Introduction Primary care databases (PCDs) are increasingly used as a resource for research, but ... more Introduction Primary care databases (PCDs) are increasingly used as a resource for research, but issues around the validity of studies based on PCDs remain. We conducted the frst fully independent replications of published PCD studies in a different PCD covering the same target population. Methods We replicated two previous PCD drug effectiveness studies through the Clinical Practice Research Datalink (CPRD). The first was an investigation of the effects of Statins on mortality of patients with ischaemic heart disease using QRESEARCH. The second was a cohort study of the effect of Beta-blocker therapy on survival in cancer patients using the Doctors’ Independent Network (DIN-LINK). Results We successfully replicated the methods of the two original studies in CPRD, but only by obtaining additional detail from the authors. Although notionally covering the same patient population, we found some notable demographic and health differences between our cohorts of CPRD patient and the cohor...
To investigate the underlying causes of intravenous medication administration errors (MAEs) in Na... more To investigate the underlying causes of intravenous medication administration errors (MAEs) in National Health Service (NHS) hospitals. Two NHS teaching hospitals in the North West of England. Twenty nurses working in a range of inpatient clinical environments were identified and recruited using purposive sampling at each study site. Semistructured interviews were conducted with nurse participants using the critical incident technique, where they were asked to discuss perceived causes of intravenous MAEs that they had been directly involved with. Transcribed interviews were analysed using the Framework approach and emerging themes were categorised according to Reason's model of accident causation. In total, 21 intravenous MAEs were discussed containing 23 individual active failures which included slips and lapses (n=11), mistakes (n=8) and deliberate violations of policy (n=4). Each active failure was associated with a range of error and violation provoking conditions. The worki...
Drug metabolism and disposition: the biological fate of chemicals, 2014
Due to the rapid turnover of the small intestinal epithelia, the rate at which enterocyte renewal... more Due to the rapid turnover of the small intestinal epithelia, the rate at which enterocyte renewal occurs plays an important role in determining the level of drug-metabolizing enzymes in the gut wall. Current physiologically based pharmacokinetic (PBPK) models consider enzyme and enterocyte recovery as a lumped first-order rate. An assessment of enterocyte turnover would enable enzyme and enterocyte renewal to be modeled more mechanistically. A literature review together with statistical analysis was employed to establish enterocyte turnover in human and preclinical species. A total of 85 studies was identified reporting enterocyte turnover in 1602 subjects in six species. In mice, the geometric weighted combined mean (WX) enterocyte turnover was 2.81 ± 1.14 days (n = 169). In rats, the weighted arithmetic mean enterocyte turnover was determined to be 2.37 days (n = 501). Humans exhibited a geometric WX enterocyte turnover of 3.48 ± 1.55 days for the gastrointestinal epithelia (n = 2...
The health professions are engaged in an ongoing and dynamic process involving reflection and ada... more The health professions are engaged in an ongoing and dynamic process involving reflection and adaptation, with factors such as socio-economic and cultural developments and technological innovations compelling professions to respond to changed circumstances. This paper concerns English community pharmacy, where recent reforms provide financial incentives to deliver interventions, which have the potential for pharmacists to promote their knowledge and skills, as part of a professionalising strategy. The paper, drawing on interviews with 49 pharmacists, describes how responses to reforms are not necessarily in accordance with either national policy goals or enhancement of professional status. Debates about professional status and role extension have often focused on health professions' subordination to medicine. This paper highlights the importance and interplay of other factors which help explain the inability to capitalise fully on the potential contribution to professional status, which reforms to extend professional roles afford.
The association between psoriasis and risk of major cardiovascular (CV) events (myocardial infarc... more The association between psoriasis and risk of major cardiovascular (CV) events (myocardial infarction, acute coronary syndrome, unstable angina and stroke) is unclear. A cohort study with 48,523 patients with psoriasis and 208,187 controls was conducted. During a median follow-up of 5.2 years, 1,257 patients with psoriasis (2.59%) had a major CV event, compared to 4,784 controls (2.30%). In the multivariable analysis, inflammatory arthritis HR 1.36 (1.18-1.58); diabetes HR 1.18 (1.06-1.31); chronic kidney disease HR 1.18 (1.07-1.31); hypertension HR 1.37 (1.29-1.45); transient ischemic attack HR 2.74 (2.41-3.12); atrial fibrillation HR 1.54 (1.36-1.73); valvular heart disease HR 1.23 (1.05-1.44); thromboembolism 1.32 (1.17-1.49); congestive heart failure HR 1.57 (1.39-1.78); depression HR 1.16 (1.01-1.34); current smoker HR 2.18 (2.03-2.33); age (year) HR 1.07 (1.07-1.07); and male gender HR 1.83 (1.69-1.98) were statistically significant for the risk of major CV events. The age and gender adjusted HRs of a major CV event for psoriasis were 1.10 (1.04-1.17) and for severe psoriasis 1.40 (1.07-1.84), while the fully adjusted HRs were attenuated to 1.02 (0.95-1.08) and 1.28 (0.96-1.69). In conclusion, neither psoriasis nor severe psoriasis were associated with the short-to-medium term (over 3 to 5 years) risk of major CV events after adjusting for known CVD risk factors.Journal of Investigative Dermatology accepted article preview online, 05 March 2015. doi:10.1038/jid.2015.87.
To determine the prevalence, nature and predictors of prescribing errors (PEs) in three mental he... more To determine the prevalence, nature and predictors of prescribing errors (PEs) in three mental health hospitals. Inpatient units in three National Health Service (NHS) mental health hospitals in the North West of England. Trained clinical pharmacists prospectively recorded the number of PEs in newly written or omitted prescription items screened during their routine work on 10 data collection days. A multidisciplinary panel reviewed PE data using established methods to confirm (1) the presence of a PE, (2) the type of PE and (3) whether errors were clinically relevant and likely to cause harm. Frequency, nature and predictors of PEs. Of 4427 screened prescription items, 281 were found to have one or more PEs (error rate 6.3% (95% CI 5.6 to 7.1%)). Multivariate analysis revealed that specialty trainees (OR 1.23 (1.01 to 1.51)) and staff grade psychiatrists (OR 1.50 (1.05 to 2.13)) were more likely to make PEs when compared to foundation year (FY) one doctors, and that specialty train...
Journal of Health Organization and Management, 2011
The aim of this paper is to report on the findings of a systematic literature review-seeking to e... more The aim of this paper is to report on the findings of a systematic literature review-seeking to elicit existing evidence of the nature of organisational culture in community pharmacy organisations. This review takes a novel approach to systematically identifying and synthesising the peer-reviewed research literature pertaining to organisational culture in this setting, its antecedents and outcomes. The review provides an overview of the scope of and research methods used in the identified literature, together with a narrative synthesis of its findings, framed within five dimensions of organisational culture: the professional-business role dichotomy; workload, management style, social support and autonomy; professional culture; attitudes to change and innovation; and entrepreneurial orientation. There is a need for more detailed and holistic exploration of organisational culture in community pharmacy, using a greater diversity of research methods and a greater focus on patient-related outcomes. This paper demonstrates that, whilst little research has explicitly investigated organisational culture in this context, there exists a range of evidence describing aspects of that culture, some of the environmental and organisational factors helping to shape it, and its impact on the pharmacy workforce, services delivered and business outcomes. It highlights the importance of the business-professional role dichotomy in community pharmacy; the influence of individual pharmacists' characteristics and organisational setting; and the impact on pharmacists' wellbeing and job satisfaction and the services delivered. It provides less evidence of the impact of organisational culture on the quality and safety of service provision.
Lists of clinical codes are the foundation for research undertaken using electronic medical recor... more Lists of clinical codes are the foundation for research undertaken using electronic medical records (EMRs). If clinical code lists are not available, reviewers are unable to determine the validity of research, full study replication is impossible, researchers are unable to make effective comparisons between studies, and the construction of new code lists is subject to much duplication of effort. Despite this, the publication of clinical codes is rarely if ever a requirement for obtaining grants, validating protocols, or publishing research. In a representative sample of 450 EMR primary research articles indexed on PubMed, we found that only 19 (5.1%) were accompanied by a full set of published clinical codes and 32 (8.6%) stated that code lists were available on request. To help address these problems, we have built an online repository where researchers using EMRs can upload and download lists of clinical codes. The repository will enable clinical researchers to better validate EMR...
Delivering a non-pharmacological symptom management intervention in patients with lung cancer is ... more Delivering a non-pharmacological symptom management intervention in patients with lung cancer is often challenging due to difficulties with recruitment, high attrition rates, high symptom burden, and other methodological problems. The aim of the present study was to elicit quantitative estimates of utility (benefit) associated with different attribute levels (delivery options) of a symptom management intervention in lung cancer patients. An application of Best-Worst scaling methodology was used. Effects (attributes) tested included the location of the intervention (home or hospital), type of trainer (health professional or trained volunteer), caregiver involvement or not, and intervention delivered individually or in groups of patients. Participants were asked to evaluate and compare their preferences (utilities) towards the different attribute levels within scenarios and select the pair of attribute levels that they consider to be furthest apart. Eighty-seven patients with lung cancer participated. The most important preferences for an intervention included the location (being delivered at home) and delivered by a health care professional. The least important preference was the involvement of a caregiver. Gender had an effect on preferences, with females being less inclined than men to prefer to receive an intervention in the home than the hospital and less inclined than men to have no other patients present. Furthermore, older participants and those in advanced stages of their disease were less inclined to have no other patients present compared to younger participants and those with earlier stages of disease, respectively. Considering patient preferences is an important step in developing feasible, patient-centred, appropriate and methodologically rigorous interventions and this study provided indications of such patient preferences.
Journal of Health Services Research & Policy, 2009
To examine whether relaxation of control of entry regulations for community pharmacy contracts in... more To examine whether relaxation of control of entry regulations for community pharmacy contracts in England, introduced in 2005, affected the distribution of community pharmacies relative to population need indicators. Community pharmacy locations and population need indicators were used to calculate three summary measures of distributional equity across Primary Care Trust (PCT) areas (n = 152): the Gini coefficient, Atkinson Index and community pharmacies per PCT population. The indicators were adjusted for need using data from NHS GP contract Quality and Outcomes Framework disease registers, deprivation, all-cause mortality and elderly population rates. Numbers of community pharmacies increased by 397 (4%) between 2005 and 2007 with three supermarket chains accounting for 152 (38%) of new pharmacies. Over one-quarter of PCTs experienced increases of 5% or more in community pharmacies per capita between 2005 and 2007. Gini and Atkinson indicators showed small increases in distributional equity across all population needs indicators. Deregulation was associated with more community pharmacies per capita and a small increase in geographic equity of community pharmacy distribution at PCT level. Future research should continue to monitor how pharmacy distribution changes over time and assess the extent to which the new regulatory framework has allowed clustering of pharmacies which could result in increased inequity below PCT level.
American Journal of Pharmaceutical Education, 2013
To define the concept of &amp... more To define the concept of "organizational philosophy" through identification of elements within undergraduate pharmacy curricula in the United Kingdom that contribute to students' learning of professionalism. A qualitative study using curriculum mapping was conducted to identify "intended," "taught," and "received" curriculum in 3 schools of pharmacy. The study involved review of course materials, interviews with teaching staff members, focus groups with final year students, and observation of classes. "Organizational philosophy" (totality of all contributors) played a vital part in students' professionalism learning. Key contributions were not restricted to the "taught" curriculum but extended to the wider academic environment. Setting of high standards appeared important; role models had particular significance. Importance of professionalism learning being grounded and longitudinal throughout the curriculum was highlighted. An "integrated" organizational philosophy appeared to be achieved where maximum overlap occurred between…
Abstract Objectives: There is a lack of focus on the broader social context, networks and influen... more Abstract Objectives: There is a lack of focus on the broader social context, networks and influences on medicine-taking as part of illness work. This work adopts a social network approach and seeks to explicate the nature of medicine-taking work that people with multiple long-term conditions (LTCs) and their social network members (SNMs) do in attempting to take their medications on a daily basis, the division of labour amongst these members and when and why SNMs become involved in that work. Methods: Semi-structured interviews were conducted with 20 people who had multiple LTCs. Medication networks were constructed and the division of labour in relation to medication-work was explored. Results: Four types of medication-work emerged: medication articulation, surveillance, emotional and informational. Involvement of SNMs in medication-work was selective, performed primarily by family members, within the home. Involvement reflected network composition and/or an individual’s conceptualisation/presentation of self. Discussion: Our findings support and extend the conceptualisation of routine medicine-taking as a type of work. Furthermore, we illustrate the involvement of SNMs in aspects of medicine-work. Health professionals should explore and support the role of SNMs in medicine-taking where possible. Future research should explore the implications of network types and compositions on medicine-taking and associated work.
Introduction Primary care databases (PCDs) are increasingly used as a resource for research, but ... more Introduction Primary care databases (PCDs) are increasingly used as a resource for research, but issues around the validity of studies based on PCDs remain. We conducted the frst fully independent replications of published PCD studies in a different PCD covering the same target population. Methods We replicated two previous PCD drug effectiveness studies through the Clinical Practice Research Datalink (CPRD). The first was an investigation of the effects of Statins on mortality of patients with ischaemic heart disease using QRESEARCH. The second was a cohort study of the effect of Beta-blocker therapy on survival in cancer patients using the Doctors’ Independent Network (DIN-LINK). Results We successfully replicated the methods of the two original studies in CPRD, but only by obtaining additional detail from the authors. Although notionally covering the same patient population, we found some notable demographic and health differences between our cohorts of CPRD patient and the cohor...
To investigate the underlying causes of intravenous medication administration errors (MAEs) in Na... more To investigate the underlying causes of intravenous medication administration errors (MAEs) in National Health Service (NHS) hospitals. Two NHS teaching hospitals in the North West of England. Twenty nurses working in a range of inpatient clinical environments were identified and recruited using purposive sampling at each study site. Semistructured interviews were conducted with nurse participants using the critical incident technique, where they were asked to discuss perceived causes of intravenous MAEs that they had been directly involved with. Transcribed interviews were analysed using the Framework approach and emerging themes were categorised according to Reason's model of accident causation. In total, 21 intravenous MAEs were discussed containing 23 individual active failures which included slips and lapses (n=11), mistakes (n=8) and deliberate violations of policy (n=4). Each active failure was associated with a range of error and violation provoking conditions. The worki...
Drug metabolism and disposition: the biological fate of chemicals, 2014
Due to the rapid turnover of the small intestinal epithelia, the rate at which enterocyte renewal... more Due to the rapid turnover of the small intestinal epithelia, the rate at which enterocyte renewal occurs plays an important role in determining the level of drug-metabolizing enzymes in the gut wall. Current physiologically based pharmacokinetic (PBPK) models consider enzyme and enterocyte recovery as a lumped first-order rate. An assessment of enterocyte turnover would enable enzyme and enterocyte renewal to be modeled more mechanistically. A literature review together with statistical analysis was employed to establish enterocyte turnover in human and preclinical species. A total of 85 studies was identified reporting enterocyte turnover in 1602 subjects in six species. In mice, the geometric weighted combined mean (WX) enterocyte turnover was 2.81 ± 1.14 days (n = 169). In rats, the weighted arithmetic mean enterocyte turnover was determined to be 2.37 days (n = 501). Humans exhibited a geometric WX enterocyte turnover of 3.48 ± 1.55 days for the gastrointestinal epithelia (n = 2...
The health professions are engaged in an ongoing and dynamic process involving reflection and ada... more The health professions are engaged in an ongoing and dynamic process involving reflection and adaptation, with factors such as socio-economic and cultural developments and technological innovations compelling professions to respond to changed circumstances. This paper concerns English community pharmacy, where recent reforms provide financial incentives to deliver interventions, which have the potential for pharmacists to promote their knowledge and skills, as part of a professionalising strategy. The paper, drawing on interviews with 49 pharmacists, describes how responses to reforms are not necessarily in accordance with either national policy goals or enhancement of professional status. Debates about professional status and role extension have often focused on health professions' subordination to medicine. This paper highlights the importance and interplay of other factors which help explain the inability to capitalise fully on the potential contribution to professional status, which reforms to extend professional roles afford.
The association between psoriasis and risk of major cardiovascular (CV) events (myocardial infarc... more The association between psoriasis and risk of major cardiovascular (CV) events (myocardial infarction, acute coronary syndrome, unstable angina and stroke) is unclear. A cohort study with 48,523 patients with psoriasis and 208,187 controls was conducted. During a median follow-up of 5.2 years, 1,257 patients with psoriasis (2.59%) had a major CV event, compared to 4,784 controls (2.30%). In the multivariable analysis, inflammatory arthritis HR 1.36 (1.18-1.58); diabetes HR 1.18 (1.06-1.31); chronic kidney disease HR 1.18 (1.07-1.31); hypertension HR 1.37 (1.29-1.45); transient ischemic attack HR 2.74 (2.41-3.12); atrial fibrillation HR 1.54 (1.36-1.73); valvular heart disease HR 1.23 (1.05-1.44); thromboembolism 1.32 (1.17-1.49); congestive heart failure HR 1.57 (1.39-1.78); depression HR 1.16 (1.01-1.34); current smoker HR 2.18 (2.03-2.33); age (year) HR 1.07 (1.07-1.07); and male gender HR 1.83 (1.69-1.98) were statistically significant for the risk of major CV events. The age and gender adjusted HRs of a major CV event for psoriasis were 1.10 (1.04-1.17) and for severe psoriasis 1.40 (1.07-1.84), while the fully adjusted HRs were attenuated to 1.02 (0.95-1.08) and 1.28 (0.96-1.69). In conclusion, neither psoriasis nor severe psoriasis were associated with the short-to-medium term (over 3 to 5 years) risk of major CV events after adjusting for known CVD risk factors.Journal of Investigative Dermatology accepted article preview online, 05 March 2015. doi:10.1038/jid.2015.87.
To determine the prevalence, nature and predictors of prescribing errors (PEs) in three mental he... more To determine the prevalence, nature and predictors of prescribing errors (PEs) in three mental health hospitals. Inpatient units in three National Health Service (NHS) mental health hospitals in the North West of England. Trained clinical pharmacists prospectively recorded the number of PEs in newly written or omitted prescription items screened during their routine work on 10 data collection days. A multidisciplinary panel reviewed PE data using established methods to confirm (1) the presence of a PE, (2) the type of PE and (3) whether errors were clinically relevant and likely to cause harm. Frequency, nature and predictors of PEs. Of 4427 screened prescription items, 281 were found to have one or more PEs (error rate 6.3% (95% CI 5.6 to 7.1%)). Multivariate analysis revealed that specialty trainees (OR 1.23 (1.01 to 1.51)) and staff grade psychiatrists (OR 1.50 (1.05 to 2.13)) were more likely to make PEs when compared to foundation year (FY) one doctors, and that specialty train...
Journal of Health Organization and Management, 2011
The aim of this paper is to report on the findings of a systematic literature review-seeking to e... more The aim of this paper is to report on the findings of a systematic literature review-seeking to elicit existing evidence of the nature of organisational culture in community pharmacy organisations. This review takes a novel approach to systematically identifying and synthesising the peer-reviewed research literature pertaining to organisational culture in this setting, its antecedents and outcomes. The review provides an overview of the scope of and research methods used in the identified literature, together with a narrative synthesis of its findings, framed within five dimensions of organisational culture: the professional-business role dichotomy; workload, management style, social support and autonomy; professional culture; attitudes to change and innovation; and entrepreneurial orientation. There is a need for more detailed and holistic exploration of organisational culture in community pharmacy, using a greater diversity of research methods and a greater focus on patient-related outcomes. This paper demonstrates that, whilst little research has explicitly investigated organisational culture in this context, there exists a range of evidence describing aspects of that culture, some of the environmental and organisational factors helping to shape it, and its impact on the pharmacy workforce, services delivered and business outcomes. It highlights the importance of the business-professional role dichotomy in community pharmacy; the influence of individual pharmacists' characteristics and organisational setting; and the impact on pharmacists' wellbeing and job satisfaction and the services delivered. It provides less evidence of the impact of organisational culture on the quality and safety of service provision.
Lists of clinical codes are the foundation for research undertaken using electronic medical recor... more Lists of clinical codes are the foundation for research undertaken using electronic medical records (EMRs). If clinical code lists are not available, reviewers are unable to determine the validity of research, full study replication is impossible, researchers are unable to make effective comparisons between studies, and the construction of new code lists is subject to much duplication of effort. Despite this, the publication of clinical codes is rarely if ever a requirement for obtaining grants, validating protocols, or publishing research. In a representative sample of 450 EMR primary research articles indexed on PubMed, we found that only 19 (5.1%) were accompanied by a full set of published clinical codes and 32 (8.6%) stated that code lists were available on request. To help address these problems, we have built an online repository where researchers using EMRs can upload and download lists of clinical codes. The repository will enable clinical researchers to better validate EMR...
Delivering a non-pharmacological symptom management intervention in patients with lung cancer is ... more Delivering a non-pharmacological symptom management intervention in patients with lung cancer is often challenging due to difficulties with recruitment, high attrition rates, high symptom burden, and other methodological problems. The aim of the present study was to elicit quantitative estimates of utility (benefit) associated with different attribute levels (delivery options) of a symptom management intervention in lung cancer patients. An application of Best-Worst scaling methodology was used. Effects (attributes) tested included the location of the intervention (home or hospital), type of trainer (health professional or trained volunteer), caregiver involvement or not, and intervention delivered individually or in groups of patients. Participants were asked to evaluate and compare their preferences (utilities) towards the different attribute levels within scenarios and select the pair of attribute levels that they consider to be furthest apart. Eighty-seven patients with lung cancer participated. The most important preferences for an intervention included the location (being delivered at home) and delivered by a health care professional. The least important preference was the involvement of a caregiver. Gender had an effect on preferences, with females being less inclined than men to prefer to receive an intervention in the home than the hospital and less inclined than men to have no other patients present. Furthermore, older participants and those in advanced stages of their disease were less inclined to have no other patients present compared to younger participants and those with earlier stages of disease, respectively. Considering patient preferences is an important step in developing feasible, patient-centred, appropriate and methodologically rigorous interventions and this study provided indications of such patient preferences.
Journal of Health Services Research & Policy, 2009
To examine whether relaxation of control of entry regulations for community pharmacy contracts in... more To examine whether relaxation of control of entry regulations for community pharmacy contracts in England, introduced in 2005, affected the distribution of community pharmacies relative to population need indicators. Community pharmacy locations and population need indicators were used to calculate three summary measures of distributional equity across Primary Care Trust (PCT) areas (n = 152): the Gini coefficient, Atkinson Index and community pharmacies per PCT population. The indicators were adjusted for need using data from NHS GP contract Quality and Outcomes Framework disease registers, deprivation, all-cause mortality and elderly population rates. Numbers of community pharmacies increased by 397 (4%) between 2005 and 2007 with three supermarket chains accounting for 152 (38%) of new pharmacies. Over one-quarter of PCTs experienced increases of 5% or more in community pharmacies per capita between 2005 and 2007. Gini and Atkinson indicators showed small increases in distributional equity across all population needs indicators. Deregulation was associated with more community pharmacies per capita and a small increase in geographic equity of community pharmacy distribution at PCT level. Future research should continue to monitor how pharmacy distribution changes over time and assess the extent to which the new regulatory framework has allowed clustering of pharmacies which could result in increased inequity below PCT level.
American Journal of Pharmaceutical Education, 2013
To define the concept of &amp... more To define the concept of "organizational philosophy" through identification of elements within undergraduate pharmacy curricula in the United Kingdom that contribute to students' learning of professionalism. A qualitative study using curriculum mapping was conducted to identify "intended," "taught," and "received" curriculum in 3 schools of pharmacy. The study involved review of course materials, interviews with teaching staff members, focus groups with final year students, and observation of classes. "Organizational philosophy" (totality of all contributors) played a vital part in students' professionalism learning. Key contributions were not restricted to the "taught" curriculum but extended to the wider academic environment. Setting of high standards appeared important; role models had particular significance. Importance of professionalism learning being grounded and longitudinal throughout the curriculum was highlighted. An "integrated" organizational philosophy appeared to be achieved where maximum overlap occurred between…
Abstract Objectives: There is a lack of focus on the broader social context, networks and influen... more Abstract Objectives: There is a lack of focus on the broader social context, networks and influences on medicine-taking as part of illness work. This work adopts a social network approach and seeks to explicate the nature of medicine-taking work that people with multiple long-term conditions (LTCs) and their social network members (SNMs) do in attempting to take their medications on a daily basis, the division of labour amongst these members and when and why SNMs become involved in that work. Methods: Semi-structured interviews were conducted with 20 people who had multiple LTCs. Medication networks were constructed and the division of labour in relation to medication-work was explored. Results: Four types of medication-work emerged: medication articulation, surveillance, emotional and informational. Involvement of SNMs in medication-work was selective, performed primarily by family members, within the home. Involvement reflected network composition and/or an individual’s conceptualisation/presentation of self. Discussion: Our findings support and extend the conceptualisation of routine medicine-taking as a type of work. Furthermore, we illustrate the involvement of SNMs in aspects of medicine-work. Health professionals should explore and support the role of SNMs in medicine-taking where possible. Future research should explore the implications of network types and compositions on medicine-taking and associated work.
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