Introduction
Methods
Results
First Phase—Interviews
Participant (surveys) | Gender | Age | Time since surgery (months) | Type of procedure | Self-reported weight at time of surgery (kg) | Self-reported weight loss at time of interview (kg) | Self-reported weight at time of interview (kg) |
---|---|---|---|---|---|---|---|
A | F | 46 | 8 | Roux-en-Y Gastric bypass | 140 | 44 | 96 |
B | F | 61 | 13 | Roux-en-Y Bypass (conversion from sleeve gastrectomy) | 123 | 12 | 111 |
C | F | 53 | 10 | One Anastomosis gastric bypass | 111 | 38 | 73 |
D | F | 63 | 10 | Roux-en-Y Gastric Bypass | 138 | 42 | 96 |
E | F | 60 | 10 | Roux-en-Y Gastric Bypass | 102 | 31 | 71 |
F | M | 61 | 6 | One Anastomosis Gastric Bypass | 154 | 21 | 133 |
G | F | 65 | 24 | Roux-en-Y Gastric Bypass | 126 | 57 | 69 |
H | F | 56 | 18 | Roux-en-Y Gastric Bypass | 120 | 70 | 70 |
I | F | 47 | 12 | One Anastomosis Gastric Bypass | 120 | 51 | 69 |
J | F | 45 | 8 | One Anastomosis Gastric Bypass | 118 | 32 | 86 |
K | F | 54 | 24 | Roux-en-Y Gastric Bypass | 133 | 57 | 57 |
L | F | 60 | 15 | Roux-en-Y Gastric Bypass | 111 | 47 | 64 |
Theme | In vivo quotes |
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Taking pills signifies illness | My Dad died from kidney and liver failure and some of this was down to the medication he was on. Because of this, I did not want to take tablets the rest of my life, and I had side effects from my blood pressure tablets. I have lost weight and I do not have symptoms anymore and I want to come off the pills, I do not want any side-effects long or short term. With the vitamins I am on seven tablets a day and I do not want to take so many (Participant L) I understand that I am taking vitamins for my health and to protect myself in the future. I see it as a priority but it is still taking pills (Participant J) |
Feeling empowered by the pharmacist | I wasn’t as scared as I thought I would be because she [Pharmacist] talked us [self and partner]through what would happen around the medications after surgery and I think she made me feel more confident in myself (Participant A) The pharmacist told me that I would have to crush to tablets and it might taste bitter, and to have a drink afterwards to take the taste away. When I was on the ward, I got my tablet from the staff, and they just handed it to me whole. I felt good about telling them that the pharmacist told me the tablet needed to be crushed and I would need a drink with it to take the taste away (Participant G) |
Preparing to comply with post-surgical recommendations | I had not thought through as to what medication was going to be needed afterwards, so it was good to have the update. If I had not had the appointment, then just been presented with tablets when I left the hospital, I would have been less prepared afterwards (Participant C) |
Informing and involving others in their care | With my husband with me at the appointment, he heard everything the pharmacist said and why I needed to take these tablets. So now, he will tell me to make sure I take my tablets on a morning, and reminding me again at night, because I used to be terrible about forgetting to take my pills (Participant A) I had an appointment with my GP and I explained I had met with the pharmacist and I actually took the sheet of paper with me for the GP to have a look at and I went through with her what had been explained to me and the GP asked how I felt about things. I said that I felt a lot better and the information helped my GP to understand what I needed (Participant B) The GP gave me the tablets to stop the gallstones, but he did not give me enough, or the right dosage. I had to go back and back, so when the letter came I went back with it and said to the GP ‘this is what I need to have, you are giving me the wrong dosage’ (Participant E) |
Valuing the expertise of the pharmacist | If I had not seen the pharmacist, I would have probably been more scared waking up the next day after the operation and someone coming up and saying I had to take these tablets. I thought it was quite interesting to speak with the pharmacist about this well before the operation (Participant A) Nobody, except the pharmacist, told me about not being able to take certain medications anymore. She explained why I could not take co-codamol after surgery. She said if I had a migraine, I would need to take paracetamol and that I had to cut codeine out completely. I was worried as I was reliant on it at the time, but I appreciated the time she took to explain everything to me (Participant K) My pharmacist appointment was critical. You need to understand what you are taking and why you are taking it, but also having the structure. It was really clear when I came out of the appointment what I needed to do and when. I think if I had not met with her, I probably would not be as informed as I am (Participant L) |
Wanting to help others | When I was in hospital having the operation, I met a man in the next bed who showed me an app for my phone, where I entered all my medication, the time, the quantity etc. and it tells me when to take it and everything else. It’s called Medisafe, and it has been so helpful. I’d recommend it to others, as it even tells you when you are running low, so you can order a new prescription (Participant E) After the pharmacist appointment, I bought a pill box, and it helped me to organise myself and my tablets. I would tell everyone to do this, as there is so much to think about after surgery and you need to be prepared (Participant H) |
Second Phase
Participant (surveys) | Gender | Age | Time since surgery (months) | Type of procedure | Self-reported weight at time of surgery (kg) | Self-reported pre-surgical health conditions | Self-reported changes to health conditions after surgery |
---|---|---|---|---|---|---|---|
1 | F | 46 | 6 | One Anastomosis Gastric Bypass | 103 | None reported | None reported |
2 | M | 53 | 6 | Roux-en-Y Gastric Bypass | 142 | Reflux | Much improved |
3 | M | 48 | 3 | One Anastomosis Gastric Bypass | 248 | T2D (diet and tablet controlled), pancreatitis, Obstructive Sleep Apnoea, Asthma | No longer diabetic |
4 | F | 42 | 2 | Roux-en-Y Gastric Bypass | 121 | Irritable Bowel Syndrome, chronic pain, reflux, depression, anxiety, arthritis | No but it is early days |
5 | F | 43 | 6 | Roux-en-Y Gastric Bypass | 122 | Pain | Reduced doses of tramadol |
6 | M | 33 | 5 | Roux-en-Y Gastric Bypass | 133 | Obstructive Sleep Apnoea | Obstructive Sleep apnoea improved and I feel 100% better |
7 | M | 63 | 5 | Roux-en-Y Gastric Bypass | 107 | Obstructive Sleep Apnoea, water retention, high blood pressure, | No Obstructive Sleep Apnoea, no high blood pressure, no water retention in legs, no aches or pains |
8 | F | 64 | 6 | Roux-en-Y Gastric Bypass | No response | No response | I am doing really well and feel so much better since the surgery |
9 | F | 46 | 2 | Roux-en-Y Gastric Bypass | No response | No response | I have lost 13 kg to date |
10 | F | 49 | 2 | Roux-en-Y Gastric Bypass | 99 | T2D, Para hyperthyroidism | Still early days – I am only two months out |
11 | F | 58 | N/R | Roux-en-Y Gastric Bypass | 129 | Hypothyroidism Fibromyalgia Depression | Post-surgery I suffered my worst fibromyalgia flare up. I was readmitted to hospital as I was presenting with a possible pulmonary embolism. Nothing was found after CT scans. Having spoken to my fibromyalgia group I discovered other had similar flare ups after surgery |
12 | F | 50 | 7 | One Anastomosis Gastric Bypass | 119 | Back and groin pain | Groin pain has eased and I have more confidence |
13 | F | 41 | 7 | One Anastomosis Gastric Bypass | 119 | Back, knee and foot pain | I feel better, less pain |
14 | F | 51 | 2 | Sleeve Gastrectomy | 91 | T2D, high blood pressure | Diabetes reversed almost immediately and I expect the blood pressure and statin tablets to be no longer required |
15 | F | 46 | 2 | One Anastomosis Gastric Bypass | 99 | Rheumatoid arthritis | I am in less pain as I am carrying less weight |
16 | F | 22 | 2 | Roux-en-Y Gastric Bypass | 141 | None, just an exceptionally high body mass index (BMI) | No response |
17 | F | 62 | 19 | Roux-en-Y Gastric Bypass | 110 | Angina, spine and neck spondylosis, irregular heartbeat, unstable blood pressure dropping very low then rising very high | Angina almost gone back, neck and knee problems bearable without medication |
18 | F | 31 | 1 | Roux-en-Y Gastric Bypass | 147 | T2D,Polycystic ovarian syndrome | No longer need metformin and I am hoping my polycystic ovarian syndrome will improve |
19 | F | 52 | N/R | Roux-en-Y Gastric Bypass | 119 | None reported | I had no illnesses but I am not likely to get any weight related ones now |
20 | F | 36 | 3 | One Anastomosis Gastric Bypass | 107 | None reported | None reported |
21 | F | 67 | 15 | Roux-en-Y Gastric Bypass | 121 | Back and hip pain, mobility, constant and chronic pain, bladder issues | Less pain in knees and I am more self-confident |
22 | M | 61 | 14 | One Anastomosis Gastric Bypass | 140 | T2D, arthritis, high blood pressure. | n/r |
23 | F | 61 | 15 | Laparoscopic banding to Roux-en-Y Gastric Bypass | 110 | Obstructive Sleep Apnoea Hypertension Gastric Reflux Osteoarthritis Chronic Pain Breast Cancer | No longer need high blood pressure medication, I have been told I can stop my CPAP machine. I hope to be able to reduce my pain medication and eventually |
24 | F | 72 | 7 | Roux-en-Y Gastric Bypass | 110 | T2D | Diabetes much improved |
25 | F | 27 | 6 | Sleeve Gastrectomy | 144 | None reported | None reported |
26 | F | 30 | 7 | Roux-en-Y Gastric Bypass | 136 | Plantar fasciitis, asthma, depression and anxiety | Plantar fasciitis has healed completely, asthma greatly improved and I have less anxiety and depression |
27 | M | 61 | 5 | Roux-en-Y Gastric Bypass | 155 | T2D | I am no longer Type 2 diabetic |
28 | F | 31 | 7 | One Anastomosis Gastric Bypass | 155 | High blood pressure, T2D, Fibromyalgia | I am no longer hypertensive and my diabetes is nearly gone |
Participant (surveys) | Were you aware you would see a pharmacist as part of pre-surgical assessment? | Length of appointment (minutes) | How did you attend? | Most valuable points made by pharmacist | If you were on medication, did the pharmacist clearly explain reasons for the changes to medication after surgery? | Did pharmacist clearly the importance of taking vitamins and supplements |
---|---|---|---|---|---|---|
1 | Cannot remember | 15 | Alone | What medications I would need to take for life after surgery | I was not on any medication so this question does not apply to me | Yes |
2 | Yes | 15 | With partner | What I should be eating and what I should avoid | Yes | Yes |
3 | Cannot Remember | Unsure | With partner | What medication will stop or start and why. Also gave me information on two types of procedures and the effects of these on medications, as I was not sure which operation I would have until the time | Yes | Yes |
4 | Cannot Remember | 20 | With partner | New ways of taking my medications after surgery | Yes | Yes |
5 | Yes | 10 | Alone | hHelp with weight loss after surgery | Yes | Yes |
6 | Yes | 30 | With partner | Awareness of what medication I would need after surgery | I was not on any medication so this question does not apply to me | Yes |
7 | Cannot Remember | 10 | Alone | No response | Yes | Yes |
8 | Yes | 30 | Alone | The importance of taking medication after surgery | Yes | Yes |
9 | Yes | 10 | Alone | Everything | Yes | Yes |
10 | Cannot Remember | 15 | Alone | Stopping metformin/postoperative medication | Yes | Yes |
11 | Yes | 15 | Alone | To stop taking Naproxen or use Ibuprofen gel so as to not aggravate my stomach. Finding out what other medications I would need. | Yes | Yes |
12 | Yes | 30 | Alone | No response | Yes | Yes |
13 | No | 30 | With someone else | Better understanding of my medication | Yes | Yes |
14 | No | 20 | With partner | Explanation of what the new medicines I had to take were for | Yes | Yes |
15 | Yes | 10 | alone | Explaining what would change after surgery | Yes | Yes |
16 | Yes | 10 | With someone else | That I have to take certain medications for life and some for just 6 months | I was not on any medication so this question does not apply to me | Yes |
17 | Yes | 15 | Alone | Need for vitamins the lady also had a bottle with salt in and explained how much salt was in soluble pain killers also told me not take certain pills at same time, i.e. calcium and iron | Yes | Yes |
18 | Yes | 20 | With partner | I was given a list of what I would be taken and for how long all my questions were answered and she noted all information so I left feeling confident | Yes | Yes |
19 | Yes | 30 | Alone | How important meds and aftercare are | Yes | Yes |
20 | Yes | 20–30 | Alone | the reasons why some medications cannot be taken and why it was important to take others | I was not on any medication so this question does not apply to me | Yes |
21 | Yes | 30 | With partner | Some medication would change from tablets to liquid form | Yes | Yes |
22 | Yes | 30 | With partner | Yes | Yes | |
23 | Yes | 30 | Alone | The pharmacist gave me the important information I needed to know about post-surgery so I was aware of what to expect and how important it was to maintain the regime. She was also kind enough to answer the questions I had and arranged my medications for discharge which was very helpful. | Yes | Yes |
24 | Yes | 10–15 | Alone | importance of not missing medication | Yes | Yes |
25 | No | 10 | Alone | None it was very un-informative | No | No |
26 | No | 10 | Alone | The importance of taking lansoprazole to protect my new stomach, that I would only take ursodeoxycholic acid along with lansoprazole for 6 months which was a relief to hear, and that the only medication I would take for life would be a multivitamin and mineral supplement. | Yes | Yes |
27 | Yes | 20 | With partner | Helped me understand what I needed to take and at what time of the day | Yes | Yes |
28 | Yes | 20 | With someone else | How I was going to take medication, i.e. soluble and why I was taking them | Yes | Yes |
Participant | Type of procedure | Self-reported pre-surgical medications | Self-reported post-surgical medications | Self-reported difference in medications/equipment post-operatively | Self-reported vitamin and mineral supplementation | Did participant feel that vitamins and minerals were medications? |
---|---|---|---|---|---|---|
1 | One Anastomosis Gastric Bypass | None | None | n/a | No response | No |
2 | Roux-en-Y Gastric Bypass | Lansoprazole | Lansoprazole | No medication changes Added: Vitamins | B12 | Yes |
3 | One Anastomosis Gastric Bypass | Metformin, Ventolin® Buscopan® | Buscopan® Lansoprazole, Ursodeoxycholic acid | No metformin Added: Lansoprazole Ursodeoxycholic acid | Iron, Vitamin D B12 | Yes |
4 | Roux-en-Y Gastric Bypass | Amlodipine Oramorph® Paracetamol Sertraline Tapentadol Lansoprazole Methotrexate Folic acid | Same as before surgery | No change | No response | No |
5 | Roux-en-Y Gastric Bypass | Tramadol | Tramadol | No change | No response | No |
6 | Roux-en-Y Gastric Bypass | None | Lansoprazole Ursodeoxycholic acid | Added: Lansoprazole, Ursodeoxycholic acid | Accrete® D3 Ferrous Fumarate Multivitamins | Yes |
7 | Roux-en-Y Gastric Bypass | Amlodipine Doxazosin Omeprazole Allopurinol | None | All medication stopped | No response | No |
8 | Roux-en-Y Gastric Bypass | None | Lansoprazole Ursodeoxycholic acid | Added: Lansoprazole Ursodeoxycholic acid | B12 injection Ferrous Fumarate Multivitamin Calcium Carbonate | Yes |
9 | Roux-en-Y Gastric Bypass | None | Lansoprazole | Added: Lansoprazole | Multivitamin, Ferrous Fumarate Adcal® D3 | Yes |
10 | Roux-en-Y Gastric Bypass | Metformin Vit D Statin | Metformin Vitamin D, | − 1 (statin) | Multivitamin | Yes |
11 | Roux-en-Y Gastric Bypass | Omeprazole Naproxen Amitriptyline Levothyroxine Sertraline, Atorvastatin Pregabalin Paracetamol, Tramadol Fultium® D3 | Omeprazole Amitriptyline Levothyroxine Sertraline Atorvastatin Pregabalin Paracetamol Tramadol Adcal® D3 | − 1 (Naproxen) | Vitamin B12 injection | Yes |
12 | One Anastomosis Gastric Bypass | Gabapentin Amitriptyline Nefopam Sertraline | Same as before | No change | No response | No response |
13 | One Anastomosis Gastric Bypass | None | Multivitamin | n/a | Multivitamin | Yes |
14 | Sleeve Gastrectomy | Lisinopril Vitamin D Amlodipine Atorvastatin Liraglutide Metformin | Colecalciferol Lisinopril, Amlodipine Atorvastatin | − 3 Added: Lansoprazole (6 months only) Ursofalk® (6 months) | Ferrous fumarate Multivitamins | Yes |
15 | One Anastomosis Gastric Bypass | Sulfasalazine, Hydroxychloroquine Tramadol Methotrexate Folic Acid, Amitriptyline, Rituximab infusion (6 monthly) | Methotrexate, Hydroxychloroquine, Amitriptyline Tramadol (but not as many) | − 3 and reduced Tramadol | Multivitamin with minerals | Yes |
16 | Roux-en-Y Gastric Bypass | None | ‘Just the ones that are necessary for post op patients’ | None Added: (Asssumed to be Lansaprazole and Ursodeoxycholic acid) | No response | No |
17 | Roux-en-Y Gastric Bypass | Atorvastatin Digoxin Codeine Phosphate Tramadol Paracetamol | Lansoprazole Bisoprolol (2.5 mg am and 1.5 mg pm) Atorvastatin | − 4 Added: Lansaprazole | Adcal® Ferrous Fumarate Calcium Vitamin B12 injection every 12 weeks | Yes |
18 | Roux-en-Y Gastric Bypass | Metformin | ‘Only ones prescribed from operation’ | No metformin Added: (Asssumed to be Lansaprazole and Ursodeoxycholic acid) | No response | No |
19 | Roux-en-Y Gastric Bypass | None | Acarbose | + 1 | Vitamins | Yes |
20 | One Anastomosis Gastric Bypass | None | Lansoprazole (6 months) | Added: Lansoprazole (6 months) | Multivitamin, Iron, Calcium, | Yes |
21 | Roux-en-Y Gastric Bypass | Amitriptyline Bendroflumethiazide Felodipine Paracetamol Loratadine Carbomer Estriol Uriplan® Carbamazepine Pregabalin Zomorph® Lansoprazole | Medications have stayed the same, but doses have been reduced with some (not stated) | No | ||
22 | One Anastomosis Gastric Bypass | Simvastatin, Doxazosin, Paracetamol Losartan Losec® | None | − 5 | Ferrous fumarate Accrete | Yes |
23 | Laparoscopic banding to Roux-en-Y Gastric Bypass | Omeprazole Tramadol Paracetamol Fluoxetine Metoprolol | Omeprazole Loperamide Paracetamol Tramadol | − 1 | Multivitamin Vitamin B12, Adcal® Iron supplement | Yes |
24 | Roux-en-Y Gastric Bypass | Diabetes medication × 3 (not stated) Amitriptyline Cetirizine Pantoprazole Statin | Amitriptyline, Cetirizine Spironolactone | − 4 | Ferrous fumarate Calcium Vitamin D | Yes |
25 | Sleeve Gastrectomy | Omeprazole | Omeprazole | 0 | Vitiman D Iron tablet Vitamin B12 injection | Yes |
26 | Roux-en-Y Gastric Bypass | Citalopram, Ventolin® inhaler | Citalopram Ursodeoxycholic acid Lansoprazole | − 1 Added: Ursodeoxycholic acid Lansoprazole | Multivitamin and mineral supplement, | Yes |
27 | Roux-en-Y Gastric Bypass | Metformin | No response | No response | No response | No response |
28 | One Anastomosis Gastric Bypass | Metformin Pregabalin Lisinopril | Pregabalin Metformin Lansoprazole | Same Added: Lansaprazole | Calcium, Iron, Multivitamin and B12 injection | Yes |
Participant | If you were on any medication, how did you feel about taking your medication when after surgery? | Overall, how did you use the information you learned from the pharmacist after surgery | Should there be a follow-up appointment with the pharmacist after surgery? | If you said yes, when would be the best time(s) up to 24 months after surgery? | How valuable was the pharmacist involvement in your pre-surgical assessment? |
---|---|---|---|---|---|
1 | Confident | No response | Yes | 6 months | Extremely valuable |
2 | Very confident | Amended my diet | Yes | 6/12/24 months | Valuable |
3 | Confident | Helped to understand what to expect and what to do | No | Not needed | Extremely valuable |
4 | Confident | Helped me to understand what effect the medications would have on me | Yes | 3 months | Valuable |
5 | Confident | No response | Yes | 6 months | Valuable |
6 | Very confident | Implemented advice into my routine, bought a pill organiser which has really helped me to keep on top of what medication I need to take | Yes | 6 months | Extremely valuable |
7 | Very confident | No response | No | Not needed | Fairly valuable |
8 | Very confident | Helped me to take my medication | Do not know | 12/24 months | Extremely valuable |
9 | Very confident | Overall the information was helpful | Do not know | 3/6 months | Extremely valuable |
10 | Unsure | I was more aware of what was needed after surgery | No | Not needed | Extremely valuable |
11 | Confident | I made sure my General Practitioner altered my medication | Do not know | Not needed | Extremely valuable |
12 | Very confident | No response | Yes | 6 months | Valuable |
13 | Very confident | Helped me to understand about the vitamins | N | 6/18/24 months | Valuable |
14 | Very confident | I was more aware of what I needed the medication and vitamins for | N | 12 months | Extremely valuable |
15 | Very confident | I was more prepared for what would happen after surgery | N | Not needed | Valuable |
16 | Very confident | I took it all in but found it all a little confusing | Y | Not needed | Fairly valuable |
17 | Fairly confident | I do as I am told, but I am still having severe constipation, if I miss the iron tablets it is easier | N | Not needed | Extremely valuable |
18 | Very confident | Helped me to organise my tablets so I have certain ones accessible at home for the morning, some at work and some in my bag so I am always covered | Y | 6/18/24 months | Extremely valuable |
19 | No response | Put advice into practice | N | Not needed | Fairly valuable |
20 | Very confident | To accurately take my medication | N | 6 months | Extremely valuable |
21 | Very confident | I have the list of medications to hand when I take my tablets | y | 3/6/12/18 months | Extremely valuable |
22 | Very confident | No response | Y | 3/12 months | Extremely valuable |
23 | Confident | I followed the advice on the sheet and made sure I took the medications as prescribed | Y | 3/6/9/12/18 months | Extremely valuable |
24 | Fairly confident | I knew what to take but was unsure of the length to take some medications | Y | 3/12/24 months | Valuable |
25 | Fairly confident | Did not really get any information to use | Y | 6/9/12/18/24 months | Not Valuable |
26 | Very confident | I used it to prepare myself for the changes to come and bought an am/pm pill sorter to ensure I stuck to my prescription post-op | Y | 6/12/24 months | Extremely valuable |
27 | Very confident | I knew what vitamins to buy and when to take my medication | Y | 6/12 months | Extremely valuable |
28 | Fairly confident | I booked an appointment with my General Practitioner to discuss everything after the pharmacist appointment | Y | 6 months | Fairly valuable |
‘I recommend that all patients are told to buy a pill organiser before surgery’‘Having a pharmacist available for patients who are discharged on a weekend’‘A more detailed leaflet which describes all the vitamins and what to take and when’‘It was all explained very well to me, but listening to the other patients on the ward after surgery I feel that some people just don’t listen carefully to the pharmacist, who explained everything to me without being patronising’‘It would be great to have an on-line Question and Answer session so that if your General Practitioner leaves you hanging, as mine did, you can get answers to your questions without needing a hospital appointment’‘More information on being aware of how hard it is to take tablets after surgery’‘I firmly believe that the pharmacists’ involvement in bariatric surgery is crucial. Patients such as myself need a lot of support pre- and post-operatively, and the information regarding medication and how/when to take them and why they are being taken is important to keeping us patients healthy and consistent in our progress’