1. Increasing MUR figures in WY using a behaviour change model
Weris Ibrahim
Hey everyone, I’m weris and my project was on increasing MUR numbers in WY using a behaviour change model. This was an area of interest for me as blabla and was an interesting opportunity to learn about theory based interventions using blablabla. The project was carried out in conjunction with CPWY, who as mentioned by my previous peers are the leading blabla. My supervisor, Margaret C ensured the smooth running of the project.

2. Introduction: National target for MUR completion = 81.89% [1]
I am confident that everyone in the room should be familiar with MURs by now. Does anyone know what it stands for? Correct. MURs are an advanced service provided in community with the aim to improve blabla.
As you can see on this (grah?), WY which is highlighted in red, is significantly under performing in the delivery of MURs compared to other UK regions. It falls below the national target by around 5%.
National target for MUR completion = 81.89% [1]

3. Why explore BCT?
Despite major campaigning from everyone, including CPS, cuts are unavoidable
“No getting away from cuts” - David Mowat
Reimbursement for the MUR service totalling up to £88,818,864 in the last year alone [2]
Intervention strategies based on sound theory are more likely to produce a long lasting effect

4. Aim:
Identify the barriers faced by community pharmacists in West Yorkshire (WY) which prevent them from achieving national medicine use review (MUR) targets
Which leads me to my aim….which is identifyiny the barriers faced by cp in Wywhich prefvents them from achieving national MUR targets

5. Flow chart showing the 5-step process of intervention implementation- using behaviour change theory
Changing the behaviour of pharmacists towards MUR completion is a small and achievable step that can be taken to allow for these league table improvements to be made. So my research makes up the early stages of the interventation implementatipn process by identifying target behaviours and barriers to implementation. A plethora of frameworks addressing behaviour change can be found. However, difficulties lie in finding and selecting a comprehensive and easily replicated framework that can be effectively used to implement intervention strategies in practice. developing an understanding of the nature of the behaviour to be changed is of utmost importance in the design of successful intervention strategies.

6. Behaviour Change Wheel
The COM-B system:
The COM-B system – a framework for understanding behaviour.

7. Method
Theoretical domains framework (TDF) based survey of all community pharmacies in WY
Convenience sampling

8. C. Beliefs about consequences
Questions:
1. Emergencies and other priorities get in the way of me being able to conduct MURs 2. There is not a good enough system in place for me to conduct MURs 3. I feel anxious if I think about having to conduct MURs 4. It’s not my responsibility to perform MURs 5. I do not find it easy to conduct MURs 6. It doesn’t matter too much if I do not conduct MURs 7. Other pharmacists don’t seem to conduct MURs 8. I worry if I think about conducting MURs 9. I am clear about my role in conducting MURs It will be bad for the patient if I do not conduct MURs There is no justifiable reason why I decide not to conduct MURs My superiors would like me to conduct MURs Things are too unpredictable to make plans to conduct MURs Patient’s carer/relative regularly collects prescription which prevents MUR completion I’m confident with my knowledge around MUR target groups to aid consultation I think there is an easy process in place to identify patients who are due an MUR I have the necessary resources (e.g., consultation room) to complete MURs Limited staff leaves me with no time to preform MURs 19. I’m not confident in my ability to perform an MUR Training given is not adequate enough to perform MURs I regularly get acknowledged for achieving MUR target I have previously encountered problems when trying to perform an MUR From my experience patient’s benefit from MURs provided I feel that GPs don’t offer enough support by referring pt’s for MUR service There is too much pressure put on me to perform MURs I don’t have enough time to carry out MURs
A. Knowledge
B. Skills
C. Beliefs about consequences
D. Motivation and goals
E. Emotion
F. Social influences
G. Beliefs about capabilities
H. Environmental context & resources
I. Professional role & identify
J. Action planning
K. Memory, attention and decision process

9. Results
Rank in order of preference what would help you to do more MURs:(Indicate by number 1-4 order, where 1 is most preferred)
Answer Options 1 2 3 4
Rating Average
Response Count
Number of staff 13 5
1.65 23
Training/Support 6 10
2.83
Remuneration
2.43 21
Recognition/Rewards 8 7
3.00 22 4 2 3 1

10. Going back to TDF. Linking this to ranking question

12. TDF domains strategy effective for Technique label and definition
Example of strategy
Social and professional role and identity
Beliefs about capabilities
Motivation and goals
Social influences
BCT 3. Provide information about others’ approval
Involves information about what other people think about the reader’s or target person’s behaviour. It clarifies whether others will approve or disapprove of what the person is doing or will do.
Use posters or screensavers with pictures of senior members of staff advocating the behaviour
BCT 6. Provide general encouragement
Involves praising or rewarding the person for effort or performance without making this contingent on specific behavioural performance; or “motivating” the person in an unspecified manner. This will include attempts to enhance self-efficacy through argument or persuasion (e.g., telling someone they will be able to perform a behaviour).
Provide praise for completing set number of MURs
Action planning
BCT 9. Prompt specific goal setting
Involves detailed planning of what the person will do including, at least, a very specific definition of the behaviour e.g., frequency (such as how many times a day/week), intensity (e.g., sped) or duration (e.g., for how long for). In addition, at least one of the following contexts i.e., where, when, how or with whom must be specified. This could include identification of sub-goals or preparatory behaviours and/or specific contexts in which the behaviour will be performed.
Encourage setting goals to ensure MURs are performed

13. Conclusions
This research confirms that existing barriers to the successful implementation of MUR delivery are still present in current practice.
Overall pharmacists displayed positive behaviours associated to MUR delivery in WY.
Substantial evidence points towards targeting the motivation/goals domain of pharmacists in WY to improve MUR uptake.
Evident need for further research on the application of BCTs in healthcare organisations as it is a relatively new and multi-faceted concept.
If anyone wants tolookat the application of bct themselves heres alinkto site b

14. Thank You
References:
1. Pharmaceutical Services Negotiating Committee. (2015). MUR statistics. Retrieved from statistics/nhs-statistics/mur-statistics/ Pharmaceutical Services Negotiating Committee. (2015). Advanced Service payments: New Medicines Service. 3. Abraham, C. & Michie, S. (2008). Health Psychology. A Taxonomy of Behaviour Change Techniques Used in Interventions, 27 (3), doi: / Yorkshire Quality and Safety Research Group. (2013). ABC for Patient Safety Toolkit. Retrieved from safety-workshop-and-toolkit/.