The research design adopted a repeated-measures, pre/ post questionnaire study that gathered data on HCP knowledge around the use of CBT-based techniques in consultations at the start and end of the training intervention. Two training days were attended by HCP’s that took place three weeks apart. The degree of satisfaction with the training intervention was assessed, along with a formulation exercise that was completed on a hypothetical patient case study pre- and post-training.

Results Training of healthcare professionals took place at the Oxford Science Park and 105 NHS staff members participated. Feedback questionnaires were received by 96 HCP’s and 46 HCP’s provided additional follow-up questionnaires at 6-months, demonstrating favourable results regarding intervention content and delivery that were consistent with a prior feasibility study. Paired samples t-tests were performed on each formulation exercise rating scale domain and for total scores. There was a highly statistically significant increase in scores for all domains including total pre- and post-training scores as measured by the Formulation Rating Scale. Intra-class Correlation Coefficient for mean FRS ratings was 0.99 (p=.000) and there was no statistically significant change in any score when attendees repeated the skills assessment at 6 months, indicating once learning had been incorporated into practice, there was no recognisable training degradation over the 6-month period. See Table 1. Table 1.Change in Scores from pre- to post-training scores using the Formulation Rating Scale. Change in Scores from Pre- to Post- Training using the Formulation Rating Scale Mean Score Difference 95% confidence intervals T score P value Relevant Cognitions 0.85 0.72–0.97 13.497 P<0.0001 Emotions 1.21 1.38-1.05 15.06 P<0.0001 Relevant Behaviours 1.04 1.19-0.9 14.25 P<0.0001 Physical Symptoms 1.29 1.46-1.12 15.26 P<0.0001 Situational Factors 0.62 0.74-0.51 10.53 P<0.0001 Total scores 5.02 5.60-4.44 17.19 P<0.0001 Conclusion The training intervention was rated favourably by attendees and was reported by participants as providing a safe environment from which to increase knowledge of CBT-based techniques, practice implementation of formulation skills and access additional peer support to help integrate learning into medicines-related consultations. The study also demonstrates this group of HCP’s were able to integrate CBT-based techniques into hypothetical medicines-related scenarios and that learning was retained over a six-month period following training intervention.