Pharmaceutical care for people with depression: Belgian pharmacists’ attitudes and perceived barriers

Barriers to pharmaceutical care provision in the community and hospital pharmacies of Motta town, Northwest Ethiopia: a cross-sectional study

BACKGROUND

Although pharmaceutical care has tangible positive importance in ensuring patient pharmacotherapy safety, its provision encounters several barriers. Therefore, this study investigated the obstacles pharmacy professionals faced while providing pharmaceutical care in Motta town, Northwest Ethiopia.

METHODS

A cross-sectional study was conducted from July 30, 2022, to August 30, 2022, at all community and hospital pharmacies in Motta town, Northwest Ethiopia. The data were collected via a self-administered questionnaire and analyzed via SPSS version 26.0. Descriptive statistics and statistical analysis tests, such as the independent t-test, variance, and multiple linear regressions, were employed to analyze the data.

RESULTS

The study had a 97.7% response rate. Among the 130 participants, 71 (54.6%) were females. The mean (± SD) total score of pharmaceutical care provision barriers was 85.06 (± 20.2). The highest and lowest mean subscale scores of pharmaceutical care provision barriers were related to lack of resources and skill, respectively. Among resource-related barriers, lack of time and money, lack of trained staff, and lack of private space for consultation scored higher than other barriers. Concerning vision/attitudinal barriers, patients and other healthcare workers' inappropriate attitudes toward pharmaceutical care obtained the highest scores. The lack of clinical education in pharmaceutical care, lack of communication, and lack of documentation skills of pharmacists scored higher than other barriers in the educational and skill-related barriers subscales. For the regulatory/environmental subscale, a lack of clinical practice guidelines and legal barriers scored higher than the other subscales did. Pharmaceutical care provision barriers were significantly associated with age (B = 14.008), years of practice (B = 13.009), and graduating institution (B=-16.773).

CONCLUSIONS

Resource and attitudinal/vision-related barriers were reported to be the most common barriers to pharmaceutical care implementation. Stakeholders should work together to develop strategic solutions to overcome these barriers and thus achieve optimal pharmaceutical care provision. These strategies should include optimizing the number of trained pharmacy staff, time and financial problems should be resolved, communication and documentation skills should be improved, pharmacy layouts should incorporate private counseling rooms, policies that support the pharmacist's role in patient care should be developed, and effective training and continuing professional education programs should be offered.

A roadmap beyond dispensing for educating and training community pharmacists on key mental health competencies: A mixed-methods national study

BACKGROUND

Including pharmacists in collaborative mental healthcare models has yielded positive results. Establishing processes to enhance pharmacists' mental health care capabilities is crucial for addressing the increasing burden and improving access to mental health services.

OBJECTIVES

This study evaluated community pharmacists' mental health competencies and analyzed associated factors using a rigorous international framework. Additionally, it sought to identify pharmacists' training needs and support requirements as the first stop in creating a roadmap for enhancing mental healthcare through community pharmacies.

METHODS

A large-scale national study employing a mixed-methods approach was conducted with community pharmacists in United Arab Emirates. Semi-structured individual interviews and a cross-sectional survey were conducted. Pharmacists' core competencies were assessed using the Core Mental Health Competencies Framework for all Pharmacy Professionals. Generalized linear models were utilized to identify predictors of pharmacists' competency levels. Thematic analysis was used to analyze qualitative data.

RESULTS

In total 650 community pharmacists completed the survey (93.7% response rate). Eight pharmacists participated in semi-structured interviews. Nearly two-thirds (63.7%) received general communication skills training, while training in motivational interviewing (44.7%), shared decision-making (37.2%), and mental illness stereotyping/stigma (23.9%) were less common. Pharmacists reported lower perceived competence in their relationship with multidisciplinary teams (M = 3.02, SD = 0.89), stigma recognition (M = 3.02, SD = 1.04), and identifying mental health crises and aiding in the person's safety (M = 3.01, SD = 1.05). Poor communication skills (p < 0.001) and working in pharmacies that do not stock psychotropic medications (p = 0.023) were associated with lower perceived competence. Qualitative analysis identified training needs in various domains, including attitudes, values, and beliefs about mental health; relationships with multidisciplinary teams; communication skills; pharmaceutical knowledge; and personal and service development.

CONCLUSIONS

Mental health-related training is needed for community pharmacists. Addressing these needs through an intentional roadmap approach will enable pharmacists to better engage with patients with mental illness and increase access to care.

Pharmacy student attitudes to mental illness and the provision of mental health care: a repeated cross-sectional survey

BACKGROUND

Attitudes to mental illness are an important factor in the willingness of professionals to engage in mental health care.

AIM

The aim of this study was to understand attitudes of undergraduate pharmacy students in Ireland to severe mental illness and the provision of medicines optimisation services as well as the variation in these attitudes throughout the undergraduate course.

METHOD

A survey instrument was compiled using existing published research and validated questionnaires. The survey was distributed to students in their first, third and Master of Pharmacy years annually between 2014 and 2019. Although designed as a longitudinal study, following the matching process there were a limited number of students who completed more than one survey and therefore data were treated as independent samples.

RESULTS

The overall average response rate was 25% per survey (n = 191 participants) Notwithstanding generally positive attitudes, a sizeable proportion of students felt people with severe depression and schizophrenia were hard to talk to (n = 48, 25.3%; n = 54, 29.2%) Less than half of MPharm students expressed confidence and competence in caring for people with more severe mental illnesses such as bipolar disorder and schizophrenia and 29% (n = 60) of students would feel awkward asking someone about their antipsychotic medication. Almost two thirds (n = 120, 63.8%) expressed an interest in a career in mental health.

CONCLUSION

Irish pharmacy students have generally positive attitudes towards people with severe mental illness and provision of medicines optimisation services. There is an opportunity to improve pharmacy graduates perceived competence and confidence to provide mental health services.

Evaluation of knowledge, experiences, and fear toward prescribing and dispensing corticosteroids among Egyptian healthcare professionals: A cross-sectional study

Background

Corticosteroids (CS) are essential drugs in the treatment of several medical conditions. Assuming different roles, physicians and pharmacists play a primary role in prescribing and dispensing these medications to optimize patients' clinical management. The data on assessing knowledge and experience of healthcare professionals toward CS is scarce. Therefore, this study aimed to assess and compare knowledge, experience, and fears towards CS among Egyptian physicians and pharmacists.

Methods

A cross-sectional, self-administrated, validated online questionnaire was used to collect the data from Egyptian healthcare professionals. The questionnaire consisted of four sections with multiple choice questions: sociodemographic (7 questions), knowledge about CS (13 questions), experience with CS prescription/dispensing (5 questions), and fears and preferences toward CS prescription/dispensing (13 questions). Descriptive and inferential statistics were used to analyze the data.

Results

A total of 600 responses were analyzed in this study. The study sample was almost two-half of healthcare providers: 303 (50.5%) pharmacists and 297 (49.5%) physicians. Pharmacists had marginally higher knowledge scores as compared to those recorded for physicians (11.29 versus 10.16, respectively; P = 0.047). Physicians had more experience choosing corticosteroids in treatment plans based on their experience (51.8% vs 38.5%) and guideline recommendations (72.8% vs 50.9%) than pharmacists. However, pharmacists had more experience dealing with corticosteroid use based on patients' preferences (19.5% vs 4.9%) and showed a broader scope of experiencing side effects of corticosteroids with their patients. The two professions demonstrated high levels of fear, with pharmacists acknowledging significantly lower concerns about CS than physicians (3.72 versus 4.0, respectively; P = 0.003).

Conclusion

Discrepancies exist among healthcare professionals in knowledge and experience, favoring better scientific knowledge of pharmacists related to corticosteroids. Based on these findings, the interprofessional collaborative efforts would provide comprehensive, patient-centered care that maximizes the benefits of CS while minimizing their risks.

Building Bridges between Pharmacy and Psychosocial Care: Supporting and Referring Patients with Psychosocial Needs in a Pilot Study with Community Pharmacists

Introduction

Community pharmacists are accessible primary care providers and therefore in a good position to detect unmet psychosocial needs of their patients and pharmacy visitors.

Description

A collaboration between pharmacists and psychosocial work was set up in Flanders, Belgium. Community pharmacists were trained to discuss psychosocial needs, to inform patients about possible help and refer them to a Center for General Wellbeing if needed. During the pilot of the project between October 2021 and January 2022, the feasibility and potential of this collaboration were examined.

Discussion

A total of 79 patient contacts about psychosocial wellbeing were reported using an online registration form, the majority of which concerned women. Family problems and mental health problems were most often reported. Focus group discussions with 28 participating pharmacists showed that they experience their role in psychosocial care as fulfilling and of valuable. Patient satisfaction was mentioned to be a major motivating factor, while time and privacy are barriers. Adequate training in psychosocial wellbeing and care was considered crucial.

Conclusion

Pharmacists can be valuable partners in the recognition and referral of patients with unmet psychosocial needs. Structural collaborations between community pharmacy and psychosocial care should be further supported.

Systematic review on the effects of the physical and social aspects of community pharmacy spaces on service users and staff

Aim:

This systematic review aimed to provide new insights into how pharmacy spaces, or the architecture of pharmacies, are experienced by pharmacy service users and staff. The review sought to identify environmental factors which may influence service users’ and staff participation in community-based pharmacy health services.

Method:

Ten databases were searched for English language publications, using a combination of search terms relating to pharmacy service users and staff; pharmacy spaces; and health and social care outcomes. Data from the final selected studies were extracted, thematically analysed using a narrative approach and the quality of each study assessed using the Integrated quality Criteria for the Review of Multiple Study designs (ICROMS).

Results:

80 articles reporting 80 studies published between 1994 and 2020 were identified; they were from 28 countries, involving around 3234 community pharmacies, 13,615 pharmacy service users, 5056 pharmacists and 78 pharmacy health staff. Most studies (94%) met the ICROMS minimum score, and half did not meet the mandatory quality criteria. Four themes likely to influence service users’ and staff experiences of pharmacy health services were identified: (1) privacy; (2) experience of the physical environment; (3) professional image; and (4) risk of error.

Conclusion:

To optimise the delivery and experience of pharmacy health services, these spaces should be made more engaging. Future applied research could focus on optimising inclusive pharmacy design features.

Impact of a pilot workshop on student pharmacists' confidence and comfort in counseling patients at risk for maternal mortality

BACKGROUND AND PURPOSE

This study examined whether a pilot workshop focused on maternal mortality had an impact on pharmacy students' confidence, comfort, and knowledge regarding preeclampsia, postpartum depression and opioid poisoning.

EDUCATIONAL ACTIVITY AND SETTING

The two-hour workshop included lecture, video, discussion and case studies. P1-P3 student pharmacists completed pre- and post-surveys measuring confidence (N = 5) and comfort (N = 15) using a 5-point Likert type scale (1 = strongly disagree to 5 = strongly agree), as well as knowledge with 12 true/false statements. Data were analyzed using paired t-tests and McNemar's tests, as well as Cronbach's alphas for scale reliability.

FINDINGS

The majority of participants (N = 27) were 18-25 years (85.2%), female (74.1%) and Asian (51.9%). Overall confidence and comfort increased significantly (p < .001) from pre- to post-intervention regarding: 1) preeclampsia (2.5 ± 0.9 to 4.5 ± 0.5); 2) postpartum depression (3.3 ± 0.8 to 4.5 ± 0.5); 3) opioids (3.5 ± 0.9 to 4.7 ± 0.5); 4) maternal mortality risk factors (2.1 ± 0.7 to 4.5 ± 0.5); and 5) pharmacist services related to maternal mortality prevention (2.0 ± 0.7 to 4.5 ± 0.5). Knowledge significantly (p < .05) improved on the majority (83.3%) of items. Scale reliabilities were ≥ 0.8.

SUMMARY

Incorporating maternal mortality training in colleges/schools of pharmacy curricula may have a positive impact on pharmacists' counseling and screening of patients at risk for maternal mortality in practice.

A survey of pharmacists' knowledge, attitudes and barriers in pharmaceutical care concept in Poland

BACKGROUND

The major goals of pharmaceutical care (PC) are to improve the patient's quality of life and ensure safety of pharmacotherapy. Inclusion of a pharmacist in the multidisciplinary team caring for the patient and integration of state-of-the-art pharmaceutical services with medical care and nursing are some of the most important challenges that the health care system in Poland is facing.

OBJECTIVES

To evaluate the pharmacists attitudes towards practice in, and knowledge of PC in Poland and to identify the barriers in PC provision.

METHODS

The study was designed as a multicenter study, conducted among Polish pharmacists. Random sampling technique was employed to select the study group. Face-to-face questionnaire method was used to interview the pharmacists, upon obtaining their prior verbal consent to participate in the study. The study was conducted between January 2017 and September 2019.

RESULTS

Only 15% of the pharmacists have ever attended a training on PC. 72% believed PC provision was necessary to ensure pharmacotherapy safety. Only 63% of the pharmacists believed that preventing and solving health-related and drug therapy problems for patients were their responsibilities. The main reason for non-provision of PC by the pharmacists was the lack of time for such activities, lack of legal regulations, lack of organizational facilities.

CONCLUSION

This study indicates that implementation of PC is expected in Poland. Educational programs in this respect are urgently needed. PC provision should be included in the curricula of academic pharmaceutical courses.

Psychosocial factors associated with pharmacists' end-of-life medication counseling and dispensing

OBJECTIVE

In 2015, California legalized physician-assisted suicide through passing the End of Life Option Act (ELOA). This study aimed to identify and describe the psychosocial factors associated with pharmacists' intention to counsel and dispense end-of-life medications.

METHODS

Data were collected using a 51-item questionnaire that was mailed to 2,000 registered community pharmacists in California. The study collected data on TPB constructs (attitude, subjective norm [SN], and perceived behavioral control [PBC]), behavioral and control beliefs, perceived obligation, and demographic and practice characteristics. Hierarchical linear regression was used to identify the factors associated with the pharmacists' intention.

RESULTS

A total of 353 responses (19.4% response rate) were received from respondents with an average age of 50.4 ± 14.8 years. Most of the respondents were women (53.1%) and religious (56.4%). Most pharmacies did not currently stock ELOA medications (n = 197, 56.1%), and most pharmacists had never been presented with an ELOA prescription in their practice (n = 319, 90.4%). The pharmacists had a positive intention (mean = 8.24 ± 4.6, range: 2-14), attitude (mean = 17.15 ± 6.9, range: 4-28), SN (mean = 1.1 ± 4.5; range: -9 to 9), and PBC (mean = 1.85 ± 3.5; range: -6 to 6) to dispense ELOA medications. Attitude (β = 0.570, P < 0.001), SN (β = 0.238, P < 0.001), and perceived obligation were statistically significant predictors of the pharmacists' intention to dispense ELOA medications for patients with a valid prescription but PBC (β = 0.022, P = 0.531) was not.

CONCLUSION

Interventions to promote pharmacists' counseling and dispensing of ELOA medications should focus on developing strong intention. Improving pharmacists' attitude, SN, and perceived obligation is critical to increasing their willingness to dispense ELOA medications.

Reprint of: Psychosocial factors associated with pharmacists' antidepressant drug treatment monitoring

OBJECTIVE

Patients undergoing antidepressant drug treatment (ADT) may face challenges regarding its adverse effects, adherence, and efficacy. Community pharmacists are well positioned to manage ADT-related problems. Little is known about the factors influencing pharmacists' ADT monitoring. This study aimed to identify the psychosocial factors associated with pharmacists' intention to perform systematic ADT monitoring and report on this monitoring.

DESIGN

Cross-sectional study based on the Theory of Planned Behavior (TPB).

SETTING AND PARTICIPANTS

Community pharmacists in the province of Quebec, Canada.

OUTCOME MEASURES

Pharmacists completed a questionnaire on their performance of ADT monitoring, TPB constructs (intention; attitude; subjective norm; perceived behavioral control; and attitudinal, normative, and control beliefs), and professional identity. Systematic ADT monitoring was defined as pharmacists' reporting 4 or more consultations with each patient during the first year of ADT to address adverse effects, adherence, and efficacy. Hierarchical linear regression models were used to identify the factors associated with the intention and reporting of systematic ADT monitoring and Poisson working models to identify the beliefs associated with intention.

RESULTS

A total of 1609 pharmacists completed the questionnaire (participation = 29.6%). Systematic ADT monitoring was not widely reported (mean score = 2.0 out of 5.0), and intention was moderate (mean = 3.2). Pharmacists' intention was the sole psychosocial factor associated with reporting systematic ADT monitoring (P < 0.0001; R² = 0.370). All TPB constructs and professional identity were associated with intention (P < 0.0001; R² = 0.611). Perceived behavioral control had the strongest association.

CONCLUSION

Interventions to promote systematic ADT monitoring should focus on developing a strong intention among pharmacists, which could, in turn, influence their practice. To influence intention, priority should be given to ensuring that pharmacists feel capable of performing this monitoring. The main barriers to overcome were the presence of only 1 pharmacist at work and limited time. Other factors identified offer complementary intervention targets.

Patient and prescriber perceptions of depression screening within a community pharmacy setting

OBJECTIVES

To determine patient and prescriber perceptions of depression screening within the community pharmacy setting and to assess the best strategies for patient engagement and care coordination.

DESIGN

Qualitative semistructured key informant interviews using the Consolidated Framework for Implementation Research as a theoretical framework.

SETTING AND PARTICIPANTS

A community pharmacy in the metropolitan Piedmont region of North Carolina from February 2019 to May 2019. Prescriber and patient interviews were audio recorded, transcribed, and independently coded by 2 investigators. A qualitative analysis was completed, with a selection of supporting quotations for each theme.

OUTCOME MEASURES

Qualitative analysis of prescriber and patient perceptions of depression screening provided in community pharmacies, strategies for patient engagement, and coordination of care for depression screenings.

RESULTS

Twelve patients and 4 prescribers participated in the study. The patient perceptions were categorized into 3 key themes: (1) private and confidential screenings; (2) disparate views regarding the potential interventions that pharmacists could offer; and (3) mental health stigma concerns. The prescriber perceptions were categorized into 3 key themes: (1) support for expanded access to depression screenings provided in community pharmacies; (2) necessity of referral algorithms for transitions of care; and (3) communication of full screening results for positive and negative screens. A mutual theme was identified among patients and prescribers: the view that mental health care provided at a community pharmacy was influenced by an established relationship with a community pharmacist.

CONCLUSION

This study describes patient and provider perceptions of depression screening within the community pharmacy setting. Prescribers were supportive of community pharmacists' ability to close the gaps in access to care for patients with mental health conditions, whereas patients had mixed feelings that may have been influenced by concerns of privacy, confidentiality, and stigma. This deeper understanding of prescriber and patient perceptions of how community pharmacies could expand access to depression screening may provide a roadmap for offering these interventions in community pharmacies.

Impact of a depression counseling intervention on student pharmacists' confidence and comfortability: A pilot study

INTRODUCTION

The objective of this study was to assess the impact of a mental health educational intervention on pharmacy students' confidence and comfortability when engaging in depression counseling.

METHODS

Third-year pharmacy students completed two 15-item rating scales addressing confidence and comfortability about depression. The intervention was 2.5 hours long and included a depression overview, consumer educator presentation, motivational interviewing, and case studies. Surveys were administered at baseline, immediately after the intervention, and three months post intervention. Data were analyzed using paired t-tests and repeated measures analyses.

RESULTS

Of the 23 students who participated in the intervention, 12 (52.2%) completed the three-month follow-up. Confidence increased significantly (p < 0.05) from 3.5 ± 0.5 to 4.1 ± 0.4 immediately post intervention and was sustained at three months post (3.9 ± 0.5). Similarly, comfortability increased significantly (p < 0.05) from 3.6 ± 0.4 to 4.1 ± 0.5 immediately post and was sustained at three months post (4.1 ± 0.6). Cronbach's alphas ranged from 0.90 to 0.96.

CONCLUSION

Pharmacy students' depression counseling confidence and comfortability improved and was sustained after a 2.5-hour intervention with motivational interviewing, consumer education, and case studies.

A qualitative study exploring opportunities for pharmacists to connect with young mental health consumers

OBJECTIVE

To explore how pharmacists can best support young people using medication for any mental health condition. The experiences of obtaining or supplying psychotropic medication and recommendations for service improvement were explored from the perspectives of young people, community pharmacists, and key stakeholders.

DESIGN

A qualitative study using semistructured interviews with young people and pharmacists and the nominal group technique as a consensus method for stakeholders.

SETTING AND PARTICIPANTS

Face-to-face interviews were conducted with 18 young people and a nominal group with 6 stakeholders at 1 of 2 mental health support organizations in Brisbane, Queensland, Australia. Phone conversations were held with 11 pharmacists who were located across Australia. The young people were aged between 14 and 25 years, had used a mental health medication for the previous 2 months, and lived in the community. Pharmacists recognized as mental health advocates or providing a mental health service and stakeholders from 1 support organization were purposively recruited.

OUTCOME MEASURES

Themes related to the current and potential roles for pharmacists when interacting with young people using psychotropic medication.

RESULTS

There was limited awareness of the role of pharmacists, possibly because of the largely transactional nature of the young people's pharmacy experiences. However, young people perceived value in receiving information from pharmacists about their psychotropic medication, in particular, their adverse effects, and interactions with alcohol and other recreational drugs. Respectful communication and access to a private space to discuss sensitive matters were ways that pharmacists could encourage the development of supportive relationships with young people.

CONCLUSION

This study provides unique insights about the experiences of young people using psychotropic medication within community pharmacies. There is an imperative for pharmacists to move beyond a transactional or reactive approach to create a safe health space and address young people's medication concerns beyond initial supply.

Psychosocial factors associated with pharmacists' antidepressant drug treatment monitoring

OBJECTIVE

Patients undergoing antidepressant drug treatment (ADT) may face challenges regarding its adverse effects, adherence, and efficacy. Community pharmacists are well positioned to manage ADT-related problems. Little is known about the factors influencing pharmacists' ADT monitoring. This study aimed to identify the psychosocial factors associated with pharmacists' intention to perform systematic ADT monitoring and report on this monitoring.

DESIGN

Cross-sectional study based on the Theory of Planned Behavior (TPB).

SETTING AND PARTICIPANTS

Community pharmacists in the province of Quebec, Canada.

OUTCOME MEASURES

Pharmacists completed a questionnaire on their performance of ADT monitoring, TPB constructs (intention; attitude; subjective norm; perceived behavioral control; and attitudinal, normative, and control beliefs), and professional identity. Systematic ADT monitoring was defined as pharmacists' reporting 4 or more consultations with each patient during the first year of ADT to address adverse effects, adherence, and efficacy. Hierarchical linear regression models were used to identify the factors associated with the intention and reporting of systematic ADT monitoring and Poisson working models to identify the beliefs associated with intention.

RESULTS

A total of 1609 pharmacists completed the questionnaire (participation = 29.6%). Systematic ADT monitoring was not widely reported (mean score = 2.0 out of 5.0), and intention was moderate (mean = 3.2). Pharmacists' intention was the sole psychosocial factor associated with reporting systematic ADT monitoring (P < 0.0001; R² = 0.370). All TPB constructs and professional identity were associated with intention (P < 0.0001; R² = 0.611). Perceived behavioral control had the strongest association.

CONCLUSION

Interventions to promote systematic ADT monitoring should focus on developing a strong intention among pharmacists, which could, in turn, influence their practice. To influence intention, priority should be given to ensuring that pharmacists feel capable of performing this monitoring. The main barriers to overcome were the presence of only 1 pharmacist at work and limited time. Other factors identified offer complementary intervention targets.

[Community pharmacists' and pharmacy technicians' attitudes and beliefs about depression in elderly]

OBJECTIVES

To analyze attitudes and beliefs of community pharmacists and pharmacy technicians about depression and treatment in older patients.

METHODS

A qualitative study was conducted with community pharmacists and pharmacy technicians. The first step of the study was to develop an interview guide to conduct semi-directive interviews. A thematic analysis was conducted based on the transcripts of the recording of audio interviews.

RESULTS

Eight pharmacists and 5 pharmacy technicians were included. The mean duration of semi-directive interviews was 14.8±4.6minutes. The main identified themes were as follows: 1/the depression: beliefs about depression and its risk factors in older patients; how to talk about depression with older patients at the counter; 2/the management of depression: how to talk about antidepressant with older patients at the counter, including treatment duration, dosage, efficacy and adverse effects of treatment, but also alternative therapies and advices; 3/barriers and facilitators of antidepressant adherence in older patients.

CONCLUSIONS

Barriers to conduct pharmaceutical care focusing on depression among older patients in community pharmacy have been identified: disease stigmatization, lack of privacy at the counter and lack of communication with the prescribing physician; but also a lack of knowledge concerning the specific therapeutic strategy for depression in the elderly. Thus, strengthening the pharmacy student teaching and the community pharmacist and pharmacy technician training regarding the posture to adopt and the therapeutic management of older patients with mental illness would be beneficial.

Perception of Community Pharmacists in Malaysia About Mental Healthcare and Barriers to Providing Pharmaceutical Care Services to Patients with Mental Disorders

The aim of this study was to assess community pharmacists' (CPs) perceptions toward mental healthcare, and the barriers faced in providing pharmaceutical care (PC) services to these patients. A 40-item survey was posted to CPs. Ninety-six pharmacists participated. The majority (84.2%) agreed there is a role for CPs to play in mental health care, while approximately 60% agreed it is their responsibility to provide PC to these patients. The biggest barrier to providing this service is the lack of knowledge, cited by close to 50% of respondents. This corresponds with the revelation that close to 60% believe that they have a poor or fair understanding of mental disorders. About 30% of respondents said they do not stock psychotropic drugs at all, mainly due to medico-legal reasons, and low prescription requests. Our findings highlight the need for more training of CPs in managing patients with mental disorders.

Patients and Caregivers Helping to Shape the Undergraduate Pharmacy Mental Health Curriculum

Objective. To develop a model system for involving patients and caregivers in curriculum development of mental health education in an undergraduate pharmacy program. Methods. Purposive recruitment was used to convene a focus group of nine people with experience in using mental health services from either the patient or caregiver perspective. Group members were asked about their experience with using pharmacy services and their suggestions for enhancement of the undergraduate curriculum. Thematic analysis was conducted independently by two researchers. Results. Patients and caregivers believed that pharmacists could contribute to the care of people who experience mental health conditions by supporting shared decision making, providing information, actively managing side effects of psychotropic medication, and conducting regular medication review. Subjects suggested that the pharmacy undergraduate curriculum should introduce mental health from the beginning, include self-care for students, integrate mental and physical health education, and enhance students' communication skills. The curriculum should include broader issues relevant to mental health beyond the use of medication, such as stigma, the recovery approach, and interprofessional cooperation. These changes could support graduates in engaging proactively with people experiencing mental health difficulties. Conclusion. Involving patients and caregivers in the design of an undergraduate pharmacy curriculum in mental health resulted in a more person-centered and student-centered approach to mental health education at our university. Ultimately, the changes made to the undergraduate curriculum will improve the ability of pharmacy graduates to better meet the needs of patients.

North Carolina community pharmacists' attitudes about suicide and willingness to conduct suicidal ideation assessment: A cross-sectional survey study

BACKGROUND

Suicide is a major and growing public health problem. Pharmacists are one of the most accessible members of the health care team. Due to their unique place in the health care system, pharmacists may be an ideal resource for monitoring patients at risk of suicide. The objectives of this study were to: (1) investigate community pharmacists' attitudes toward suicide; (2) identify pharmacist-reported barriers to suicidal ideation assessment; and (3) evaluate facilitators and barriers to pharmacists conducting suicidal ideation assessment.

METHODS

An anonymous questionnaire was distributed to North Carolina (NC) community pharmacists. Measures included contact with suicide, perceived role in suicidal ideation assessment, Attitudes Towards Suicide (ATTS), and barriers in suicidal ideation assessment. Multivariable logistic regression was used to analyze the data.

RESULTS

There were usable and complete data for 225 participants (3.52% response rate). The median ATTS score was 70 (IQR = 7). Community pharmacists were significantly more likely to perform a suicidal ideation assessment at least sometimes when (s)he reported a lower number of barriers (OR = 0.70, 99.5% CI = 0.51-0.98) and when (s)he agreed or strongly agreed that they knew how to help someone who was suicidal (OR = 6.63, 99.5% CI = 1.74, 25.23). The most common barrier to suicidal ideation assessment was lack of education in mental health screening (n = 176).

CONCLUSIONS

Suicide prevention education programs for pharmacists may need to address reducing barriers, increasing knowledge about suicide, and improving self-efficacy. Targeting these areas may lead more pharmacists conducting these assessments.

Pharmacy Students' Reflections on an Experiential Learning Visit to a Psychiatric Hospital

Objective. To create a brief, experiential educational intervention for undergraduate pharmacy students aimed at developing appropriate attitudes, knowledge, and skills for the delivery of recovery-focused pharmacy services to people with mental illness, and to elicit student perceptions of the value and impact of the intervention. Methods. A brief intervention was developed in which a cohort of 44 fourth-year pharmacy students attended a psychiatric teaching hospital in groups of 10 to12. The intervention was integrated into the therapeutics module, and was based on Fink's taxonomy of learning. Delivery of the intervention included input from a multidisciplinary team of mental health professionals and the use of active-learning strategies to give students an insight into the holistic approach to care and the patient journey. Students participated in an exercise in reflective practice following the visit. Content analysis was performed on the reflective writings of consenting students to identify themes and insights gained. Results. Thirty-eight of the 44 students gave their consent for their reflective writings to be analyzed for the purpose of this research. Students expressed some apprehension before their visit to the hospital, but later gained an appreciation of the patient experience of care in the psychiatric setting. Students also described having a greater appreciation of the role of the pharmacist in caring for psychiatric patients as well as an insight into the role of other health care professionals and interventions supporting recovery. Conclusion. A brief experiential intervention helped students integrate their learning and appreciate the value of their expertise in supporting those experiencing mental illness.

A survey of Canadian and Australian pharmacists' stigma of suicide

Background

There is limited information available regarding community pharmacists' stigma of suicide. Pharmacists regularly interact with people at risk of suicide and stigmatizing attitudes may impact care.

Objective

To measure community pharmacists' stigma of suicide.

Method

Pharmacists in Canada and Australia completed an online survey with the Stigma of Suicide Scale-Short Form. Data were analysed descriptively and with univariate and multivariate analyses.

Results

Three hundred and ninety-six pharmacists returned completed surveys (Canada n = 235; Australia n = 161; female 70%; mean age = 38.6 ± 12.7 years). The rate of endorsement of stigmatizing terms was low overall. Canadian and Australian pharmacists differed (p < 0.05) for several variables (e.g. age, friend or relative with a mental illness, training in mental health crisis). Pharmacists without someone close to them living with a mental illness were more likely to strongly agree/agree with words describing those who die by suicide as pathetic, stupid, irresponsible, and cowardly. Those without a personal diagnosis of mental illness strongly agreed/agreed with the terms immoral, irresponsible, vengeful, and cowardly. More Australian pharmacists strongly agreed/agreed that people who die by suicide are irresponsible, cowardly, and disconnected. Independent variables associated with a higher stigma were male sex, Australian, and negative perceptions about suicide preventability.

Conclusion

Community pharmacists frequently interact with people at risk of suicide and generally have low agreement of stigmatizing terms for people who die by suicide. Research should focus on whether approaches such as contact-based education can minimize existing stigma.

Development and Psychometric Evaluation of a Questionnaire to Measure Attitudes Toward Perinatal Depression and Acceptability of Screening: The PND Attitudes and Screening Acceptability Questionnaire (PASAQ)

Prior to implementing perinatal depression (PND) screening, health-care professionals' acceptability of screening and their attitudes toward PND should be explored. We aimed to develop and psychometrically evaluate a questionnaire measuring PND attitudes and screening acceptability. A 31-item questionnaire was developed based on published questionnaires and a systematic review on PND screening acceptability. Principal components analysis with direct oblimin rotation was used to determine construct validity. Reliability of the resulting components was explored using Cronbach's α. Pharmacists (N = 153) were recruited from the Australian Association of Consultant Pharmacy. The scree plot and parallel analysis indicated a six-component solution. Due to cross-loadings (<.2 difference) and low loadings (<.445), it was necessary to delete 7 items. The six components explored PND screening acceptability, screening readiness, stigma, attitudes toward treatment efficacy, medication counseling responsibility, and the effect PND has on others. The six components explained 59.8% of the variance. Item loadings ranged from .445 to .880. Cronbach's α for each component ranged from .45 to .86. The construct validity and internal consistency reliability of the PND attitudes and screening acceptability questionnaire have been explored. Future measurements of these constructs using uniform, psychometrically sound scales may facilitate comparisons across studies.

Patient perspectives on the role of community pharmacists for antidepressant treatment: A qualitative study

Objectives

Patients prescribed antidepressant drug treatment (ADT) for major depression report several needs in relation to their treatment, and a large proportion of these patients will end ADT prematurely. Community pharmacists may play an important role in monitoring ADT and supporting these patients. However, little is known about patient experiences of the services provided in community pharmacies. The objectives of this study were to 1) explore patients' experiences with the services community pharmacists provide for ADT and 2) identify potential avenues for improvement of pharmacists' services within the context of ADT.

Methods

A qualitative descriptive exploratory study was conducted among individuals diagnosed with major depression who had initiated ADT at some point in the 12 months prior to their participation in the study. A total of 14 persons recruited in a local health centre and a community-based organization participated in individual interviews. A thematic analysis of the interview transcripts was conducted.

Results

Pharmacists tend to concentrate their involvement in treatment at initiation and at the first refill when questions, uncertainties and side effects are major issues. Patients felt that the pharmacists' contributions consisted of providing information and reassurance; in these respects, their needs were met. Participants had few ideas as to what additional services pharmacists could implement to improve patients' experience with ADT. Patients' sole expectations were that pharmacists extend this information role to the whole length of the treatment and enhance the confidentiality of discussions in pharmacy.

Conclusion

Pharmacists should provide counselling throughout the entire treatment rather than passively waiting for patients to ask their questions. However, facilitation of open discussions may not be achieved unless confidentiality at pharmacies is secured.

Evaluating the Impact of an Anti-stigma Intervention on Pharmacy Students' Willingness to Counsel People Living with Mental Illness

Third-year pharmacy students (n = 88) participated in an anti-stigma intervention program consisting of presentations, videos, discussion and active-learning exercises. Willingness to counsel (WTC) people with mental illness (MI) was evaluated using immediate pre and post-tests comparing diabetes, depression and schizophrenia. At pre-test, WTC diabetes was highest (higher = increased WTC) while schizophrenia was the lowest. There were no statistically significant differences between pre/post-test WTC for diabetes and depression, while schizophrenia WTC increased significantly (p < 0.05). At post-test, diabetes WTC was significantly higher than depression and schizophrenia (p < 0.0001). Regression results for WTC depression showed that comfortability and gender were significant (p < 0.05) predictors. Regression results for WTC schizophrenia showed that comfortability was a significant (p < 0.05) predictor. As highly accessible healthcare providers, pharmacists have the potential to positively impact healthcare, but this depends on WTC. Colleges of pharmacy may consider instituting policies that support experiential education involving counseling people living with MI, as this may increase comfortability.

From personal crisis care to convenience shopping: an interpretive description of the experiences of people with mental illness and addictions in community pharmacies

BACKGROUND

The role of community pharmacists is changing globally with pharmacists engaging in more clinically-oriented roles, including in mental health care. Pharmacists' interventions have been shown to improve mental health related outcomes but various barriers can limit pharmacists in their care of patients. We aimed to explore the experiences of people with lived experience of mental illness and addictions in community pharmacies to generate findings to inform practice improvements.

METHODS

We used interpretive description methodology with analytic procedures of thematic analysis to explore the experiences of people with lived experience of mental illness and addictions with community pharmacy services. Participants were recruited through multiple mechanisms (e.g., paper and online advertisements), offered honorarium for their time, and given the option of a focus group or interview for participation in our study. Data were gathered during July to September of 2012. Interviews and focus groups were audio-recorded, transcribed verbatim, and analyzed by two researchers.

RESULTS

We collected approximately nine hours of audio data from 18 individuals in two focus groups (n = 12) and six individual interviews. Fourteen participants were female and the average age was 41 years (range 24 to 57 years). Expectations, decision-making, and supports were identified as central themes underlying the community pharmacy experiences of people with lived experience of mental illness and addictions. Eight subthemes were identified including: relationships with pharmacy staff; patient's role in the pharmacist-patient relationship; crisis and triage; privacy and confidentiality; time; stigma and judgment; medication-related and other services; and transparency.

CONCLUSIONS

People with lived experience of mental illness and addictions demonstrate a high regard and respect for pharmacist's knowledge and abilities but hold conservative expectations of pharmacy health services shaped by experience, observations, and assumptions. To some extent, expectation management occurs with the recognition of the demands on pharmacists and constraints inherent to community pharmacy practice. Relationships with pharmacy staff are critical to people with lived experience and influence their decision-making. Research in the area of pharmacists' roles in crises and triage, especially in the area of suicide assessment and mitigation, is needed urgently.

Attitudes and attributes of pharmacists in relation to practice change - A scoping review and discussion

BACKGROUND

Multiple barriers and facilitators to the uptake of cognitive services in pharmacy practice have been identified. Pharmacists' attitudes and attributes have been described as barriers and facilitators in relation to the uptake of extended pharmacy services, in addition to those of a more systemic nature.

OBJECTIVES

To systematically scope and review the literature describing pharmacists' attitudes and attributes in relation to the implementation of cognitive services or role extension and to critically analyze and discuss their relevance as barriers or facilitators.

METHOD

A scoping review of the literature on attitudes and attributes of pharmacists in relation to pharmacy practice was performed, including 47 articles on attitudes and 12 on attributes, forming the basis for a critical analysis within theoretical frameworks.

RESULTS

Pharmacists' attitudes toward role extensions and new pharmacy service models are generally positive and their personal attributes and personality traits appear favorable for roles as health professionals. Pharmacists perceived a number of barriers to the uptake of extended roles.

CONCLUSION

Pharmacists' attributes, including personality traits, and attitudes favor the implementation of cognitive and patient-focused health care services and should not be regarded as major barriers to the uptake of extended pharmacy practice roles. Framing their attitudes and attributes within the theories of planned behavior and personality trait theories indicates that individual motivation needs to be underscored by systemic support for pharmacy practice change to succeed on a wide scale.

A Systematic Review of the Effects of Continuing Education Programs on Providing Clinical Community Pharmacy Services

Objective. To summarize the effects of media methods used in continuing education (CE) programs on providing clinical community pharmacy services and the methods used to evaluate the effectiveness of these programs. Methods. A systematic review was performed using Medline, SciELO, and Scopus databases. The timeline of the search was 1990 to 2013. Searches were conducted in English, Portuguese, and Spanish. Results. Nineteen articles of 3990 were included. Fourteen studies used only one media method, and the live method (n=11) was the most frequent (alone or in combination). Only two studies found that the CE program was ineffective or partially effective; these studies used only the live method. Most studies used nonrobust, nonvalidated, and nonstandardized methods to measure effectiveness. The majority of studies focused on the effect of the CE program on modifying the knowledge and skills of the pharmacists. One study assessed the CE program's benefits to patients or clients. Conclusion. No evidence was obtained regarding which media methods are the most effective. Robust and validated methods, as well as assessment standardization, are required to clearly determine whether a particular media method is effective.

Impact of a Mental Illness Stigma Awareness Intervention on Pharmacy Student Attitudes and Knowledge

Objective. To determine if exposure to an intervention course impacts pharmacy students' mental health stigma (MHS) and mental health knowledge (MHK). Methods. A one-group pre/posttest intervention study of third-year pharmacy students (N=120) was conducted. Dependent variables were subdomains of MHS (recovery, safety, disclosure, separation, comfort) which were measured on a 5-point Likert scale (1=strongly disagree; 5=strongly agree). Mental health knowledge was measured with 10 true/false questions. The 2.5-hour intervention included presentations, videos, discussions, and active-learning exercises. Pre/posttests were administered, and data were analyzed using paired t tests and McNemar's tests. Results. Among responding students (n=88; 73.3% response rate), the following stigma subdomains significantly decreased after the intervention for depression and schizophrenia: recovery, safety, separation, and comfort. Mental health knowledge scores significantly increased from 5.9 (1.5) to 6.8 (1.5). Conclusion. Pharmacy students' MHS and MHK related to depression and schizophrenia can be improved through a brief and interactive anti-stigma intervention.

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.

Effectiveness of a tailored training programme in behaviour change counselling for community pharmacists: A pilot study

OBJECTIVE

To undertake a pilot study assessing effectiveness of a tailored training programme in behaviour change counselling (BCC) for community pharmacists on, their competence and confidence in delivering behaviour change consultations, skill retention over time and impact on practice.

METHODS

Community pharmacists (N=87) attending Primary Care Trust training were given study information and invited to take part. Baseline BCC competence of consenting pharmacists (n=17) was assessed using the Behaviour Change Counselling Index (BECCI). Following BCC training, competence was reassessed at 1, 3 and 6 months. Friedman's test was used to compare median BECCI item scores at baseline and after 6 months. Structured interviews were conducted to assess pharmacists' confidence in BCC consultations after training.

RESULTS

Baseline BECCI scores of 0-2 demonstrated pharmacists had not reached competence threshold. Six months after training, BECCI scores improved significantly from baseline (p<0.05). Competence in delivering BCC (scores of 3-4) was achieved at 3 months, but lost at 6 months for some items. After training, pharmacists felt confident in delivering BCC.

CONCLUSION

Training pharmacists enabled them to deliver BCC competently and confidently.

PRACTICE IMPLICATIONS

BCC aligns with pharmacist-patient consultations. It took 3 months to achieve competence. Ongoing support may be needed to maintain competence long-term.

Community pharmacists' support improves antidepressant adherence in the community

The treatment goal of major depressive disorder (MDD) is achieving and maintaining remission. One of the major obstacles in attaining remission is poor adherence to the medication regimen. Community pharmacists (CPs) are accessible to primary care patients and are in a unique position to help improve adherence. The aim was to compare the effectiveness of pharmacist intervention with standard care for patients with MDD. This was an exploratory controlled trial conducted in 17 general pharmacies with clinical pharmacists in Israel. Participants were patients with MDD prescribed escitalopram by their general practitioner. CP medication review was initiated at enrollment, with face-to-face pharmacist adherence support at treatment initiation and every month throughout the study. Treatment as usual (TAU) was derived from computerized medical charts for the same pharmacies during the same time period. Comparison with published 'historical' controls was also carried out. No blinding was possible. Continuous antidepressant treatment at 6 months as reflected in computerized pharmacy records was the primary outcome. Within a 1-year period, 173 patients were enrolled. There were 49 men (28%) and 124 women (72%) in the CP group, mean age 53.9 ± 18.9 years. There were 4079 men (32%) and 8667 women (68%) in the TAU group, mean age 50.4 ± 17.8 years. Ninety-six patients (55%) completed 6 months of antidepressant treatment. At 1 month, the adherence rate was 71% in the CP arm and at 6 months, the rates were 55% versus published norms of 42% (P=0.004). At 1 month, the adherence rate was 57% (N=7256) in the TAU arm and at 6 months, the rate was 15.2% (N=1934) (compared with CP rates: P<0.0001). There were no differences between sites in adherence rates. CPs participating in this study reported higher levels of confidence in supporting MDD patients at the end of the study. This is the first trial of pharmacist adherence support in Israel, and shows benefits for patients in the community with MDD.

Confronting inequities: A scoping review of the literature on pharmacist practice and health-related disparities

BACKGROUND

An expanding body of literature is exploring the presence and impact of health and health care disparities among marginalized populations. This research challenges policy makers, health professionals, and scholars to examine how unjust and avoidable inequities are created at the societal, institutional, and individual level, and explore strategies for mitigating challenges.

OBJECTIVES

Recognizing the significance of this broader conversation, this scoping review provides an overview of pharmacy-specific research attentive to health-related disparities.

METHODS

Following Arksey and O'Malley's framework, a rigorous screening process yielded 93 peer-reviewed and 23 grey literature articles, each analyzed for core themes.

RESULTS

Lending critical insight to how pharmacy practice researchers are conceptualizing and measuring health inequities, this review highlights three paths of inquiry evident across this literature, including research focused on what pharmacists know about marginalized groups, how pharmacists perceive these groups, and how they provide services. Striving to drive research and practice forward, this review details research gaps and opportunities, including a need to expand the scope of research and integrate knowledge.

CONCLUSIONS

As pharmacists endeavor to provide equitable and impactful patient care, it is essential to understand challenges, and build strong evidence for meaningful action.

Perspective of community pharmacists on their practice with patients who have an antidepressant drug treatment: findings from a focus group study

BACKGROUND

Around 2/3 of patients with major depression discontinue their antidepressant drug treatment (ADT) prematurely. Community pharmacists can rely on their regular contacts with patients to identify and support those experiencing difficulties with their ADT.

OBJECTIVE

The aim of this study is to describe pharmacists' perceptions with respect to their practices related to patients having an ADT.

METHODS

A qualitative study was conducted based on 6 focus groups involving 43 community pharmacists in 5 regions of Quebec province, Canada. Verbatim transcripts of focus groups were analyzed using computer-assisted thematic analysis.

RESULTS

The discussions revealed three major aspects of the participants' pharmacy practice: convincing patients to initiate ADT, dealing with side effects in the first weeks of the treatment, and taking a reactive approach to managing the treatment for the remainder of the follow-up. Discussions also enabled participants to identify the challenges they face concerning their practice with patients who have an ADT, and voice their recommendations for improving pharmacy practice and ultimately patient adherence to ADT.

CONCLUSIONS

Pharmacists wishing to help their patients to adequately manage their ADT face important barriers. Potential solutions include tools designed to help pharmacists better detect and intervene in ADT-related problems. Study findings will guide the on-going development of training and tools to support pharmacists' practice in this context.

Enhancing collaborative pharmaceutical care for patients with chronic kidney disease: survey of community pharmacists

BACKGROUND

The Kidney Care Clinic at Sunnybrook Health Sciences Centre provides multidisciplinary care for patients with stage 4 or 5 chronic kidney disease. These patients are at high risk of drug therapy problems. Clinic pharmacists review medications and provide recommendations at each visit, but potential gaps in care exist between clinic visits. Community pharmacists are ideally situated to identify and resolve drug therapy problems between visits.

OBJECTIVES

To determine community pharmacists' confidence in managing care for patients with chronic kidney disease; to identify opportunities for improving collaboration between clinic and community pharmacists; and to determine the key clinical information that community pharmacists would use when caring for these patients.

METHODS

An anonymous survey was sent by mail and electronically to community pharmacies that were providing prescription medications for clinic patients. A total of 318 surveys were sent to 96 pharmacies. Data analysis was based on descriptive statistics, including frequencies, ranges, and measures of central tendency.

RESULTS

Fifty-one completed surveys were returned (response rate 16%). Thirty-five (69%) of the responding pharmacists were not aware or were unsure that a patient from the Kidney Care Clinic was a client of their pharmacy. Forty-six (90%) were confident in providing counselling about medications used to manage chronic kidney disease, and 32 (63%) indicated confidence in recommending drug dosing changes based on kidney function. Forty-five (88%) of the pharmacists indicated a willingness to play a greater role in reviewing medications for patients with chronic kidney disease, and all agreed that they would benefit from education about the complications of this disease and their management. Clinical information ranked most useful included an updated medication list with indications and details regarding recent medication changes.

CONCLUSIONS

Community pharmacists indicated willingness to have greater involvement in the care of patients with chronic kidney disease. The survey results revealed a need to increase awareness of clinic patients among community providers. Participants were receptive to continuing education, and initial efforts should focus on dosing adjustments of renal drugs and the complications of chronic kidney disease. Tools for transferring clinical information must be developed.

Pharmaceutical care for patients with COPD in Belgium and views on protocol implementation

BACKGROUND

A protocol-based pharmaceutical care program (the PHARMACOP-protocol) focusing on patient counselling during prescription filling has shown to be effective in patients with chronic obstructive pulmonary disease (COPD). However, implementation of this protocol in daily practice has not yet been studied.

OBJECTIVE

To describe current implementation level of the items included in the PHARMACOP-protocol in Belgian community pharmacies and to evaluate pharmacists' perspectives on the implementation of this protocol in daily practice.

METHOD

A cross-sectional study was conducted from April to June 2012, in randomly selected community pharmacies in Flanders. Pharmacists were questionned using structured interviews.

RESULTS

125 pharmacies were contacted and 80 managing pharmacists (64 %) participated. In >70 % of pharmacies, 4/7 protocol items for first prescriptions and 3/5 protocol items for follow-up prescriptions were already routinely implemented. For first and follow-up prescriptions, respectively 39 (49 %) and 34 pharmacists (43 %) stated they would need to spend at least 5 min extra to offer optimal patient counselling. Most mentioned barriers preventing protocol implementation included lack of time (80 %), no integration in pharmacy software (61 %) and too much administrative burden (58 %).

CONCLUSION

Approximately 50 % of the PHARMACOP-protocol items are currently routinely provided in Belgian community pharmacies. Nearly all interviewed pharmacists are willing to implement the protocol fully or partially in daily practice.

Pharmacy students' experiences in provision of community pharmacy mental health services

BACKGROUND

Little information is available describing the pharmacy student's experience working in community practice with people with lived experience of mental illness. Students' perspectives as observers, learners, technical staff and future pharmacists are important.

OBJECTIVE

To gain a better understanding of the pharmacy student experience in community pharmacy-based service provision to people with lived experience of mental illness.

METHODS

We conducted a qualitative study using interpretive description and application of the Theoretical Domains Framework. Focus groups were held with third- and fourth-year undergraduate pharmacy students from one Canadian university.

RESULTS

Two student focus groups were held in the fall of 2012 with 11 students (7 third year and 4 fourth year), 6 women and 5 men, mean age 24.5 (range, 21 to 30) years, averaging 3.2 years (range, 2 weeks to 7 years) of cumulative, mostly part-time, community pharmacy experience. Three broad themes emerged from the pharmacy student experience: (1) business tension; (2) roles, responsibilities and relationships; and (3) stigma. Students discussed their own roles, responsibilities and relationships in a pluralistic identity experience (i.e., pharmacy student, technician, future pharmacist). Application of the Theoretical Domains Framework demonstrated numerous influences on behaviour.

CONCLUSIONS

From the students' description of community pharmacy-based care of people with lived experience of mental illness, significant issues exist with current practices and behaviours. Advancing the role of pharmacists and pharmacy students to meet the needs of people with mental illness will require strategies to address multifactorial influences on behaviour.

Impact of training on pharmacists' counseling of patients starting antidepressant therapy

OBJECTIVE

To measure the impact of a one-day depression-related training program on pharmacists' counseling of unannounced "mystery shoppers" (MS) starting antidepressant therapy.

METHODS

Clustered RCT pharmacies; intervention group pharmacists received communication skills training related to depression (n=21); control pharmacists did not (n=19). Eight months after training, the 40 community pharmacies were visited by MS with a first prescription for antidepressants. The pharmacy interactions were recorded and analyzed using the Roter Interaction Analysis System (RIAS). Mann-Whitney U tests were used to evaluate the impact of training on pharmacy interactions and MS evaluations of the pharmacists' skills and attitudes.

RESULTS

Interactions of intervention group pharmacists were significantly longer and consisted of more education and counseling statements about lifestyle and psychosocial concerns. Intervention group pharmacists asked more questions about medical condition and therapeutic regimen, as well as socioemotional concerns. MS gave more socioemotional information to intervention group pharmacists and were more positive in their assessment of these pharmacists' skills and attitudes (p values<0.05).

CONCLUSION

Pharmacist training in depression care can positively affect the quality of patient care.

PRACTICE IMPLICATIONS

Postgraduate training in depression related services is a worthwhile approach to improve the quality of pharmaceutical care.

A depression training session with consumer educators to reduce stigmatizing views and improve pharmacists' depression care attitudes and practices

OBJECTIVE

To measure the impact of a depression training day for pharmacists that included a 75-minute session with a consumer educator.

DESIGN

The training day included interactive lectures on depression; the effects and side effects of and indications for the use of antidepressants; adherence issues; non-drug treatment options for depression; and basic skills in communication. Pharmacists also participated in a session with a consumer educator and in counseling exercises that included role playing.

ASSESSMENT

The study used a randomized, clustered, comparative design to measure pharmacists' stigma, attitudes, and current practice related to the provision of pharmaceutical care to people with depression. Mean scores for depression-care practice after the training session were significantly higher in the intervention group than in the control group. Analysis of the changes between baseline and postintervention measures in both the control and intervention groups confirmed a significant difference in the change in both social distance and practice but no significant difference in the change in attitude between the 2 groups of pharmacists.

CONCLUSION

A continuing-education depression training day for pharmacists that involve consumer educators may improve the care delivered in the community pharmacy to people with depression.

Effectiveness of contact-based education for reducing mental illness-related stigma in pharmacy students

BACKGROUND

A strategy for reducing mental illness-related stigma in health-profession students is to include contact-based sessions in their educational curricula. In such sessions students are able to interact socially with a person that has a mental illness. We sought to evaluate the effectiveness of this strategy in a multi-centre study of pharmacy students.

METHODS

The study was a randomized controlled trial conducted at three sites. Because it was necessary that all students receive the contact-based sessions, the students were randomized either to an early or late intervention, with the late intervention group not having participated in the contact-based education at the time when the primary outcome was assessed. The primary outcome, stigma, was assessed using an attitudes scale called the Opening Minds Survey for Health Care Providers (OMS-HC).

RESULTS

We initially confirmed that outcomes were homogeneous across study centres, centre by group interaction, p = 0.76. The results were pooled across the three study centres. A significant reduction in stigma was observed in association with the contact-based sessions (mean change 4.3 versus 1.5, t=2.1, p=0.04). The effect size (Cohen's d) was 0.45. A similar reduction was seen in the control group when they later received the intervention.

CONCLUSIONS

Contact-based education is an effective method of reducing stigma during pharmacy education. These results add to a growing literature confirming the effectiveness of contact-based strategies for stigma reduction in health profession trainees.