1
|
Shalash A, Zolezzi M. The evolving role of pharmacists in depression care: a scoping review. Int J Clin Pharm 2024; 46:1044-1066. [PMID: 39007991 PMCID: PMC11399168 DOI: 10.1007/s11096-024-01759-1] [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: 12/07/2023] [Accepted: 05/22/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND Worldwide, depression is known to contribute significantly to the global burden of disease. Considering pharmacists are among the most approachable healthcare providers, they are well-placed to assist people with depression achieve positive treatment outcomes. AIM The primary aim was to examine the evidence regarding pharmacists' roles in interventions, outcomes, and barriers to implementation within depression care globally, with the secondary aim focusing on the Arab region. METHOD A scoping review was conducted according to the PRISMA-ScR extension guidelines and the Joanna Briggs Institute framework, using Scopus, Cochrane, ProQuest, and Medline databases for studies worldwide and within the Arab region (22 Arab-league countries). Article selection, along with data extraction, analysis, and narrative synthesis were performed independently by two reviewers. Discrepancies were resolved by consensus. RESULTS Forty studies reporting various roles and services provided by pharmacists in depression management were included. Most articles (24) described studies on pharmacist-led specific/single interventions/management strategies, and 16 described studies in which pharmacists provided comprehensive or team-based services. The majority of studies reported positive impact on patient outcomes. In accordance with the secondary aim, only three studies assessed various pharmacists' services for people with depression in the Arab region. Barriers to effective depression-related care included time constraints and training needs. CONCLUSION This scoping review supports the expanding role of pharmacists in depression management. The interventions, impact, challenges, and research gaps identified serve as preliminary evidence for advocating for an expanded pharmacists' scope of practice in mental health, both globally and in the Arab region.
Collapse
Affiliation(s)
- Ala' Shalash
- Clinical Pharmacy Department, Lehbi Renal Care, Riyadh, Kingdom of Saudi Arabia
| | - Monica Zolezzi
- Clinical Pharmacy and Practice, College of Pharmacy, QU Health, Qatar University, Doha, Qatar.
| |
Collapse
|
2
|
Goetschi AN, Meyer-Massetti C. Characterising pharmacists' interventions in chronic non-cancer pain care: a scoping review. Int J Clin Pharm 2024; 46:1010-1023. [PMID: 38861043 PMCID: PMC11399199 DOI: 10.1007/s11096-024-01741-x] [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: 02/08/2024] [Accepted: 04/08/2024] [Indexed: 06/12/2024]
Abstract
BACKGROUND Chronic non-cancer pain may affect up to 51% of the general population. Pharmacist interventions have shown promise in enhancing patient safety and outcomes. However, our understanding of the scope of pharmacists' interventions remains incomplete. AIM Our goal was to characterise pharmacists' interventions for the management of chronic non-cancer pain. METHOD Medline, Embase, PsycINFO via Ovid, CINAHL via EBSCO databases and the Cochrane Library were systematically searched. Abstracts and full texts were independently screened by two reviewers. Data were extracted by one reviewer, and validated by the second. Outcomes of studies were charted using the dimensions of the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT). RESULTS Forty-eight reports were included. Interventions ensuring appropriate drug prescription occurred in 37 (79%) studies. Patient education and healthcare professional education were reported in 28 (60%) and 5 (11%) studies, respectively. Therapy monitoring occurred in 17 (36%) studies. Interventions regularly involved interprofessional collaboration. A median of 75% of reported outcome domains improved due to pharmacist interventions, especially patient disposition (adherence), medication safety and satisfaction with therapy. CONCLUSION Pharmacists' interventions enhanced the management of chronic non-cancer pain. Underreported outcome domains and interventions, such as medication management, merit further investigation.
Collapse
Affiliation(s)
- Aljoscha Noël Goetschi
- Clinical Pharmacology and Toxicology, General Internal Medicine, University Hospital of Bern, Anna-Von-Krauchthal-Weg 7, 3010, Bern, Switzerland.
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland.
| | - Carla Meyer-Massetti
- Clinical Pharmacology and Toxicology, General Internal Medicine, University Hospital of Bern, Anna-Von-Krauchthal-Weg 7, 3010, Bern, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| |
Collapse
|
3
|
Inotai A, Kaló Z, Petykó Z, Gyöngyösi K, O’Keeffe DT, Czech M, Ágh T. Facilitators and Barriers of Incremental Innovation by Fixed Dose Combinations in Cardiovascular Diseases. J Cardiovasc Dev Dis 2024; 11:186. [PMID: 39057609 PMCID: PMC11277553 DOI: 10.3390/jcdd11070186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 06/18/2024] [Accepted: 06/19/2024] [Indexed: 07/28/2024] Open
Abstract
Despite the availability of affordable pharmaceuticals treating cardiovascular diseases (CVDs), many of the risk factors remain poorly controlled. Fixed-dose combinations (FDCs), a form of incremental innovation, have already demonstrated improvements over combinations of single medicines in adherence and hard clinical endpoints. Nevertheless, there are many barriers related to the wider use of FDCs in CVDs. Our aim was to identify these barriers and explore system-level facilitators from a multi-stakeholder perspective. Identified barriers include (i) hurdles in evidence generation for manufacturers, (ii) limited acceptance of adherence as an endpoint by clinical guideline developers and policymakers, (iii) limited options for a price premium for incremental innovation for healthcare payers, (iv) limited availability of real-world evidence, and (v) methodological issues to measure improved adherence. Initiatives to standardize and link healthcare databases in European countries, movements towards improved patient centricity in healthcare, and extended value assessment provide opportunities to capture the benefits of FDCs. Still, there is an emerging need to facilitate the generalizability of sporadic clinical evidence across different FDCs and to improve adherence measures. Finally, healthcare payers need to be convinced to pay a fair premium price for the added value of FDCs to incentivize incremental innovation in CVD treatment.
Collapse
Affiliation(s)
- András Inotai
- Center for Health Technology Assessment, Semmelweis University, 1091 Budapest, Hungary; (A.I.); (Z.P.); (K.G.)
- Syreon Research Institute, 1142 Budapest, Hungary;
| | - Zoltán Kaló
- Center for Health Technology Assessment, Semmelweis University, 1091 Budapest, Hungary; (A.I.); (Z.P.); (K.G.)
- Syreon Research Institute, 1142 Budapest, Hungary;
| | - Zsuzsanna Petykó
- Center for Health Technology Assessment, Semmelweis University, 1091 Budapest, Hungary; (A.I.); (Z.P.); (K.G.)
- Syreon Research Institute, 1142 Budapest, Hungary;
| | - Kristóf Gyöngyösi
- Center for Health Technology Assessment, Semmelweis University, 1091 Budapest, Hungary; (A.I.); (Z.P.); (K.G.)
- Syreon Research Institute, 1142 Budapest, Hungary;
| | | | - Marcin Czech
- Department of Pharmacoeconomics, Institute of Mother and Child, 01-211 Warsaw, Poland;
| | - Tamás Ágh
- Syreon Research Institute, 1142 Budapest, Hungary;
- Medication Adherence Research Group, Center for Health Technology Assessment and Pharmacoeconomic Research, University of Pécs, 7623 Pécs, Hungary
| |
Collapse
|
4
|
Urick BY, Adams JK, Bruce MR. State Telepharmacy Policies and Pharmacy Deserts. JAMA Netw Open 2023; 6:e2328810. [PMID: 37578793 PMCID: PMC10425826 DOI: 10.1001/jamanetworkopen.2023.28810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 07/03/2023] [Indexed: 08/15/2023] Open
Abstract
Importance Pharmacy deserts have increased, potentially affecting patient access and care. Historically, telepharmacies have been used to reduce pharmacy deserts to restore access, but states frequently restrict their operation. Objective To analyze whether telepharmacy policy is associated with pharmacy deserts and access to pharmacy services. Design, Setting, and Participants This cohort study analyzed pharmacy location and census data from 2016 through 2019 for US states with new telepharmacy policies. Nearby control states were used for comparison in a pretest-posttest nonequivalent group design. Statistical analysis was performed from January 2022 to July 2023. Exposure Intervention states were selected if a change in telepharmacy policy was adopted in 2017 or 2018. Main Outcomes and Measures Pharmacy deserts were defined as any geographic area located at least 10 miles from the nearest pharmacy. Primary outcomes included the change in number of telepharmacies, pharmacy deserts, and population in pharmacy deserts. Secondary outcomes included the percentage of telepharmacies located in medically underserved areas or populations (MUA/Ps), and the association between a telepharmacy opening nearby and the transition of a pharmacy desert into a nonpharmacy desert. Results Twelve US states were included in the study (8 intervention states, 4 control states). Intervention states experienced an increase in the mean number of telepharmacies to 7.25 with a range of 4 (Arizona, Indiana) to 14 (Iowa), but control states remained at a mean of 0.25 telepharmacies with a range of 0 to 1 (Kansas). Compared with controls, intervention states experienced a 4.5% (95% CI, 1.6% to 7.4%) decrease in the percentage of places defined as pharmacy deserts (P = .001) and an 11.1% (95% CI, 2.4% to 22.6%) decrease in the population in a pharmacy desert (P = .03). Telepharmacies were more likely to be located in a MUA/P than traditional pharmacies (preperiod in MUA/P: 63.2% of telepharmacies [12 of 19] vs 33.9% of traditional pharmacies [5984 of 17 511]; P = .01; postperiod in MUA/P: 62.7% of telepharmacies [37 of 59] vs 33.7% of traditional pharmacies [5998 of 17 800]; P < .001). When a telepharmacy was established in pharmacy deserts, 37.5% (30 of 80) no longer met the study's definition of a pharmacy desert the following year. In contrast, only 1.8% of places (68 of 3892) where a nearby telepharmacy did not open experienced this change (χ21=416.4; P < .001). Conclusions and Relevance In this cohort study, intervention states experienced a reduced population in pharmacy deserts, suggesting an association with new telepharmacy openings. States aiming to improve pharmacy access might consider less restrictive telepharmacy policies to potentially elicit greater patient outcomes.
Collapse
Affiliation(s)
- Benjamin Y. Urick
- Prime Therapeutics, Eagan, Minnesota
- UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill
| | | | | |
Collapse
|
5
|
Kelly WN, Ho MJ, Smith T, Bullers K, Kumar A. Association of pharmacist intervention counseling with medication adherence and quality of life: A systematic review and meta-analysis of randomized trials. J Am Pharm Assoc (2003) 2023; 63:1095-1105. [PMID: 37142053 DOI: 10.1016/j.japh.2023.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 03/20/2023] [Accepted: 04/25/2023] [Indexed: 05/06/2023]
Abstract
OBJECTIVE(S) To assess the association between pharmacist intervention counseling with medication adherence and quality of life. Also, to assess if these associations vary by the focus, structure, training, or robustness of the counseling. METHODS The initial search identified 1805 references, of which 62 randomized trials (RCTs) met inclusion criteria for the systematic review. Of the 62 RCTs, 60 (with 62 results) had extractable data for the meta-analysis. Data were pooled using a random-effects model. RESULTS Most study patients were older and taking multiple prescription drugs. The pooled results showed a statistically significant increase in the odds of medication adherence with the pharmacist counseling intervention versus no counseling (pooled odds ratio [OR] = 4.41; 95% confidence interval [CI] 2.46-7.91; P < 0.01). The results of a subgroup analysis suggest the primary disease, counseling focus, location, and robustness may modify the effect of pharmacist counseling on medication adherence. There was a statistically significant improvement in the quality of life with pharmacist counseling versus no pharmacist counseling (pooled standardized mean difference [SMD] = 0.69; 95% CI 0.41-0.96; P < 0.01). The results of a subgroup analysis suggest that counseling focus, location, training, robustness, and the measurement method, but not the disease category, may modify the effect of pharmacist counseling on quality of life. CONCLUSION The evidence supports pharmacist intervention counseling to increase mediation adherence and quality of life. The counseling location and structure may be significant factors in improving medication adherence. The overall methodological quality of evidence was very low.
Collapse
|
6
|
A qualitative exploration of mental health services provided in community pharmacies. PLoS One 2022; 17:e0268259. [PMID: 35551556 PMCID: PMC9098086 DOI: 10.1371/journal.pone.0268259] [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: 11/05/2021] [Accepted: 04/26/2022] [Indexed: 11/19/2022] Open
Abstract
The burden of mental health problems continues to grow worldwide. Community pharmacists’, as part of the primary care team, optimise care for people living with mental illness. This study aims to examine the factors that support or hinder the delivery of mental health services delivered in Australian community pharmacies and proposes ideas for improvement. A qualitative study was conducted comprising focus groups with community pharmacists and pharmacy staff across metropolitan, regional, and rural areas of New South Wales, Australia. Data were collected in eight focus groups between December 2020 and June 2021. Qualitative data were analysed using thematic analysis. Thirty-three community pharmacists and pharmacy staff participated in an initial round of focus groups. Eleven community pharmacists and pharmacy staff participated in a second round of focus groups. Twenty-four factors that enable or hinder the delivery of mental health services in community pharmacy were identified. Participant’s perception of a lack of recognition and integration of community pharmacy within primary care were identified as major barriers, in addition to consumers’ stigma and lack of awareness regarding service offering. Suggestions for improvement to mental health care delivery in community pharmacy included standardised practice through the use of protocols, remuneration and public awareness. A framework detailing the factors moderating pharmacists, pharmacy staff and consumers’ empowerment in mental health care delivery in community pharmacy is proposed. This study has highlighted that policy and funding support for mental health services is needed that complement and expand integrated models, promote access to services led by or are conducted in collaboration with pharmacists and recognise the professional contribution and competencies of community pharmacists in mental health care. The framework proposed may be a step to strengthening mental health support delivered in community pharmacies.
Collapse
|
7
|
El-Den S, Collins JC, Chen TF, O'reilly CL. Pharmacists' roles in mental healthcare: Past, present and future. Pharm Pract (Granada) 2021; 19:2545. [PMID: 34621456 PMCID: PMC8456342 DOI: 10.18549/pharmpract.2021.3.2545] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Mental illnesses cause significant disease burden globally, with medicines being a major modality of treatment for most mental illnesses. Pharmacists are accessible and trusted healthcare professionals who have an important role in supporting people living with mental illness. This commentary discusses the role of pharmacists in mental healthcare, as part of multidisciplinary teams, the current evidence to support these roles, and the training, remuneration and policy changes needed to recognize these roles and embed pharmacists as core members of the mental healthcare team.
Collapse
Affiliation(s)
- Sarira El-Den
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney. Sydney, NSW (Australia).
| | - Jack C Collins
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney. Sydney, NSW (Australia).
| | - Timothy F Chen
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney. Sydney, NSW (Australia).
| | - Claire L O'reilly
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney. Sydney, NSW (Australia).
| |
Collapse
|
8
|
An investigation of new medications initiation during ambulatory care visits in patients with dementia. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2021; 3:100058. [PMID: 35480611 PMCID: PMC9030674 DOI: 10.1016/j.rcsop.2021.100058] [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: 03/24/2021] [Revised: 06/23/2021] [Accepted: 08/06/2021] [Indexed: 11/21/2022] Open
Abstract
Background Objectives Methods Results Conclusion What was already known?Dementia remains responsible for a large economic burden; research has shown that patients with dementia have increased utilization of ambulatory care visits before and after diagnosis. Prior research in patients with dementia has focused on inappropriate prescribing, adverse drug interactions, and polypharmacy, but little work has been published investigating new medications prescribed at outpatient visits. Opportunities exist for pharmacists to manage medications in the outpatient setting for patients with complex medication regimens.
What the study adds?Though fewer visits for patients with dementia provided new medications compared to visits for patients without dementia, there was no statistically significant difference in odds of a new medication being provided after adjustment for important confounders. Some of the new medications more commonly provided to dementia patients include anticoagulants and antipsychotics that often require close monitoring and dosage adjustments. Pharmacist led services would likely improve the care of the dementia population in an outpatient setting, but further investigation of new medication usage and the utility of pharmacists is needed.
Collapse
|
9
|
Bunchuailua W, Samprasit N, Kotirum S, Kapol N. Impact of Pharmacist Activities in Patients With Depression: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Ann Pharmacother 2021; 56:556-564. [PMID: 34459265 DOI: 10.1177/10600280211041274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Depression is a substantial health burden. Pharmacist activities may help improve health outcomes of patients with depression when comparing to current practice with no pharmacist-involved intervention. OBJECTIVE To systematically review and analyze randomized controlled trials assessing the impact of pharmacist services on patients with depression compared to usual care using a meta-analysis approach. METHODS Four international and 3 domestic electronic databases were systematically searched. Data from database inception to December 2019 were included. Studies were selected using predefined inclusion criteria, and quality was assessed using the risk-of-bias criteria. Pooled estimation was analyzed to report the relative risk (RR) and standard mean difference (SMD). The meta-analysis used the random-effect model when heterogeneity was observed between studies. RESULTS A total of 12 eligible studies with 2133 patients with depression were included in the analysis. The relevant pharmacist interventions included medication therapy management, adherence counseling, and educational advice about depression and antidepressants. Pooled data in the meta-analysis showed a significantly increased number of patients with good adherence (RR = 1.39; 95% CI = 1.11 to 1.75) and improved medication adherence score (SMD = 0.32; 95% CI = 0.07 to 0.56) associated with pharmacist activities compared to usual care. No significant differences were detected in clinical rating scales (SMD = -0.03; 95% CI = -0.16 to 0.10) and quality of life (SMD = 0.10; 95% CI = -0.04 to 0.25). CONCLUSION AND RELEVANCE This review suggests that the role of pharmacists in patients with depression has a positive impact on medication adherence.
Collapse
Affiliation(s)
| | | | - Surachai Kotirum
- Faculty of Pharmacy, Silpakorn University, Nakhon Pathom, Thailand.,College of Pharmacy, Rangsit University, Pathum Thani, Thailand
| | - Nattiya Kapol
- Faculty of Pharmacy, Silpakorn University, Nakhon Pathom, Thailand
| |
Collapse
|
10
|
Yusuf H, Magaji MG, Maiha BB, Yakubu SI, Haruna WC, Mohammed S. Impact of pharmacist intervention on antidepressant medication adherence and disease severity in patients with major depressive disorder in fragile north-east Nigeria. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2021. [DOI: 10.1093/jphsr/rmab030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Objectives
Medication adherence is emerging as a major public health challenge particularly in patients with depression. The aim of this study was to explore the usefulness of a pharmacist intervention to improve antidepressant medication adherence and disease severity in patients with major depressive disorder.
Methods
This prospective interventional study was conducted between April 2019 and March 2020 among 101 patients at the Federal Neuro-Psychiatric Hospital, Maiduguri, Nigeria. Consenting patients were randomised into usual care or intervention groups using a computer-generated list. Data were collected at baseline, 3 months and 6 months. Medication adherence and depression severity were assessed using the Medication Adherence Rating Scale and Beck Depression Inventory respectively.
Key findings
At baseline, both the usual care and intervention groups had low mean scores for medication adherence [5.22 (SD = 1.51) versus 5.46 (SD = 1.46)] and high mean scores for depression severity [24.16 (SD = 13.50) versus 27.07 (SD = 16.12)]. At 6 months, there was a significant difference (P < 0.001) between the mean medication adherence scores of 5.22 (SD = 1.90) and 9.15 (SD = 1.62), in the usual care and intervention groups respectively. A significant difference (P = 0.033) was also observed at 6 months between the mean depression severity scores of the usual care and intervention groups [21.40 (SD = 11.52) and 17.34 (SD = 6.96)]. Medication adherence (P < 0.001, Partial eta squared = 0.279) and depression severity (P < 0.001, Partial eta squared = 0.170) positively changed with time in the presence of the intervention.
Conclusions
The intervention significantly improved antidepressant medication adherence and disease severity in patients with major depressive disorder.
Collapse
Affiliation(s)
- Hadiza Yusuf
- Department of Clinical Pharmacy and Pharmacy Administration, Faculty of Pharmacy, University of Maiduguri, Maiduguri, Nigeria
| | - Mohammed G Magaji
- Department of Pharmacology and Therapeutics, Faculty of Pharmaceutical Sciences, Ahmadu Bello University, Zaria, Nigeria
| | - Bilkisu B Maiha
- Department of Pharmacology and Therapeutics, Faculty of Pharmaceutical Sciences, Ahmadu Bello University, Zaria, Nigeria
| | - Sani I Yakubu
- Department of Clinical Pharmacy and Pharmacy Administration, Faculty of Pharmacy, University of Maiduguri, Maiduguri, Nigeria
| | - Wazis C Haruna
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, University of Maiduguri, Maiduguri, Nigeria
| | - Shafiu Mohammed
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmaceutical Sciences, Ahmadu Bello University, Zaria, Nigeria
- Health Systems and Policy Research Unit, Ahmadu Bello University, Zaria, Nigeria
| |
Collapse
|
11
|
Okoro RN, Nduaguba SO. Community pharmacists on the frontline in the chronic disease management: The need for primary healthcare policy reforms in low and middle income countries. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2021; 2:100011. [PMID: 35481111 PMCID: PMC9032016 DOI: 10.1016/j.rcsop.2021.100011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 03/31/2021] [Accepted: 04/11/2021] [Indexed: 11/02/2022] Open
Abstract
In low- and middle-income countries (LMICs), over 12 million people die yearly from chronic diseases and this number is expected to increase if concerted actions are not taken. The purpose of this paper is to highlight the roles and impact of community pharmacists in chronic disease management support and the need for policymakers in LMICs to reposition community pharmacists appropriately for this extended role. Recent findings have shown that community pharmacists are the most accessible healthcare providers to the members of the community. Published evidence have demonstrated that community pharmacists' interventions in chronic diseases significantly improve economic, clinical, and humanistic outcomes. However, they are not officially recognized as primary healthcare providers in LMICs. Therefore, there is need for policy reforms that will encourage strategic use of the clinical skills of community pharmacists as part of the primary healthcare team in LMICs.
Collapse
|
12
|
Tong V, Krass I, Luckie K, Aslani P. The evolving profile of cognitive pharmaceutical services in Australia. Res Social Adm Pharm 2021; 18:2529-2537. [PMID: 33992586 DOI: 10.1016/j.sapharm.2021.03.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 03/17/2021] [Indexed: 11/19/2022]
Abstract
Globally, the availability and delivery of cognitive pharmaceutical services (CPS) by pharmacists has expanded over time. Australia has been no exception to this trend, with government funding to support the provision of certain CPS significantly increasing over the last two decades. Whilst medication management services have been consistently funded by the government for more than 15 years, fluctuations in the funding of other CPS have been observed; for example, certain disease state management CPS and introduction of funded MedsChecks. Furthermore, legislative changes have broadened pharmacists' scope of practice and the CPS provided, contributing to an increase in user-pay services. Although the literature to date has highlighted positive impacts associated with CPS on economic, clinical and/or humanistic outcomes, context-specific, real world evidence for the benefits of CPS is much needed to ensure the profession engages in evidence-based practice. The aim of this commentary is to outline the changes in CPS provision and funding within the Australian context, the existing evidence for CPS, and highlight the implications for future research.
Collapse
Affiliation(s)
- Vivien Tong
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Australia.
| | - Ines Krass
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Australia.
| | - Kate Luckie
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Australia.
| | - Parisa Aslani
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Australia.
| |
Collapse
|
13
|
Association of pharmacist counseling with adherence, 30-day readmission, and mortality: A systematic review and meta-analysis of randomized trials. J Am Pharm Assoc (2003) 2021; 61:340-350.e5. [PMID: 33678564 DOI: 10.1016/j.japh.2021.01.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 01/13/2021] [Accepted: 01/19/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE(S) To determine the association of pharmacist medication counseling with medication adherence, 30-day hospital readmission, and mortality. METHODS The initial search identified 21,590 citations. After applying the inclusion and exclusion criteria, 62 randomized controlled trials (RCTs) (49 for the meta-analysis) were included in the final analysis. Data were pooled using a random-effects model. RESULTS The participants in most of the studies were older patients with chronic diseases who, therefore, were taking many drugs. The overall methodologic quality of evidence ranged from low to very low. Pharmacist medication counseling versus no such counseling was associated with a statistically significant 30% increase in relative risk (RR) for medication adherence, a 24% RR reduction in 30-day hospital readmission (number needed to treat = 4.2), and a 30% RR reduction in emergency department visits. RR reductions for primary care visits and mortality were not statistically significant. CONCLUSION The evidence supports pharmacist medication counseling to increase medication adherence and to reduce 30-day hospital readmissions and emergency department visits. However, higher-quality RCT studies are needed to confirm or refute these findings.
Collapse
|
14
|
Ayorinde AA, Williams I, Mannion R, Song F, Skrybant M, Lilford RJ, Chen YF. Publication and related bias in quantitative health services and delivery research: a multimethod study. HEALTH SERVICES AND DELIVERY RESEARCH 2020. [DOI: 10.3310/hsdr08330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Bias in the publication and reporting of research findings (referred to as publication and related bias here) poses a major threat in evidence synthesis and evidence-based decision-making. Although this bias has been well documented in clinical research, little is known about its occurrence and magnitude in health services and delivery research.
Objectives
To obtain empirical evidence on publication and related bias in quantitative health services and delivery research; to examine current practice in detecting/mitigating this bias in health services and delivery research systematic reviews; and to explore stakeholders’ perception and experiences concerning such bias.
Methods
The project included five distinct but interrelated work packages. Work package 1 was a systematic review of empirical and methodological studies. Work package 2 involved a survey (meta-epidemiological study) of randomly selected systematic reviews of health services and delivery research topics (n = 200) to evaluate current practice in the assessment of publication and outcome reporting bias during evidence synthesis. Work package 3 included four case studies to explore the applicability of statistical methods for detecting such bias in health services and delivery research. In work package 4 we followed up four cohorts of health services and delivery research studies (total n = 300) to ascertain their publication status, and examined whether publication status was associated with statistical significance or perceived ‘positivity’ of study findings. Work package 5 involved key informant interviews with diverse health services and delivery research stakeholders (n = 24), and a focus group discussion with patient and service user representatives (n = 8).
Results
We identified only four studies that set out to investigate publication and related bias in health services and delivery research in work package 1. Three of these studies focused on health informatics research and one concerned health economics. All four studies reported evidence of the existence of this bias, but had methodological weaknesses. We also identified three health services and delivery research systematic reviews in which findings were compared between published and grey/unpublished literature. These reviews found that the quality and volume of evidence and effect estimates sometimes differed significantly between published and unpublished literature. Work package 2 showed low prevalence of considering/assessing publication (43%) and outcome reporting (17%) bias in health services and delivery research systematic reviews. The prevalence was lower among reviews of associations than among reviews of interventions. The case studies in work package 3 highlighted limitations in current methods for detecting these biases due to heterogeneity and potential confounders. Follow-up of health services and delivery research cohorts in work package 4 showed positive association between publication status and having statistically significant or positive findings. Diverse views concerning publication and related bias and insights into how features of health services and delivery research might influence its occurrence were uncovered through the interviews with health services and delivery research stakeholders and focus group discussion conducted in work package 5.
Conclusions
This study provided prima facie evidence on publication and related bias in quantitative health services and delivery research. This bias does appear to exist, but its prevalence and impact may vary depending on study characteristics, such as study design, and motivation for conducting the evaluation. Emphasis on methodological novelty and focus beyond summative assessments may mitigate/lessen the risk of such bias in health services and delivery research. Methodological and epistemological diversity in health services and delivery research and changing landscape in research publication need to be considered when interpreting the evidence. Collection of further empirical evidence and exploration of optimal health services and delivery research practice are required.
Study registration
This study is registered as PROSPERO CRD42016052333 and CRD42016052366.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 33. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Abimbola A Ayorinde
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Iestyn Williams
- Health Services Management Centre, School of Social Policy, University of Birmingham, Birmingham, UK
| | - Russell Mannion
- Health Services Management Centre, School of Social Policy, University of Birmingham, Birmingham, UK
| | - Fujian Song
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Magdalena Skrybant
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Richard J Lilford
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Yen-Fu Chen
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| |
Collapse
|
15
|
El-Den S, McMillan SS, Wheeler AJ, Ng R, Roennfeldt H, O'Reilly CL. Pharmacists' roles in supporting people living with severe and persistent mental illness: a systematic review protocol. BMJ Open 2020; 10:e038270. [PMID: 32665350 PMCID: PMC7359051 DOI: 10.1136/bmjopen-2020-038270] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 05/12/2020] [Accepted: 05/15/2020] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Severe and persistent mental illness (SPMI) can significantly impact a person's social, personal and professional life. Previous studies have demonstrated pharmacists' roles in mental healthcare; however, limited studies to date have focused on pharmacists' roles in providing healthcare services, specifically, to people living with SPMI. The aim of this systematic review is to explore the pharmacists' roles in providing support to people living with SPMI. METHODS AND ANALYSIS A systematic search will be conducted in Medline, Embase (Ovid), PsycINFO, CINAHL, Web of Science, Scopus, Cochrane Library, International Pharmaceutical Abstracts and ProQuest Dissertations and Theses to identify potentially relevant primary research for inclusion. This will be guided by the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols checklist for systematic reviews. All primary research publications regardless of study design exploring or reporting on pharmacists' involvement in supporting people living with SPMI will be considered for inclusion. A tabular summary will be completed using data extracted from each included publication. Data synthesis and quality assessment methods will be chosen based on included study designs. ETHICS AND DISSEMINATION The results will be published in a peer-reviewed journal and used to inform the development of a pharmacist-specific training package to support people living with SPMI. PROSPERO REGISTRATION NUMBER CRD42020170711.
Collapse
Affiliation(s)
- Sarira El-Den
- Sydney Pharmacy School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Sara S McMillan
- School of Pharmacy and Pharmacology, Griffith University, Southport, Queensland, Australia
- Menzies Health Institute, Griffith University, Nathan, Queensland, Australia
| | - Amanda J Wheeler
- Menzies Health Institute, Griffith University, Nathan, Queensland, Australia
- Faculty of Health and Medical Sciences, University of Auckland, Auckland, New Zealand
| | - Ricki Ng
- Sydney Pharmacy School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Helena Roennfeldt
- Menzies Health Institute, Griffith University, Nathan, Queensland, Australia
- The University of Melbourne Centre for Psychiatric Nursing, Carlton, Victoria, Australia
| | - Claire L O'Reilly
- Sydney Pharmacy School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
16
|
Fénélon-Dimanche R, Guénette L, Trudel-Bourgault F, Yousif A, Lalonde G, Beauchesne MF, Collin J, Blais L. Development of an electronic tool (e-AdPharm) to address unmet needs and barriers of community pharmacists to provide medication adherence support to patients. Res Social Adm Pharm 2020; 17:506-513. [PMID: 32402728 DOI: 10.1016/j.sapharm.2020.04.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 02/20/2020] [Accepted: 04/20/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Community pharmacists are best placed to improve medication adherence because they frequently interact with patients and have been trained to manage medication-related problems. Therefore, it is essential to equip pharmacists adequately to detect non-adherent patients quickly and intervene to improve medication adherence. OBJECTIVE To design e-AdPharm, a tool that addresses unmet needs and barriers of community pharmacists to provide medication adherence support to patients with chronic diseases. METHODS A qualitative study using 4 focus group discussions with community pharmacists was conducted with a semi-structured interview guide and discussions lasting for 1-2 h. The discussions covered the barriers and needs of pharmacists related to medication adherence support provided to patients, their expectations of an electronic tool based on prescription refills to help them provide this support, and the design of the tool. Focus group data were coded and analyzed using an iterative process, with thematic and descriptive analyses. RESULTS Twenty-six community pharmacists participated. Lack of time and motivation from pharmacists and patients were common barriers to the provision of medication adherence support. Accordingly, community pharmacists wished to measure medication adherence quickly, provide easily interpretable data to patients on their medication use, and raise the patient's awareness of non-adherence. The pharmacists expressed their need to have an electronic tool to share medication adherence information with the treating physician. Regarding the design of e-AdPharm, the pharmacists wanted a table displaying medication adherence with a color code representing adherence level. They also stressed the importance of a structured section enabling them to continuously document the interventions made and the need for patient follow-ups. CONCLUSIONS e-AdPharm meet the needs and overcome the barriers of community pharmacists to provide medication adherence support to their patients. Future studies should examine the feasibility of implementing e-AdPharm in community pharmacies and test its efficacy for improving medication adherence.
Collapse
Affiliation(s)
- Rébecca Fénélon-Dimanche
- Faculty of Pharmacy, Université de Montréal, Montréal, Québec, Canada; Research Centre, CIUSSS du Nord-de-l'île de Montréal, Montréal, Québec, Canada.
| | - Line Guénette
- Faculty of Pharmacy, Université Laval, Québec, Québec, Canada; CHU de Québec Research Centre, Population Health and Optimal Health Practices Research Unit, Québec, Québec, Canada.
| | | | - Alia Yousif
- Faculty of Pharmacy, Université de Montréal, Montréal, Québec, Canada; Research Centre, CIUSSS du Nord-de-l'île de Montréal, Montréal, Québec, Canada.
| | - Geneviève Lalonde
- Faculty of Pharmacy, Université de Montréal, Montréal, Québec, Canada; Research Centre, CIUSSS du Nord-de-l'île de Montréal, Montréal, Québec, Canada.
| | - Marie-France Beauchesne
- Faculty of Pharmacy, Université de Montréal, Montréal, Québec, Canada; Research Centre, CIUSSS du Nord-de-l'île de Montréal, Montréal, Québec, Canada; Research Centre, CIUSSS de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada.
| | - Johanne Collin
- Faculty of Pharmacy, Université de Montréal, Montréal, Québec, Canada.
| | - Lucie Blais
- Faculty of Pharmacy, Université de Montréal, Montréal, Québec, Canada; Research Centre, CIUSSS du Nord-de-l'île de Montréal, Montréal, Québec, Canada; Endowment Pharmaceutical Chair AstraZeneca in Respiratory Health, Montréal, Québec, Canada.
| |
Collapse
|
17
|
Reasons for medication non-initiation: A qualitative exploration of the patients’ perspective. Res Social Adm Pharm 2020; 16:663-672. [DOI: 10.1016/j.sapharm.2019.08.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 07/25/2019] [Accepted: 08/01/2019] [Indexed: 12/14/2022]
|
18
|
Fénélon-Dimanche R, Guénette L, Yousif A, Lalonde G, Beauchesne MF, Collin J, Blais L. Monitoring and managing medication adherence in community pharmacies in Quebec, Canada. Can Pharm J (Ott) 2020; 153:108-121. [PMID: 32206156 DOI: 10.1177/1715163520902494] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background Community pharmacists have direct access to prescription refill information and regularly interact with their patients. Therefore, they are in a unique position to promote optimal medication use. Objectives To describe how community pharmacists in Quebec, Canada, identify nonadherent patients, monitor medication use and promote optimal medication adherence. Methods An invitation to complete a web-based survey was published online through different platforms, including a Facebook pharmacists' group, an electronic newsletter, a pharmacy network forum and e-mail. The survey included questions on participant characteristics, methods used by pharmacists to identify nonadherent patients and monitor medication use and interventions they used to promote medication adherence. Results In total, 342 community pharmacists completed the survey. The participants were mainly women (71.6%), staff pharmacists (56.7%) and aged 30 to 39 years (34.2%). The most common method to identify nonadherent patients was to check gaps between prescription refills (98.8%). The most common intervention to promote adherence was patient counselling (82.5%). The most common barriers to identifying nonadherent patients were lack of time (73.1%) and lack of prescription information (65.8%), whereas the most common barriers to intervening were anticipation of a negative reaction from their patients (91.2%) and lack of time (64%). Conclusion Lack of time and lack of prescription information are frequent challenges encountered by community pharmacists regarding effective monitoring and management of patients with poor medication adherence. Pharmacists could benefit from electronic tools based on prescription refills that would provide quick and easily interpretable information on their patients' medication adherence. Can Pharm J (Ott) 2020;153:xx-xx.
Collapse
Affiliation(s)
- Rébecca Fénélon-Dimanche
- Faculty of Pharmacy (Fénélon-Dimanche, Yousif, Lalonde, Beauchesne, Collin, Blais), Université de Montréal, Montréal
- Research Centre, CIUSSS du Nord-de-l'île de Montréal (Fénélon-Dimanche, Yousif, Lalonde, Beauchesne, Collin, Blais), Montréal
- Faculty of Pharmacy, Université Laval (Guénette), Québec
- CHU de Québec Research Centre (Guénette), Population Health and Optimal Health Practices Research Unit, Québec
- Research Centre, CIUSSS de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (Beauchesne), Sherbrooke, Québec
| | - Line Guénette
- Faculty of Pharmacy (Fénélon-Dimanche, Yousif, Lalonde, Beauchesne, Collin, Blais), Université de Montréal, Montréal
- Research Centre, CIUSSS du Nord-de-l'île de Montréal (Fénélon-Dimanche, Yousif, Lalonde, Beauchesne, Collin, Blais), Montréal
- Faculty of Pharmacy, Université Laval (Guénette), Québec
- CHU de Québec Research Centre (Guénette), Population Health and Optimal Health Practices Research Unit, Québec
- Research Centre, CIUSSS de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (Beauchesne), Sherbrooke, Québec
| | - Alia Yousif
- Faculty of Pharmacy (Fénélon-Dimanche, Yousif, Lalonde, Beauchesne, Collin, Blais), Université de Montréal, Montréal
- Research Centre, CIUSSS du Nord-de-l'île de Montréal (Fénélon-Dimanche, Yousif, Lalonde, Beauchesne, Collin, Blais), Montréal
- Faculty of Pharmacy, Université Laval (Guénette), Québec
- CHU de Québec Research Centre (Guénette), Population Health and Optimal Health Practices Research Unit, Québec
- Research Centre, CIUSSS de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (Beauchesne), Sherbrooke, Québec
| | - Geneviève Lalonde
- Faculty of Pharmacy (Fénélon-Dimanche, Yousif, Lalonde, Beauchesne, Collin, Blais), Université de Montréal, Montréal
- Research Centre, CIUSSS du Nord-de-l'île de Montréal (Fénélon-Dimanche, Yousif, Lalonde, Beauchesne, Collin, Blais), Montréal
- Faculty of Pharmacy, Université Laval (Guénette), Québec
- CHU de Québec Research Centre (Guénette), Population Health and Optimal Health Practices Research Unit, Québec
- Research Centre, CIUSSS de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (Beauchesne), Sherbrooke, Québec
| | - Marie-France Beauchesne
- Faculty of Pharmacy (Fénélon-Dimanche, Yousif, Lalonde, Beauchesne, Collin, Blais), Université de Montréal, Montréal
- Research Centre, CIUSSS du Nord-de-l'île de Montréal (Fénélon-Dimanche, Yousif, Lalonde, Beauchesne, Collin, Blais), Montréal
- Faculty of Pharmacy, Université Laval (Guénette), Québec
- CHU de Québec Research Centre (Guénette), Population Health and Optimal Health Practices Research Unit, Québec
- Research Centre, CIUSSS de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (Beauchesne), Sherbrooke, Québec
| | - Johanne Collin
- Faculty of Pharmacy (Fénélon-Dimanche, Yousif, Lalonde, Beauchesne, Collin, Blais), Université de Montréal, Montréal
- Research Centre, CIUSSS du Nord-de-l'île de Montréal (Fénélon-Dimanche, Yousif, Lalonde, Beauchesne, Collin, Blais), Montréal
- Faculty of Pharmacy, Université Laval (Guénette), Québec
- CHU de Québec Research Centre (Guénette), Population Health and Optimal Health Practices Research Unit, Québec
- Research Centre, CIUSSS de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (Beauchesne), Sherbrooke, Québec
| | - Lucie Blais
- Faculty of Pharmacy (Fénélon-Dimanche, Yousif, Lalonde, Beauchesne, Collin, Blais), Université de Montréal, Montréal
- Research Centre, CIUSSS du Nord-de-l'île de Montréal (Fénélon-Dimanche, Yousif, Lalonde, Beauchesne, Collin, Blais), Montréal
- Faculty of Pharmacy, Université Laval (Guénette), Québec
- CHU de Québec Research Centre (Guénette), Population Health and Optimal Health Practices Research Unit, Québec
- Research Centre, CIUSSS de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (Beauchesne), Sherbrooke, Québec
| |
Collapse
|
19
|
Shoji M, Fujiwara A, Onda M. Creation and validation of a semi-quantitative instrument to assess the confidence of pharmacists in medication consultation for patients with depression: The pharmacists' confidence scale about medication consultation for depressive patients (PCMCD). Pharm Pract (Granada) 2020; 17:1628. [PMID: 31897261 PMCID: PMC6935550 DOI: 10.18549/pharmpract.2019.4.1628] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 10/20/2019] [Indexed: 11/14/2022] Open
Abstract
Objectives To develop a semi-quantitative instrument to assess pharmacists' confidence in medication counseling for patients with depression, The Pharmacists' Confidence scale about Medication Consultation for Depressive patients (PCMCD), and investigated its validity. Methods Following discussions with practicing pharmacists, we developed a 12-item questionnaire to assess pharmacists' confidence in medication counseling for patients with depression. We launched web-based cross-sectional survey during November and December 2018 to 77 pharmacists employed at drug chain stores in Kansai area. Factor analysis was performed to evaluate the configuration concept validity. The least-squares method was used for factor extraction, and the resulting factors were subjected to direct oblimin rotation, with a factor loading cut-off of 0.4. To assess internal consistency, Cronbach's alpha values were calculated for each of the extracted factors (subscales). A multiple regression analysis was performed using simultaneous forced entry, with the scores obtained for each subscale as dependent variables and responder attributes as independent variables in order to investigate the factors associated with each subscale. Results During the factor analysis procedure, four questions were excluded by the cut-off rule. Eventually, a model with three subscales was identified, with a cumulative sum of squared loadings being 61.9%. The subscales were termed "relationship building," "comprehension of condition," and "information provision" based on the nature of the questions relevant for each of them. The Cronbach's alpha values for these subscales were 0.92, 0.73, and 0.72, respectively. The average inter-item correlation was 0.378. In addition, multiple regression analysis revealed that there were significant correlations between pharmacist career and both relationship building and information provision. Conclusions The PCMCD model demonstrated a satisfactory construct validity and internal consistency. This model will provide an excellent tool for assessing pharmacists' confidence in depression care.
Collapse
Affiliation(s)
- Masaki Shoji
- PhD. Assistant Professor. Department of Social and Administrative Pharmacy, Osaka University of Pharmaceutical Sciences. Osaka (Japan).
| | - Atsuko Fujiwara
- BPharm. General manager of Division of Planning and management of pharmacists training. Apis Pharmacy. Osaka (Japan).
| | - Mitsuko Onda
- PhD. Professor. Department of Social and Administrative Pharmacy, Osaka University of Pharmaceutical Sciences. Osaka (Japan).
| |
Collapse
|
20
|
Haslam L, Gardner DM, Murphy AL. A retrospective analysis of patient care activities in a community pharmacy mental illness and addictions program. Res Social Adm Pharm 2019; 16:522-528. [PMID: 31327736 DOI: 10.1016/j.sapharm.2019.07.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 07/04/2019] [Accepted: 07/05/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND The Bloom Program, a community pharmacy-based mental health and addictions care program, was developed and implemented to optimize pharmacists' care of eligible patients. Characterizing pharmacists' activities in the Bloom Program can facilitate program quality improvement and contribute more broadly to the knowledge base regarding pharmacists' roles and contributions to patient care. OBJECTIVES To characterize the patient care activities of the pharmacists in the Bloom Program. METHODS A retrospective analysis of patient charts for participants enrolled in the program for three months or longer was conducted. Using all available documentation, pharmacists' activities were coded into eight non-mutually exclusive categories: navigation/resource support, urgent triage, medication management, collaboration/communication, education, social support, self-care, and other. RESULTS 2055 activities from 1144 patient care encounters were identified for 126 participants (48 ± 16 years of age, 61% female, 5 regular medications). Medication management was coded most often per encounter (73%). Each of social support, collaboration/communication, and education were coded in 20-25% of encounters. Frequency of navigation/resources, self-care, and urgent triage were 16.6%, 13.5%, and 2.8%, respectively. Non-medication management activities represented 59.4% of all pharmacist patient care services. CONCLUSIONS Medication management activities were coded in over 70% of patient encounters for pharmacists delivering a community pharmacy-based mental illness and addictions program. However, this accounted for 40.6% of activities with an average of 1.8 activities per encounter. Other activities were identified frequently (e.g., education, collaboration, social support, navigation and resource support) and help to characterize the nature of pharmacist-patient encounters and facilitates a better understanding of the role of the pharmacist in mental illness and addictions patient care.
Collapse
Affiliation(s)
- Lauren Haslam
- Dalhousie Medical School, Dalhousie University, Halifax, Nova Scotia, PO Box 15000, B3H 4R2, Canada.
| | - David M Gardner
- Department of Psychiatry, Dalhousie University, QEII HSC, AJLB 7517, 5909 Veterans' Memorial Lane, Halifax, Nova Scotia, B3H 2E2, Canada.
| | - Andrea Lynn Murphy
- College of Pharmacy, Dalhousie University, 5968 College St., PO Box 15000, Halifax, Nova Scotia, B3H 4R2, Canada.
| |
Collapse
|
21
|
Rubio-Valera M, Peñarrubia-María MT, Iglesias-González M, Knapp M, McCrone P, Roig M, Sabes-Figuera R, Luciano JV, Mendive JM, Murrugara-Centurión AG, Alonso J, Serrano-Blanco A. Cost-effectiveness of antidepressants versus active monitoring for mild-to-moderate major depressive disorder: a multisite non-randomized-controlled trial in primary care (INFAP study). THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2019; 20:703-713. [PMID: 30725226 DOI: 10.1007/s10198-019-01034-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 01/31/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate the cost-effectiveness of antidepressants vs active monitoring (AM) for patients with mild-moderate major depressive disorder. METHODS This was a 12-month observational prospective controlled trial. Adult patients with a new episode of major depression were invited to participate and assigned to AM or antidepressants according to General Practitioners' clinical judgment and experience. Patients were evaluated at baseline, and 6 and 12-month follow-up. Quality-adjusted life years (QALYs) gained were estimated and used to calculate incremental cost-utility ratios (ICUR) from the healthcare and government perspective. To minimize the bias resulting from non-randomization, a propensity score-based method was used. RESULTS At 6 and 12-month follow-up, ICUR was 2549 €/QALY and 6,142 €/QALY, respectively, in favor of antidepressants. At 6 months, for a willingness to pay (WTP) of 25,000 €/QALY, antidepressants had a probability of 0.89 (healthcare perspective) and 0.81 (government perspective) of being more cost-effective than AM. At 12 months, this probability was 0.86 (healthcare perspective) and 0.73 (government perspective). CONCLUSIONS Incremental cost-utility ratios favor pharmacological treatment as a first-line approach for patients with mild-moderate major depressive disorder. While our results should be interpreted with caution and further real world research is needed, clinical practice guidelines should consider antidepressant therapy for mild-moderate major depressive patients as an alternative to active monitoring in PC.
Collapse
Affiliation(s)
- Maria Rubio-Valera
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, C/ Pablo Picasso 12, 08830, Sant Boi de Llobregat, Spain.
- Centre for Biomedical Research in Epidemiology and Public Health, CIBERESP, Madrid, Spain.
- Department Pharmacology, Toxicology and Therapeutic Chemistry, School of Pharmacy, Universitat de Barcelona, Barcelona, Spain.
| | - María Teresa Peñarrubia-María
- Primary Care Health Centre Bartomeu Fabrés Anglada, Servei d'Atenció Primària Delta Llobregat, Àmbit Costa de Ponent, Institut Català de la Salut, Gavà, Spain
| | - Maria Iglesias-González
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, C/ Pablo Picasso 12, 08830, Sant Boi de Llobregat, Spain
| | - Martin Knapp
- Centre for Biomedical Research in Epidemiology and Public Health, CIBERESP, Madrid, Spain
- Personal Social Services Research Unit, London School of Economics and Political Science, Houghton Street, London, UK
| | - Paul McCrone
- Institute of Psychiatry, King's College London, De Crespigny Park, London, UK
| | - Marta Roig
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, C/ Pablo Picasso 12, 08830, Sant Boi de Llobregat, Spain
- Department Pharmacology, Toxicology and Therapeutic Chemistry, School of Pharmacy, Universitat de Barcelona, Barcelona, Spain
| | - Ramón Sabes-Figuera
- Centre for Biomedical Research in Epidemiology and Public Health, CIBERESP, Madrid, Spain
- Faculty of Economic and Business Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Juan V Luciano
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, C/ Pablo Picasso 12, 08830, Sant Boi de Llobregat, Spain
- Primary Care Prevention and Health Promotion Research Network (RedIAPP), Barcelona, Spain
- Open University of Catalonia (UOC), Barcelona, Spain
| | - Juan M Mendive
- Primary Care Prevention and Health Promotion Research Network (RedIAPP), Barcelona, Spain
- La Mina Primary Care Centre, Institut Català de la Salut, Sant Adrià de Besós, Barcelona, Spain
| | - Ana Gabriela Murrugara-Centurión
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, C/ Pablo Picasso 12, 08830, Sant Boi de Llobregat, Spain
- Primary Care Prevention and Health Promotion Research Network (RedIAPP), Barcelona, Spain
| | - Jordi Alonso
- Centre for Biomedical Research in Epidemiology and Public Health, CIBERESP, Madrid, Spain
- Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain
- Department Experimental and Health Sciences, Pompeu Fabra University (UPF), Barcelona, Spain
| | - Antoni Serrano-Blanco
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, C/ Pablo Picasso 12, 08830, Sant Boi de Llobregat, Spain
- Centre for Biomedical Research in Epidemiology and Public Health, CIBERESP, Madrid, Spain
| |
Collapse
|
22
|
Feng Y, Xiao L, Wang WW, Ungvari GS, Ng CH, Wang G, Xiang YT. Guidelines for the diagnosis and treatment of depressive disorders in China: The second edition. J Affect Disord 2019; 253:352-356. [PMID: 31078835 DOI: 10.1016/j.jad.2019.04.104] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 04/24/2019] [Accepted: 04/30/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND The recent guidelines for depressive disorders in China are based on both the first edition published in 2003, and new scientific evidence reviewed until the end of 2014. The purpose of the guidelines is to provide a comprehensive overview of the scientific evidence for the diagnosis and treatment of depressive disorders for Chinese patients. METHODS The data used in the guidelines were extracted from the recent literature, and various international treatment guidelines. RESULTS The current (second) guidelines are based on both evidence-based and measurement-based approaches. Comprehensive and regular assessments with standard instruments are recommended in the acute, continuation, and maintenance treatment phases, and the stage prior to the termination of treatment. In order to reduce the risk of relapse, the new guidelines are extended to the entire course of treatment. Recommendations for pharmacotherapeutic and other treatment modalities are described in detail. CONCLUSIONS Although major advances have been made compared to the 2003 edition of the guidelines, more intensive research is needed to optimize diagnosis and treatment of depressive disorders in China. The new guidelines provide only recommendations for diagnosis and treatment, therefore clinicians should develop individualized treatment plans along the lines of the comprehensive information obtained from patients and their families.
Collapse
Affiliation(s)
- Yuan Feng
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, School of Mental Health, Beijing, China
| | - Le Xiao
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, School of Mental Health, Beijing, China
| | - Wei-Wei Wang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, School of Mental Health, Beijing, China
| | - Gabor S Ungvari
- The University of Notre Dame Australia, Fremantle, Australia; Division of Psychiatry, School of Medicine, University of Western Australia, Perth, Australia
| | - Chee H Ng
- Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia
| | - Gang Wang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, School of Mental Health, Beijing, China.
| | - Yu-Tao Xiang
- Unit of Psychiatry, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China.
| |
Collapse
|
23
|
Zhang J, Qian X, Zhang L, Hu L, Fan L, Wang Q, Lan B, Sheng C, Li L, Zheng W, Xie J. Evaluation of the Effectiveness of Clinical Pharmacists' Consultation in the Treatment of Infectious Diseases: A Single-Arm, Prospective Cohort Study. Front Pharmacol 2019; 10:187. [PMID: 30881307 PMCID: PMC6405418 DOI: 10.3389/fphar.2019.00187] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 02/14/2019] [Indexed: 12/17/2022] Open
Abstract
Background: With the implementation of Antimicrobial Stewardship Program, clinical pharmacists’ consultation (CPC) for infectious diseases (ID) is gradually adopted by many hospitals in China. We conducted a cohort study to evaluate the effectiveness of CPC in ID treatment on patient outcomes and potential determinants. Methods: Based on a registry database, a prospective cohort study was conducted in Guizhou Provincial People’s Hospital. The main exposure factor was whether clinician adopted the suggestion from clinical pharmacist. The outcome was effective response rate (ERR) of ID patients. The variables associated with the outcome (e.g., age, gender, severity of infection, liver function, and kidney function) were also prospectively recorded. A multilevel model was performed to analyze the factors related to ERR. Results: A total of 733 ID inpatients were included in the final analysis according to the predesigned inclusion and exclusion criteria. The proportion of clinical pharmacists’ suggestions adopted by clinicians and ERR were 88.13 and 69.03%, respectively. Significant data aggregation (P < 0.05) for individuals at the level of department was observed. According to the two-level variance component model, liver dysfunction (Adjusted Odds Ratio (AOR) = 0.649, 95%Credible Interval (CI): 0.432–0.976), severity of infection (AOR = 0.602, 95%CI: 0.464–0.781), and adopting the suggestion from pharmacist (AOR = 1.738, 95%CI: 1.028–2.940) had significant association with ERR. Conclusion: Our study suggests that the effect of CPC on ID treatment is significant. The policy/decision makers or hospital managers should be cognizant of the critical value of clinical pharmacists in ID treatment.
Collapse
Affiliation(s)
- Jiaxing Zhang
- Department of Pharmacy, Guizhou Provincial People's Hospital, Guiyang, China
| | - Xin Qian
- Department of Pharmacy, Guizhou Provincial People's Hospital, Guiyang, China
| | - Lingmin Zhang
- Department of Pharmacy, Guizhou Provincial People's Hospital, Guiyang, China
| | - Linfang Hu
- Department of Pharmacy, Guizhou Provincial People's Hospital, Guiyang, China
| | - Lingyan Fan
- Department of Pharmacy, Guizhou Provincial People's Hospital, Guiyang, China
| | - Qingchen Wang
- Department of Pharmacy, Guizhou Provincial People's Hospital, Guiyang, China
| | - Bo Lan
- Department of Pharmacy, Guizhou Provincial People's Hospital, Guiyang, China
| | - Changcheng Sheng
- Department of Pharmacy, Guizhou Provincial People's Hospital, Guiyang, China
| | - Li Li
- Department of Pharmacy, Guizhou Provincial People's Hospital, Guiyang, China
| | - Wenyi Zheng
- Experimental Cancer Medicine, Clinical Research Center, Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden
| | - Juan Xie
- Department of Pharmacy, Guizhou Provincial People's Hospital, Guiyang, China
| |
Collapse
|
24
|
Sathienluckana T, Unaharassamee W, Suthisisang C, Suanchang O, Suansanae T. Anticholinergic discontinuation and cognitive functions in patients with schizophrenia: a pharmacist-physician collaboration in the outpatient department. INTEGRATED PHARMACY RESEARCH AND PRACTICE 2018; 7:161-171. [PMID: 30464898 PMCID: PMC6208936 DOI: 10.2147/iprp.s176653] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Cognitive impairment is a core feature and shows the highest impact on functional outcome in patients with schizophrenia. There have been no previous studies investigating the role of the pharmacist in a multidisciplinary team on cognitive outcomes in patients with schizophrenia. PURPOSE We evaluated the impact of pharmacist intervention on cognitive outcomes in patients with schizophrenia by focusing on anticholinergic discontinuation. PATIENTS AND METHODS A prospective, open-label, randomized, controlled study was conducted. Patients with schizophrenia were randomly assigned to either the pharmacist intervention or usual care groups. In the pharmacist intervention group, the pharmacist identified drug-related problems (DRPs) and provided a pharmacotherapy suggestion, while there was no intervention in the usual care group. The primary outcome was mean change from baseline of executive function by using Wisconsin Card Sorting Test (WCST) perseverative errors within the pharmacist intervention group at week 12. RESULTS A total of 30 patients completed the study (13 in the pharmacist intervention group and 17 in the usual care group). WCST perseverative errors at the end of the study within the pharmacist intervention group improved significantly from baseline (P=0.003). DRPs at week 12 were reduced by 85.19% and 9.76% in the pharmacist intervention and usual care groups, respectively. The most common intervention was the discontinuation of anticholinergics in patients without extrapyramidal side effects. CONCLUSION Added-on pharmacist intervention in a multidisciplinary team could help to improve cognitive functions in patients with schizophrenia by reducing DRPs and optimizing the drug therapy regimen, especially for anticholinergic discontinuation.
Collapse
Affiliation(s)
| | | | | | - Orabhorn Suanchang
- Department of Pharmacy, Somdet Chaophraya Institute of Psychiatry, Bangkok, Thailand
| | - Thanarat Suansanae
- Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand,
| |
Collapse
|
25
|
Effectiveness of watchful waiting versus antidepressants for patients diagnosed of mild to moderate depression in primary care: A 12-month pragmatic clinical trial (INFAP study). Eur Psychiatry 2018; 53:66-73. [DOI: 10.1016/j.eurpsy.2018.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 06/19/2018] [Accepted: 06/19/2018] [Indexed: 11/21/2022] Open
Abstract
AbstractBackground:Although mild to moderate major depressive disorder (MDD) is one of the main reasons for consulting a general practitioner (GP), there is still no international consensus on the most appropriate therapeutic approach.Methods:The aim of this study is to evaluate the clinical effectiveness of watchful waiting (WW) compared with the use of antidepressants (ADs) for the treatment of mild to moderate depressive symptoms in 263 primary care (PC) usual-practice patients in a 12-month pragmatic non-randomised controlled trial. Both longitudinal and per-protocol analyses were performed, through a multilevel longitudinal analysis and a sensitivity analysis.Results:We observed a statistically significant time x treatment interaction in the severity of depression (Patient Health Questionnaire, PHQ-9) and disability (World Health Organization Disability Assessment Schedule, WHODAS) in favour of the AD group at 6 months but not at 12 months. The effect size of this difference was small. No statistically significant differences were observed between groups in severity of anxiety (Beck Anxiety Inventory, BAI) or health-related quality-of-life (EuroQol-5D, EQ-5D). Sensitivity analysis and per-protocol analysis showed no differences between the two groups in any of the evaluated scales.Conclusions:Superiority of either treatment (WW and AD) was not demonstrated in patients treated for depression in PC after one year of follow-up.
Collapse
|
26
|
Readdean KC, Heuer AJ, Scott Parrott J. Effect of pharmacist intervention on improving antidepressant medication adherence and depression symptomology: A systematic review and meta-analysis. Res Social Adm Pharm 2018. [DOI: 10.1016/j.sapharm.2017.05.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
27
|
Elkhodr S, Saba M, O'Reilly C, Saini B. The role of community pharmacists in the identification and ongoing management of women at risk for perinatal depression: A qualitative study. Int J Soc Psychiatry 2018; 64:37-48. [PMID: 29219031 DOI: 10.1177/0020764017746198] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND While pharmacists are among the most accessible primary health professionals within a mother's healthcare team to identify potential cases of perinatal depression (PND), very little in the literature suggests that this role has been explored. AIM The aim of this study was to explore community pharmacists' perspectives on their potential roles in perinatal mental health promotion (recognition and health education) and the factors affecting these roles. METHODS In total, 20 semi-structured, in-depth interviews were conducted with community pharmacists. RESULTS Most pharmacists highlighted their significant roles in recognising PND symptoms and providing medication-related support to perinatal mothers. Barriers to service provision included inter-professional role boundaries, the lack of established referral systems and service remuneration and the lack of adequate training in mental health. CONCLUSION Pharmacists could potentially reinforce their involvement in mental health promotion activities.
Collapse
Affiliation(s)
- Sabrine Elkhodr
- 1 Faculty of Pharmacy, The University of Sydney, Camperdown, New South Wales, Australia
| | - Maya Saba
- 1 Faculty of Pharmacy, The University of Sydney, Camperdown, New South Wales, Australia
| | - Claire O'Reilly
- 1 Faculty of Pharmacy, The University of Sydney, Camperdown, New South Wales, Australia
| | - Bandana Saini
- 1 Faculty of Pharmacy, The University of Sydney, Camperdown, New South Wales, Australia.,2 Woolcock Institute of Medical Research, Glebe, New South Wales, Australia
| |
Collapse
|
28
|
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.
Collapse
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
| |
Collapse
|
29
|
The mental health community: An underserved and undertreated population: Encouraging research but challenges remain. J Am Pharm Assoc (2003) 2017; 57:650-652. [PMID: 29092763 DOI: 10.1016/j.japh.2017.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
30
|
McMillan SS, Kelly F, Hattingh HL, Fowler JL, Mihala G, Wheeler AJ. The impact of a person-centred community pharmacy mental health medication support service on consumer outcomes. J Ment Health 2017; 27:164-173. [PMID: 28675321 DOI: 10.1080/09638237.2017.1340618] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Mental illness is a worldwide health priority. As medication is commonly used to treat mental illness, community pharmacy staff is well placed to assist consumers. AIM To evaluate the effectiveness of a multifaceted, community pharmacy medication support service for mental health consumers. METHOD Pharmacists and pharmacy support staff in three Australian states were trained to deliver a flexible, goal-oriented medication support service for adults with mental illness over 3-6 months. Consumer-related outcome measures included perceptions of illness and health-related quality of life, medication beliefs, treatment satisfaction and medication adherence. RESULTS Fifty-five of 100 trained pharmacies completed the intervention with 295 of the 418 recruited consumers (70.6% completion rate); 51.2% of consumers received two or more follow-ups. Significant improvements were reported by consumers for overall perceptions of illness (p < 0.001), the mental health domain of quality of life (p < 0.001), concerns about medication (p = 0.001) and global satisfaction with medication (p < 0.001). Consumers also reported an increase in medication adherence (p = 0.005). CONCLUSIONS A community pharmacy mental health medication support service that is goal-oriented, flexible and individualised, improved consumer outcomes across various measures. While further research into the cost-effectiveness and sustainability of such a service is warranted, this intervention could easily be adapted to other contexts.
Collapse
Affiliation(s)
- Sara S McMillan
- a Menzies Health Institute Queensland, Griffith University , Brisbane , Australia
| | - Fiona Kelly
- b Menzies Health Institute Queensland, Griffith University , Gold Coast , Australia
| | | | - Jane L Fowler
- a Menzies Health Institute Queensland, Griffith University , Brisbane , Australia
| | - Gabor Mihala
- d Menzies Health Institute Queensland, Centre for Applied Health Economics, Griffith University , Brisbane , Australia , and
| | - Amanda J Wheeler
- a Menzies Health Institute Queensland, Griffith University , Brisbane , Australia.,e Faculty of Medical and Health Sciences , University of Auckland , Auckland , New Zealand
| |
Collapse
|
31
|
Bamgbade BA, Barner JC, Ford KH. Evaluating the Impact of an Anti-stigma Intervention on Pharmacy Students' Willingness to Counsel People Living with Mental Illness. Community Ment Health J 2017; 53:525-533. [PMID: 27981413 DOI: 10.1007/s10597-016-0075-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 12/02/2016] [Indexed: 11/24/2022]
Abstract
Third-year pharmacy students (n = 88) participated in an anti-stigma intervention program consisting of presentations, videos, discussion and active-learning exercises. Willingness to counsel (WTC) people with mental illness (MI) was evaluated using immediate pre and post-tests comparing diabetes, depression and schizophrenia. At pre-test, WTC diabetes was highest (higher = increased WTC) while schizophrenia was the lowest. There were no statistically significant differences between pre/post-test WTC for diabetes and depression, while schizophrenia WTC increased significantly (p < 0.05). At post-test, diabetes WTC was significantly higher than depression and schizophrenia (p < 0.0001). Regression results for WTC depression showed that comfortability and gender were significant (p < 0.05) predictors. Regression results for WTC schizophrenia showed that comfortability was a significant (p < 0.05) predictor. As highly accessible healthcare providers, pharmacists have the potential to positively impact healthcare, but this depends on WTC. Colleges of pharmacy may consider instituting policies that support experiential education involving counseling people living with MI, as this may increase comfortability.
Collapse
Affiliation(s)
- Benita A Bamgbade
- Health Outcomes and Pharmacy Practice Division, The University of Texas at Austin College of Pharmacy, 2409 University Ave., STOP A1930, Austin, TX, 78712-1120, USA
| | - Jamie C Barner
- Health Outcomes and Pharmacy Practice Division, The University of Texas at Austin College of Pharmacy, 2409 University Ave., STOP A1930, Austin, TX, 78712-1120, USA.
| | - Kentya H Ford
- Health Outcomes and Pharmacy Practice Division, The University of Texas at Austin College of Pharmacy, 2409 University Ave., STOP A1930, Austin, TX, 78712-1120, USA
| |
Collapse
|
32
|
De Nadai AS, Karver MS, Murphy TK, Cavitt MA, Alvaro JL, Bengtson M, Stock S, Rakhshani AC, Storch EA. Common Factors in Pediatric Psychiatry: A Review of Essential and Adjunctive Mechanisms of Treatment Outcome. J Child Adolesc Psychopharmacol 2017; 27:10-18. [PMID: 27128785 PMCID: PMC5326981 DOI: 10.1089/cap.2015.0263] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The purpose of this article is to review the literature on hypothesized behavioral correlates of pharmacotherapy treatment response. A particular focus is placed on what have been referred to as "common factors" across mental health treatments, including medication adherence, therapeutic alliance, motivation for behavior change, and expectancies for positive treatment outcomes. These understudied factors may provide unique explanations for mechanisms of symptom change, patient risk as a result of protocol deviation, and attenuated treatment outcomes. METHOD A literature search was conducted to evaluate the relationship between treatment processes in pediatric psychiatry and medication adherence, therapeutic alliance, motivation for behavior change, and expectancies for positive treatment outcomes. RESULTS Substantial variability and room for improvement was identified for each common factor. Behavioral protocols have already been developed to address many aspects of common factors in pediatric psychiatric treatment, but are not yet a part of many practice parameters. CONCLUSION Interventions to improve common factors can be used immediately in tandem with psychopharmacological interventions to provide increased symptom relief and reduce patient risk. Furthermore, incorporating instruction in common factors interventions can positively affect training of future providers and enhance understanding of the mechanisms of effect of medications. An increased focus on common factors, with a particular emphasis on quantifying the magnitude and mechanisms of their effects on psychopharmacological interventions stand to benefit child patients, their families, treatment providers, training facilities, and pharmaceutical manufacturers.
Collapse
Affiliation(s)
- Alessandro S. De Nadai
- Department of Pediatrics, Rothman Center for Pediatric Neuropsychiatry, University of South Florida Morsani College of Medicine, Tampa, Florida
- Department of Psychiatry, University of South Florida, Tampa, Florida
- Department of Psychology, University of South Florida, Tampa, Florida
| | - Marc S. Karver
- Department of Psychology, University of South Florida, Tampa, Florida
| | - Tanya K. Murphy
- Department of Pediatrics, Rothman Center for Pediatric Neuropsychiatry, University of South Florida Morsani College of Medicine, Tampa, Florida
- Department of Psychiatry, University of South Florida, Tampa, Florida
| | - Mark A. Cavitt
- Department of Psychiatry, University of South Florida, Tampa, Florida
- All Children's Hospital—Johns Hopkins Medicine, St. Petersburg, Florida
| | - Jeffrey L. Alvaro
- Department of Psychiatry, University of South Florida, Tampa, Florida
- All Children's Hospital—Johns Hopkins Medicine, St. Petersburg, Florida
| | | | - Saundra Stock
- Department of Psychiatry, University of South Florida, Tampa, Florida
| | | | - Eric A. Storch
- Department of Pediatrics, Rothman Center for Pediatric Neuropsychiatry, University of South Florida Morsani College of Medicine, Tampa, Florida
- Department of Psychiatry, University of South Florida, Tampa, Florida
- Department of Psychology, University of South Florida, Tampa, Florida
- All Children's Hospital—Johns Hopkins Medicine, St. Petersburg, Florida
- Rogers Behavioral Health—Tampa Bay, Tampa, Florida
| |
Collapse
|
33
|
Nair N, Kvizhinadze G, Blakely T. Cancer Care Coordinators to Improve Tamoxifen Persistence in Breast Cancer: How Heterogeneity in Baseline Prognosis Impacts on Cost-Effectiveness. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2016; 19:936-944. [PMID: 27987643 DOI: 10.1016/j.jval.2016.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 05/05/2016] [Accepted: 05/28/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To assess the cost-effectiveness of a cancer care coordinator (CCC) in helping women with estrogen receptor positive (ER+) early breast cancer persist with tamoxifen for 5 years. METHODS We investigated the cost-effectiveness of a CCC across eight breast cancer subtypes, defined by progesterone receptor (PR) status, human epidermal growth factor receptor 2 (HER2) status, and local/regional spread. These subtypes range from excellent to poorer prognoses. The CCC helped in improving tamoxifen persistence by providing information, checking-in by phone, and "troubleshooting" concerns. We constructed a Markov macrosimulation model to estimate health gain (in quality-adjusted life-years or QALYs) and health system costs in New Zealand, compared with no CCC. Participants were modeled until death or till the age of 110 years. Some input parameters (e.g., the impact of a CCC on tamoxifen persistence) had sparse evidence. Therefore, we used estimates with generous uncertainty and conducted sensitivity analyses. RESULTS The cost-effectiveness of a CCC for regional ER+/PR-/HER2+ breast cancer (worst prognosis) was NZ $23,400 (US $15,800) per QALY gained, compared with NZ $368,500 (US $248,800) for local ER+/PR+/HER2- breast cancer (best prognosis). Using a cost-effectiveness threshold of NZ $45,000 (US $30,400) per QALY, a CCC would be cost-effective only in the four subtypes with the worst prognoses. CONCLUSIONS There is value in investigating cost-effectiveness by different subtypes within a disease. In this example of breast cancer, the poorer the prognosis, the greater the health gains from a CCC and the better the cost-effectiveness. Incorporating heterogeneity in a cost-utility analysis is important and can inform resource allocation decisions. It is also feasible to undertake in practice.
Collapse
Affiliation(s)
- Nisha Nair
- Burden of Disease Epidemiology, Equity and Cost-Effectiveness Programme, Department of Public Health, University of Otago Wellington, Wellington, New Zealand.
| | - Giorgi Kvizhinadze
- Burden of Disease Epidemiology, Equity and Cost-Effectiveness Programme, Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - Tony Blakely
- Burden of Disease Epidemiology, Equity and Cost-Effectiveness Programme, Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| |
Collapse
|
34
|
Rashrash ME, Tomaszewski DM, Schommer JC, Brown LM. Consumers' characteristics associated with the use of mail pharmacy services in the United States: Findings from the 2015 National Consumer Survey on the Medication Experience. J Am Pharm Assoc (2003) 2016; 57:206-210. [PMID: 27838390 DOI: 10.1016/j.japh.2016.09.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 09/26/2016] [Indexed: 12/22/2022]
Abstract
OBJECTIVES The purpose of this study was to describe current users of mail pharmacy services and to evaluate factors associated with the use of mail pharmacy services. DESIGN Cross-sectional online survey-based study. SETTING AND PARTICIPANTS The data were obtained from the 2015 National Consumer Survey on the Medication Experience, which included 26,173 adults from throughout the United States. OUTCOME MEASURES Mail pharmacy utilization was based on participant self-report. Demographic variables included age, education, race, gender, insurance status, distance to nearest pharmacy, number of disease states, and income. Chi-square and t test analyses were conducted to assess the factors associated with mail pharmacy use. Multivariable logistic regressions were used to compute the odds ratios (ORs) and 95% confidence intervals for the predictors of mail pharmacy usage. RESULTS Overall, 17% of respondents reported the use of mail pharmacy services. Based on chi-square analysis, use of mail pharmacy services was significantly associated with age, education, race, and region. In addition, distance to nearest pharmacy and the report of the presence of certain disease states were significantly associated with mail pharmacy use (P <0.001). Based on the results of logistic regression analysis, there was a significant association of mail pharmacy use by age, having chronic diseases, level of education, distance to nearest pharmacy, and other included variables (P <0.05). CONCLUSION Mail pharmacy service users accounted for 17% of the respondents of this study. Advancing age, presence of chronic diseases, increasing level of education, and increasing distance to the nearest pharmacy were positively associated with the use of mail pharmacies. Further research is needed to better understand patient-specific reasons for choosing mail pharmacies or community pharmacies.
Collapse
|
35
|
Deniz S, Sancar M, Okuyan B, Ata P, Ozakpinar OB, Talas A, Gunes T, Caliskan M, Izzettin FV. Determination of CYP2C19 Polymorphism, Side Effects, and Medication Adherence in Patients Who have Utilized Selective Serotonin Reuptake Inhibitors. KLINIK PSIKOFARMAKOLOJI BÜLTENI-BULLETIN OF CLINICAL PSYCHOPHARMACOLOGY 2016. [DOI: 10.5455/bcp.20151003060610] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Semanur Deniz
- Marmara University, Faculty of Pharmacy, Department of Clinical Pharmacy, Istanbul - Turkey
| | - Mesut Sancar
- Marmara University, Faculty of Pharmacy, Department of Clinical Pharmacy, Istanbul - Turkey
| | - Betul Okuyan
- Marmara University, Faculty of Pharmacy, Department of Clinical Pharmacy, Istanbul - Turkey
| | - Pinar Ata
- Marmara University, Faculty of Medicine, Department of Medical Genetics, Istanbul - Turkey
| | | | - Anil Talas
- Haydarpasa Numune Training and Research Hospital, Department of Psychiatry, Istanbul - Turkey
| | - Tufan Gunes
- Haydarpasa Numune Training and Research Hospital, Department of Psychiatry, Istanbul - Turkey
| | - Mecit Caliskan
- Haydarpasa Numune Training and Research Hospital, Department of Psychiatry, Istanbul - Turkey
| | - Fikret Vehbi Izzettin
- Marmara University, Faculty of Pharmacy, Department of Clinical Pharmacy, Istanbul - Turkey
| |
Collapse
|
36
|
Kooij MJ, Heerdink ER, van Dijk L, van Geffen ECG, Belitser SV, Bouvy ML. Effects of Telephone Counseling Intervention by Pharmacists (TelCIP) on Medication Adherence; Results of a Cluster Randomized Trial. Front Pharmacol 2016; 7:269. [PMID: 27625605 PMCID: PMC5003869 DOI: 10.3389/fphar.2016.00269] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 08/10/2016] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To assess the effect of a pharmacist telephone counseling intervention on patients' medication adherence. DESIGN Pragmatic cluster randomized controlled trial. SETTING 53 Community pharmacies in The Netherlands. PARTICIPANTS Patients ≥18 years initiating treatment with antidepressants, bisphosphonates, Renin-Angiotensin System (RAS)-inhibitors, or statins (lipid lowering drugs). Pharmacies in arm A provided the intervention for antidepressants and bisphosphonates and usual care for RAS-inhibitors and statins. Pharmacies in arm B provided the intervention for RAS-inhibitors and statins and usual care for antidepressants and bisphosphonates. INTERVENTION INTERVENTION consisted of a telephone counseling intervention 7-21 days after the start of therapy. Counseling included assessment of practical and perceptual barriers and provision of information and motivation. MAIN OUTCOME MEASURE Primary outcome was refill adherence measured over 1 year expressed as continuous outcome and dichotomous (refill rate≥80%). Secondary outcome was discontinuation within 1 year. RESULTS In the control arms 3627 patients were eligible and in the intervention arms 3094 patients. Of the latter, 1054 patients (34%) received the intervention. Intention to treat analysis showed no difference in adherence rates between the intervention and the usual care arm (74.7%, SD 37.5 respectively 74.5%, 37.9). More patients starting with RAS-inhibitors had a refill ratio ≥80% in the intervention arm compared to usual care (81.4 vs. 74.9% with odds ratio (OR) 1.43, 95%CI 1.11-1.99). Comparing patients with counseling to patients with usual care (per protocol analysis), adherence was statistically significant higher for patients starting with RAS-inhibitors, statins and bisphosphonates. Patients initiating antidepressants did not benefit from the intervention. CONCLUSIONS Telephone counseling at start of therapy improved adherence in patients initiating RAS-inhibitors. The per protocol analysis indicated an improvement for lipid lowering drugs and bisphosphonates. No effect for on adherence in patients initiating antidepressants was found. The trial was registered at www.trialregister.nl under the identifier NTR3237.
Collapse
Affiliation(s)
- Marcel J. Kooij
- Department of Pharmacoepidemiology and Clinical Pharmacology, Utrecht UniversityUtrecht, Netherlands
- Service Apotheek KoningAmsterdam, Netherlands
| | - Eibert R. Heerdink
- Department of Pharmacoepidemiology and Clinical Pharmacology, Utrecht UniversityUtrecht, Netherlands
| | - Liset van Dijk
- NIVEL (Netherlands Institute for Health Services Research)Utrecht, Netherlands
| | | | - Svetlana V. Belitser
- Department of Pharmacoepidemiology and Clinical Pharmacology, Utrecht UniversityUtrecht, Netherlands
| | - Marcel L. Bouvy
- Department of Pharmacoepidemiology and Clinical Pharmacology, Utrecht UniversityUtrecht, Netherlands
| |
Collapse
|
37
|
Ho SC, Chong HY, Chaiyakunapruk N, Tangiisuran B, Jacob SA. Clinical and economic impact of non-adherence to antidepressants in major depressive disorder: A systematic review. J Affect Disord 2016; 193:1-10. [PMID: 26748881 DOI: 10.1016/j.jad.2015.12.029] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 12/16/2015] [Accepted: 12/19/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Medication non-adherence is one of the major challenges in treating patients with depression. This systematic review aims to determine the clinical and economic outcomes of non-adherence in depression. METHODS A systematic search was performed across the following databases: PubMed, EMBASE, DARE, CINAHL, PsycINFO, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews; from database inception to March 31, 2015. Studies must report on the association between adherence and outcomes, and English full texts needed to be available. The quality of each study was assessed using the Newcastle-Ottawa scale. RESULTS A total of 11 articles were included, with eight reporting on clinical outcomes, two reporting on economic outcomes, and one reporting on both. The majority of studies were retrospective cohort studies. The mean quality of all included studies was 7, with a range from 3 to 9. Results clearly indicate that patients who were non-adherent were more likely to experience increased risks of relapse and/or recurrence, emergency department visits, and hospitalization rates; increased severity of depression, and a decrease in response and remission rates. The worsening of clinical outcomes in patients who were non-adherent subsequently translated to an increase in healthcare utilization and charges. LIMITATIONS No standardized adherence measurement tools were used, and few studies looked at the economic impact of non-adherence in depression. CONCLUSION There is a strong association between non-adherence to antidepressants and a worsening of patients' clinical and economic outcomes. Cost-effective interventions should be directed to this group of patients to improve medication adherence.
Collapse
Affiliation(s)
- Siew Ching Ho
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 USM, Penang Malaysia
| | - Huey Yi Chong
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, 47500 Bandar Sunway, Selangor, Malaysia
| | - Nathorn Chaiyakunapruk
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, 47500 Bandar Sunway, Selangor, Malaysia; Center of Pharmaceutical Outcomes Research (CPOR), Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand; School of Pharmacy, University of Wisconsin, Madison, USA; School of Population Health, University of Queensland, Brisbane, Australia
| | | | - Sabrina Anne Jacob
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, 47500 Bandar Sunway, Selangor, Malaysia.
| |
Collapse
|
38
|
Hattingh HL, Scahill S, Fowler JL, Wheeler AJ. Exploring an increased role for Australian community pharmacy in mental health professional service delivery: evaluation of the literature . J Ment Health 2015; 25:550-559. [PMID: 26607639 DOI: 10.3109/09638237.2015.1101418] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Australian general practitioners primarily treat mental health problems by prescribing medication dispensed by community pharmacists. Pharmacists therefore have regular interactions with mental health consumers and carers. AIMS This narrative review explored the potential role of community pharmacy in mental health services. METHOD Medline, CINAHL, ProQuest, Emerald, PsycINFO, Science Direct, PubMed, Web of Knowledge and IPA were utilised. The Cochrane Library as well as grey literature and "lay" search engines such as GoogleScholar were also searched. RESULTS Four systematic reviews and ten community pharmacy randomised controlled trials were identified. Various relevant reviews outlining the impact of community pharmacy based disease state or medicines management services were also identified. CONCLUSION International studies involving professional service interventions for mental health consumers could be contextualised for the Australian setting. Australian studies of pharmacy professional services for chronic physical health conditions provided further guidance for the expansion of community pharmacy mental health professional services.
Collapse
Affiliation(s)
- H Laetitia Hattingh
- a Faculty of Health Sciences , Curtin University , Bentley , Perth , Australia
| | - Shane Scahill
- b School of Management, Business School, Massey University , Auckland , New Zealand.,c School of Pharmacy, University of Auckland , New Zealand
| | - Jane L Fowler
- d Griffith Health Institute, Griffith University , Brisbane , Australia , and
| | - Amanda J Wheeler
- d Griffith Health Institute, Griffith University , Brisbane , Australia , and.,e Faculty of Medical and Health Sciences , University of Auckland , New Zealand
| |
Collapse
|
39
|
Abstract
The treatment goal of major depressive disorder (MDD) is achieving and maintaining remission. One of the major obstacles in attaining remission is poor adherence to the medication regimen. Community pharmacists (CPs) are accessible to primary care patients and are in a unique position to help improve adherence. The aim was to compare the effectiveness of pharmacist intervention with standard care for patients with MDD. This was an exploratory controlled trial conducted in 17 general pharmacies with clinical pharmacists in Israel. Participants were patients with MDD prescribed escitalopram by their general practitioner. CP medication review was initiated at enrollment, with face-to-face pharmacist adherence support at treatment initiation and every month throughout the study. Treatment as usual (TAU) was derived from computerized medical charts for the same pharmacies during the same time period. Comparison with published 'historical' controls was also carried out. No blinding was possible. Continuous antidepressant treatment at 6 months as reflected in computerized pharmacy records was the primary outcome. Within a 1-year period, 173 patients were enrolled. There were 49 men (28%) and 124 women (72%) in the CP group, mean age 53.9 ± 18.9 years. There were 4079 men (32%) and 8667 women (68%) in the TAU group, mean age 50.4 ± 17.8 years. Ninety-six patients (55%) completed 6 months of antidepressant treatment. At 1 month, the adherence rate was 71% in the CP arm and at 6 months, the rates were 55% versus published norms of 42% (P=0.004). At 1 month, the adherence rate was 57% (N=7256) in the TAU arm and at 6 months, the rate was 15.2% (N=1934) (compared with CP rates: P<0.0001). There were no differences between sites in adherence rates. CPs participating in this study reported higher levels of confidence in supporting MDD patients at the end of the study. This is the first trial of pharmacist adherence support in Israel, and shows benefits for patients in the community with MDD.
Collapse
|
40
|
Pauly A, Wolf C, Mayr A, Lenz B, Kornhuber J, Friedland K. Effect of a Multi-Dimensional and Inter-Sectoral Intervention on the Adherence of Psychiatric Patients. PLoS One 2015; 10:e0139302. [PMID: 26437449 PMCID: PMC4593549 DOI: 10.1371/journal.pone.0139302] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 09/08/2015] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND In psychiatry, hospital stays and transitions to the ambulatory sector are susceptible to major changes in drug therapy that lead to complex medication regimens and common non-adherence among psychiatric patients. A multi-dimensional and inter-sectoral intervention is hypothesized to improve the adherence of psychiatric patients to their pharmacotherapy. METHODS 269 patients from a German university hospital were included in a prospective, open, clinical trial with consecutive control and intervention groups. Control patients (09/2012-03/2013) received usual care, whereas intervention patients (05/2013-12/2013) underwent a program to enhance adherence during their stay and up to three months after discharge. The program consisted of therapy simplification and individualized patient education (multi-dimensional component) during the stay and at discharge, as well as subsequent phone calls after discharge (inter-sectoral component). Adherence was measured by the "Medication Adherence Report Scale" (MARS) and the "Drug Attitude Inventory" (DAI). RESULTS The improvement in the MARS score between admission and three months after discharge was 1.33 points (95% CI: 0.73-1.93) higher in the intervention group compared to controls. In addition, the DAI score improved 1.93 points (95% CI: 1.15-2.72) more for intervention patients. CONCLUSION These two findings indicate significantly higher medication adherence following the investigated multi-dimensional and inter-sectoral program. TRIAL REGISTRATION German Clinical Trials Register DRKS00006358.
Collapse
Affiliation(s)
- Anne Pauly
- Molecular & Clinical Pharmacy, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Carolin Wolf
- Molecular & Clinical Pharmacy, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Andreas Mayr
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Bernd Lenz
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Johannes Kornhuber
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Kristina Friedland
- Molecular & Clinical Pharmacy, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| |
Collapse
|
41
|
Leguelinel-Blache G, Dubois F, Bouvet S, Roux-Marson C, Arnaud F, Castelli C, Ray V, Kinowski JM, Sotto A. Improving Patient's Primary Medication Adherence: The Value of Pharmaceutical Counseling. Medicine (Baltimore) 2015; 94:e1805. [PMID: 26469927 PMCID: PMC4616785 DOI: 10.1097/md.0000000000001805] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Quality of transitions of care is one of the first concerns in patient safety. Redesigning the discharge process to incorporate clinical pharmacy activities could reduce the incidence of postdischarge adverse events by improving medication adherence. The present study investigated the value of pharmacist counseling sessions on primary medication adherence after hospital discharge.This study was conducted in a 1844-bed hospital in France. It was divided in an observational period and an interventional period of 3 months each. In both periods, ward-based clinical pharmacists performed medication reconciliation and inpatient follow-up. In interventional period, initial counseling and discharge counseling sessions were added to pharmaceutical care. The primary medication adherence was assessed by calling community pharmacists 7 days after patient discharge.We compared the measure of adherence between the patients from the observational period (n = 201) and the interventional period (n = 193). The rate of patients who were adherent increased from 51.0% to 66.7% between both periods (P < 0.01). When discharge counseling was performed (n = 78), this rate rose to 79.7% (P < 0.001). The multivariate regression performed on data from both periods showed that age of at least 78 years old, and 3 or less new medications on discharge order were predictive factors of adherence. New medications ordered at discharge represented 42.0% (n = 1018/2426) of all medications on discharge order. The rate of unfilled new medications decreased from 50.2% in the observational period to 32.5% in the interventional period (P < 10). However, patients included in the observational period were not significantly more often readmitted or visited the emergency department than the patients who experienced discharge counseling during the interventional period (45.3% vs. 46.2%; P = 0.89).This study highlights that discharge counseling sessions are essential to improve outpatients' primary medication adherence. We identified predictive factors of primary nonadherence in order to target the most eligible patients for discharge counseling sessions. Moreover, implementation of discharge counseling could be facilitated by using Health Information Technology to adapt human resources and select patients at risk of nonadherence.
Collapse
Affiliation(s)
- Géraldine Leguelinel-Blache
- From the Department of Pharmacy, Nîmes University Hospital, Nîmes, France (GLB, FD, CRM, FA, JMK); Laboratory of Biostatistics, Epidemiology, Clinical Research and Health Economics, EA2415, University Institute of Clinical Research, Montpellier University, Montpellier, France (GLB, CRM, CC, JMK); Department of Biostatistics, Epidemiology, Clinical Research and Health Economics, Nîmes University Hospital, Nîmes, France (SB, CC); Department of General Medicine, Nîmes University Hospital, Nîmes, France (VR); and Department of Infectious and Tropical Diseases, Nîmes University Hospital, Nîmes, France (AS)
| | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Scahill S, Fowler JL, Hattingh HL, Kelly F, Wheeler AJ. Mapping the terrain: A conceptual schema for a mental health medication support service in community pharmacy. SAGE Open Med 2015; 3:2050312115603002. [PMID: 26770802 PMCID: PMC4679331 DOI: 10.1177/2050312115603002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 07/31/2015] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Mental health-related problems pose a serious issue for primary care, and community pharmacy could make a significant contribution, but there is a dearth of information. METHODS This article reports synthesis of the literature on mental health interventions across a range of pharmacy models, and pharmacy services in contexts beyond mental health. To best inform the design of a community pharmacy medication support intervention for mental health consumers, the literature was reported as a conceptual schema and subsequent recommendations for development, implementation and evaluation of the service. A broad conceptualisation was taken in this review. In addition to mental health and community pharmacy literature, policy/initiatives, organisational culture and change management principles, and evaluative processes were reviewed. Key words were selected and literature reviews undertaken using EMBASE, PubMed, CINAHL and Web of Science. RESULTS Recommendations were made around: medication support intervention design, consumer recruitment, implementation in community pharmacy and evaluation. Surprisingly, there is a scarce literature relating to mental health interventions in community pharmacy. Even so, findings from other pharmacy models and broader medicines management for chronic illness can inform development of a medication support service for mental health consumers. Key learnings include the need to expand medicines management beyond adherence with respect to both intervention design and evaluation. CONCLUSION The conceptual framework is grounded in the need for programmes to be embedded within pharmacies that are part of the health system as a whole.
Collapse
Affiliation(s)
- Shane Scahill
- School of Management, Massey Business School, Massey University, Auckland, New Zealand
- School of Pharmacy, University of Auckland, Auckland, New Zealand
| | - Jane L Fowler
- Griffith Health Institute, Griffith University, Brisbane, QLD, Australia
| | | | - Fiona Kelly
- School of Pharmacy, Griffith University, Gold Coast Campus, Brisbane, QLD, Australia
| | - Amanda J Wheeler
- Mental Health, Population & Social Health Research Program, Griffith Health Institute, Griffith University, Brisbane, QLD, Australia
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| |
Collapse
|
43
|
Rubio-Valera M, Peñarrubia-María MT, Fernández-Vergel R, Carvajal Tejadillo AC, Fernández Sánchez A, Aznar-Lou I, March-Pujol M, Serrano-Blanco A. [Impact of pharmaceutical intervention in preventing relapses in depression in Primary Care]. Aten Primaria 2015; 48:308-15. [PMID: 26415743 PMCID: PMC6877882 DOI: 10.1016/j.aprim.2015.05.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 05/21/2015] [Accepted: 05/25/2015] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE To evaluate the long-term impact of a brief pharmacist intervention (PI) compared with usual care (UC) on prevention of depression relapse. DESIGN randomised controlled clinical trial SETTING Primary Care PARTICIPANTS Of the 179 depressed patients initiating antidepressants, the 113 whose clinical symptoms had remitted (main definition) at 6 months assessment were selected for this secondary study (PI=58; UC=55). INTERVENTION PI was an interview to promote medication adherence when patients get antidepressants from pharmacy. MAIN MEASUREMENTS Baseline, 3 months, and six-months follow-up assessments were made. The severity of depressive symptoms was evaluated with PHQ9. Patients presenting a remission of symptoms were selected. The patient medical records were reviewed to identify a relapse in the following 12 months by using 4 indicators. RESULTS There was a lower proportion of patients that relapsed in the PI group than in the UC group 18 months after initiation of treatment, but the difference was not statistically significant either in the intent-to-treat analysis (OR=0.734 [95%CI; 0.273-1.975]) or the per-protocol analysis (OR=0.615 [95%CI; 0.183 -2.060]). All the sensitivity analyses showed consistent results. The sample size and adherence to the protocol in the intervention group were low. CONCLUSION PI group showed a non-statistically significant tendency towards presenting fewer relapses. This could be related to the improvement in adherence among patients that received the intervention.
Collapse
Affiliation(s)
- María Rubio-Valera
- Unidad de investigación y desarrollo, Fundació Sant Joan de Déu, Esplugues de Llobregat, Barcelona, España; Departamento de Prácticas Tuteladas, Facultad de Farmacia, Universidad de Barcelona, Barcelona, España; Grupo de Investigación Prisma, Red de Investigación Española en Actividades Preventivas y de Promoción de la Salud en Atención Primaria (RedIAPP), Barcelona, España
| | - M Teresa Peñarrubia-María
- Grupo de Investigación Prisma, Red de Investigación Española en Actividades Preventivas y de Promoción de la Salud en Atención Primaria (RedIAPP), Barcelona, España; Servicio de Atención Primaria Delta Llobregat, Centro de Atención Primaria Bartomeu Fabrés Anglada, Ámbito Costa Ponent, Institut Català de la Salut, Gavà, España.
| | - Rita Fernández-Vergel
- Grupo de Investigación Prisma, Red de Investigación Española en Actividades Preventivas y de Promoción de la Salud en Atención Primaria (RedIAPP), Barcelona, España; Servicio de Atención Primaria Delta Llobregat, Centro de Atención Primaria Bartomeu Fabrés Anglada, Ámbito Costa Ponent, Institut Català de la Salut, Gavà, España
| | - Andrea Cecilia Carvajal Tejadillo
- Servicio de Atención Primaria Delta Llobregat, Centro de Atención Primaria Bartomeu Fabrés Anglada, Ámbito Costa Ponent, Institut Català de la Salut, Gavà, España
| | - Ana Fernández Sánchez
- Grupo de Investigación Prisma, Red de Investigación Española en Actividades Preventivas y de Promoción de la Salud en Atención Primaria (RedIAPP), Barcelona, España; Observatorio de Investigación y Política, Facultad de Ciencias de la Salud, Universidad de Sydney, Sydney, Australia
| | - Ignacio Aznar-Lou
- Unidad de investigación y desarrollo, Fundació Sant Joan de Déu, Esplugues de Llobregat, Barcelona, España
| | - Marian March-Pujol
- Departamento de Prácticas Tuteladas, Facultad de Farmacia, Universidad de Barcelona, Barcelona, España
| | - Antoni Serrano-Blanco
- Unidad de investigación y desarrollo, Fundació Sant Joan de Déu, Esplugues de Llobregat, Barcelona, España; Grupo de Investigación Prisma, Red de Investigación Española en Actividades Preventivas y de Promoción de la Salud en Atención Primaria (RedIAPP), Barcelona, España
| |
Collapse
|
44
|
Boeni F, Arnet I, Hersberger KE. Adherence counseling during patient contacts in swiss community pharmacies. Patient Prefer Adherence 2015; 9:597-605. [PMID: 25960642 PMCID: PMC4423509 DOI: 10.2147/ppa.s76027] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Numerous studies showed the effectiveness of pharmaceutical care in improving medication adherence in primary care patients. However, in daily pharmacy practice, the provision of pharmaceutical care appears to be limited. We aimed at quantifying the content of counseling by community pharmacy staff during patient contacts, especially adherence counseling, and at investigating pharmacist views about their practice of adherence counseling. PATIENTS AND METHODS A Master's student in Pharmacy observed patient contacts at selected community pharmacies in the region of Basel, Switzerland. Content of counseling was manually ticked on a checklist with predefined themes (administration, dose, effect, and adherence). Pharmacists working in the pharmacy were interviewed on triggers, topics, and barriers in adherence counseling. RESULTS In 20 community pharmacies and during a total of 148.1 hours, 1,866 patient contacts were observed. During the 1,476 patient contacts including the dispensing of one or more medications, counseling was provided to 799 (54.1%) patients; with 735 (49.8%) patients counseled about administration, 362 (24.5%) about dose, 267 (18.1%) about effect, and 99 (6.7%) about adherence. Significantly more patients received counseling when they obtained prescribed versus over-the-counter medication (P=0.002), a new prescription versus a repeat prescription (P<0.001), or when they were served by a pharmacist versus by another staff member (P<0.001). Of the 33 interviewed pharmacists, all except one reported actively approaching patients for adherence counseling. Triggers included medication-related and patient-related factors. The pharmacists named predominantly product-centered topics of adherence counseling. The most cited barriers were rejection of counseling by the patient and lack of time. CONCLUSION Half of the patients receiving one or more medications were counseled, and only 6.7% of all contacts included adherence counseling. Future studies should clarify how barriers to adherence counseling at the community pharmacy can be overcome.
Collapse
Affiliation(s)
- Fabienne Boeni
- Pharmaceutical care research group, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
- Correspondence: Fabienne Boeni, Pharmaceutical care research group, Department of Pharmaceutical sciences, University of Basel, Klingelbergstrasse 50, CH-4056 Basel, Switzerland, Tel +41 61 267 15 29, Fax +41 61 267 14 26, Email
| | - Isabelle Arnet
- Pharmaceutical care research group, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | - Kurt E Hersberger
- Pharmaceutical care research group, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| |
Collapse
|
45
|
Caractéristiques des revues systématiques présentant les interventions de pharmaciens. ANNALES PHARMACEUTIQUES FRANÇAISES 2014; 72:429-39. [DOI: 10.1016/j.pharma.2014.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Revised: 05/13/2014] [Accepted: 05/16/2014] [Indexed: 11/24/2022]
|
46
|
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.
Collapse
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.
| |
Collapse
|
47
|
Perspective of community pharmacists on their practice with patients who have an antidepressant drug treatment: findings from a focus group study. Res Social Adm Pharm 2014; 11:e43-56. [PMID: 25443641 DOI: 10.1016/j.sapharm.2014.07.180] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Revised: 07/29/2014] [Accepted: 07/29/2014] [Indexed: 01/12/2023]
Abstract
BACKGROUND Around 2/3 of patients with major depression discontinue their antidepressant drug treatment (ADT) prematurely. Community pharmacists can rely on their regular contacts with patients to identify and support those experiencing difficulties with their ADT. OBJECTIVE The aim of this study is to describe pharmacists' perceptions with respect to their practices related to patients having an ADT. METHODS A qualitative study was conducted based on 6 focus groups involving 43 community pharmacists in 5 regions of Quebec province, Canada. Verbatim transcripts of focus groups were analyzed using computer-assisted thematic analysis. RESULTS The discussions revealed three major aspects of the participants' pharmacy practice: convincing patients to initiate ADT, dealing with side effects in the first weeks of the treatment, and taking a reactive approach to managing the treatment for the remainder of the follow-up. Discussions also enabled participants to identify the challenges they face concerning their practice with patients who have an ADT, and voice their recommendations for improving pharmacy practice and ultimately patient adherence to ADT. CONCLUSIONS Pharmacists wishing to help their patients to adequately manage their ADT face important barriers. Potential solutions include tools designed to help pharmacists better detect and intervene in ADT-related problems. Study findings will guide the on-going development of training and tools to support pharmacists' practice in this context.
Collapse
|
48
|
Faria R, Barbieri M, Light K, Elliott RA, Sculpher M. The economics of medicines optimization: policy developments, remaining challenges and research priorities. Br Med Bull 2014; 111:45-61. [PMID: 25190760 PMCID: PMC4154397 DOI: 10.1093/bmb/ldu021] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/15/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND This review scopes the evidence on the effectiveness and cost-effectiveness of interventions to improve suboptimal use of medicines in order to determine the evidence gaps and help inform research priorities. SOURCES OF DATA Systematic searches of the National Health Service (NHS) Economic Evaluation Database, the Cochrane Database of Systematic Reviews and the Database of Abstracts of Reviews of Effects. AREAS OF AGREEMENT The majority of the studies evaluated interventions to improve adherence, inappropriate prescribing and prescribing errors. AREAS OF CONTROVERSY Interventions tend to be specific to a particular stage of the pathway and/or to a particular disease and have mostly been evaluated for their effect on intermediate or process outcomes. GROWING POINTS Medicines optimization offers an opportunity to improve health outcomes and efficiency of healthcare. AREAS TIMELY FOR DEVELOPING RESEARCH The available evidence is insufficient to assess the effectiveness and cost-effectiveness of interventions to address suboptimal medicine use in the UK NHS. Decision modelling, evidence synthesis and elicitation have the potential to address the evidence gaps and help prioritize research.
Collapse
Affiliation(s)
- Rita Faria
- Centre for Health Economics, University of York, York, UK
| | - Marco Barbieri
- Centre for Health Economics, University of York, York, UK
| | - Kate Light
- Centre for Reviews and Disseminations, University of York, York, UK
| | | | - Mark Sculpher
- Centre for Health Economics, University of York, York, UK
| |
Collapse
|
49
|
Richardson TE, O'Reilly CL, Chen TF. A comprehensive review of the impact of clinical pharmacy services on patient outcomes in mental health. Int J Clin Pharm 2013; 36:222-32. [PMID: 24306436 DOI: 10.1007/s11096-013-9900-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Accepted: 11/25/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND The importance of pharmacists in mental healthcare is starting to be recognised around the world. However few studies have focused on the evidence supporting pharmacist involvement in the inpatient mental healthcare setting. AIM Evaluate types of outcomes achieved and level of evidence supporting clinical pharmacy services in inpatient mental health settings. METHODS Medline, PyscINFO and International Pharmaceutical Abstracts databases were searched from January 1990 to March 31 2013. Studies were included if in an inpatient setting, published in English, and reported an intervention provided by a pharmacist or involving a pharmacist with a pivotal role in an intervention team. Data were extracted according to sample population and size, study design and outline, country, role of the pharmacist in the study, and the main results of the study. The level of evidence for each study was assessed using Australia's National Health and Medical Research Council's hierarchy of clinical evidence and results were categorised as having economic, clinical and/or humanistic outcomes. RESULTS Eighteen articles met the inclusion criteria. A range of pharmaceutical services provided by pharmacists in inpatient mental healthcare were identified. These services highlight the role of pharmacists as reviewers of medication charts, laboratory results and medication prescribing and as educators of patients and other health care professionals. Six studies included a control or comparison group and had pre and post intervention measures. These comprised of three randomised control trials, one historical control study and two case series post and pre-post tests, corresponding to evidence levels of II, III-3 and IV respectively. Seven studies reported clinical outcomes, two economical and one humanistic outcomes. One study reported both clinical and economical outcomes. Seven studies focused on impact evaluation measures. CONCLUSIONS Pharmacists provide a variety of services and play a significant role in inpatient mental healthcare. However, the level of evidence supporting these services is limited and the type of outcomes achieved is narrow.
Collapse
Affiliation(s)
- Tom E Richardson
- Faculty of Pharmacy, The University of Sydney, Sydney, NSW, 2006, Australia,
| | | | | |
Collapse
|
50
|
Kodaka M, Inagaki M, Yamada M. Factors Associated With Attitudes Toward Suicide. CRISIS 2013; 34:420-7. [DOI: 10.1027/0227-5910/a000219] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background: Pharmacists could play a significant role in providing care for suicidal individuals. Previous studies reported that gatekeeper attitudes toward suicide could affect caregiving behaviors toward people at risk for suicide. Nevertheless, only few studies have examined the attitudes of pharmacists toward suicide. Aims: This study explores the factors associated with the attitudes of pharmacists toward suicide. Methods: A self-administered questionnaire and written explanation of the study were mailed to 541 pharmacists who had registered for the Board Certified Psychiatry Pharmacy Specialist Seminar in Tokyo, Japan. A Japanese version of the Attitudes Toward Suicide questionnaire was used to assess participant attitudes toward suicide. Multivariate analysis of covariance was used to assess relationships between participant attitudes toward suicide as well as demographics, occupational, and personal factors. Results: Participants who had previously received suicide-related education were more likely to have positive attitudes toward suicide prevention. Conversely, those with a lifetime history of suicidal thoughts had more permissive attitudes toward one’s right to commit suicide. Conclusions: Our findings suggest that pharmacist suicide prevention training programs should aim to alter permissiveness attitudes of trainees toward suicide.
Collapse
Affiliation(s)
- Manami Kodaka
- Center for Suicide Prevention, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Masatoshi Inagaki
- Department of Neuropsychiatry, Okayama University Hospital, Okayama, Japan
| | - Mitsuhiko Yamada
- Department of Neuropsychopharmacology, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| |
Collapse
|