Desire for information about drugs: a survey of the need for information in psychiatric in-patients

Clinical and other specialty services offered by pharmacists in the community: the international arena and Israel

The community pharmacy setting is a venue that is readily accessible to the public. In addition, it is staffed by a pharmacist, who is a healthcare provider, trained and capable of delivering comprehensive pharmaceutical care. As such, community pharmacists have a colossal opportunity to serve as key contributors to patients’ health by ensuring appropriate use of medications, preventing medication misadventures, identifying drug-therapy needs, as well as by being involved in disease management, screening, and prevention programs. This unique position gives the pharmacist the privilege and duty to serve patients in roles other than solely that of the stereotypical drug dispenser.

Worldwide, as well as in Israel, pharmacists already offer a variety of pharmaceutical services and tend to patients’ and the healthcare system’s needs. This article provides examples of professional, clinical or other specialty services offered by community pharmacists around the world and in Israel and describes these interventions as well as the evidence for their efficacy. Examples of such activities which were recently introduced to the Israeli pharmacy landscape due to legislative changes which expanded the pharmacist’s scope of practice include emergency supply of medications, pharmacists prescribing, and influenza vaccination. Despite the progress already made, further expansion of these opportunities is warranted but challenging. Independent prescribing, as practiced in the United Kingdom or collaborative drug therapy management programs, as practiced in the United States, expansion of vaccination programs, or wide-spread recognition and reimbursement for medication therapy management (MTM) programs are unrealized opportunities. Obstacles such as time constraints, lack of financial incentives, inadequate facilities and technology, and lack of professional buy-in, and suggested means for overcoming these challenges are also discussed.

Consumer satisfaction with National Alliance on Mental Illness written medicine information

Introduction

Written medicine information (WMI) is a collection of facts for a specific medication, and it helps facilitate patient understanding of medication therapy. The primary objective of this study was to assess consumer satisfaction with National Alliance on Mental Illness (NAMI) WMI. A secondary objective was to assess health care professional satisfaction.

Methods

National Alliance on Mental Illness WMI and surveys were offered to consumers, health care professionals, and trainees at 3 treatment centers with psychiatric services. All adults who received medication counseling were eligible for inclusion. Survey responses were evaluated using descriptive statistics.

Results

Most consumers (82.4%) and providers (74.5%) reported overall satisfaction with NAMI WMI. Consumers were least satisfied with information on how to manage unwanted effects, drug-drug interactions, and readability (9.5%, 14.9%, 41.9% dissatisfaction).

Discussion

Evaluation and feedback from consumers and health care professionals may influence decisions to refine NAMI WMI to meet consumer needs.

How to meet patients' individual needs for drug information - a scoping review

PURPOSE

The aim of this study was to 1) describe drug information desired by patients and 2) analyze how such information could be customized to be presented to patients according to their individual information needs.

MATERIALS AND METHODS

We performed a scoping literature search and identified relevant drug information topics by assessing and clustering 1) studies analyzing patients' enquiries to drug information hotlines and services, and 2) qualitative studies evaluating patient drug information needs. For the two most frequently mentioned topics, we further analyzed which components (ie, information domains) the topics contained and examined patients' and health care professionals' (HCPs) views on these components.

RESULTS

Of 27 identified drug information topics in the literature search, patients most frequently requested information on adverse drug reactions (ADRs) and drug-drug interactions (DDIs). Hypothetically, those topics are composed of seven distinct information domains each (eg, ADR and DDI classification by frequency, severity, or onset; information on management strategies, monitoring, and prevention strategies). Patients' and HCPs' appraisal concerning the information content of these domains varies greatly and is even lacking sometimes.

CONCLUSION

Patients particularly request information on ADRs and DDIs. Approaches to customize such information are sparse. The identified information domains of each topic could be used to structure corresponding drug information and to thus facilitate customization to individual information needs.

Desire for information of people with severe mental illness

PURPOSE

To assess (1) the desire of people with severe mental illness for information on their treatment and (2) whether the desire for information is associated with socio-demographic variables, diagnosis, illness duration, therapeutic relationship, needs and symptom severity.

METHODS

588 outpatients with severe mental illness were recruited in six European countries (Germany, Denmark, Hungary, Italy, Switzerland, United Kingdom) during the "Clinical decision making and outcome in routine care of people with severe mental illness (CEDAR)" study (ISRCTN75841675). Desire for information was assessed by the Information subscale of the Clinical Decision Making Style Scale. Study participants with high desire for information were compared with those with moderate or low desire for information.

RESULTS

80 % of study participants (n = 462) wanted to receive information on all aspects of their treatment (management, prognosis, alternative options for care). Participants with a high desire for information had less severe symptoms (OR = 0.988, CI = 0.977-1.000) and a better self-rated therapeutic alliance (OR = 1.304, CI = 1.130-1.508) with their clinician.

CONCLUSIONS

Most, but not all, people with severe mental illness have a high desire for information. Desire for information is associated with variables, such as therapeutic relationship and symptom severity, which are amenable to change during treatment.

Information on antidepressants for psychiatric inpatients: the divide between patient needs and professional practice

BACKGROUND

Medicine information is an integral part of patient care and a patient right. In particular, patients with a mental health diagnosis have a need for information on medicines.

OBJECTIVE

This study aims to describe the current practice on information provision on antidepressants to inpatients in psychiatric hospitals.

METHODS

A qualitative study was conducted consisting of semi-structured interviews with health care professionals (n=46) and patients (n=17) in 11 Flemish psychiatric hospitals. Two topic guides were designed for conducting the interviews with these respective stakeholders. The issues addressed in the topic guides related to: organization of information provision in the hospital, information on demand of the patient, information provision by health care professionals, information for relatives, evaluation of provided information, interdisciplinary contacts on information provision and satisfaction on current practice of information provision. The interviews were analysed according to the five stages of the framework analysis.

RESULTS

Psychiatrists and nurses are the key players to provide information on antidepressants. Their approach depends on patient characteristics and mental state. Information is provided mainly orally. Health care professionals consider non-verbal cues of patients to verify if information has been understood. Health care professionals reported lack of time and lack of interdisciplinary contacts as negative aspects. Patients indicated that health care professionals take too little initiative to provide medicine information.

CONCLUSIONS

Patients are informed about their antidepressants through various pathways. Although the awareness is present of the importance of the individual approach and efforts are done to tailor information to the individual patient, improvement is still possible. Tailoring communication; assessing patient needs and preferences; matching of health care professional style and patient needs; and achieving concordance, is a complex and challenging task for health care professionals in mental health care.

Differentiated information on antidepressants at hospital discharge: a hypothesis-generating study

Objectives

This hypothesis-generating study examined the clinical, humanistic and economic impact of providing differentiated medication information depending on the patient's information desire as compared with undifferentiated information to patients with a major depressive episode at hospital discharge.

Methods

A longitudinal multi-centre study with quasi-experimental design comprised two experimental groups ((un)differentiated antidepressant information) and one ‘no information’ group. Patients were followed up for 1 year assessing adherence, economic outcomes (i.e. costs of medicines, consultations, productivity loss and re-admissions), clinical outcomes (i.e. depressive, anxiety and somatic symptoms and side effects) and humanistic outcomes (i.e. quality of life, satisfaction with information). A linear model for repeated measures was applied to assess differences over time and between groups.

Key findings

Ninety-nine patients participated. Still participating 1 year later were 78. No beneficial effect was observed for adherence. Lower productivity loss (P = 0.021) and costs of consultations with healthcare professionals (P = 0.036) were observed in the differentiated group. About one-third of patients were re-admitted within 1 year following discharge. Patients in the ‘no information’ group had significantly more re-admissions than patients in the undifferentiated group (P = 0.031).

Conclusions

The hypothesis of differentiated information could be supported for economic outcomes only. Future medication therapy intervention studies should apply a more rigorous study design.

Risk perception and medicines information needs in pregnant women with epilepsy--a qualitative study

PURPOSE

To explore risk perception and medicines information needs in pregnant women with epilepsy (WWE).

METHOD

In-depth interviews with pregnant WWE treated with antiepileptic drugs (AEDs).

RESULTS

Ten women aged 22-39 years in 20-34 weeks' gestation were interviewed. Avoiding seizures by taking AEDs in pregnancy outweighed perceived risks, but dose adjustments during and after pregnancy increased perceived risks of teratogenicity or seizures. The women had restrictive attitudes towards taking medicines for other indications than epilepsy. They appreciated their neurologist as a source for medicines information, though their needs for medicines information were reduced by long-term use of AEDs.

CONCLUSIONS

Pregnant WWE were confident in using AEDs through communication with their neurologist, but dose adjustments caused concern. Medicines information to pregnant WWE should focus on empowering the women to control the disease, supporting realistic risk perceptions of AEDs and other necessary medicines. In this article, we outline some medicines information strategies to pregnant WWE.

Outcomes from a regular medication information programme for consumers with a mental illness

OBJECTIVE

To describe the development of, and outcomes from, a medication information programme facilitated by trained mental health clinicians in an area mental health service.

METHOD

A step-wise programme entailing: (a) a consumer-led project to determine barriers faced by consumers in acquiring information about medication (Medicine Awareness Project:MAP); (b) the introduction of a weekly medication information forum (MIF) in an acute inpatient service; and (c) the development and roll-out of consumer and carer support materials in community settings.

RESULTS

The MAP survey demonstrated that consumers' knowledge about and access to standard Consumer Medicine Information (CMI) leaflets was poor and that they perceived a number of barriers in obtaining balanced information about their medication. Nearly half of the respondents preferred information about medications presented in both written and verbal form. Participants in the MIF sessions showed an increase in positive attitudes toward their medication following the forums. These findings brought upon the production of a tailored, consumer and carer-focused resource, which has been widely distributed throughout Australia.

CONCLUSIONS

A medication information programme can provide opportunities for mental health consumers and their carers to gain knowledge of psychotropic medications. The use of written and verbal formats enhances the transfer of such information.

Explicit and implicit information needs of people with depression: a qualitative investigation of problems reported on an online depression support forum

BACKGROUND

Health management is impeded when consumers do not possess adequate knowledge about their illness. At a public health level, consumer knowledge about depression is particularly important because depression is highly prevalent and causes substantial disability and burden. However, currently little is known about the information needs of people with depression. This study aimed to investigate the explicit and implicit information needs of users of an online depression support forum.

METHODS

A sample of 2680 posts was systematically selected from three discussion forums on an online depression bulletin board (blueboard.anu.edu.au). Data were examined for evidence of requests for information (reflecting explicit needs) and reports of past or current problems (implicit needs). Thematic analysis was conducted using a data-driven inductive approach with the assistance of NVivo 7, and instances of questions and people reporting particular types of problems were recorded.

RESULTS

A total of 134 participants with personal experience of depression contributed to the data analysed. Six broad themes represented participant queries and reported problems: Understanding depression; disclosure and stigma; medication; treatment and services; coping with depression; and comorbid health problems. A variety of specific needs were evident within these broad thematic areas. Some people (n = 46) expressed their information needs by asking direct questions (47 queries) but the majority of needs were expressed implicitly (351 problems) by the 134 participants. The most evident need for information related to coping with depression and its consequences, followed by topics associated with medication, treatment and services.

CONCLUSIONS

People with depression have substantial unmet information needs and require strategies to deal with the difficulties they face. They require access to high quality and relevant online resources and professionals; thus, there is a need to rectify current gaps in the provision of information and limitations of dissemination. Greater knowledge about depression and its treatment is also needed at the general community level.

Predictors of safety-related enquiries about psychotropic medication in young people and families accessing a medicines information service

BACKGROUND

Many consumers express concerns about the safety of psychotropic medication for young people. Despite the increased use of psychotropic medication in children and adolescents, few studies have examined information needs of this group and predictors of safety-related concerns.

METHODS

This study was conducted within a national, consumer-based medicines information service. Between September, 2002, and December, 2005, all calls relating to use of psychotropic medications in children and adolescents were identified and reviewed. Information extracted included call characteristics, reason for calling, prior information, and medication details. Calls related to safety were compared to calls about non-safety-related issues.

RESULTS

A total of 286 calls related to psychotropic medication in young people were reviewed. The majority of callers were adults calling on behalf of either a child (73.4%) or client (12.9%). Stimulants were the most common medication enquired about (44.0% of calls), followed by antidepressants (40.2%), and antipsychotics (18.9%). More than half of all calls were for medicines not registered for pediatric use. Almost two thirds of calls related to safety issues (61.9%; 177/286). Safety-related calls were not related to specific medication groups (e.g., stimulants or antidepressants). Significant and independent predictors of safety-related concerns were medication not registered for pediatric use (p < 0.05), receipt of lay information (p < 0.05), concomitant enquiry about nonpsychotropic medication (p < 0.01), and a potential medication problem (p < 0.05).

CONCLUSIONS

Safety is one of the key areas of concern in young people and families accessing a medicines information service with questions about psychotropic medication. Off-label use of medication was common and may contribute to safety concerns. Provision of information that is tailored for young people has the potential to improve outcomes in this group.

The "extent of information desired"-scale in psychiatric in-patients: a behavioural approach

OBJECTIVE

The purpose of this study was to investigate the "extent of information desired" (EID)-scale through a behavioural approach.

METHODS

Standardised interviews consisting of the EID-scale and four (half) open questions were conducted in a convenience sample of psychiatric in-patients and information seeking behaviour was measured. At the same time, socially desirable behaviour was assessed by means of Marlowe-Crowne social desirability (MCSD).

RESULTS

39 patients were interviewed. The behavioural approach yielded mixed results, but there was no correlation between EID- and MCSD-scores.

DISCUSSION

From the calculated correlations information seeking behaviour is perceived as socially undesirable, whereas EID-scores seem unaffected by social desirability.

CONCLUSION

It is difficult to define independent variables which would reflect information seeking behaviour. The ones we used might have been confounded. We found a correlation between the EID-scale used and the information seeking behaviour, without a strong correlation with social desirability.

PRACTICE IMPLICATIONS

The EID-scale used may predict patients' desire for information within a well-defined clinical context. The step to validation requires more robustness of the research model and a better profiling of patients.