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Howe J, Lindsey L. The role of pharmacists in supporting service users to optimise antipsychotic medication. Int J Clin Pharm 2023; 45:1293-1298. [PMID: 37704913 PMCID: PMC10600309 DOI: 10.1007/s11096-023-01630-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 07/22/2023] [Indexed: 09/15/2023]
Abstract
Pharmacists have a contribution to make in improving optimising medication use for people on antipsychotic medication. The rates of prescribing antipsychotics have increased in England with an 18% rise from 2015 to 2020. People on antipsychotic medication are not treated as equal partners in conversations about their medications. This can leave people to make decisions about their antipsychotic medications without input from their prescribers which can have significant consequences for individuals. Involving people in the decision-making process, as experts on their own condition, has the potential to improve treatment outcomes. The evidence suggests that involving pharmacists in supporting people with serious mental illnesses will lead to improved clinical outcomes. Key areas for pharmacist involvement are providing information, education and counselling on antipsychotic medication and the side effects and reducing polypharmacy especially when antipsychotics are prescribed off license.
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Affiliation(s)
- Jo Howe
- School of Pharmacy, Aston University, Birmingham, B4 7ET, England.
| | - Laura Lindsey
- Faculty of Medical Sciences, School of Pharmacy, Newcastle University, Newcastle upon Tyne, NE1 7RU, England
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Alshammari MK, Alotaibi NM, Al Suroor SN, Al Saed RS, Al-Hamoud AA, Alluwaif MA, Alamry MA, Alshehri NM, Alfaidi BE, Alzahrani RA, Almutiri BB, Alosaimi YS, Alosman AS, Alharbi AA, Alenezi AM. Global Advancement in Pharmacy Services for Mental Health: A Review for Evidence-Based Practices. Healthcare (Basel) 2023; 11:healthcare11081082. [PMID: 37107916 PMCID: PMC10137606 DOI: 10.3390/healthcare11081082] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 03/24/2023] [Accepted: 03/27/2023] [Indexed: 04/29/2023] Open
Abstract
The symptoms of psychiatric infirmities have variability, and selected drug regimens for mental illness are comparatively complex and individualized; therefore, pharmacy services vary with respect to patients, diseases, healthcare settings, community structures, and countries. Clinical pharmacy services for mental health (MH) are continuously being upgraded. A structured search of the literature was performed in the Cochrane, PubMed (Medline), PsycINFO, Google scholar, Scopus, Science Direct, and Springer Links databases. The title and abstract of each retrieved article were evaluated for relevance. To remove uncertainty and ambiguity, the full-text articles were retrieved and examined for relevance. The articles were further assessed on the basis of inclusion and exclusion criteria. Narrative synthesis was performed, creating new categories and relevant subcategories and further subsections. The articles and the results were assessed for quality and bias. Pharmacists have a range of expertise in psychiatric care. The services can be classified as conventional, extended, and advanced pharmacy services. Conventional services include the quality use of medicines in healthcare settings and medication support services in communities that ensure medication adherence. Pharmacists perform extended roles in collaborative medication therapy management, multidisciplinary community mental health teams, collaborative care, patient education, home medication review, hospital-to-home transit, and screening services. In the USA, the role of pharmacists was advanced by prescribing as collaborative and interim prescribers. Australia launched an accredited program for psychiatric first-aid pharmacists. Pharmacists can provide mental care to rural populations using health technology. The role of pharmacists in MH is appreciated either independently or as a team member. Patients and healthcare providers rank the services of pharmacists in MH highly. Still, there is a margin for improvement in the training of pharmacists. Pharmacists cannot provide sufficient time to their patients. Public awareness about the role of pharmacists in MH needs more attention. Moreover, the training of psychiatric pharmacists should be standardized around the world.
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Affiliation(s)
| | - Nawaf M Alotaibi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Northern Border University, Rafha 73213, Saudi Arabia
| | | | - Rami Saleh Al Saed
- Department of Pharmacy, Maternity and Children Hospital Dammam, Dammam 63400, Saudi Arabia
| | - Aliaa Ali Al-Hamoud
- Department of Pharmacy, Maternity and Children Hospital Dammam, Dammam 63400, Saudi Arabia
| | - Mawahb Ahmed Alluwaif
- Department of Pharmacy, Maternity and Children Hospital Dammam, Dammam 63400, Saudi Arabia
| | - Mona Awadh Alamry
- Department of Pharmacy, Khamis Mushait General Hospital, Khamis Mushait 62441, Saudi Arabia
| | | | - Bashaier Eed Alfaidi
- Department of Pharmacy, Umluj General Hospital, Ministry of Health, Northern Region, Umluj City 48312, Saudi Arabia
| | | | | | - Yousef Saud Alosaimi
- Department of Pharmacy, Dr. Sulaiman Al Habib Hospital, Riyadh 14926, Saudi Arabia
| | - Amal Saeed Alosman
- Department of Pharmacy, King Khalid University, South Zone, Abha 62541, Saudi Arabia
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Vadiei N, Lee JK. An innovative approach to teaching depression and anxiety medication management: Virtual choose your own adventure, psychiatry edition. Ment Health Clin 2022; 12:225-231. [PMID: 36071737 PMCID: PMC9405630 DOI: 10.9740/mhc.2022.08.225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 06/20/2022] [Indexed: 12/05/2022] Open
Abstract
Introduction Rates of depression and anxiety continue to increase in the United States. It's important for pharmacy students to graduate knowledgeable and confident in treating these disorders. The purpose of this study was to evaluate whether a virtual active-learning exercise (choose your own adventure) is helpful in teaching students how to manage medications for depression and anxiety. Methods Third-year pharmacy students responded to preactivity questions and then worked on a single patient case in which the presenting problem is worsening depression and anxiety. Students worked in virtual groups of 4 to 5 to select 1 treatment among 5 multiple-choice options and documented the rationale for their choice. Each multiple-choice option led to a different follow-up case. After writing their assessment and plan, the instructor debriefed on therapeutic concepts from each follow-up case. Students then answered postactivity questions and participated in a voluntary survey consisting of 10 retrospective questions. Results Of 106 participants, 85 completed the survey (80.2% response rate). Most agreed that their understanding of treatment of depression and anxiety disorders increased following participation (92.9% strongly/somewhat agreed). This was supported by an increase in the percentage of correct responses on the knowledge questions (preactivity: 67.2%, n = 91; postactivity: 83.5%, n = 97; P = .01). Additionally, students reported their confidence in their understanding of depression and anxiety management increased following activity participation (93.0% strongly/somewhat agreed). Discussion The virtual active-learning exercise improved student knowledge and confidence in managing depression and anxiety treatments. Educators teaching depression and anxiety pharmacotherapy may consider implementing such activity into their lecture(s).
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Affiliation(s)
| | - Jeannie K. Lee
- 2 Assistant Dean and Associate Professor, Department of Pharmacy Practice and Science, The University of Arizona College of Pharmacy, Tucson, Arizona
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Qunaibi EA, Afeef MM, Othman B, Al-Zoubani AZ, Basheti IA. Perspectives of psychiatric patients in rural areas of Jordan: Barriers to compliance and pharmacist role. Int J Clin Pract 2021; 75:e14575. [PMID: 34171149 DOI: 10.1111/ijcp.14575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 06/24/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Successful management of psychiatric disorders is affected by patient perspectives and several barriers, that is, conceptual, psychological, social, or logistic reasons that can decrease patient adherence to therapy. In this perspective, pharmacists have a vital role in identifying patients in need of help and in dealing with barriers. OBJECTIVE The aim of this study was to investigate perspectives of patients diagnosed with psychiatric disorders, living in rural areas in Jerash, Jordan, regarding their awareness about their conditions, including religious and cultural factors, adherence to their treatment and related barriers, with special focus on pharmacist's role. METHODS This cross-sectional survey study was conducted in Jordan from August to November 2019. A validated questionnaire was administered by two pharmacy students via a structured interview with patients waiting for their appointment in the psychiatric clinic. Data were analysed using the Statistical Package for the Social Sciences. RESULTS One hundred twenty patients (age 39.4 ± 9.5, 66.7% males) completed the questionnaire. Most of them (71.0%) reported adherence to their medications, and 47.5% reported complete control of their symptoms with treatment. Most patients (59.2%) reported that they perceive their psychiatric problem in terms of religious faith as being counted for their favour in the Hereafter, and 52.5% of them always/usually looked at themselves positively and unaffected by their psychiatric problem; with both factors correlating significantly with better treatment adherence (P < .045 and P < .001; respectively). Barriers affecting adherence included mainly suffering from adverse effects (31.9%) and being unconvinced that they needed a medication (23.3%). Only 14.2% of patients reported that they refer to the pharmacist to get information about their medications. CONCLUSION This study shows suboptimal symptom control of psychiatric patients in Jerash. Nonadherence is an issue, with barriers identified. Positive religious and self-image perspectives correlated with better adherence. Patient referral to pharmacists is minimal and needs to be optimised.
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Affiliation(s)
- Eyad A Qunaibi
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, Jerash University, Amman, Jordan
| | | | - Bayan Othman
- Department of Pharmaceutical Sciences and Pharmaceutics, Faculty of Pharmacy, Applied Sciences Private University, Amman, Jordan
| | | | - Iman A Basheti
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Sciences Private University, Amman, Jordan
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Kretchy IA, Blewuada EK, Debrah AB. A qualitative study exploring community pharmacists’ perspectives of child and adolescent mental healthcare. SCIENTIFIC AFRICAN 2021. [DOI: 10.1016/j.sciaf.2021.e00969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Expanding pharmacists' roles: Pharmacists' perspectives on barriers and facilitators to collaborative practice. J Am Pharm Assoc (2003) 2020; 61:213-220.e1. [PMID: 33359117 DOI: 10.1016/j.japh.2020.11.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 11/30/2020] [Accepted: 11/30/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The pharmacy profession is shifting from transactional dispensing of medication to a more comprehensive, patient-centered model of care. Collaborative practice agreements (CPAs) extend the role of a pharmacist to initiate, monitor, modify, and discontinue drug therapies and provide other clinical services. Although collaborative practice has been shown to improve health system efficiency and patient outcomes, little is known about how pharmacists perceive CPAs. To explore pharmacists' perspectives of CPAs, including barriers and facilitators to CPA implementation. METHODS Semistructured key informant interviews were used to elicit information from licensed pharmacists practicing in a variety of settings in Arizona. Thematic analysis was used to identify key qualitative themes. RESULTS Seventeen interviews of pharmacists with (n = 11, 64.7%) and without (n = 6, 35.3%) CPAs were conducted in April-May 2019. The pharmacists saw their role in CPAs as supportive, filling a care gap for overburdened providers. A heightened sense of job satisfaction was reported owing to increased pharmacist autonomy, application of advanced knowledge and clinical skills, and ability to have a positive impact on patients' health. Challenges to the implementation of CPAs included liability and billing issues, logistic concerns, some experiences with provider hesitancy, and lack of information and resources to establish and maintain a CPA. The barriers could be overcome with conscious team-building efforts to establish trust and prove the worth of pharmacists in health care teams; strategic engagement of stakeholders in the development of CPAs, including billing and legal departments; and mentorship in the CPA creation process. CONCLUSIONS The pharmacists in this study enjoyed practicing collaboratively and had overall positive perceptions of CPAs. As health worker shortages become more dire and pharmacy practice evolves to expand the role of pharmacists in providing direct patient care, CPAs will be an important tool for restructuring care tasks within health systems.
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AbuNaba'a Y, Basheti IA. Assessing the impact of medication management review service for females diagnosed with depression and anxiety: A randomized control trial. J Eval Clin Pract 2020; 26:1478-1489. [PMID: 31692212 DOI: 10.1111/jep.13314] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 10/14/2019] [Accepted: 10/16/2019] [Indexed: 01/02/2023]
Abstract
Rationale, aims, and objectives Depression and anxiety are common mental illnesses suffered by females worldwide. Females face treatment-related problems (TRPs), including lack of adherence to their treatment. The Medication Management Review service (MMR) can be effective in identifying and resolving the TRPs. This study sought to assess the impact of the MMR service on identifying and resolving TRPs, improving adherence, depression, and anxiety scores in females diagnosed with depression and anxiety in Jordan. Design and settings Participants were recruited into this single-blind parallel randomized controlled trial and randomized into active and control groups. A clinical pharmacist identified TRPs for all participants. Adherence, depression, and anxiety scores were assessed. Active group patients received the MMR service: pharmacist-delivered counseling and a letter with recommended changes in the patient's treatment plan were sent to the patient's psychiatrist to be applied. Control group participants did not receive the intervention. Follow-up assessments were completed for all patients at 3 months from baseline. Main outcome measures were TRPs, adherence, depression, and anxiety scores. RESULTS: Study participants (n = 73; mean age = 41.8 [SD = 16.27]) had 177 TRPs identified, with 2.42(SD = 1.06) TRPs per patient. At baseline, only 54.8% of the participants reported to be adherent to their treatment, and no significant differences were found between the groups. At follow-up, a significant decline in the number of TRPs was found for the active versus control group (active: 0.58[SD = 0.64], control: 1.78[SD = 1.13], P < .001). A significantly higher proportion of adherent patients was identified in the active (88.9%) versus control group (51.4%), P < .001. Significant improvements in the depression (P < .001) and anxiety (P = .003) scores were detected for the active versus control group. CONCLUSION: The MMR service led to a significant decrease in the number of TRPs, improved adherence, depression, and anxiety scores for females diagnosed with depression and anxiety.
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Affiliation(s)
- Yasmeen AbuNaba'a
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman, Jordan
| | - Iman A Basheti
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman, Jordan
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Pouplin M, Caty-Villa C, Meriglier L, Egron A, Parneix-Sediey L. Coordination des activités de pharmacie clinique dans une unité de psychiatrie adulte : impact clinique et médicoéconomique des interventions pharmaceutiques. ANNALES PHARMACEUTIQUES FRANÇAISES 2020; 78:415-425. [DOI: 10.1016/j.pharma.2020.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 03/19/2020] [Accepted: 04/27/2020] [Indexed: 10/24/2022]
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Davis B, Qian J, Ngorsuraches S, Jeminiwa R, Garza KB. The clinical impact of pharmacist services on mental health collaborative teams: A systematic review. J Am Pharm Assoc (2003) 2020; 60:S44-S53. [PMID: 32600986 DOI: 10.1016/j.japh.2020.05.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 02/14/2020] [Accepted: 05/09/2020] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To evaluate the clinical impact of mental health collaborative teams that include pharmacists. DATA SOURCES PubMed, PsychInfo, Clinialtrials.gov, International Pharmaceutical Abstracts. STUDY SELECTIONS Studies in which pharmacists were part of a mental health collaborative team (defined as 2 or more health care providers working together to provide enhanced mental health care services to patients), mental health clinical outcomes were measured with a validated tool, and the articles were written in English were included. Articles were searched from database inception to July 2019 and were excluded if a quantifiable comparison of mental health clinical outcomes was not included or collaboration was not described. DATA EXTRACTION Two authors independently screened titles and abstracts for relevance. Full-text articles that potentially met inclusion criteria were retrieved, read, and evaluated for inclusion using the eligibility criteria. RESULTS All 9 included studies reported improvements in mental health clinical outcomes when using collaborative teams that included pharmacists. Depression (n = 8) and post-traumatic stress disorder (PTSD) (n = 1) were the mental health conditions included in the studies. Overall, 5 of 7 of the randomized controlled trials (RCTs) had statistically significant improvement in mental health clinical outcomes between the intervention groups, which included the collaborative teams and a "usual care" groups, which did not. Four of the 5 studies were set in Veterans Affairs (VA) clinics. The 2 non-RCT pre-post studies showed improvements in clinical outcomes but did not achieve statistical significance. CONCLUSION Evidence shows that collaborative teams that include pharmacists are effective at improving mental health outcomes in patients with depression and PTSD. Future studies should include non-VA settings and other mental health conditions to understand pharmacists' impact more broadly in mental health collaborative teams. Clarifying and understanding the overlapping roles and responsibilities of members of the team may be the next step to continue improving mental health clinical outcomes.
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Andrade HS, Guimarães EAA, Obreli Neto PR, Pereira ML, Zanetti MOB, Reis TM, Baldoni AO. Conceptual aspects, impact, and state of the art of dependent prescription in Brazil: narrative review. Porto Biomed J 2020; 5:e66. [PMID: 33299947 PMCID: PMC7722403 DOI: 10.1097/j.pbj.0000000000000066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 03/29/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Nonmedical prescription is recognized in several countries as an excellent strategy in facing emerging demands that put a strain on the health system. It is a practice carried out by professionals who are not doctors and who, after obtaining specific qualifications and legal authorization, can prescribe medication and curatives. In Brazil, although there is already a legal subsidy for prescription in some professions, it is still an underdeveloped activity with few studies. OBJECTIVE This study aimed to describe the conceptual aspects and state of the art of this type of prescription in Brazil. METHODS It is a narrative review of the literature that included national and international regulations related to the subject, as well as available articles, published in electronic journals in different databases. Key terms used were nonmedical prescription, nursing prescription, and pharmaceutical prescription. RESULTS It was evidenced that nonmedical prescription has ample potential for improving the quality of care and the health conditions of patients. One can highlight as positive results the improvement of work satisfaction and self-confidence of those who have developed this practice; improvement of teamwork reported by other professionals due to the reduction of work overload; greater patient satisfaction in relation to access; and care provided by prescribers. CONCLUSIONS It is understood that there are many challenges for the consolidation of this activity in Brazil and that its success depends on a joint effort of health and educational institutions, health professionals, and patients.
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Affiliation(s)
- Heuler S Andrade
- Universidade Federal de São João Del-Rei (UFSJ) - CCO - Divinópolis, Minas Gerais, Brazil
| | - Eliete A A Guimarães
- Universidade Federal de São João Del-Rei (UFSJ) - CCO - Divinópolis, Minas Gerais, Brazil
| | - Paulo R Obreli Neto
- Universidade Federal de São João Del-Rei (UFSJ) - CCO - Divinópolis, Minas Gerais, Brazil
| | - Mariana L Pereira
- Universidade Federal de São João Del-Rei (UFSJ) - CCO - Divinópolis, Minas Gerais, Brazil
| | - Maria O B Zanetti
- Universidade Federal de São João Del-Rei (UFSJ) - CCO - Divinópolis, Minas Gerais, Brazil
| | - Tiago M Reis
- Universidade Federal de São João Del-Rei (UFSJ) - CCO - Divinópolis, Minas Gerais, Brazil
| | - André O Baldoni
- Universidade Federal de São João Del-Rei (UFSJ) - CCO - Divinópolis, Minas Gerais, Brazil
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A structural equation model for behaviors of pharmacy students toward mentally ill patients. CURRENT PSYCHOLOGY 2020. [DOI: 10.1007/s12144-020-00642-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Zhou M, Desborough J, Parkinson A, Douglas K, McDonald D, Boom K. Barriers to pharmacist prescribing: a scoping review comparing the UK, New Zealand, Canadian and Australian experiences. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2019; 27:479-489. [DOI: 10.1111/ijpp.12557] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 05/07/2019] [Accepted: 06/03/2019] [Indexed: 12/01/2022]
Abstract
Abstract
Objectives
Non-medical prescribers, including pharmacists, have been found to achieve comparable clinical outcomes with doctors for certain health conditions. Legislation supporting pharmacist prescribing (PP) has been implemented in the United Kingdom (UK), Canada and New Zealand (NZ); however, to date, Australian pharmacists have not been extended prescribing rights. The purpose of this review was to describe the barriers to PP found in the literature from the UK, Canada, NZ and Australia, and examine the implications of these for the development of PP in Australia.
Methods
We conducted a scoping review, which included peer-reviewed and grey literature, and consultation with stakeholders. Sources – Scopus, PubMed and CINAHL; Google Scholar, OpenGrey and organisational websites from January 2003 to March 2018 in the UK, Canada, NZ and Australia. Inclusion criteria – articles published in English, related to implementation of PP and articulated barriers to PP.
Key findings
Of 863 unique records, 120 were reviewed and 64 articles were eligible for inclusion. Three key themes emerged: (1) Socio-political context, (2) Resourcing issues and (3) Prescriber competence. The most common barriers were inadequate training regarding diagnostic knowledge and skills, inadequate support from authorities and stakeholders, and insufficient funding/reimbursement.
Conclusions
If implementation of PP is to occur, attention needs to be focused on addressing identified barriers to PP implementation, including fostering a favourable socio-political context and prescriber competence. As such, a concerted effort is required to develop clear policy pathways, including targeted training courses, raising stakeholder recognition of PP and identifying specific funding, infrastructure and resourcing needs to ensure the smooth integration of pharmacist prescribers within interprofessional clinical teams.
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Affiliation(s)
- Mingming Zhou
- People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Jane Desborough
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Anne Parkinson
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Kirsty Douglas
- Academic Unit of General Practice, ANU Medical School, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - David McDonald
- National Centre for Epidemiology and Population Health, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Katja Boom
- Independent Consultant/Accredited Australian Pharmacist Working in General Practice, Canberra, ACT, Australia
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Silva SN, Lima MG, Ruas CM. Pharmaceutical interventions in mental health: A review of the literature to support evidence-informed policymaking. Res Social Adm Pharm 2017; 14:891-900. [PMID: 29195731 DOI: 10.1016/j.sapharm.2017.11.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 11/23/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Pharmaceutical interventions may have an impact on different treatment aspects, such as therapy adherence, reducing the number of different medications in use and lowering treatment costs. OBJECTIVE Identify pharmaceutical interventions in the mental health field and their possible application in Brazilian public mental health services, considering the evidence-based model to establish implementation options. METHODS A structured search of the literature was performed in the Pubmed (Medline), Cochrane, PsycINFO and Lilacs databases to identify the main pharmaceutical intervention studies conducted in the mental health area. The articles selected were evaluated according to the quality of the evidence. The current laws and public database were researched to collect information on services and procedures provided by the Brazilian units, known as CAPS, and the number the pharmacists allocated to them. The proposal to synthesize the results of pharmaceutical interventions in Brazil was based on SUPPORT methodology items to prepare evidence-based policies. RESULTS A total of 1442 studies were identified, 18 of which were included. Several interventions are reported in the literature, educational interventions being frequently cited. However, there is a need for further studies with more methodological rigor. The number of pharmacists working in the CAPS is insufficient to cover all the services, since only 26.5% of CAPS employ pharmacists, who work an average of 29 (±11.1) hours a week. Three options were formulated to implement interventions in the Brazilian context that consider including pharmacists on the basic team of CAPS professionals and educational interventions through pharmacist training. CONCLUSIONS The present study could support the establishment of health policies, based on a synthesis of the evidence, contextualization of the current situation, given the absence of local evidence, and a discussion of the options available to implement pharmaceutical interventions in the Brazilian health system. Organizational changes in CAPS are needed to broaden pharmacist participation on the multidisciplinary team.
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Affiliation(s)
- Sarah Nascimento Silva
- Department of Social Pharmacy, School of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil.
| | - Marina Guimarães Lima
- Department of Social Pharmacy, School of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Cristina Mariano Ruas
- Department of Social Pharmacy, School of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil
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Chevalier B, Neville HL, Thompson K, Nodwell L, MacNeil M. Health Care Professionals' Opinions and Expectations of Clinical Pharmacy Services on a Surgical Ward. Can J Hosp Pharm 2016; 69:439-448. [PMID: 28123189 DOI: 10.4212/cjhp.v69i6.1606] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Pharmacists have made significant contributions to patient care and have been recognized as integral members of the interprofessional team. Health care professionals differ in their opinions and expectations of clinical pharmacy services. Very little has been published about health care professionals' perspectives on advanced clinical pharmacy roles, such as prescriptive authority or administration of vaccines. In 2013, clinical pharmacy services were introduced in a vascular and general surgery ward where a pharmacist had not previously been assigned. OBJECTIVES To explore surgical nurses' and physicians' opinions and expectations of clinical pharmacy services and to determine how these views changed over time; to compare pharmacists' views of clinical pharmacy services with those of nurses and physicians; and to develop validated survey tools. METHODS Three survey tools were created and validated, one for each profession. Surveys were distributed to nurses and physicians assigned to the general and vascular surgery ward before introduction of clinical pharmacy services and 8 months after implementation. Hospital pharmacists were invited to complete the survey at one time point. RESULTS Differences existed in the opinions of nurses, physicians, and pharmacists about some traditional activities. Nurses and physicians indicated stronger agreement with pharmacists participating in medication reconciliation activities than did pharmacists (p < 0.001), whereas a greater proportion of pharmacists felt that they were the most appropriate health care professionals to provide medication discharge counselling, relative to nurses and physicians (p = 0.001). Respondents supported advanced roles for pharmacists, such as collaborative practice agreements, but there was less support for prescribing, physical assessments, and administration of vaccines. Nurses indicated the strongest agreement with pharmacist prescribing (82% versus 69% among pharmacists and 27% among physicians; p < 0.001). Nurses and physicians expressed strong endorsements of clinical pharmacy services in the surveys' comment sections. CONCLUSIONS The introduction of clinical pharmacy services to a surgical health care team resulted in high levels of satisfaction among nurses and physicians who responded to this survey. Differences in perceptions of traditional clinical pharmacy service activities and advanced practice roles need to be studied in more depth to better understand the factors influencing health care professionals' views.
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Affiliation(s)
- Bernadette Chevalier
- , BSc(Hon), BScPharm, ACPR, was, at the time of this study, a Drug Utilization Pharmacist with the Nova Scotia Health Authority, Halifax, Nova Scotia. She is now a PhD candidate with the School of Pharmacy, Pharmacy Australia Centre of Excellence, The University of Queensland, Woolloongabba, Brisbane, Australia
| | - Heather L Neville
- , BScPharm, MSc, is Drug Utilization Pharmacist and Pharmacy Research Coordinator, Nova Scotia Health Authority, Halifax, Nova Scotia
| | - Kara Thompson
- , BSc, MSc, is a Biostatistician with the Research Methods Unit, Nova Scotia Health Authority, Halifax, Nova Scotia
| | - Lisa Nodwell
- , BScPharm, ACPR, is a Clinical Pharmacist with the Nova Scotia Health Authority, Halifax, Nova Scotia
| | - Michael MacNeil
- , PharmD, ACPR, is a Surgery Pharmacist with the Nova Scotia Health Authority, Halifax, Nova Scotia
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Weeks G, George J, Maclure K, Stewart D. Non-medical prescribing versus medical prescribing for acute and chronic disease management in primary and secondary care. Cochrane Database Syst Rev 2016; 11:CD011227. [PMID: 27873322 PMCID: PMC6464275 DOI: 10.1002/14651858.cd011227.pub2] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND A range of health workforce strategies are needed to address health service demands in low-, middle- and high-income countries. Non-medical prescribing involves nurses, pharmacists, allied health professionals, and physician assistants substituting for doctors in a prescribing role, and this is one approach to improve access to medicines. OBJECTIVES To assess clinical, patient-reported, and resource use outcomes of non-medical prescribing for managing acute and chronic health conditions in primary and secondary care settings compared with medical prescribing (usual care). SEARCH METHODS We searched databases including CENTRAL, MEDLINE, Embase, and five other databases on 19 July 2016. We also searched the grey literature and handsearched bibliographies of relevant papers and publications. SELECTION CRITERIA Randomised controlled trials (RCTs), cluster-RCTs, controlled before-and-after (CBA) studies (with at least two intervention and two control sites) and interrupted time series analysis (with at least three observations before and after the intervention) comparing: 1. non-medical prescribing versus medical prescribing in acute care; 2. non-medical prescribing versus medical prescribing in chronic care; 3. non-medical prescribing versus medical prescribing in secondary care; 4 non-medical prescribing versus medical prescribing in primary care; 5. comparisons between different non-medical prescriber groups; and 6. non-medical healthcare providers with formal prescribing training versus those without formal prescribing training. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. Two review authors independently reviewed studies for inclusion, extracted data, and assessed study quality with discrepancies resolved by discussion. Two review authors independently assessed risk of bias for the included studies according to EPOC criteria. We undertook meta-analyses using the fixed-effect model where studies were examining the same treatment effect and to account for small sample sizes. We compared outcomes to a random-effects model where clinical or statistical heterogeneity existed. MAIN RESULTS We included 46 studies (37,337 participants); non-medical prescribing was undertaken by nurses in 26 studies and pharmacists in 20 studies. In 45 studies non-medical prescribing as a component of care was compared with usual care medical prescribing. A further study compared nurse prescribing supported by guidelines with usual nurse prescribing care. No studies were found with non-medical prescribing being undertaken by other health professionals. The education requirement for non-medical prescribing varied with country and location.A meta-analysis of surrogate markers of chronic disease (systolic blood pressure, glycated haemoglobin, and low-density lipoprotein) showed positive intervention group effects. There was a moderate-certainty of evidence for studies of blood pressure at 12 months (mean difference (MD) -5.31 mmHg, 95% confidence interval (CI) -6.46 to -4.16; 12 studies, 4229 participants) and low-density lipoprotein (MD -0.21, 95% CI -0.29 to -0.14; 7 studies, 1469 participants); we downgraded the certainty of evidence from high due to considerations of serious inconsistency (considerable heterogeneity), multifaceted interventions, and variable prescribing autonomy. A high-certainty of evidence existed for comparative studies of glycated haemoglobin management at 12 months (MD -0.62, 95% CI -0.85 to -0.38; 6 studies, 775 participants). While there appeared little difference in medication adherence across studies, a meta-analysis of continuous outcome data from four studies showed an effect favouring patient adherence in the non-medical prescribing group (MD 0.15, 95% CI 0.00 to 0.30; 4 studies, 700 participants). We downgraded the certainty of evidence for adherence to moderate due to the serious risk of performance bias. While little difference was seen in patient-related adverse events between treatment groups, we downgraded the certainty of evidence to low due to indirectness, as the range of adverse events may not be related to the intervention and selective reporting failed to adequately report adverse events in many studies.Patients were generally satisfied with non-medical prescriber care (14 studies, 7514 participants). We downgraded the certainty of evidence from high to moderate due to indirectness, in that satisfaction with the prescribing component of care was only addressed in one study, and there was variability of satisfaction measures with little use of validated tools. A meta-analysis of health-related quality of life scores (SF-12 and SF-36) found a difference favouring usual care for the physical component score (MD 1.17, 95% CI 0.16 to 2.17), but not the mental component score (MD 0.58, 95% CI -0.40 to 1.55). However, the quality of life measurement may more appropriately reflect composite care rather than the prescribing component of care, and for this reason we downgraded the certainty of evidence to moderate due to indirectness of the measure of effect. A wide variety of resource use measures were reported across studies with little difference between groups for hospitalisations, emergency department visits, and outpatient visits. In the majority of studies reporting medication use, non-medical prescribers prescribed more drugs, intensified drug doses, and used a greater variety of drugs compared to usual care medical prescribers.The risk of bias across studies was generally low for selection bias (random sequence generation), detection bias (blinding of outcome assessment), attrition bias (incomplete outcome data), and reporting bias (selective reporting). There was an unclear risk of selection bias (allocation concealment) and for other biases. A high risk of performance bias (blinding of participants and personnel) existed. AUTHORS' CONCLUSIONS The findings suggest that non-medical prescribers, practising with varying but high levels of prescribing autonomy, in a range of settings, were as effective as usual care medical prescribers. Non-medical prescribers can deliver comparable outcomes for systolic blood pressure, glycated haemoglobin, low-density lipoprotein, medication adherence, patient satisfaction, and health-related quality of life. It was difficult to determine the impact of non-medical prescribing compared to medical prescribing for adverse events and resource use outcomes due to the inconsistency and variability in reporting across studies. Future efforts should be directed towards more rigorous studies that can clearly identify the clinical, patient-reported, resource use, and economic outcomes of non-medical prescribing, in both high-income and low-income countries.
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Affiliation(s)
- Greg Weeks
- Monash UniversityCentre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical SciencesParkvilleVICAustralia3052
- Barwon HealthPharmacy DepartmentGeelongVictoriaAustralia
| | - Johnson George
- Monash UniversityCentre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical SciencesParkvilleVICAustralia3052
| | - Katie Maclure
- Robert Gordon UniversitySchool of PharmacyRiverside EastGarthdee RoadAberdeenUKAB10 7GJ
| | - Derek Stewart
- Robert Gordon UniversitySchool of PharmacyRiverside EastGarthdee RoadAberdeenUKAB10 7GJ
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From personal crisis care to convenience shopping: an interpretive description of the experiences of people with mental illness and addictions in community pharmacies. BMC Health Serv Res 2016; 16:569. [PMID: 27729051 PMCID: PMC5059973 DOI: 10.1186/s12913-016-1817-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 10/04/2016] [Indexed: 11/10/2022] Open
Abstract
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.
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Gregory PAM, Whyte B, Austin Z. How do community pharmacists make decisions? Results of an exploratory qualitative study in Ontario. Can Pharm J (Ott) 2016; 149:90-8. [PMID: 27076820 DOI: 10.1177/1715163515625656] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND As the complexity of pharmacy practice increases, pharmacists are required to make more decisions under ambiguous or information-deficient conditions. There is scant literature examining how pharmacists make decisions and what factors or values influence their choices. The objective of this exploratory research was to characterize decision-making patterns in the clinical setting of community pharmacists in Ontario. METHODS The think-aloud decision-making method was used for this study. Community pharmacists with 3 or more years' experience were presented with 2 clinical case studies dealing with challenging situations and were asked to verbally reason through their decision-making process while being probed by an interviewer for clarification, justification and further explication. Verbatim transcripts were analyzed using a protocol analysis method. RESULTS AND DISCUSSION A total of 12 pharmacists participated in this study. Participants experienced cognitive dissonance in attempting to reconcile their desire for a clear and confrontation-free conclusion to the case discussion and the reality of the challenge presented within each case. Strategies for resolving this cognitive dissonance included strong emphasis on the educational (rather than decision-making) role of the pharmacist, the value of strong interpersonal relationships as a way to avoid conflict and achieve desired outcomes, the desire to seek external advice or defer to others' authority to avoid making a decision and the use of strict interpretations of rules to avoid ambiguity and contextual interpretation. This research was neither representative nor generalizable but was indicative of patterns of decisional avoidance and fear of assuming responsibility for outcomes that warrant further investigation. CONCLUSION The think-aloud method functioned effectively in this context and provided insights into pharmacists' decision-making patterns in the clinical setting. Can Pharm J (Ott) 2016;149:90-98.
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Affiliation(s)
- Paul A M Gregory
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario
| | - Brenna Whyte
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario
| | - Zubin Austin
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario
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18
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Murphy AL, Phelan H, Haslam S, Martin-Misener R, Kutcher SP, Gardner DM. Community pharmacists' experiences in mental illness and addictions care: a qualitative study. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2016; 11:6. [PMID: 26821700 PMCID: PMC4730654 DOI: 10.1186/s13011-016-0050-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Accepted: 01/18/2016] [Indexed: 11/10/2022]
Abstract
Background Community pharmacists are accessible health care professionals who encounter people with lived experience of mental illness and addictions in daily practice. Although some existing research supports that community pharmacists’ interventions result in improved patient mental health outcomes, gaps in knowledge regarding the pharmacists’ experiences with service provision to this population remain. Improving knowledge regarding the pharmacists’ experiences with mental illness and addictions service provision can facilitate a better understanding of their perspectives and be used to inform the development and implementation of interventions delivered by community pharmacists for people with lived experience of mental illness and addictions in communities. Methods We conducted a qualitative study using a directed content analysis and the Theoretical Domains Framework as part of our underlying theory of behaviour change and our analytic framework for theme development. The Theoretical Domains Framework facilitates understanding of behaviours of health care professionals and implementation challenges and opportunities for interventions in health care. Thematic analysis co-occurred throughout the process of the directed content analysis. We recruited community pharmacists, with experience dispensing psychotropics, at a minimum, through multiple mechanisms (e.g., professional associations) in a convenience sampling approach. Potential participants were offered the option of focus groups or interviews. Results Data were collected from one focus group and two interviews involving six pharmacists. Theoretical Domains Framework coding was primarily weighted in two domains: social/professional role and identity and environmental context and resources. We identified five main themes in the experiences of pharmacists in mental illness and addictions care: competing interests, demands, and time; relationships, rapport, and trust; stigma; collaboration and triage; and role expectations and clarity. Conclusions Pharmacists are not practicing to their full scope of practice in mental illness and addictions care for several reasons including limitations within the work environment and lack of structures and processes in place to be fully engaged as health care professionals. More research and policy work are needed to examine better integration of pharmacists as members of the mental health care team in communities. Electronic supplementary material The online version of this article (doi:10.1186/s13011-016-0050-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Andrea L Murphy
- College of Pharmacy, Dalhousie University, 5968 College St., PO Box 15000, Halifax, NS, B3H 4R2, Canada.
| | - Heather Phelan
- College of Pharmacy, Dalhousie University, 5968 College St., PO Box 15000, Halifax, NS, B3H 4R2, Canada.
| | - Scott Haslam
- College of Pharmacy, Dalhousie University, 5968 College St., PO Box 15000, Halifax, NS, B3H 4R2, Canada.
| | - Ruth Martin-Misener
- School of Nursing, Dalhousie University, 5869 University Ave., PO Box 15000, Halifax, NS, B3H 4R2, Canada.
| | - Stan P Kutcher
- Sun Life Financial Chair in Adolescent Mental Health, Dalhousie University/IWK Health Centre, 5850 University Ave., PO Box 9700, Halifax, NS, B3K 6R8, Canada.
| | - David M Gardner
- Department of Psychiatry, Dalhousie University, QEII HSC, AJLB 7517, 5909 Veterans' Memorial Lane, Halifax, NS, B3H 2E2, Canada.
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Murphy AL, Gardner DM, Martin-Misener R, Naylor T, Kutcher SP. Partnering to enhance mental health care capacity in communities: A qualitative study of the More Than Meds program. Can Pharm J (Ott) 2015; 148:314-24. [PMID: 26600823 DOI: 10.1177/1715163515607310] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Community pharmacists care for and support people with lived experience of mental illness in their communities. We developed a program called More Than Meds to facilitate enhancing capacity of community pharmacists' roles in mental health care. METHODS We conducted a qualitative study and used a directed content analysis with application of the Theoretical Domains Framework as part of our underlying theory of behaviour change and our analytic framework. RESULTS Ten interviews (n = 6 pharmacists, n = 4 community members) were conducted with participants from the More Than Meds program. Three key themes were identified from the experiences of More Than Meds participants: networking and bridging, stigma, and expectations and permissions. The most frequently coded domains in the data from the Theoretical Domains Framework were social/professional role, skills, beliefs about capabilities, knowledge and environmental context and resources. CONCLUSIONS The More than Meds Program enabled community pharmacists to increase their capabilities, opportunities and motivation in providing mental health care and support. Involving community pharmacists together with people with lived experience of mental illness was identified as an innovative component of the program.
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Affiliation(s)
- Andrea L Murphy
- College of Pharmacy (Murphy, Gardner, Naylor), Dalhousie University, Halifax, Nova Scotia
| | - David M Gardner
- College of Pharmacy (Murphy, Gardner, Naylor), Dalhousie University, Halifax, Nova Scotia
| | - Ruth Martin-Misener
- College of Pharmacy (Murphy, Gardner, Naylor), Dalhousie University, Halifax, Nova Scotia
| | - Ted Naylor
- College of Pharmacy (Murphy, Gardner, Naylor), Dalhousie University, Halifax, Nova Scotia
| | - Stan P Kutcher
- College of Pharmacy (Murphy, Gardner, Naylor), Dalhousie University, Halifax, Nova Scotia
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Garcia BH, Giverhaug T, Høgli JU, Skjold F, Småbrekke L. A pharmacist-led follow-up program for patients with established coronary heart disease in North Norway - a randomized controlled trial. Pharm Pract (Granada) 2015; 13:575. [PMID: 26131047 PMCID: PMC4482847 DOI: 10.18549/pharmpract.2015.02.575] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 06/07/2015] [Indexed: 11/29/2022] Open
Abstract
Objectives: The aim of the study was twofold; 1) to develop a clinical pharmacist-led 12 month lasting follow-up program for patients with established coronary heart disease (CHD) discharged from the University Hospital of North Norway, and 2) to explore the impact of the program with regards to adherence to a medication assessment tool for secondary prevention of CHD and change in biomedical risk factors. Methods: A total of 102 patients aged 18-82 years were enrolled in a non-blinded randomized controlled trial with an intervention group and a control group. The intervention comprised medication reconciliation, medication review and patient education during three meetings; at discharge, after three months and after twelve months. The control group received standard care from their general practitioner. Primary outcomes were adherence to clinical guideline recommendations concerning prescription, therapy goal achievement and lifestyle education defined in the medication assessment tool for secondary prevention of CHD (MAT-CHDSP). Secondary outcomes included changes in the biomedical risk factors cholesterol, blood pressure and blood glucose. Results: Ninety-four patients completed the trial, 48 intervention group patients and 46 controls. Appropriate prescribing was high, but therapy goal achievement was low in both groups. Overall adherence to MAT-CHDSP criteria increased in both groups and was significantly higher in the intervention group at study end, 78.4% vs. 62.0%, p<0.001. The difference was statistically significant for the documented lifestyle advices in intervention group patients. No significant improvements in biomedical risk factors were observed in favor of the intervention group. Conclusions: The study showed an increased guideline adherence in both study groups. This indicates that attention to clinical practice guideline recommendations in itself increases adherence – which may be a clinical pharmacist task. A larger adequately powered study is needed to show a significant difference in biomedical risk factor improvements in favor of the intervention. Amendments to the follow-up program are suggested before implementation in standard patient care can be recommended.
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Affiliation(s)
- Beate H Garcia
- Hospital Pharmacy of North Norway; & Department of Pharmacy, University of Tromsø . Tromsø ( Norway ).
| | - Trude Giverhaug
- Regional Drug Information Center of North Norway & University Hospital of North-Norway. Tromsø ( Norway ).
| | - June U Høgli
- Department of Pharmacy, University of Tromsø . Tromsø ( Norway ).
| | - Frode Skjold
- Department of Pharmacy, University of Tromsø , Tromsø ( Norway ).
| | - Lars Småbrekke
- Department of Pharmacy, University of Tromsø . Tromsø ( Norway ).
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Rubio-Valera M, Chen TF, O'Reilly CL. New roles for pharmacists in community mental health care: a narrative review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:10967-90. [PMID: 25337943 PMCID: PMC4211017 DOI: 10.3390/ijerph111010967] [Citation(s) in RCA: 111] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 09/30/2014] [Accepted: 10/07/2014] [Indexed: 02/05/2023]
Abstract
Medicines are a major treatment modality for many mental illnesses, and with the growing burden of mental disorders worldwide pharmacists are ideally positioned to play a greater role in supporting people with a mental illness. This narrative review aims to describe the evidence for pharmacist-delivered services in mental health care and address the barriers and facilitators to increasing the uptake of pharmacist services as part of the broader mental health care team. This narrative review is divided into three main sections: (1) the role of the pharmacist in mental health care in multidisciplinary teams and in supporting early detection of mental illness; (2) the pharmacists' role in supporting quality use of medicines in medication review, strategies to improve medication adherence and antipsychotic polypharmacy, and shared decision making; and (3) barriers and facilitators to the implementation of mental health pharmacy services with a focus on organizational culture and mental health stigma. In the first section, the review presents new roles for pharmacists within multidisciplinary teams, such as in case conferencing or collaborative drug therapy management; and new roles that would benefit from increased pharmacist involvement, such as the early detection of mental health conditions, development of care plans and follow up of people with mental health problems. The second section describes the impact of medication review services and other pharmacist-led interventions designed to reduce inappropriate use of psychotropic medicines and improve medication adherence. Other new potential roles discussed include the management of antipsychotic polypharmacy and involvement in patient-centered care. Finally, barriers related to pharmacists' attitudes, stigma and skills in the care of patients with mental health problems and barriers affecting pharmacist-physician collaboration are described, along with strategies to reduce mental health stigma.
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Affiliation(s)
- Maria Rubio-Valera
- Research and Development Unit, Fundació Sant Joan de Déu, Department of Pharmacology and Therapeutic Chemistry, School of Pharmacy, Universitat de Barcelona, Barcelona 08830, Spain.
| | - Timothy F Chen
- Faculty of Pharmacy, The University of Sydney, Sydney 2006, Australia.
| | - Claire L O'Reilly
- Faculty of Pharmacy, The University of Sydney, Sydney 2006, Australia.
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Emich B, van Dijk L, Monteiro SP, de Gier JJ. A study comparing the effectiveness of three warning labels on the package of driving-impairing medicines. Int J Clin Pharm 2014; 36:1152-9. [DOI: 10.1007/s11096-014-0010-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 08/21/2014] [Indexed: 11/29/2022]
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Godman B, Petzold M, Bennett K, Bennie M, Bucsics A, Finlayson AE, Martin A, Persson M, Piessnegger J, Raschi E, Simoens S, Zara C, Barbui C. Can authorities appreciably enhance the prescribing of oral generic risperidone to conserve resources? Findings from across Europe and their implications. BMC Med 2014; 12:98. [PMID: 24927744 PMCID: PMC4073810 DOI: 10.1186/1741-7015-12-98] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 05/23/2014] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Generic atypical antipsychotic drugs offer health authorities opportunities for considerable savings. However, schizophrenia and bipolar disorders are complex diseases that require tailored treatments. Consequently, generally there have been limited demand-side measures by health authorities to encourage the preferential prescribing of generics. This is unlike the situation with hypertension, hypercholaesterolaemia or acid-related stomach disorders.The objectives of this study were to compare the effect of the limited demand-side measures in Western European countries and regions on the subsequent prescribing of risperidone following generics; to utilise the findings to provide future guidance to health authorities; and where possible, to investigate the utilisation of generic versus originator risperidone and the prices for generic risperidone. METHODS Principally, this was a segmented regression analysis of retrospective time-series data of the effect of the various initiatives in Belgium, Ireland, Scotland and Sweden following the introduction of generic risperidone. The study included patients prescribed at least one atypical antipsychotic drug up to 20 months before and up to 20 months after generic risperidone. In addition, retrospective observational studies were carried out in Austria and Spain (Catalonia) from 2005 to 2011 as well as one English primary care organisation (Bury Primary Care Trust (PCT)). RESULTS There was a consistent steady reduction in risperidone as a percentage of total selected atypical antipsychotic utilisation following generics. A similar pattern was seen in Austria and Spain, with stable utilisation in one English PCT. However, there was considerable variation in the utilisation of generic risperidone, ranging from 98% of total risperidone in Scotland to only 14% in Ireland. Similarly, the price of generic risperidone varied considerably. In Scotland, generic risperidone was only 16% of pre-patent loss prices versus 72% in Ireland. CONCLUSION Consistent findings of no increased prescribing of risperidone post generics with limited specific demand-side measures suggests no 'spillover' effect from one class to another encouraging the preferential prescribing of generic atypical antipsychotic drugs. This is exacerbated by the complexity of the disease area and differences in the side-effects between treatments. There appeared to be no clinical issues with generic risperidone, and prices inversely reflected measures to enhance their utilisation.
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Affiliation(s)
- Brian Godman
- Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Karolinska University Hospital Huddinge, SE-141 86 Stockholm, Sweden.
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Garcia BH, Storli SL, Småbrekke L. A pharmacist-led follow-up program for patients with coronary heart disease in North Norway--a qualitative study exploring patient experiences. BMC Res Notes 2014; 7:197. [PMID: 24679131 PMCID: PMC3974183 DOI: 10.1186/1756-0500-7-197] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 03/27/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Coronary heart disease (CHD) is one of the leading causes of death worldwide. Scientific literature shows that prevention of CHD is inadequate. The clinical pharmacist's role in patient-centred care has been shown favourable in a large amount of studies, also in relation to reduction of risk factors related to CHD. We developed and piloted a pharmacist-led follow-up program for patients with established CHD after hospital discharge from a hospital in North Norway. The aim of the present study was to explore how participants in the follow-up program experienced the program with regard to four main topics; medication knowledge, feeling of safety and comfort with medications, the functionality of the program and the clinical pharmacist's role in the interdisciplinary team. METHODS We performed semi-structured thematic interviews with four patients included in the program. After verbatim transcribing, we analysed the interviews using "qualitative content analyses" by Graneheim and Lundman. Trial registration http://www.clinicaltrials.gov: NCT01131715. RESULTS All participants appreciated the follow-up program because their medication knowledge had increased, participation had made them feel safe, they were reassured about the appropriateness of their medications, and they had become more involved in their own medication. The participants reported that the program was well structured and the clinical pharmacist was said to be an important caretaker in the health-care system. The importance of collaboration between pharmacists and physicians, both in hospital and primary care, was emphasized. CONCLUSION Our results indicate that the follow-up program was highly appreciated among the four participants included in this study. The results must be interpreted in the context of the health care system in Norway today. Here, few pharmacists are working in hospitals or in close relation to the general practitioners. In addition, physicians are short of time in order to supply appropriate medication information, both in hospital and primary care. Involving pharmacists in follow-up of patients with CHD seems to be highly appreciated among patients and may be a step towards improving patient care. The study is limited by the low number of participants.
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Affiliation(s)
- Beate Hennie Garcia
- Hospital Pharmacy of North Norway Trust, PO 6147, Langnes, 9291 Tromsø, Norway
- Department of Pharmacy, Faculty of Health Sciences, University of Tromsø, N-9037 Tromsø, Norway
| | - Sissel Lisa Storli
- Department of Health and Care Sciences, Faculty of Health Sciences, University of Tromsø, N-9037 Tromsø, Norway
| | - Lars Småbrekke
- Department of Pharmacy, Faculty of Health Sciences, University of Tromsø, N-9037 Tromsø, Norway
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Godman B, De Bruyn K, Miranda J, Raschi E, Bennie M, Barbui C, Simoens S. Generic atypical antipsychotic drugs in Belgium: their influence and implications. J Comp Eff Res 2013; 2:551-61. [DOI: 10.2217/cer.13.75] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Introduction: Generic atypical antipsychotic drugs should be a focus of attention given their expenditure. However, there is a recognized need to tailor treatments. There were no specific measures in Belgium to enhance the prescribing of oral risperidone following generics in January 2008. Prescribing restrictions have remained for long-acting risperidone injections throughout. Objective: Assess changes in risperidone utilization before and after oral generics were reimbursed, as well as the utilization and expenditure of the various risperidone preparations. Method: Principally a retrospective observational study and interrupted time series design. Results: As expected, no increased utilization of oral risperidone after generics. Both originator and generic oral risperidone prescribed, with the originator reducing its price. Generic risperidone was 59% below prepatent loss prices by September 2012. Conclusion: Authorities cannot rely on a ‘spill over’ of learning from other disease areas to affect changes in physician prescribing habits. Specific measures are needed to encourage generic risperidone where appropriate. However, their influence will be limited by the complexity of the disease area.
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Affiliation(s)
- Brian Godman
- Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
- Strathclyde Institute of Pharmacy & Biomedical Sciences, University of Strathclyde, Glasgow, UK
- National Institute of Science & Technology on Innovation on Neglected Diseases, Centre for Technological Development in Health, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil
| | - Kristien De Bruyn
- Statistics Department, Association of Belgian Pharmacists, Archimedesstraat 11, B-1000 Brussels, Belgium
| | - Jamilette Miranda
- Department of Development, Public Healthcare Services Committee Administration, Stockholm County Council, Stockholm, Sweden
| | - Emanuel Raschi
- Department of Medical & Surgical Sciences, Alma Mater Studiorum – University of Bologna, Bologna, Italy
| | - Marion Bennie
- Strathclyde Institute of Pharmacy & Biomedical Sciences, University of Strathclyde, Glasgow, UK
- Public Health & Intelligence Strategic Business Unit, NHS National Services Scotland, Edinburgh, EH12 9EB, UK
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health & Service Evaluation, Department of Public Health & Community Medicine, Section of Psychiatry, University of Verona, Policlinico G.B. Rossi, Piazzale L.A. Scuro 10, 37134 Verona, Italy
| | - Steven Simoens
- KU Leuven, Department of Pharmaceutical & Pharmacological Sciences, KU Leuven, Herestraat 49, O & N 2 Bus 521, 3000 Leuven, Belgium
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Frankel GEC, Austin Z. Responsibility and confidence: Identifying barriers to advanced pharmacy practice. Can Pharm J (Ott) 2013; 146:155-61. [PMID: 23795200 DOI: 10.1177/1715163513487309] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Despite the changing role of the pharmacist in patient-centred practice, pharmacists anecdotally reported little confidence in their clinical decision-making skills and do not feel responsible for their patients. Observational findings have suggested these trends within the profession, but there is a paucity of evidence to explain why. We conducted an exploratory study with an objective to identify reasons for the lack of responsibility and/or confidence in various pharmacy practice settings. METHODS Pharmacist interviews were conducted via written response, face-to-face or telephone. Seven questions were asked on the topic of responsibility and confidence as it applies to pharmacy practice and how pharmacists think these themes differ in medicine. Interview transcripts were analyzed and divided by common theme. Quotations to support these themes are presented. RESULTS Twenty-nine pharmacists were asked to participate, and 18 responded (62% response rate). From these interviews, 6 themes were identified as barriers to confidence and responsibility: hierarchy of the medical system, role definitions, evolution of responsibility, ownership of decisions for confidence building, quality and consequences of mentorship and personality traits upon admission. DISCUSSION We identified 6 potential barriers to the development of pharmacists' self-confidence and responsibility. These findings have practical applicability for educational research, future curriculum changes, experiential learning structure and pharmacy practice. Due to bias and the limitations of this form of exploratory research and small sample size, evidence should be interpreted cautiously. CONCLUSION Pharmacists feel neither responsible nor confident for their clinical decisions due to social, educational, experiential and personal reasons. Can Pharm J 2013;146:155-161.
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Medicines and driving: evaluation of training and software support for patient counselling by pharmacists. Int J Clin Pharm 2012; 34:633-43. [PMID: 22678812 DOI: 10.1007/s11096-012-9658-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Accepted: 05/15/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND The consumption of some psychotropic medicines has a negative effect on the fitness to drive. Pharmacists are expected to give useful advice to patients on their participation in traffic. However, almost no information is available on this topic. OBJECTIVE To assess the effect of training and implementation of new dispensing guidelines with regard to driving-impairing medicines, in two types of dispensing support tools. User acceptance was measured as well as the effect on pharmacists' attitudes & awareness, self-reported behaviour and knowledge. SETTING Pharmacists from East Flanders in Belgium. METHODS Two intervention groups and a control group participated. The intervention groups followed a training and were provided with a dispensing support tool containing information on the effect of medicines on driving ability, which was either stand-alone (USB stick) or integrated into the daily used software (ViaNova). The three groups filled out a questionnaire prior to and after the intervention period. MAIN OUTCOME MEASURE Answers to a pre/post-questionnaire on attitudes and awareness, self-reported behaviour, knowledge and user acceptance. RESULTS Many pharmacists were already strongly interested in the topic at the beginning of the study. Positive changes in attitude, self-reported behaviour and knowledge were measured mostly in the group of pharmacists for which the information was integrated in their daily used software. These pharmacists asked significantly more about the patients' driving experience, informed them more about driving-related risk and gave more detailed information on impairing effects of medicines. The knowledge of the participating pharmacists on the topic 'medicines and driving' remained generally low. The participants acknowledge the importance of being aware of the topic medicines and driving but they report a lack of information or education. They strongly prefer a tool that integrates the information in their daily used software. CONCLUSION Dispensing support tools with information on the potential impairing effect of a medicine on the fitness to drive increases awareness, reported risk communication behaviour as well as knowledge of pharmacists on this topic. Computerised dispensing support tools are most effective when the information is integrated into the daily used dispensing software.
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