Is the Internet replacing health professionals? A population survey on sources of medicines information among people with mental disorders

Internet Use for Obtaining Medicine Information: Cross-sectional Survey

BACKGROUND

The internet is increasingly being used as a source of medicine-related information. People want information to facilitate decision-making and self-management, and they tend to prefer the internet for ease of access. However, it is widely acknowledged that the quality of web-based information varies. Poor interpretation of medicine information can lead to anxiety and poor adherence to drug therapy. It is therefore important to understand how people search, select, and trust medicine information.

OBJECTIVE

The objectives of this study were to establish the extent of internet use for seeking medicine information among Norwegian pharmacy customers, analyze factors associated with internet use, and investigate the level of trust in different sources and websites.

METHODS

This is a cross-sectional study with a convenience sample of pharmacy customers recruited from all but one community pharmacy in Tromsø, a medium size municipality in Norway (77,000 inhabitants). Persons (aged ≥16 years) able to complete a questionnaire in Norwegian were asked to participate in the study. The recruitment took place in September and October 2020. Due to COVID-19 restrictions, social media was also used to recruit medicine users.

RESULTS

A total of 303 respondents reported which sources they used to obtain information about their medicines (both prescription and over the counter) and to what extent they trusted these sources. A total of 125 (41.3%) respondents used the internet for medicine information, and the only factor associated with internet use was age. The odds of using the internet declined by 5% per year of age (odds ratio 0.95, 95% CI 0.94-0.97; P=.048). We found no association between internet use and gender, level of education, or regular medicine use. The main purpose reported for using the internet was to obtain information about side effects. Other main sources of medicine information were physicians (n=191, 63%), pharmacy personnel (n=142, 47%), and medication package leaflets (n=124, 42%), while 36 (12%) respondents did not obtain medicine information from any sources. Note that 272 (91%) respondents trusted health professionals as a source of medicine information, whereas 58 (46%) respondents who used the internet trusted the information they found on the internet. The most reliable websites were the national health portals and other official health information sites.

CONCLUSIONS

Norwegian pharmacy customers use the internet as a source of medicine information, but most still obtain medicine information from health professionals and packet leaflets. People are aware of the potential for misinformation on websites, and they mainly trust high-quality sites run by health authorities.

Exploring mental health clients' current medication knowledge, beliefs and experience with healthcare providers in the community in South Australia

In Australia, mental illness has been recognised as a National Health Priority area, with the coronavirus pandemic adding a layer of urgency to the need to address the multiple health problems faced by clients with mental illnesses. Whilst much has been done in efforts to support these clients, little is known about their medication knowledge and experience with health professionals. The aim of the study was to explore the knowledge and beliefs of clients on the use of psychotropic medications and study their experiences with healthcare providers. Adult participants at a not-for-profit community-managed specialist mental health service provider in Adelaide, South Australia were recruited. Four focus group sessions were conducted between February 2020 and March 2021. All sessions were co-facilitated by a peer practitioner with lived experience. Sessions were audio recorded and transcribed verbatim. Participants (n = 27) reported that provision of medication education was inadequate and, in some cases, non-existent. There was an apparent lack of support for monitoring and managing common side effects, such as weight gain. Participants described not being involved in any decision-making processes and that establishing and maintaining a therapeutic relationship with their healthcare providers was challenging. Perceived stigma remains a barrier in accessing healthcare. Despite participants regularly interacting with a range of healthcare providers, findings highlight key gaps in care, particularly medication education and establishing a therapeutic relationship with their healthcare providers. Future mental health reforms should consider the provision of additional medication education in community settings, such as at not-for-profit organisations. Moreover, healthcare providers should take a proactive approach in establishing therapeutic relationships.

Pharmacists and Mental Health First Aid training: A comparative analysis of confidence, mental health assistance behaviours and perceived barriers

BACKGROUND

Pharmacists are aptly positioned to provide first aid-level assistance to patients experiencing a mental health problem or crisis, yet often lack confidence or perceive barriers to intervention. One potential solution is Mental Health First Aid (MHFA) training-an evidence-based psycho-educational programme. This study evaluates MHFA training within pharmacy by (1) assessing pharmacists' perceptions of the prevalence of patients experiencing a mental health-related problem or crisis, (2) investigating whether MHFA is associated with increased confidence, intervention and assistance quality and (3) examining perceived intervention barriers.

METHODS

Pharmacists working in Australia were surveyed. The survey included validated measures and research objectives were assessed using descriptives and ANOVAs.

RESULTS

One hundred sixty-one pharmacists were included; 90 MHFA trained and 71 untrained. Overall, 86% of reported encountering at least one patient perceived to be experiencing a mental health problem or crisis in the last year. MHFA trained pharmacists reported being more confident, with notable differences in their confidence to recognize signs, approach and ask someone about suicide. Pharmacists did not intervene ~25% of the time in which a problem/ crisis was identified. When they did intervene, results suggest the assistance was similar in content. Intervention barriers were reported to impede MHFA trained pharmacists significantly less than untrained pharmacists.

CONCLUSION

Results suggest pharmacists frequently encounter patients experiencing a mental health problem or crisis and that MHFA training may support pharmacists in helping these patients. Future research can utilize experimental methods to provide causal evidence as to the utility of MHFA training for pharmacists and patients.

Pharmacists' perceptions of the use of internet-based medication information by patients: A cross-sectional survey

PURPOSE

The credibility and the reliability of Internet webpages to seek medication-related information is questionable. The main objective of the current study was to evaluate perception and experience of pharmacists with the use of Internet-based medication information by their patients.

METHODS

This is a cross-sectional descriptive study that was conducted to evaluate perception and experience of pharmacists with the use of Internet-based medication information by their patients. During the study period, 200 pharmacists were approached to participate in the study using a paper-based survey to assess their perceptions and current experience with the use of Internet-based medication information by their patients. Data were analyzed using descriptive statistics (mean/standard deviation for continuous variables, and frequency/percentages for qualitative variables). Also, simple linear regression was utilized to screen factors affecting pharmacists' perception scores of the use of Internet-based medication information.

RESULTS

Among 161 recruited pharmacists, the majority (n = 129, 80.1%) reported receiving inquiries from patients about Internet-based medication information within the last year. Among them, only 22.6% (n = 29) of pharmacists believed that Internet-based medication information is somewhat or very accurate. Unfortunately, only 24.2% (n = 31) of them stated that they always had enough time for their patient to discuss their Internet-based medication information. Regarding pharmacists' perception of the use of Internet-based medication information by their patients, more than half of the pharmacists (>50%) believe that Internet-based medication information could increase the patient's role in taking responsibility. On the other hand, 54.7% (n = 88) of the pharmacists believed that Internet-based medication information would contribute to rising the healthcare cost by obtaining unnecessary medications by patients. Finally, pharmacists' educational level was found to significantly affect their perception scores toward patient use of Internet-based medication information where those with higher educational level showed lower perception score (r = -0.200, P-value = 0.011).

CONCLUSION

Although pharmacists felt that usage of Internet-based data by patients is beneficial, they also have believed that it has a negative impact in terms of rising the healthcare cost, and it promotes unnecessary fear or concern about medications. We suggest that pharmacists be trained on principles of critical appraisal to become professional in retrieval information on the Internet that might improve their delivery of healthcare information and their recommendations to patients.

[Acceptance and Use of the e-Mental Health Website - www.psychenet.de]

OBJECTIVES

Aim of our study was to investigate acceptance and use of the German e-mental health website - www.psychenet.de offering evidence-based health information, self-tests and patient decision aids concerning mental disorders and issues.

METHODS

The website was evaluated by means of an online survey (acceptance) and automatically generated data by web analysis software (use).

RESULTS

Overall, the website psychenet.de achieved high acceptance ratings among its users. In addition, the number of visitors to the website has increased steadily.

CONCLUSION

Results indicate that psychenet.de offers mental health information that are more likely to be used by certain groups (e. g., highly educated persons). Future research should focus on different presentation modes of health information (e. g. text- vs. video-based) for hard to reach target groups in order to potentially increase reach of health information to a broader audience.

Withdrawal and Misuse Concerns of Consumers regarding Opioid Analgesic and Anxiolytic, Hypnotic and Sedative Medicines

Opioid analgesic (OA) and anxiolytic, hypnotic and sedative (AHS) medicines use raise community concerns about risks of dependence: dose escalation, unintentional misuse. Objectives: We aimed to identify common consumer OA and AHS information gaps and concerns that led to information seeking from a hotline. Methods: We conducted a retrospective, mixed-method observational study of consumers' OA and AHS-related calls to an Australian national medicines call center (September 2002-30 June 2010). We analyzed these medicines' call characteristics compared to their respective rest of calls (ROC) and thematically explored narratives concerning withdrawal and misuse. Results: Of 123,217 calls, 7,395 (6.0%) involved OA and 7,789 (6.2%) AHS, with consistency between call characteristics. While female middle-aged callers predominated, more males called for these medicines than their complementary ROC. Uncertainty about unresolved OA and AHS concerns led to help-seeking that was consistent over eight years. Main motivations were inadequate information (OA 44.5%; AHS 41.2%), seeking a second opinion (OA 24.2%; AHS 24.2%), worrying symptoms (OA 21.6%; AHS 23.1%), and conflicting information (OA 4.9%; AHS 5.1%). Callers focused on withdrawal and issues related to inadvertent overuse or deliberate misuse (OA 9.2% vs. non-OA ROC 2.9%; AHS 12.6% vs. non-AHS ROC 2.7%). Primary themes were similar for both cohorts: concern about harm or aiming to minimize harm by information seeking, requesting a strategy, or reassurance. Conclusions: Consumers have under-recognized perceptions of harm from OA and AHS use, particularly withdrawal and misuse. Resources based on real world consumer concerns can encourage open dialogue between patients and their prescribers.

Trends in the receipt of medicines information among Finnish adults in 1999-2014: a nationwide repeated cross-sectional survey

OBJECTIVE

The aim of this study was to examine long-term trends in the receipt of medicines information (MI) among adult medicine users from 1999 to 2014.

DESIGN

Repeated cross-sectional postal survey from the years 1999, 2002, 2005 and 2008-2014.

SETTING

Each study year, a new nationally representative sample of 5000 Finns aged 15-64 years was drawn from the Population Register Centre of Finland.

PARTICIPANTS

The range of annual respondents varied from 2545 to 3371 and response rates from 53% to 67%. Of the total responses (n=29 465), 64% were from medicine users (n=18 862, ranging by year from 58% to 68%).

OUTCOME MEASURES

Receipt of information on medicines in use within 12 months prior to the survey from a given list of consumer MI sources available in Finland.

RESULTS

Physicians, community pharmacists and package leaflets were the most common MI sources throughout the study period. Receipt of MI increased most from the Internet (from 1% in 1999 to 16% in 2014), while decreased most from physicians (62% to 47%) and package leaflets (44% to 34%), and remained stable from community pharmacists (46% to 45%) and nurses (14% to 14%). In 1999, of the medicine users 4% did not report receipt of MI from any of the sources listed in the survey, while this proportion had remarkably increased to 28% in 2014.

CONCLUSIONS

Healthcare professionals and package leaflets had still a dominating importance in 2014 despite the growing number of MI sources over time, but still a minority of adult medicine users reported receiving MI via the Internet in 2014. Worrying is that the proportion of adult medicine users who did not receive MI from any of the sources became seven fold during the study period.

A national approach to medicines information research: A systematic review

BACKGROUND

The Finnish Medicines Agency Fimea published the first National Medicines Information (MI) strategy in 2012. For the purpose of implementing the MI strategy into practice by the national MI Network, a comprehensive inventory of MI research in Finland was needed.

OBJECTIVE

To systematically review literature on MI research conducted in Finland by analyzing and classifying the studies, and identifying the gaps in MI research.

METHODS

Medline, Scopus and Medic databases were searched for peer-reviewed MI publications by using key word screening criteria. The search and extraction process followed PRISMA Guidelines and covered the period from January 2000 to June 2016. Included studies were content analyzed according to MI practices identified, trends over time in research methodology and theory.

RESULTS

Included publications (n = 126) applied a variety of research methods, most often cross-sectional surveys (n = 51, 40% of all studies), but more than half of the studies were qualitative (n = 68, 54%). Twelve were intervention studies of which 6 were randomized and had a control group. Studies were categorized into: patient counseling in different settings (n = 45); MI sources and needs of medicine users (n = 25); healthcare professionals' (HCPs) competence in patient counseling and pharmacotherapy (n = 25); MI sources and needs of HCPs (n = 23); MI education and literacy (n = 13); and MI policies and strategies (n = 3). Most of the studies were descriptive, and only 6 studies applied a theory.

CONCLUSIONS

Regardless of some methodological pitfalls, MI research conducted in Finland since 2000 provides multifaceted understanding of MI practices and their development needs. Research should shift towards larger research lines having a stronger theory base and study designs to deepen the understanding of MI practices and behaviors, and effectiveness of MI in different healthcare settings. Future research should cover also the use of electronic MI sources and services which apply modern information technology to clinical decision making and medication reviews, national MI policy, MI literacy, MI needs of HCPs and consumers.

Mutual Involvement in Families With Type 2 Diabetes Through Web-Based Health Care Solutions: Quantitative Survey Study of Family Preferences, Challenges, and Potentials

Background

Type 2 diabetes (T2D) is a prevalent chronic disease that affects not just patients but entire families. Both the patient and the rest of the family may benefit from gaining knowledge about the disease and from supportive interfamilial interaction. The Internet is becoming a widely-used resource for health information, so a Web-based solution could potentially promote awareness and knowledge on how to manage T2D as a family, while also providing support for the family.

Objective

We aim to assess the usage of online diabetes information by patients with T2D and their relatives, and explore the families’ needs and preferences regarding online information on diabetes.

Methods

A quantitative self-reported questionnaire survey was performed with Danish families that had at least one family member diagnosed with T2D. The survey consisted of 36 closed questions on demographics, usage of the Internet, preferences in the source of information, interest in online information on six problem domains within family life related to T2D, preferences towards the delivery format of online information, and peer-to-peer communication. Two open-ended questions were also included to elicit any additional comments or suggestions about improving online information on T2D regarding family life.

Results

Fifty participants from 22 families with T2D answered the questionnaire individually. Relatives (25/28, 89%) and patients (22/22, 100%) indicated that information on T2D is relevant for them, while indicating that the Internet is the first or second preferred source when in need of information on T2D (25/28, 89% vs 21/22, 95%). Only a minority of the participants indicated that they had searched the Internet to gain knowledge on T2D regarding family life (9/28, 32% vs 10/22, 46%). Also, patients were more likely to have used the Internet to gain information on T2D (P=.027). Both groups indicated a preference for watching videos or reading about T2D in relation to family life while a minority of the participants indicated an interest in peer-to-peer communication. Regarding the six problem domains, the domains Support, Knowledge, and Everyday Life were slightly more popular. These three domains were considered interesting by at least 79% (22/28) and 73% (16/22) of the relatives and patients respectively, while the domains Communication, Worries, and Roles were considered interesting by at least 46% (20/28) and 50% (11/22).

Conclusions

Despite an interest in online information on T2D, there appears to be an unsatisfied need for more supportive online information on T2D aimed at Danish families with T2D. Based on family preferences, online information should focus on the six problem domains and be presented through text and videos by health care practitioners and peers. Peer-to-peer communication elements may be beneficial, but are only expected to be used by a very limited number of families.

Community pharmacists' perspectives of online health-related information: A qualitative insight from Kuala Lumpur, Malaysia

BACKGROUND

The Internet is a resource used by health professionals as well as the public to access health information. Within this context, little is reported on community pharmacists' (CPs') perceptions of online health-related information. The objective of this study was to explore the attitudes of Malaysian CPs towards online health-related information.

METHODS

A qualitative research method was adopted with face-to-face interviews, using a semi-structured interview guide. Purposive and snowball sampling techniques were used to recruit a convenient sample of CPs who were practising in the Federal Territory of Kuala Lumpur, Malaysia. All interviews were audio recorded and transcribed verbatim. The data were analysed by the research team using a thematic content analysis framework.

RESULTS

Eleven CPs participated in the study. Participants reported that online health-related information was accessible, useful, fast, and in some respects, the Internet is a unique source of information. It was reported that there was a need to establish websites for trusted information. CPs also reported that training was needed in Internet searching and website evaluation skills. Most information accessed by CPs related to drugs and diseases and to knowledge-based information. Barriers to efficacy of Internet usage were related to the reliability and volume of information available on the Internet.

CONCLUSION

Frequent use of online health-related information among CPs was reported. Many CPs supported the use of the Internet for health-related information but certain reservations were also reported. An analysis of the reasons for information seeking and barriers suggests that a wider range of influences on health information seeking should be investigated.

Public attitudes towards psychiatry and psychiatric treatment at the beginning of the 21st century: a systematic review and meta-analysis of population surveys

Public attitudes towards psychiatry are crucial determinants of help-seeking for mental illness. It has been argued that psychiatry as a discipline enjoys low esteem among the public, and a "crisis" of psychiatry has been noted. We conducted a systematic review and meta-analysis of population studies examining public attitudes towards various aspects of psychiatric care. Our search in PubMed, Web of Science, PsychINFO and bibliographies yielded 162 papers based on population surveys conducted since 2000 and published no later than 2015. We found that professional help for mental disorders generally enjoys high esteem. While general practitioners are the preferred source of help for depression, mental health professionals are the most trusted helpers for schizophrenia. If respondents have to rank sources of help, they tend to favor mental health professionals, while open questions yield results more favorable to general practitioners. Psychiatrists and psychologists/psychotherapists are equally recommended for the treatment of schizophrenia, while for depression psychologists/psychotherapists are more recommended, at least in Europe and America. Psychotherapy is consistently preferred over medication. Attitudes towards seeking help from psychiatrists or psychologists/psychotherapists as well as towards medication and psychotherapy have markedly improved over the last twenty-five years. Biological concepts of mental illness are associated with stronger approval of psychiatric help, particularly medication. Self-stigma and negative attitudes towards persons with mental illness decrease the likelihood of personally considering psychiatric help. In conclusion, the public readily recommends psychiatric help for the treatment of mental disorders. Psychotherapy is the most popular method of psychiatric treatment. A useful strategy to further improve the public image of psychiatry could be to stress that listening and understanding are at the core of psychiatric care.

Mental health first aid training needs of Australian community pharmacists

BACKGROUND

Pharmacists are highly accessible health care professionals and have regular interactions with consumers that suffer acute mental illness. Though pharmacists are trained in psychopharmacology, they lack formal mental health intervention skills. A solution to address this gap is to up-skill pharmacists in mental health first aid (MHFA).

OBJECTIVES

The purpose of this study was to establish the mental health first aid training needs for Australian rural pharmacists in the community setting. In addition, barriers to pharmacists providing MHFA support were ascertained.

METHODS

This study was conducted in two parts. First, semi-structured interviews were conducted with eight rural community pharmacists to ascertain enablers and barriers to MHFA training. Second, an online survey was conducted to assess the attitudes of pharmacists to MHFA and their training requirements. Data from the interviews were thematically analyzed.

RESULTS

Six major themes were identified including evolving role of the pharmacist, importance of relationships, complexity of mental health, need for training in MHFA, low confidence and barriers to assisting in acute mental illness. Pharmacists were accepting of the need for MHFA, but expressed concern over their lack of training, time and resources. The survey results also supported these findings.

CONCLUSIONS

Pharmacists supported MHFA training, but expressed difficulties in balancing professional and business responsibilities. Given that pharmacists are accessible and regularly exposed to mental health, MHFA training should be a core component of pharmacists' training and their primary health care role. Further research is needed to evaluate the benefits of such training in terms of the consumers' mental health outcomes.

Experiences of and attitudes towards receiving information about non-steroidal anti-inflammatory drugs: a cross-sectional survey of patients in Thailand

OBJECTIVE

To determine sources of information about NSAIDs used by out-patients, factors related to receipt of information and patient attitudes towards receiving safety information.

RESEARCH DESIGN AND METHODS

Cross-sectional survey, using self-completed questionnaires distributed directly to 500 outpatients prescribed any NSAIDs from an orthopaedic clinic in Thailand, over a 4-month period.

RESULTS

There were 548 patients approached and 474 completed questionnaires returned (94.8%). The most frequent aspects of medicines information that were provided related to administration (97.2%), mostly provided by pharmacists, and indication (85.8%), mostly provided by physicians. Information on identifying, monitoring and managing adverse effects was received by fewer than 50% of patients. Safety information was received significantly more frequently by younger patients (P<0.01), those using non-selective COX-2 inhibitors (P<0.001), intermittent NSAIDs (P<0.05) and fewer concomitant medicines (P<0.05). Only 14.1% patients used additional information sources. Attitudes towards receiving medicines safety information were positive. Most patients agreed they should know about ADRs (98.1%) and receive information leaflets with first prescription (96.8%).

CONCLUSIONS

Patients received medicines information mostly from healthcare professionals, but safety information was limited. Type of NSAIDs, regularity of NSAID use and age affected receipt of safety information about NSAIDs. Provision of more medicine information is needed, particularly written documents.

Consumers' questions about antipsychotic medication: revealing safety concerns and the silent voices of young men

PURPOSE

Little is known about consumer information needs regarding antipsychotic medicines. Medicines call centre (MCC)-derived data are underutilised; and could provide insight into issues of importance to consumers. This study aimed to explore consumers' information needs about antipsychotic medication sought from a national MCC in Australia.

METHODS

Questions received by the National Prescribing Service Medicines Line relating to antipsychotic medication from September 2002 to June 2010 were examined by antipsychotic subclass and in relation to other medication queries.

RESULTS

We identified 6,295 calls related to antipsychotic medication. While female callers predominated, the percentage of males with antipsychotic questions was statistically significantly higher than for other medication calls (33.9 vs 22.6 %; p < 0.001). There were distinct gender differences in medicines information seeking across age ranges. Younger men asked about second-generation antipsychotics, shifting toward first-generation antipsychotics after 45 years of age. Female interest in both subclasses was comparable, irrespective of age. Most callers asking about antipsychotics sought information for themselves (69.4 %). Callers were primarily concerned about safety (57.0 %), especially adverse drug reactions (28.8 %), and were more often prompted by a worrying symptom (23.8 %) compared with the rest of calls (17.2 %). Trends of antipsychotic questions received corresponded with antipsychotic prescription data.

CONCLUSIONS

The number of calls received by this MCC over time reveals an ongoing consumer need for additional, targeted information about antipsychotics. Noticeable was the relatively high frequency of young male callers asking about antipsychotics, indicating that call centres could be a way to reach these traditionally poor users of health services.

Psychenet.de: Development and process evaluation of an e-mental health portal

BACKGROUND

E-mental health interventions can have a positive impact on patient-reported and clinical outcomes. The purpose of this project was to develop a user-centered e-mental health portal.

METHODS

The development of the portal www.psychenet.de included mixed-methods techniques for needs assessment to identify user-relevant content. Furthermore, user-centered design techniques were applied by utilizing individual usability testing with cognitive task analysis. First, a basic version of the portal was created and introduced to the public by means of a media campaign. After the development of module-specific content, exposure and use of the portal was investigated as part of a process evaluation.

RESULTS

Relevant content identified by needs assessment covered both, overarching and diagnosis-specific topics. Results of the process evaluation showed a highly accessed website. During the first 18 months, 119,423 visits were tracked. The portal was predominantly accessed by Google searches (73.9%), while 17.6% of visits were related to direct traffic.

DISCUSSION

Serving as a complement to face-to-face consultations, www.psychenet.de attempts to inform about mental disorders, and engage patients in the course of their treatment. Results of the process evaluation confirm the high relevance and potential of the portal and can be used for further improvements and extensions in the future.

Self-reported contacts for mental health problems by rural residents: predicted service needs, facilitators and barriers

BACKGROUND

Rural and remote Australians face a range of barriers to mental health care, potentially limiting the extent to which current services and support networks may provide assistance. This paper examines self-reported mental health problems and contacts during the last 12 months, and explores cross-sectional associations between potential facilitators/barriers and professional and non-professional help-seeking, while taking into account expected associations with socio-demographic and health-related factors.

METHODS

During the 3-year follow-up of the Australian Rural Mental Health Study (ARMHS) a self-report survey was completed by adult rural residents (N = 1,231; 61% female; 77% married; 22% remote location; mean age = 59 years), which examined socio-demographic characteristics, current health status factors, predicted service needs, self-reported professional and non-professional contacts for mental health problems in the last 12 months, other aspects of help-seeking, and perceived barriers.

RESULTS

Professional contacts for mental health problems were reported by 18% of the sample (including 14% reporting General Practitioner contacts), while non-professional contacts were reported by 16% (including 14% reporting discussions with family/friends). Perceived barriers to health care fell under the domains of structural (e.g., costs, distance), attitudinal (e.g., stigma concerns, confidentiality), and time commitments. Participants with 12-month mental health problems who reported their needs as met had the highest levels of service use. Hierarchical logistic regressions revealed a dose-response relationship between the level of predicted need and the likelihood of reporting professional and non-professional contacts, together with associations with socio-demographic characteristics (e.g., gender, relationships, and financial circumstances), suicidal ideation, and attitudinal factors, but not geographical remoteness.

CONCLUSIONS

Rates of self-reported mental health problems were consistent with baseline findings, including higher rural contact rates with General Practitioners. Structural barriers displayed mixed associations with help-seeking, while attitudinal barriers were consistently associated with lower service contacts. Developing appropriate interventions that address perceptions of mental illness and attitudes towards help-seeking is likely to be vital in optimising treatment access and mental health outcomes in rural areas.

Sources of information used to support quality use of medicines: findings from a national survey of nurse practitioners in Australia

PURPOSE

The purpose of this study was to investigate the sources, both print and electronic formats, which Australian nurse practitioners (NPs) currently use to obtain information regarding quality use of medicines (QUM). An additional aim was to document NPs' preferences for continuing education in relation to QUM.

DATA SOURCES

A national electronic survey of Australian NPs was conducted in 2007 and again in 2010.

CONCLUSIONS

Eighty percent of respondents accessed information on QUM from professional literature, which may include scholarly journal articles, reports, and independent publications. There was a decrease in the percentage of respondents who obtained information from drug industry representatives. NPs prefer to receive medicines information in an electronic form, rather than a paper-based version, and over the time period more NPs are utilizing electronic sources rather than paper.

IMPLICATIONS FOR PRACTICE

These findings provide important insights into medical information products for the developers who may be able to use these results to ensure that their products meet the needs of NP clinicians. Additionally, the finding that NPs prefer to receive their continuing information related to medicines in electronic format, but also highly value conference proceedings, may help to inform future planning of NP education needs in relation to QUM.

Feasibility of internet-delivered mental health treatments for rural populations

PURPOSE

Rural populations face numerous barriers to mental health care. Although internet-delivered mental health treatments may offer an accessible and cost-effective answer to these barriers, there has been little evaluation of the feasibility of this approach among rural communities.

METHODS

Data were obtained from a random rural community sample through the third wave of the Australian Rural Mental Health Study. Attitudes towards internet-delivered mental health treatments and availability of internet access were explored. Data were analysed to identify sub-groups in whom internet-delivered treatments may be usefully targeted.

RESULTS

Twelve hundred and forty-six participants completed the survey (mean age 59 years, 61% females, 22% from remote areas). Overall, 75% had internet access and 20% would consider using internet-based interventions, with 18% meeting both of these feasibility criteria. Logistic regression revealed feasibility for internet-delivered mental health treatment was associated with younger age, male gender, being a carer, and a 12-month mental health problem. Participants who had used internet-delivered services in the past were significantly more likely to endorse these treatments as acceptable.

CONCLUSIONS

There is considerable potential for internet-delivered treatments to increase service accessibility to some sub-groups, particularly among people with mental health problems who are not currently seeking help. Resistance to internet treatments appears to be largely attitudinal, suggesting that enhancing community education and familiarity with such programs may be effective in improving perceptions and ultimately access.

Person-centred web-based support--development through a Swedish multi-case study

Background

Departing from the widespread use of the internet in modern society and the emerging use of web applications in healthcare this project captures persons’ needs and expectations in order to develop highly usable web recourses. The purpose of this paper is to outline a multi-case research project focused on the development and evaluation of person-centred web-based support for people with long-term illness. To support the underlying idea to move beyond the illness, we approach the development of web support from the perspective of the emergent area of person-centred care. The project aims to contribute to the ongoing development of web-based supports in health care and to the emerging field of person-centred care.

Methods/Design

The research design uses a meta-analytical approach through its focus on synthesizing experiences from four Swedish regional and national cases of design and use of web-based support in long-term illness. The cases include children (bladder dysfunction and urogenital malformation), young adults (living close to persons with mental illness), and two different cases of adults (women with breast cancer and childbearing women with type 1 diabetes). All of the cases are ongoing, though in different stages of design, implementation, and analysis. This, we argue, will lead to a synthesis of results on a meta-level not yet described.

Discussion

To allow valid comparisons between the four cases we explore and problematize them in relation to four main aspects: 1) The use of people’s experiences and needs; 2) The role of use of theories in the design of person-centred web-based supports; 3) The evaluation of the effects of health outcomes for the informants involved and 4) The development of a generic person-centred model for learning and social support for people with long-term illness and their significant others. Person-centred web-based support is a new area and few studies focus on how web-based interventions can contribute to the development of person-centred care. In summary, the main intention of the project outlined here is to contribute with both a synthesis of results on meta-level from four cases and a substantial contribution to the field person-centred care.

Cyber-support: an analysis of online self-help forums (online self-help forums in bipolar disorder)

BACKGROUND

The Internet is becoming increasingly important in psychiatry and psychotherapy.

AIMS

The objective of this study was to evaluate if and how online self-help forums are used by patients with bipolar disorders, their relatives and treating professionals.

METHODS

A total of 2400 postings in two online forums were analysed qualitatively and quantitatively.

RESULTS

"Disclosure", "friendship" and "online-group cohesion" were the main self-help mechanisms. The topics most discussed were "social network", "symptoms of the illness" and "medication". Factor analyses revealed three factors concerning self-help mechanisms: "group cohesion", "emotional support" and "exchange of information", as well as three factors concerning fields of interest: "illness-related aspects", "social aspects" and "financial and legal issues".

CONCLUSION

We infer that the main interest in participating in online forums for patients with bipolar disorders and their relatives is to share emotions and to discuss their daily struggles with the illness. Our study also reveals that social networking is very important for patients coping with bipolar disorders. Psycho-educative programmes should focus on those aspects.

Unmet depression information needs in the community

BACKGROUND

Despite the well acknowledged importance of consumer health information, little is known about the public's depression information needs. This study aimed to develop a formal measure of unmet need for depression information in the community, to investigate the level of this unmet need and to identify its predictors.

METHODS

Data were collected as part of a survey of 12,319 Australian adults aged 18-65 years. This survey incorporated 21 questions targeting depression information need, together with measures of demographic status, self-reported current depression and personal stigma. The information needs data were subjected to principal components analysis followed by linear regression analyses to determine the demographic and other predictors of each of the resulting components.

RESULTS

Between 50 and 75% of participants endorsed the need for more information on each of the 21 information need topics. The PCA yielded a 20-item Depression Information Needs Scale (DINS) of high reliability and factor validity comprising four subscales: General (facts about depression), Specific Treatments, Research and Policies, and Lived Experience. Controlling for other factors, those with self-reported current depression and those without tertiary education had greater information needs across all four factors.

LIMITATIONS

The survey response rate was low and further research is required to establish the adequacy of the psychometric properties of the DINS.

CONCLUSIONS

Given the high unmet need for depression information there is a need to develop and implement evidence-based strategies for ensuring the accessibility and uptake of depression information relevant to the needs of members of the community.

Identification of the factors associated with outcomes in a Condition Management Programme

BACKGROUND

A requirement of the Government's Pathways to Work (PtW) agenda was to introduce a Condition Management Programme (CMP). The aim of the present study was to identify the differences between those who engaged and made progress in this telephone-based biopsychosocial intervention, in terms of their health, and those who did not and to determine the client and practitioner characteristics and programme elements associated with success in a programme aimed at improving health.

METHODS

Data were obtained from the CMP electronic spreadsheets and clients paper-based case records. CMP standard practice was that questionnaires were administered during the pre- and post-assessment phases over the telephone. Each client's record contains their socio-demographic data, their primary health condition, as well as the pre- and post-intervention scores of the health assessment tool administered. Univariate and multivariate statistical analysis was used to investigate the relationships between the database variables. Clients were included in the study if their records were available for analysis from July 2006 to December 2007.

RESULTS

On average there were 112 referrals per month, totalling 2016 referrals during the evaluation period. The majority (62.8%) of clients had a mental-health condition. Successful completion of the programme was 28.5% (575 "completers"; 144 "discharges"). Several factors, such as age, health condition, mode of contact, and practitioner characteristics, were significant determinants of participation and completion of the programme. The results showed that completion of the CMP was associated with a better mental-health status, by reducing the number of clients that were either anxious, depressed or both, before undertaking the programme, from 74% to 32.5%.

CONCLUSIONS

Our findings showed that an individual's characteristics are associated with success in the programme, defined as completing the intervention and demonstrating an improved health status. This study provides some evidence that the systematic evaluation of such programmes and interventions could identify ways in which they could be improved.

Mental health consumers and caregivers as instructors for health professional students: a qualitative study

PURPOSE

The purpose of this study was to explore the self-reported effect of consumer and caregiver-led education for pharmacy students and to explore the goals, challenges and benefits of mental health consumer educators providing education to health professional students.

METHODS

Five focus groups (mean duration 46 min, SD 22 min) were held with 23 participants (11 undergraduate pharmacy students, 12 mental health consumer educators) using semi-structured interview guides. The focus groups were digitally audio-recorded, transcribed verbatim and thematically content analyzed using a constant comparison approach.

RESULTS

Three major themes emerged from the data; raising awareness about mental health, impact on professional practice and impact on mental health consumers. The students reported decreased stigma, improved attitudes toward mental illness and behavior changes in their professional practice. The primary reason for becoming an educator was to raise awareness and reduce mental health stigma. However, educators also benefited personally through empowerment, improved confidence and social skills.

CONCLUSION

Providing students the opportunity to have contact with consumers with a mental illness in a safe, educational setting led to decreases in stigma, the fostering of empathy and self-reported behavior changes in practice. Sharing personal stories about mental illness is a powerful tool to decrease mental health stigma and may be an important aspect of a person's recovery from mental illness. Contact with mental health consumers in an educational setting is recommended, particularly for future health care professionals. Appropriate training and support of consumers is crucial to ensure the experience is positive for all involved.

Price, familiarity, and availability determine the choice of drug - a population-based survey five years after generic substitution was introduced in Finland

Background

Mandatory generic substitution (GS) was introduced in Finland at the beginning of April 2003. However, individual patients or physicians may forbid the substitution. GS was a significant change for Finnish medicine users. It was thought it would confuse people when the names, colors, packages, etc., changed. The purpose of this study was to explore what medicine-related factors influence people's choice of prescription drugs five years after generic substitution was introduced in Finland.

Methods

A population survey was carried out during the autumn of 2008. A random sample was drawn from five mainland counties. A questionnaire was mailed to 3000 people at least 18 years old and living in Finland. The questionnaire consisted of both structured and open-ended questions. Factors that influenced the subjects' choice of medicines were asked with a structured question containing 11 propositions. Descriptive statistical analyses were performed.

Results

In total, 1844 questionnaires were returned (response rate, 62%). The percentage of female respondents was 55%. Price, availability, and familiarity were the three most important factors that influenced the choice of medicines. For the people who had refused GS, the familiarity of the medicine was the most important factor. For the subjects who had allowed GS and for those who had both refused and allowed GS, price was the most important factor.

Conclusions

The present study shows that price, familiarity, and availability were important factors in the choice of prescription medicines. The external characteristics of the medicines, for instance the color and shape of the tablet/capsule or the appearance of the package, were not significant characteristics for people.

Impact of mental health first aid training on pharmacy students' knowledge, attitudes and self-reported behaviour: a controlled trial

OBJECTIVE

The aim of this study was to assess the impact of delivering Mental Health First Aid (MHFA) training for pharmacy students on their mental health literacy and stigma towards mental illness.

METHODS

A non-randomized controlled design was used, with all third year pharmacy students at the University of Sydney (n = 272) in 2009 invited to participate in one of two MHFA training courses, each of 12 hours duration. Of these, 174 students applied for MHFA training, of whom 60 were randomly selected and offered MHFA training. Outcome measures that were completed by all participants in the MHFA and non-MHFA groups before and after the MHFA training included an evaluation of mental health literacy, the 7-item social distance scale, and 16 items related to self-reported behaviour.

RESULTS

The survey instrument was completed by 258 participants at baseline (59 MHFA and 199 non-MHFA) and 223 participants at follow up (53 MHFA and 170 non-MHFA). The MHFA training improved the participants' ability to correctly identify a mental illness (p = 0.004). There was a significant mean decrease in total social distance of 2.18 (SD 3.35) p <0.001 for the MHFA group, indicating less stigmatizing attitudes. There were improvements in recognition of helpful interventions with participants' views becoming more concordant with health professional views about treatments for depression (p = 0.009) and schizophrenia (p = 0.08), and participants were significantly more confident (p < 0.01) to provide pharmaceutical services to consumers with a mental illness following the training.

CONCLUSION

This study demonstrated that MHFA training can reduce pharmacy students' mental health stigma, improve recognition of mental disorders and improve confidence in providing services to consumers with a mental illness in the pharmacy setting.

The quality of online antidepressant drug information: an evaluation of English and Finnish language Web sites

BACKGROUND

The Internet is a frequently used source of drug information, including among people with mental disorders. Online drug information may be narrow in scope, incomplete, and contain errors of omission.

OBJECTIVE

To evaluate the quality of online antidepressant drug information in English and Finnish.

METHODS

Forty Web sites were identified using the search terms antidepressants and masennuslääkkeet in English and Finnish, respectively. Included Web sites (14 English, 8 Finnish) were evaluated for aesthetics, interactivity, content coverage, and content correctness using published criteria. All Web sites were assessed using the Date, Author, References, Type, Sponsor (DARTS) and DISCERN quality assessment tools.

RESULTS

English and Finnish Web sites had similar aesthetics, content coverage, and content correctness scores. English Web sites were more interactive than Finnish Web sites (P<.05). Overall, adverse drug reactions were covered on 21 of 22 Web sites; however, drug-alcohol interactions were addressed on only 9 of 22 Web sites, and dose was addressed on only 6 of 22 Web sites. Few (2/22 Web sites) provided incorrect information. The DISCERN score was significantly correlated with content coverage (r=0.670, P<.01), content correctness (r=0.663, P<.01), and the DARTS score (r=0.459, P<.05).

CONCLUSIONS

No Web site provided information about all aspects of antidepressant treatment. Nevertheless, few Web sites provided incorrect information. Both English and Finnish Web sites were similar in terms of aesthetics, content coverage, and content correctness.

Community pharmacists' involvement in smoking cessation: familiarity and implementation of the National smoking cessation guideline in Finland

BACKGROUND

Guidelines on smoking cessation (SC) emphasize healthcare cooperation and community pharmacists' involvement. This study explored the familiarity and implementation of the National SC Guideline in Finnish community pharmacies, factors relating to Guideline familiarity, implementation and provision of SC services.

METHODS

A nationwide mail survey was sent to a systematic, sample of community pharmacy owners and staff pharmacists (total n = 2291). Response rate was 54% (n = 1190). Factors related to the SC Guideline familiarity were assessed by bivariate and multivariate analysis.

RESULTS

Almost half (47%) of the respondents (n = 1190) were familiar with the SC Guideline and familiarity enhanced Guideline implementation. The familiarity was associated with the respondents' perceptions of their personal SC skills and knowledge (OR 3.8); of customers' value of counseling on nicotine replacement therapy (NRT) (OR 3.3); and regular use of a pocket card supporting SC counseling (OR 3.0). Pharmacists' workplaces' characteristics, such as size and geographical location were not associated with familiarity. In addition to recommending NRT, the pharmacists familiar with the Guideline used more frequently other Guideline-based SC methods, such as recommended non-pharmacological SC aids, compared to unfamiliar respondents.

CONCLUSIONS

SC Guideline familiarity and implementation is crucial for community pharmacists' involvement in SC actions in addition to selling NRT products. Pharmacists can constitute a potential public health resource in SC easily accessible throughout the country.