Papers by Deborah McCahon
Context Prescription medication sharing means giving medication prescribed for you to someone els... more Context Prescription medication sharing means giving medication prescribed for you to someone else or taking medication that has been prescribed for someone else. Prevalence rates for sharing range from 5-52%. However, there has been no research in the UK on this topic. Negative aspects of sharing include increased risk of adverse effects, drug interactions, or delayed healthcare seeking.
Current guidelines recommend self-monitoring, including patient self-management, of oral anticoag... more Current guidelines recommend self-monitoring, including patient self-management, of oral anticoagulation for suitable adults with atrial fibrillation and heart valve disease on long-term anticoagulation therapy (generally warfarin in the UK). Self monitoring involves the patient being responsible for the measurement of their own international normalised ratio (INR) using a finger prick blood sample and a portable point of care coagulometer device. Patients may either interpret their INR test result themselves and adjust their warfarin dose and test frequency accordingly (self-management) or contact a healthcare professional for dosing advice (self-testing). Despite evidence supporting this model of patient care, only around 1–2% of people receiving oral anti-coagulation engage in self-monitoring in the UK
British Journal of General Practice
Background: Prescription medication sharing refers to the lending or borrowing of prescription me... more Background: Prescription medication sharing refers to the lending or borrowing of prescription medications where the recipient is someone other than the person for whom the prescription is intended. Sharing prescription medication can cause significant harm. Adverse consequences include an increased risk of side effects, delayed health seeking and severity of disease. Prevalence estimates vary across different populations and peoples’ reasons for and perceptions of risks from sharing, are poorly understood. Aim: To better understand prescription medication sharing behaviours and practices, specifically, the prevalence, types of medications, reasons, perceived benefits and risks, and factors associated with medication sharing. Design and Setting: A systematic review. Method: Electronic databases were searched from inception of databases to February 2023. Results: 19 studies were included. Prevalence ranged from 13-78%. All 19 studies reported that analgesics were the most shared, fol...
Annals of Internal Medicine, 2005
TO THE EDITOR: The design of the study by Menndez-Jndula and colleagues on patient self-managemen... more TO THE EDITOR: The design of the study by Menndez-Jndula and colleagues on patient self-management of oral anticoagulant therapy (1) has some important limitations. The authors compared monthly conventional management of anticoagulant therapy with weekly self-management and reported no significant difference in unadjusted percentages of end-range international normalized ratios (INRs). However, this is an unfair comparison. In my office, prothrombin times are checked every 2 weeks and then weekly if the dose has to be adjusted. Patients who do not require frequent dose adjustments can have this interval increased to 3 or 4 weeks. It would seem more reasonable for Menndez-Jndula and colleagues to have compared conventional and self-management approaches using the same interval between tests. Furthermore, in my experience, portable INR monitors are not as accurate or as consistent as those used in the laboratory in my hospital. If the real therapeutic range is wider when portable monitors are used, more INR measurements would be within the therapeutic range. In Menndez-Jndula and colleagues' study, were the INR measurements obtained from the portable monitors repeated in the office so the true accuracy and consistency of the portable monitors could be determined? Given these 2 limitations, I do not feel that self-management of poor anticoagulant therapy is ready for prime time. Finally, if the U.S. Food and Drug Administration would get around to approving a nonwarfarin anticoagulant, such as the thrombin inhibitor ximelagatran, self-management would probably become a moot point.
Family Practice, Apr 12, 2014
Introduction. Atrial fibrillation (AF) is an important independent risk factor for stroke and ora... more Introduction. Atrial fibrillation (AF) is an important independent risk factor for stroke and oral anticoagulation therapy provides a highly effective treatment to reduce this risk. Active screening strategies improve detection of AF in comparison with routine care; however, whether screen-detected patients have stroke risk profiles favouring anticoagulation is unclear. Using data derived from the screening for AF in the elderly (SAFE) study, the aim of this article was to determine if patients with AF detected via active screening have stroke risk profiles that warrant prophylactic anticoagulation. Methods. Secondary analysis of data derived from 25 general practices within which cohorts of 200 patients were randomly allocated to opportunistic [pulse and electrocardiogram (ECG)] or systematic screening (postal invitation for ECG). Stroke risk assessment was undertaken using baseline data extracted from medical records and CHADS2 criteria. CHADS2 scores were compared between the screening groups. Results. One hundred and forty-nine new cases of AF were detected, 75 via opportunistic screening and 74 via systematic screening. CHADS2 scores were ≥1 in 83% [95% confidence interval (CI) 72.6-89.6] of patients detected via opportunistic screening and 78% (95% CI 67.7-86.2) detected via systematic screening. There were no significant differences in stroke risk profiles of patients detected via opportunistic and systematic screenings. Conclusion. Stroke risk profiles of patients detected via opportunistic and systematic screenings were similar. Data derived from the SAFE study suggest that active screening for AF in patients aged ≥65 years in primary care is a useful screening programme with 78-83% of patients identified eligible for anticoagulation treatment according to the CHADS2 criteria.
Table 9.5A Presence versus absence of pairs of hypothyroid symptoms; comparison of serum FT4 conc... more Table 9.5A Presence versus absence of pairs of hypothyroid symptoms; comparison of serum FT4 concentration continued Muscle cramps Median FT4 (n) Constipation Median FT4 (n) Sensitivity to cold Median FT4 (n) Slow thinking Median TF4 (n) Weight gain Median FT4 (n)
The Journal of Laryngology & Otology, 2016
Objectives:To determine the proportion of UK surfers aware of external auditory canal exostosis, ... more Objectives:To determine the proportion of UK surfers aware of external auditory canal exostosis, to identify surfer characteristics associated with knowledge of the condition and to explore attitudes to earplug use.Method:An online, cross-sectional survey of UK-based surfers.Results:Of 375 surfers, 86.1 per cent (n = 323; 95 per cent confidence interval = 82.3–89.3) reported awareness of external auditory canal exostosis. Further investigation revealed that, despite their awareness of the condition, 23.4 per cent of these surfers (88 out of 323; 95 per cent confidence interval = 19.5–28.0) had little or no knowledge about external auditory canal exostosis. Predictors of knowledge included: distance from nearest surfing beach (p = 0.001), surfing standard (ability) (p = 0.008), earplug use (p = 0.024) and positive external auditory canal exostosis diagnosis (p = 0.009).Conclusion:The findings suggest that a significant minority of UK surfers have no knowledge about this condition. Kn...
Table 9.5A Presence versus absence of pairs of hypothyroid symptoms; comparison of serum FT4 conc... more Table 9.5A Presence versus absence of pairs of hypothyroid symptoms; comparison of serum FT4 concentration continued Muscle cramps Median FT4 (n) Constipation Median FT4 (n) Sensitivity to cold Median FT4 (n) Slow thinking Median TF4 (n) Weight gain Median FT4 (n)
Family Practice, 2014
Introduction. Atrial fibrillation (AF) is an important independent risk factor for stroke and ora... more Introduction. Atrial fibrillation (AF) is an important independent risk factor for stroke and oral anticoagulation therapy provides a highly effective treatment to reduce this risk. Active screening strategies improve detection of AF in comparison with routine care; however, whether screen-detected patients have stroke risk profiles favouring anticoagulation is unclear. Using data derived from the screening for AF in the elderly (SAFE) study, the aim of this article was to determine if patients with AF detected via active screening have stroke risk profiles that warrant prophylactic anticoagulation. Methods. Secondary analysis of data derived from 25 general practices within which cohorts of 200 patients were randomly allocated to opportunistic [pulse and electrocardiogram (ECG)] or systematic screening (postal invitation for ECG). Stroke risk assessment was undertaken using baseline data extracted from medical records and CHADS2 criteria. CHADS2 scores were compared between the screening groups. Results. One hundred and forty-nine new cases of AF were detected, 75 via opportunistic screening and 74 via systematic screening. CHADS2 scores were ≥1 in 83% [95% confidence interval (CI) 72.6-89.6] of patients detected via opportunistic screening and 78% (95% CI 67.7-86.2) detected via systematic screening. There were no significant differences in stroke risk profiles of patients detected via opportunistic and systematic screenings. Conclusion. Stroke risk profiles of patients detected via opportunistic and systematic screenings were similar. Data derived from the SAFE study suggest that active screening for AF in patients aged ≥65 years in primary care is a useful screening programme with 78-83% of patients identified eligible for anticoagulation treatment according to the CHADS2 criteria.
BMC Medicine, 2021
Background Medication review is a core aspect of medicine optimisation, yet existing models of re... more Background Medication review is a core aspect of medicine optimisation, yet existing models of review vary substantially in structure and content and are not necessarily easy to implement in clinical practice. This study aimed to use evidence from the existing literature to identify key medication review components and use this to inform the design of an improved review model. Methods A systematic review was conducted (PROSPERO: CRD42018109788) to identify randomised control trials of stand-alone medication review in adults (18+ years). The review updated that by Huiskes et al. (BMC Fam Pract. 18:5, 2017), using the same search strategy implemented in MEDLINE and Embase. Studies were assessed using the Cochrane risk of bias tool. Key review components were identified, alongside relevant clinical and health service outcomes. A working group (patients, doctors and pharmacists) developed the model through an iterative consensus process (appraisal of documents plus group discussions), w...
Background Over one billion prescription items are dispensed in the United Kingdom annually. Up t... more Background Over one billion prescription items are dispensed in the United Kingdom annually. Up to 50% of medicines are not used as intended, resulting in sub-optimal health outcomes and harm. Medicines optimisation is ‘a person-centred approach to safe and effective medicines use, to ensure people obtain the best possible outcomes from their medicines’. The purpose of this study was to co-produce a prioritised research agenda for medicines optimisation using a multi-stakeholder (patient, public and health professionals) approach. Methods A three-stage, multiple method process was used including: generation of preliminary research questions (Stage 1) using a modified Nominal Group Technique; electronic consultation and ranking with a wider multi-stakeholder group (Stage 2); a face-to-face, one-day consensus meeting involving representatives from all stakeholder groups (Stage 3). Results In total, 92 research questions were identified during Stages 1 and 2 and ranked in order of prio...
BMC Primary Care
Background Clinical medication reviews are a recognised strategy to address polypharmacy, a key p... more Background Clinical medication reviews are a recognised strategy to address polypharmacy, a key part of general practice and positively associated with patient safety and clinical effectiveness. To date there has been little investigation of the patient perspective of medication reviews. Objective To explore patient experiences of medication review including the processes and activities that led up to and shaped the review. Methods Qualitative interview study within 10 general practices in Bristol. Participants were adults with polypharmacy (≥ 4 medications) and ≥ 2 long-term conditions who had a record of medication review with either a GP or pharmacist. Interviews were transcribed verbatim and analysed thematically using a data driven approach. Co-design work was undertaken with four patient and public involvement advisers to design and develop resources to support patient preparation for medication review. Results Twenty-one patients were interviewed (10 female, mean age 73 years...
NIHR Open Research
Introduction: Polypharmacy is increasingly common, and associated with undesirable consequences. ... more Introduction: Polypharmacy is increasingly common, and associated with undesirable consequences. Polypharmacy management necessitates balancing therapeutic benefits and risks, and varying clinical and patient priorities. Current guidance for managing polypharmacy is not supported by high quality evidence. The aim of the Improving Medicines use in People with Polypharmacy in Primary Care (IMPPP) trial is to evaluate the effectiveness of an intervention to optimise medication use for patients with polypharmacy in a general practice setting. Methods: This trial will use a multicentre, open-label, cluster-randomised controlled approach, with two parallel groups. Practices will be randomised to a complex intervention comprising structured medication review (including interprofessional GP/pharmacist treatment planning and patient-facing review) supported by performance feedback, financial incentivisation, clinician training and clinical informatics (intervention), or usual care (control)....
Programme Grants for Applied Research, 2020
Background Deep-vein thrombosis and pulmonary embolism, collectively known as venous thromboembol... more Background Deep-vein thrombosis and pulmonary embolism, collectively known as venous thromboembolism when clots are formed in the venous circulation, are common disorders that are often unprovoked (i.e. there is no obvious reason for the clot occurring). Some people, after having an unprovoked clot, are at a high risk of developing another, or at risk of developing a secondary clot, most importantly in the lungs. Furthermore, in the long term, some patients will develop circulation problems known as post-thrombotic syndrome. The aim of this programme was to improve the understanding of both the prevention and the treatment of thrombosis in people at the highest risk of recurrence. Objectives To clarify if it is possible to identify those people at the highest risk of having a recurrent venous thromboembolism, and if it is possible to prevent this happening by giving anticoagulation treatment for longer. To clarify if it is possible to identify those people at the highest risk of dev...
British Journal of General Practice, 2020
BackgroundMany UK GP practices now employ a practice pharmacist, but little is known about how GP... more BackgroundMany UK GP practices now employ a practice pharmacist, but little is known about how GPs and pharmacists work together to optimise medications for complex patients with multimorbidity.AimTo explore GP and pharmacist perspectives on collaborative working within the context of optimising medications for patients with multimorbidity.Design and settingA qualitative analysis of semi-structured interviews with GPs and pharmacists working in the West of England, Northern England, and Scotland.MethodThirteen GPs and 10 pharmacists were sampled from practices enrolled in the 3D trial (a complex intervention for people with multimorbidity). Participants’ views on collaborative working were explored with interviews that were audiorecorded, transcribed, and analysed thematically. Saturation of data was achieved with no new insights arising from later interviews.ResultsGPs from surgeries that employed a pharmacist tended to value their expertise more than GPs who had not worked with on...
British Journal of General Practice, 2020
BackgroundSubclinical thyroid dysfunction — abnormal serum thyrotrophin (thyroid-stimulating horm... more BackgroundSubclinical thyroid dysfunction — abnormal serum thyrotrophin (thyroid-stimulating hormone; TSH) concentrations with normal free thyroxine (FT4) is common in older people. It remains unclear whether individuals with subclinical serum status experience an increased symptom profile.AimTo compare the prevalence of those symptoms typically associated with overt thyroid dysfunction in older individuals with a subclinical and euthyroid serum profile.Design and settingCross-sectional study, nested within the Birmingham Elderly Thyroid Study (BETS); from 19 UK general practices.MethodAdults living in a community setting (aged ≥65 years), without overt thyroid dysfunction or associated treatment, self-reported the presence or absence of 18 symptoms (while serum result naïve). Serum concentrations of TSH and FT4 were measured to establish thyroid status.ResultsA total of 2870 individuals were screened: 2703 (94%) were categorised as euthyroid (normal), 29 (1%) subclinically hyperthy...
British Journal of Haematology, 2019
A randomised controlled trial of extended anticoagulation treatment versus standard treatment for... more A randomised controlled trial of extended anticoagulation treatment versus standard treatment for the prevention of recurrent venous thromboembolism (VTE) and postthrombotic syndrome in patients being treated for a first episode of unprovoked VTE (the ExACT study)', British Journal of Haematology.
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Papers by Deborah McCahon