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

Global Advancement in Pharmacy Services for Mental Health: A Review for Evidence-Based Practices

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.

Pharmacists' Experiences, Perceptions, and Attitudes towards Suicide and Suicide Prevention: A Scoping Review

It is important to understand pharmacists' experiences, stigmas, trainings, and attitudes to suicide, as they can affect the way pharmacists interact with at-risk individuals and influence outcomes. The aim of this scoping review is to explore pharmacists' willingness, experiences, and attitudes towards suicide prevention, as well as to examine the impact of suicide prevention training programs. A systemic search was conducted using the following databases: PubMed, EMBASE, CINAHL, PsycINFO, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews. Studies included were from database inception to 31 August 2022, in English, with full-text available. A total of 13 studies were included. Training was a key factor which had an impact on pharmacists' attitudes, experiences, and preparedness to participate in suicide care, with studies revealing the lack of training and the call for more training by pharmacists. Another key factor was closeness to mental illness, which also impacted pharmacists' attitudes and experiences with at-risk patients. More research is needed worldwide to understand the different barriers and facilitators to pharmacist involvement in suicide care. Targeted training programs should also be developed to not only increase knowledge and competence, but also to address stigma related to suicide.

Suicide Prevention in Nigeria: Can Community Pharmacists Have a Role?

Suicide is a global public health problem and is among the leading causes of death worldwide. Over 700,000 people die by suicide globally each year, affecting all ages, genders, and regions. Community pharmacists are easily accessible and trusted frontline healthcare professionals. They provide pharmaceutical care to the community, yet their role is still yet to be fully optimised. With the expanding role of community pharmacists and their constant accessibility to the local population, they could have a potential role in suicide prevention and awareness in Nigeria through restriction of means, signposting to services, and conversations with patients built on trusting relationships. In this commentary, we review the literature on the involvement of community pharmacists in suicide prevention. In addition, we discuss the potential role of community pharmacists in Nigeria through establishing trusting relationships with patients, clinical counselling, and medication gatekeeping, given the existing gaps in knowledge and awareness of suicide prevention within community settings. This commentary also outlines potential barriers and solutions, making suggestions for future research.

Attitudes and Beliefs of Pediatric Residents and Physician Assistant Students Toward Screening Adolescents for Suicide in Primary Care

INTRODUCTION

The objectives of this study were to: (1) describe attitudes of health professional trainees for conducting routine screening for suicidal ideation with adolescents; (2) identify the relationship between intention to conduct suicide risk assessments and behavioral attitudes, norm referents, and behavioral control; and (3) investigate the relationship between intention to conduct these assessments and self-reported clinic behavior.

METHODS

Second-year physician assistant (PA) students and pediatric residents (MD) at 3 universities voluntarily completed an anonymous cross-sectional questionnaire. The questionnaire was guided by the Theory of Planned Behavior and included items about previous experience with suicide. Pearson correlation and multivariable linear regression were used to analyze the data.

RESULTS

There were usable and complete data for 105 respondents (n = 105). The sample included PA students (89.52%, n = 94) and pediatric residents (10.48%, n = 11). Trainees were significantly more likely to have higher intention to conduct suicide risk assessments when they reported greater behavioral control (Std. β = 0.34, p <0.001) and reported suicide being discussed during previous clinic visits as a student/resident (Std. β = 0.21, p = 0.03), controlling for profession, race, behavioral attitudes, and norm referents. Trainees were significantly more likely to report conducting suicide risk assessments when they had greater behavioral control (Std. β = 0.27, p = 0.01) and greater intention to conduct these assessments (Std. β = 0.21, p = 0.03), controlling for profession, race, behavioral attitudes, and norm referents.

DISCUSSION

Second-year PA students and pediatric residents support screening adolescents for suicide risk. Training on methods to increase behavioral control may increase rates of screenings.

Best practice model for outpatient psychiatric pharmacy practice, part 2: Confirmation of the attribute statements

Introduction

The American Association of Psychiatric Pharmacists (AAPP) used multiple modalities to develop and refine 28 attribute statements to describe a best practice model for outpatient psychiatric pharmacists. Before addressing implementation, assessment, and field testing, it was necessary to finalize and confirm the statements and their supporting narratives among stakeholders. The objective of this project was to confirm the attribute statements and supporting justifications for a best practice model for outpatient psychiatric pharmacists providing direct patient care.

Methods

The 4 phases that resulted in the 28 attribute statements and supporting narratives have been described and published elsewhere. As part of phase 5, the confirmation survey was distributed to pharmacists and resident members of AAPP in November 2021 for 3 weeks.

Results

The survey respondents (n = 74; 6.1%) were licensed pharmacists for an average of 15.6 years (SD = 12.0) and had been practicing as psychiatric pharmacists for an average of 11.3 years (SD = 10.4). Slightly more than half (54.2%) of the respondents reported practicing in the outpatient setting and three-fourths (74.3%) were Board Certified Psychiatric Pharmacists. For each of the 28 statements, more than 90% of respondents either agreed or agreed with minimal reservations.

Discussion

Given the high degree of agreement on the proposed practice model statements, they will be used as the basis for the outpatient psychiatric pharmacist best practice model. Next steps in developing this model include establishing implementation guidance, determining appropriate metrics for evaluation of these statements in practice, and establishing appropriate field-testing methods.

Exploring the impact of suicide care experiences and post-intervention supports sought among community pharmacists: a cross-sectional survey

BACKGROUND

There is a need to appropriately train, support and remunerate pharmacists for their expanding roles in mental healthcare. Pharmacists often care for people experiencing mental health crises, including suicidal thoughts and behaviours, but little is known about pharmacists' suicide care experiences.

AIM

This cross-sectional study aimed to explore the impact of professional experiences with people at risk of suicide and support accessed, among community pharmacists.

METHOD

A survey exploring pharmacists' experiences with people at risk of suicide and post-intervention support-seeking was disseminated through Australian and Canadian professional associations, conferences and social media (June 2016-May 2017). Quantitative data were analysed using Chi-squared, Fisher's exact and independent t-tests, where appropriate. Qualitative data exploring the impact of these experiences were thematically analysed, and reasons for not seeking help post-intervention were identified.

RESULTS

Among 378 respondents, 84% had encountered patients at risk of suicide and 28% had lost patients to suicide. Some were negatively affected personally and/or professionally (11%), of which 88% did not seek professional support, mainly due to uncertainty about available services. Pharmacists were significantly more negatively affected if they had a personal mental health diagnosis (p = 0.017) and previous suicide care experiences (p = 0.001). Qualitative themes included: expanding knowledge and skills, role limitation and emotional impact and response.

CONCLUSION

A large proportion of pharmacists have interacted with suicidal patients and are impacted by these experiences, yet few seek help due to lack of awareness and access. There is a need to recognize pharmacists' roles in suicide care, and develop pharmacist-specific post-intervention support.

Pharmacist attitudes and provision of harm reduction services in North Carolina: an exploratory study

BACKGROUND

Pharmacists are among the most accessible healthcare providers in the United States and uniquely positioned to provide harm reduction services. The availability of pharmacy-based harm reduction services and pharmacist attitudes toward delivering these services have been understudied to date. We examine North Carolina (NC) pharmacists' experiences with and attitudes about harm reduction services and explore differences between rural and urban pharmacists.

METHODS

A convenience sample of NC pharmacists participated in an anonymous, online survey regarding harm reduction services: non-prescription syringe sales; naloxone dispensing; and human immunodeficiency virus (HIV) and hepatitis C virus (HCV) screening. Urban-rural differences were analyzed using Pearson's chi-square or Fisher's exact tests. Open-ended responses were analyzed thematically.

RESULTS

Three hundred pharmacists responded to the survey; 68 (23%) practiced in rural counties. Dispensing non-prescription syringes and naloxone at least occasionally was reported by 77% (n = 231) and 88% (n = 263) pharmacists, respectively. Pharmacy-delivered HIV or HCV screening was rare. Urban pharmacists dispensed naloxone more frequently than rural pharmacies (p = 0.04). Only 52% of pharmacists agreed that persons who inject drugs should always be allowed to buy non-prescription syringes. Rural pharmacists' attitudes toward harm reduction services for persons who inject drugs were statistically, though marginally, less supportive when compared to urban pharmacists' attitudes. The most common barrier to non-prescription syringe access was requiring patients to provide proof of prescription injection medication use, which 21% of pharmacists reported was required by their pharmacy's policy on non-prescription syringe sales.

CONCLUSIONS

Although most pharmacies distributed naloxone and sold non-prescription syringes, pharmacy store policies and personal beliefs inhibited naloxone and non-prescription syringe dispensing. NC community pharmacies infrequently offer HIV and HCV screening. Paired with disseminating the evidence of the positive impact of harm reduction on individual and public health outcomes to NC pharmacists, institutional and systems changes to practice and policy may be important to promote harm reduction service availability, particularly for rural NC residents.

TRIAL REGISTRATION

N/A.

Student pharmacists' perceptions regarding pharmacist-prescribed hormonal contraceptives and their professional responsibility

BACKGROUND

Currently, 13 U.S. jurisdictions allow for pharmacist-prescribed contraception; however, pharmacists' intention to use and ultimate uptake of this patient care opportunity have been variable.

OBJECTIVES

The objectives of this study were to (1) identify student pharmacists' attitudes toward pharmacist-prescribed hormonal contraception (HC), (2) identify student pharmacist perceived barriers regarding pharmacist-prescribed HC, and (3) explore what factors affect student pharmacists' viewpoints.

METHODS

An anonymous survey was administered using Qualtrics among third-year student pharmacists in a public health course. The survey was developed using the Theory of Planned Behavior (TPB) and previously published literature. TPB was developed to predict an individuals' intention to engage in a behavior at a specific time and place. All responses were anonymous. Survey responses were summarized using descriptive statistics, and Wilcoxon Mann-Whitney test was used to compare differences based on student pharmacist gender and religion.

RESULTS

A total of 67 student pharmacists participated in the survey (response rate 80.7%). Most agreed-strongly agreed (n = 59, 88.1%) that pharmacists are capable of appropriately assessing and selecting HC therapies and believe it should be within a pharmacist's scope of practice (n = 53, 79.1%). Similarly, most agreed-strongly agreed that it is a professional responsibility for pharmacists to provide this service (n = 56, 83.6%). Potential barriers identified included limited access to patient medical records (n = 55, 82.1%), interruption to workflow (n = 51, 76.1%), and concerns for a decrease in well-women examinations (n = 51, 76.1%). Most identified with the Christian faith (n = 45, 67.2%) but said this did not influence their opinions (n = 40, 59.7%). Gender, age, and religion were not found to be associated with student pharmacists' attitudes. However, an increasing number of barriers were negatively associated with their attitudes.

CONCLUSION

Student pharmacists believe it is within a pharmacist's scope of practice and a professional responsibly to prescribe HC. Student pharmacists were less supportive of pharmacist-prescribed HC if they reported a greater number of barriers.

Student Pharmacists' Attitudes Toward Suicide and the Perceived Role of Community Pharmacists in Suicidal Ideation Assessment

Objective. To determine first-year Doctor of Pharmacy students' attitudes toward suicide and perceptions of the role of the pharmacist in assessing patients for suicidal ideation, and whether their previous pharmacy work experience influences these attitudes and perceptions. Methods. An anonymous online survey was administered to first-year student pharmacists at one school of pharmacy in North Carolina. Measures included gender, previous community pharmacy work experience, personal contact with suicide, and score on the Attitudes Toward Suicide (ATTS) scale. Results. Seventy-three student pharmacists (75%) completed the survey. The vast majority (92%) agreed or strongly agreed that suicide was a real disease. Similarly, most students (79%) agreed or strongly agreed that pharmacists have a professional responsibility to assess for suicidal ideation. There was not a significant association between ATTS score and previous community pharmacy work experience nor the perceived pharmacist's role in assessing for suicidal ideation. Additionally, there was no association between ATTS score and personal contact with suicide. Conclusion. First-year student pharmacists, while undecided on their personal attitudes toward suicide, overwhelmingly agreed that suicide is a disease and that pharmacists have an important role in assessing patients for suicidal ideation. Pharmacy schools should implement training programs to prepare student pharmacists to identify suicidal ideation, design interventions to address student pharmacists' personal beliefs that may impact their ability to provide patient care, and provide students with adequate support skills to care for patients experiencing mental health crises.