An elective psychiatric course to reduce pharmacy students' social distance toward people with severe mental illness

Relative exposure to psychiatric conditions and medications in pharmacy education

INTRODUCTION

Common psychiatric conditions occur at rates similar to chronic medical conditions. This study aimed to evaluate the exposure to psychiatric disease states as comorbidities in relation to other common chronic conditions within the curriculum at one college of pharmacy.

METHODS

Researchers reviewed course activities for instances of specific conditions as comorbidities. The comorbidities evaluated fell into two categories: psychiatric and non-psychiatric. The primary outcome was the frequency each comorbidity appeared within course content. Secondary outcomes included characterization of instances of comorbidities, including the semester, course topic, and corresponding step of the Pharmacists' Patient Care Process. Prevalence data were analyzed for the health system where students conducted experiential learning.

RESULTS

Overall, hypertension, diabetes, and hyperlipidemia appeared as comorbidities more frequently in the curriculum than depression and anxiety, despite similar prevalence patterns between these conditions. Students received the most exposure to these conditions as comorbidities during team-based learning case activities in therapeutics courses taught during the second professional year.

CONCLUSIONS

This study found that psychiatric conditions were represented as comorbidities less frequently in the curriculum, despite similar prevalence patterns with other common comorbid disease states. With this knowledge, educators may identify potential opportunities for enhancing the curriculum around psychiatric illnesses.

Impact of a Neuropsychiatric Therapeutics Course and a Case-Based Course on Pharmacy Students' Mental Health Stigma

OBJECTIVE

Mental health education can reduce the stigma held by medical and nursing students; however, findings in this regard are limited in pharmacy academia. This study investigated the impact of a neuropsychiatric therapeutics course followed by a case-based course on the mental health stigma held by pharmacy students.

METHODS

A survey was conducted of second-year pharmacy students (n = 202) on the first and last day of a neuropsychiatric therapeutics course and 4 months later, at the end of a case-based course. The questionnaires included the Opening Minds Stigma Scale for HealthCare Providers (OMS-HC) scale, Recovery scale, Empowerment scale, and Attribution Questionnaire (AQ-9). Omnibus Friedman tests evaluated the main effect of time, followed by Wilcoxon signed-rank post hoc tests to compare baseline and postcourse scores.

RESULTS

Friedman test outcomes showed significant main effects of Time for OMS-HC, Recovery, Empowerment, and AQ-9 scales. Post hoc analysis indicated that compared to the baseline scores, the scores on Recovery and Empowerment scales significantly increased, OMS-HC scores decreased, but AQ-9 scores did not change after the therapeutics course. Compared to the baseline, OMS-HC and AQ-9 scores decreased, Recovery scale score increased, but the Empowerment scale score did not change after the case-based course. The scores did not decrease further after the case-based course compared to those after the therapeutics course.

CONCLUSION

The decreases in OMS-HC and AQ-9 scores and increases in Recovery and Empowerment scores indicate reductions in mental health stigma. Stigma among students was overall reduced after the therapeutics course and this reduction was maintained after the case-based course.

Mental health training programs for community pharmacists, pharmacy staff and students: A systematic review

BACKGROUND

Primary care is often the first point of contact for people living with mental disorders. Community pharmacists, pharmacy staff and students are increasingly being trained to deliver mental health care. However, there is still a gap in the literature exploring the characteristics of all available mental health training programs and their components and their influence on pharmacists, pharmacy staff and students' outcomes.

OBJECTIVES

To summarize the evidence evaluating mental health training programs completed by community pharmacists, pharmacy staff and students. More specifically, to explore the components of mental health training programs and identify those that facilitate significant improvements in outcomes.

METHODS

A systematic review was conducted following the Cochrane handbook and reported according to PRISMA guidelines. A search for published literature was conducted in three databases (PubMed, Scopus, and Web of Science) in July 2021. Eligible studies were included if they described and evaluated the impact of mental health training programs delivered to community pharmacists, pharmacy staff and pharmacy students regardless of design or comparator. The methodological quality of included studies was appraised using both the NIH quality assessment, to evaluate studies with an uncontrolled pre-post design, and the Cochrane EPOC risk of bias assessment, to evaluate studies with a controlled (randomized and non-randomized) study design.

RESULTS

Thirty-three studies were included. Most of the identified mental health training programs contained knowledge-based components and active learning activities. Changes in participants' attitudes, stigma, knowledge, confidence and skills were frequently assessed. An extensive range of self-assessment and observational instruments used to evaluate the impact of the training programs were identified. Positive improvements in participants' attitudes, knowledge and stigma were frequently identified following participation in training programs.

CONCLUSIONS

This systematic review highlights the importance of mental health training programs in increasing pharmacists', pharmacy staff and pharmacy students' skills and confidence to deliver mental health care in community pharmacy. Future research should build upon this basis and further focus on finding the most efficient measures to evaluate these training programs and assess their long-term effectiveness, allowing comparison between programs.

A pilot psychedelic psychopharmacology elective

BACKGROUND AND PURPOSE

There is renewed research attention on the use of psychedelic drugs to treat psychiatric illnesses. If psychedelic drugs are approved for medical use in the United States, patients, professionals, and policy makers will look to pharmacists as medication experts for advice on the safe, effective, and ethical use of these substances. To help prepare a future generation of pharmacists in this therapeutic area, a psychedelic psychopharmacology elective was developed and piloted.

EDUCATIONAL ACTIVITY AND SETTING

Broadly, the objectives of the course were to train students to (1) analyze scientific literature, (2) engage in ethical discussions, and (3) make evidence-based clinical recommendations about the use of psychedelics. The pilot elective course was delivered synchronously online to 12 second- and third-year pharmacy students during spring 2021. Activities included journal clubs, textbook reading assignments, reflective structured dialogues, a monograph, and a term paper.

FINDINGS

The course was feasible for a single instructor and well-received by students. A mix of instructor-directed and self-directed learning approaches were utilized.

SUMMARY

The pilot psychedelic psychopharmacology elective was a success, providing a framework for future courses.

The role of community pharmacists in depression management: a survey of attitudes, practices and perceived barriers

Background Community pharmacists play a significant role in depression care. Depression is a health priority in national health strategies around the world, including in Qatar. Objective To describe current practices, attitudes and perceived barriers of community pharmacists towards depression care, and to investigate factors associated with these practices. Setting Community pharmacies in Qatar. Method A cross-sectional online survey using an adapted survey instrument. Scores were measured on a five-point Likert scale. Descriptive univariate and bivariate analyses of study outcomes, followed by multivariate regression examining the association between pharmacists' practices and their attitudes, socio-demographic and professional characteristics. Main outcome measure Pharmacists' scores on self-reported attitudes towards depression and depression care practices and the number of perceived barriers for depression care. Result: 358 pharmacists (response rate 39%) completed the questionnaire. Pharmacists' attitudes to depression were moderately positive (mean score = 3.41, SD = 0.26) but involvement in depression care was very low (mean score = 2.64, SD = 0.94). Three major barriers were lack of access to patients' medical records (83.21%), lack of patients' insight on depression and the importance of treatment (81.85%), and lack of knowledge and training on mental health (79.63%). Female pharmacists and those graduated more than 10 years prior were significantly less involved in depression care compared to their counterparts (practice scores (95% CI) -4.36 (-7.46 to -1.26) and -7.51 (-15.10 to -1.35), respectively), while those who had access to private counselling area were more involved (practice score 3.39 (0.20 to 6.59). Pharmacists' depression practice score was positively associated with attitudes (p = 0.001). Conclusion Pharmacists' moderately positive attitudes were not reflected in their suboptimal depression-care practices. Action from policymakers is needed to improve pharmacists' practices and attitudes to depression.

Somatic health care professionals' stigmatization of patients with mental disorder: a scoping review

BACKGROUND

Patients with mental disorders have an increased risk of developing somatic disorders, just as they have a higher risk of dying from them. These patients often report feeling devaluated and rejected by health professionals in the somatic health care system, and increasing evidence shows that disparities in health care provision contribute to poor health outcomes. The aim of this review was to map and synthesize literature on somatic health professionals' stigmatization toward patients with mental disorders.

METHODS

We conducted a scoping review using Arksey and O'Malley's framework and carried out a systematic search in three databases: Cinahl, MEDLINE, and PsycINFO in May-June 2019. Peer-reviewed articles published in English or Scandinavian languages during 2008-2019 were reviewed according to title, abstract and full-text reading. We organized and analyzed data using NVivo.

RESULTS

A total of 137 articles meeting the eligibility criteria were reviewed and categorized as observational studies (n = 73) and intervention studies (n = 64). A majority of studies (N = 85) focused on patients with an unspecified number of mental disorders, while 52 studies focused on specific diagnoses, primarily schizophrenia (n = 13), self-harm (n = 13), and eating disorders (n = 9). Half of the studies focused on health students (n = 64), primarily nursing students (n = 26) and medical students (n = 25), while (n = 66) focused on health care professionals, primarily emergency staff (n = 16) and general practitioners (n = 13). Additionally, seven studies focused on both health professionals and students. A detailed characterization of the identified intervention studies was conducted, resulting in eight main types of interventions.

CONCLUSIONS

The large number of studies identified in this review suggests that stigmatizing attitudes and behaviors toward patients with mental disorders is a worldwide challenge within a somatic health care setting. For more targeted interventions, there is a need for further research on underexposed mental diagnoses and knowledge on whether specific health professionals have a more stigmatizing attitude or behavior toward specific mental disorders.

Impact of a psychiatry elective on mental health stigma among pharmacy students

BACKGROUND AND PURPOSE

Mental health stigma among healthcare providers remains a significant barrier to patients receiving optimal care for psychiatric conditions. This study's purpose is to evaluate the impact of a psychiatry elective on pharmacy students' attitudes toward patients with mental health disorders.

EDUCATIONAL ACTIVITY AND SETTING

This study cohort included pharmacy students enrolled in a Special Topics in Psychiatry elective. Attitudes toward mental health disorders were measured at baseline (first day of class) and post-exposure (last day of class) using the 21-item Beliefs toward Mental Illness (BMI) Scale. Wilcoxon signed-rank tests were used to compare each component of the BMI scale as well as each subscale (dangerousness, poor social and interpersonal skills, and incurability) at baseline and post-exposure.

FINDINGS

Fifty-eight pharmacy students (68% response rate) participated in this study. Most respondents were in their first year of the pharmacy program (44%), female (72%), and Asian (59%). There was a statistically significant decline in each BMI subscale at the end of the course: dangerousness, poor interpersonal and social skills, and incurability. There was no significant difference in mean change for the BMI sub-scores by gender, race, or personal experience with mental health disorders.

SUMMARY

Incorporating a psychiatry elective into the pharmacy school curriculum can improve attitudes toward patients with mental health disorders. Future areas of research are warranted on the influence of specific components of a psychiatry elective that impact BMI scores and whether this translates to improved quality of care during clinical practice.

Assessment of pharmacy student attitudes and beliefs toward patients with mental illnesses on inpatient psychiatric units

Introduction

People with mental illness continue to face stigma, despite these illnesses being common. Previous studies have demonstrated reduced stigma in pharmacy students after various exposures and education, although results have been mixed. The primary objective of this study was to evaluate the effects of an advanced pharmacy practice experience (APPE) in psychiatric pharmacy on students' stigma toward patients with mental illness using the Opening Minds Stigma Scale for Healthcare Providers (OMS-HC) at 2 psychiatric hospitals.

Methods

This was a prospective, multicenter survey study of pharmacy students on an APPE rotation at an inpatient psychiatric hospital conducted during 3 academic years. Prior to starting and upon completion of their rotation, participants completed the OMS-HC and provided demographic and rotation information.

Results

A total of 26 students participated in the prerotation survey, with 88.5% (n = 23) completing the postrotation survey. The primary outcome showed a significant decrease in total OMS-HC score (Z = −2.376, P = .017), indicating a decreased level of stigma at rotation completion. Analysis of the OMS-HC subscales for attitudes toward people with mental illness and attitudes toward self-disclosure of a mental illness also yielded significant decreases (Z = −2.425, P = .015; Z = −2.462, P = .014, respectively).

Discussion

This study showed that APPE rotations at inpatient psychiatric hospitals may help reduce stigma among pharmacy students. Pharmacy schools should consider increasing access to and encouraging completion of psychiatric pharmacy rotations to help reduce stigma prior to graduation.

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

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

Navigating social distance in foundational clinical encounters: Understanding medical students' early experiences with diverse patients

BACKGROUND

Social distance between patients and physicians has been shown to affect the quality of care that patients receive. Little is known about how social distance between students and patients is experienced by learners during early clinical exposures in medical school.

OBJECTIVE

This study aims to explore students' stories of experiencing social distance with patients with concordant and discordant social characteristics as themselves, respectively, as well as students' needs from medical curricula regarding developing social competence.

METHODS

Semi-structured interviews of medical students [n = 16] were performed, and a post-interview survey and a visual analog scale were completed. The interviews were audio-recorded and transcribed. The written transcripts were coded using the constant comparison method and analyzed for emerging themes.

RESULTS

Students experience social distance with patients; yet, they are not taught explicitly by their preceptors how to manage these experiences. Students identified their needs for the curriculum in regard to developing social competence and proposed various strategies and curriculum recommendations.

CONCLUSIONS

Our results support that students believe that social competence training is important for their professional development to improve relationship-building with diverse patients. As such, it would be valuable to incorporate student recommendations in the formation of a social competence curriculum.

Social distance in Lithuanian psychology and social work students and professionals

PURPOSE

This cross-sectional study aimed to compare desire for social distance from people with mental illness in the disciplines of social work and psychology, and among students and professionals having different professional experience.

METHODS

948 respondents (715 students and 233 professionals) from Lithuanian educational and mental health-care institutions participated in an anonymous survey. Social distance was measured using Lithuanian Social Distance Scale which was created for this study. Participants also answered questions about familiarity with mental illness. Bias of social desirability was measured using the balanced inventory of desirable responding.

RESULTS

Series of ANCOVA analysis revealed that psychology and social work master's and PhD students reported less social distance from people with mental illness when compared with bachelor's students. Familiarity with mental illness was significantly related to less social distance in the student sample, but not in professionals' sample. The strongest desire for social distance in the professionals' sample was observed in social workers having less than 5 years of professional practice and most experienced psychologists with more than 10 years of professional practice.

CONCLUSIONS

Social distance from people with mental illness decreases through the study years; however, results of professional psychologists and social workers illustrate different trajectories in social distance through the professional career. The results of this study support the need for anti-stigma programmes and initiatives orientated towards mental health professionals.

Survey highlights the need to expand offerings of introductory pharmacy practice experiences in psychiatry and neurology: Benefits and example experiences

Introduction

Introductory pharmacy practice experiences (IPPEs) are 1 requirement schools and colleges of pharmacy must fulfill to meet accreditation standards. The purpose of this manuscript is to report existing IPPEs in psychiatry and neurology across the United States.

Methods

Two separate electronic surveys were administered to individual College of Psychiatric and Neurologic Pharmacists members with board certification in psychiatric pharmacy with an academic affiliation and academic institutions in the 2014-15 academic year to assess the neuropsychiatric curriculum in pharmacy programs. Results focusing on IPPEs were summarized using descriptive statistics.

Results

Academic institutional data reveal only 37.3% offered IPPEs in psychiatry, and 6.7% offered neurology. The number of available IPPEs is low even if a program offered an available rotation. The majority of College of Psychiatric and Neurologic Pharmacists member respondents (69.9%) did not offer IPPEs in psychiatry in the 2014-15 academic year, and none offered an IPPE in neurology. More than half of individual respondents feel their institution should increase IPPEs in psychiatry and neurology in order to enhance their curriculum.

Discussion

To expand IPPE availability, pharmacy programs should increase early exposure of pharmacy students to patients with psychiatric and neurologic conditions. Longitudinal experiences may allow students to engage in hands-on experiences, which may impact future career aspirations and reduce stigma. Current example IPPEs at the authors' institutions are included to stimulate discussion and action among readers on how IPPEs in these practice areas may be developed. Implementation of IPPEs in psychiatry and neurology is needed for students to gain experience working with these patients.

Cases in Psychiatry: A description of a multi-campus elective course for pharmacy students

Cases in Psychiatry was a multi-campus elective course aimed to expand psychiatry knowledge beyond the required course curriculum. The format of the class included didactic course work, small group discussion of patient cases and article evaluation, submission of written notes, debates, and script concordance test questions delivered via a live online platform. Based on student assessment and feedback at the end of the course, the elective course was determined to meet the prespecified course objectives.

Student pharmacists' social distancing toward people with mental illness

Introduction

Findings from previous studies indicated patients with mental illness feel pharmacists do not provide appropriate care. In addition, many patients with mental illness report not having a strong relationship with their pharmacist. The objective of this study was to determine the level of social distance of student pharmacists toward patients with mental illness.

Methods

Student pharmacists completed an anonymous survey. Data were collected using the Bogardus Social Distance Scale (SDS). Level and correlates of social distancing were examined.

Results

Incomplete surveys were excluded, resulting in 334 completed surveys. A total of 276 students (83%) had an SDS score ≥14, indicating social distancing. There was no statistical difference noted in social distancing between students and year of training (P = .482). The greatest social distancing was in relation to trusting someone with mental illness to "care for their child," where less than 1 in 5 students (17%) were willing to do this. Most students (88%) were willing to work or be neighbors with someone with mental illness, indicating less social distancing in these domains. Regression analysis indicated a significant change in sum score with knowing someone or having a first-degree relative with mental illness.

Discussion

Results indicate social distancing is prominent among pharmacy students. Results may be used in the future to help identify solutions for improving social distancing and increasing pharmacy student interaction to patients with mental illness. Further training related to mental illness may assist with decreasing social distancing among pharmacy students.

Community pharmacists and mental illness: a survey of service provision, stigma, attitudes and beliefs

Background Half of Americans experience mental illness during their lifetime. Significant opportunity exists for community pharmacists to deliver services to these patients; however, personal and practice-related barriers may prevent full engagement. Objective To assess the demographics, practice characteristics, service provision, stigma, attitudes and beliefs of a national sample of community pharmacists towards individuals with mental illness. Setting National random sample of 3008 community pharmacists in the USA. Method 101-item cross-sectional mailed survey questionnaire on: (1) demographics, (2) knowledge and practice characteristics, (3) provision of clinical pharmacy services, and (4) comparative opinions. Main outcome measure Scaled measures of service provision (comfort, confidence, willingness and interest) and comparative opinions (stigma, attitudes and beliefs) of mental illness, four linear regression models to predict service provision. Results A total of 239 responses were received (response rate 7.95%). Across pharmacy services, ratings for willingness/interest were higher than those for comfort/confidence. Pharmacists who reported providing medication therapy management (MTM) services for patients reported higher comfort (18.36 vs. 17.46, p < 0.05), confidence (17.73 vs. 16.01, p < 0.05), willingness (20.0 vs. 18.62, p < 0.05) and interest (19.13 vs. 17.66, p < 0.05). Pharmacists with personal experience with mental illness also resulted in higher scores across all four domains of service provision, lower levels of stigma (18.28 vs. 20.76, p < 0.05) and more positive attitudes (52.24 vs. 50.53, p < 0.01). Regression analyses demonstrated increased frequency of MTM service delivery and more positive attitudes as significantly predictive across all four models for comfort, confidence, willingness and interest. Increased delivery of pharmacy services was significantly associated with both willingness and interest to provide mental illness-specific services. Conclusion Despite willingness/interest to provide services to patients with mental illness, decreased levels of comfort/confidence remain service-related barriers for community pharmacists.

Key Ingredients-Target Groups, Methods and Messages, and Evaluation-of Local-Level, Public Interventions to Counter Stigma and Discrimination: A Lived Experience Informed Selective Narrative Literature Review

A proliferation of recent literature provides substantial direction as to the key ingredients-target groups, messages and methods, and evaluation-of local-level, public interventions to counter stigma and discrimination. This paper provides a selective narrative review of that literature from the perspective or standpoint of anti-stigma experts with lived experience of mental distress, the key findings of which have been synthesised and presented in diagrammatic overviews (infographics). These are intended to guide providers in planning, delivering and evaluating lived experience-directed local-level, public interventions to counter stigma and discrimination in accord with current best practice.

A survey of pharmacists' perceptions of the adequacy of their training for addressing mental health-related medication issues

Introduction

The purpose of this study was to conduct a survey of North Carolina pharmacists' perceptions of their pharmacy training in mental health-related medication issues and how this influenced their perceived ability to address these issues in the provision of pharmaceutical care to their patients.

Methods

A survey consisting of 17 questions was developed and emailed to licensed pharmacists in North Carolina. Surveys that were returned were analyzed to see if conclusions could be made regarding the pharmacists' perceptions about their mental health-related medication training and its influence on their practice.

Results

A total of 848 pharmacists completed the survey (response rate of 7.9%). Of the survey participants, 489 (58.2%) reported that pharmacy school training adequately prepared them to provide basic pharmaceutical care to patients taking mental health-related medications. However, 350 (41.4%) reported feeling less comfortable providing medication counseling for mental health-related medications compared to cardiac medications.

Discussion

Despite the volume of prescriptions that mental health-related medications represent in day-to-day practice, a significant portion of licensed pharmacists responding to our survey indicate that the emphasis on mental health in their training may have been inadequate.

Effects of a psychiatric clinical rotation on pharmacy students' attitudes toward mental illness and the provision of pharmaceutical care to the mentally ill

Introduction

Previous studies have found ineffectiveness of psychiatric clinical rotations to change pharmacy students' attitudes toward mental illness, but those studies had various limitations that cast doubt on this conclusion.

Methods

Pharmacy students who participated in a psychiatric clinical rotation over a 2-year time frame were invited to complete a survey at the beginning and end of their rotation. The survey included scales that measured attitudes toward dangerousness, social distance, stigmatization, suicide prevention, and provision of pharmaceutical care.

Results

Forty-one (100%) students participated in the study. Statistically significant positive changes in total scale scores from pre-rotation to post-rotation were seen in the areas of stigmatization toward patients with schizophrenia (P = .02), attitudes toward suicide prevention (P = .05), and provision of pharmaceutical care services to patients with schizophrenia (P < .00001) and depression (P = .0006). There were no statistically significant changes on the total scores of the other scales, but there was a moderate improvement in stigmatization toward patients with depression.

Discussion

Pharmacy students' participation in a psychiatric clinical rotation failed to have a major impact on their social distance from mentally ill patients. Findings were mixed in regards to stigmatization of mentally ill patients. However, pharmacy students' attitudes toward suicide prevention and providing pharmaceutical care services to mentally ill patients were significantly improved by participation in a psychiatric clinical rotation. Preceptors in the clinical setting should consider including educational techniques that address pharmacy students' attitudes toward mental illness, as improvement in such attitudes may further enhance their willingness to provide pharmaceutical care services.

Student pharmacist experiences as inpatient psychiatry medication education group leaders during an early immersion program

BACKGROUND AND PURPOSE

While research suggests that pharmacists generally hold positive attitudes toward consumers of psychiatric medications, they often feel less comfortable talking about these medications and providing services for patients with mental illness. The purpose of this program was to train second and third year student pharmacists as psychiatry medication education groups leaders and to examine resulting student self-efficacy and mental health stigma.

EDUCATIONAL ACTIVITY AND SETTING

In partnership with the University of North Carolina (UNC) Eshelman School of Pharmacy, the inpatient psychiatry service at UNC Medical Center expanded weekly medication education groups with the help of trained student pharmacists. All second- and third-year student pharmacists were invited to participate. Pre/post surveys and reflection statements were collected from 13 students that received training, provided informed consent, and participated in one or more medication education groups. Data were analyzed with a mixed methods approach.

FINDINGS

Student responses revealed an increase in student self-efficacy (p < 0.05), improved understanding of mental illness, and new strategies for engaging in direct patient care.

DISCUSSION AND SUMMARY

Results from this study suggest that students gained an appreciation for pharmacists and the workplace while developing self-efficacy and strategies for engaging with patients with mental illness as a part of medication education groups.

Curriculum in Psychiatry and Neurology for Pharmacy Programs

Objective. To describe pharmacy curricula in psychiatry and neurology and to report on neuropsychiatric pharmacy specialists' views on optimal curriculum. Methods. Design and administer one electronic survey to accredited pharmacy programs asking them to report information on curricula in psychiatry and neurology for the 2014-2015 academic year. Design and administer a separate electronic survey to board certified pharmacists with an academic affiliation who are members of the College of Psychiatric and Neurologic Pharmacists (CPNP) asking about their teaching activities and their opinion on optimal curricula. Results. Fifty-six percent of pharmacy programs and 65% of CPNP members responded to the surveys. The program survey revealed greater than 80% of topics were taught by full-time faculty. Didactic lecturing, team-based learning, and case studies were the most common teaching methods. Programs dedicated the most didactics (3 to 5+ hours) to epilepsy, depression, schizophrenia, substance use disorders, and pain. Autism, traumatic brain injury, personality, and eating disorders were either not taught or given ≤ 1 hour of didactics in most programs. Inpatient psychiatry had the most APPE placements with a mean of 19.6, range 0-83. APPE electives in psychiatry outnumbered those in neurology 5 to 1. CPNP member survey results showed 2 out of 3 members agreed that curriculum could be improved with additional APPEs in psychiatry and neurology. Conclusion. Didactic hour distribution in psychiatry and neurology could be improved to better align with board certification in psychiatric pharmacy (BCPP) recommendations and disorder prevalence and complexity. Specialists recommend an experiential component in neurology and psychiatry to combat stigma and improve pharmacist knowledge and skills.

Emphasizing Bloom's Affective Domain to Reduce Pharmacy Students' Stigmatizing Attitudes

Objective. To create a learning environment using Bloom's affective domain as a framework that would reduce third-year pharmacy students' stigmatizing attitudes toward patients with mental illness. Design. Prior to the start of the module, students were asked to complete the 27-question Attribution Questionnaire Short Form (AQ-27). The teaching approach and in-class activities were designed to allow students' to experience the major categories within Bloom's affective domain. The module used patient cases, interactive-learning activities, and reflective discussions to augment pharmacological and therapeutic knowledge with a humanistic understanding of mental illness. Students were asked to retake the AQ-27 after completing the module. Assessment. Paired responses on the AQ-27 were reported for 74 of 104 students, which represents a response rate of 71.2%. Students' scores changed significantly on nine of the 27 questions. Students' attitudes pre- to post-module revealed a significant increase in the help construct, while there was a significant decrease in the dangerousness and fear constructs. Conclusion. Designing and implementing a course along the continuum of Bloom's affective domain resulted in appropriate changes in students' attitudes toward patients with mental illness.

Supporting patients with mental illness: Deconstructing barriers to community pharmacist access

OBJECTIVES

To discuss the barriers faced by individuals with mental health conditions attempting to access their community pharmacists and to propose solutions toward deconstructing those barriers.

SUMMARY

Given the prevalence of mental illness and the frequency at which psychotropic medications are dispensed, community pharmacists have a daily opportunity to engage patients with mental illness and be active participants in community-based mental health care. Yet multiple barriers affect patient access to community pharmacists. Some barriers, such as heavy dispensing workload, can be considered as "external" to the pharmacist. Other barriers, such as negative attitudes about mental illness, are considered to be "internal." Research about mental illness stigma in pharmacy often reports that community pharmacists are uncomfortable with, or have little time for, mental health patients. Patients also report experiencing stigma from pharmacists and pharmacy staff. Expanded efforts are needed by the pharmacy profession to deconstruct barriers that patients with mental illness are faced with in community pharmacy, especially related to stigma. Specifically, these efforts should include critically evaluating and addressing the quality of didactic and experiential opportunities in psychiatric pharmacotherapy for pharmacy students, transforming the physical layout of community pharmacies to offer true counseling privacy, educating community pharmacists and pharmacy staff about mental illness, and educating patients about what to expect from community pharmacists.

CONCLUSION

There are opportunities for community pharmacy to improve its impact on mental health treatment outcomes by resolving mental illness stigma and other barriers that prevent patients with mental illness from accessing their community pharmacist.

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

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

A consumer-led intervention to improve pharmacists' attitudes toward mental illness

Introduction:

Individuals with a severe and persistent mental illness often manage complex medication regimens and would benefit from support and education from their pharmacist. Past research has shown that community pharmacists have negative attitudes toward mental illnesses, and these attitudes affect willingness to provide services to patients with mental illnesses. Consumer-led interventions have shown benefit to improve student attitudes toward mental illness. However, there are no known studies showing the benefit of consumer-led educational programs to improve pharmacist attitudes toward mental illness and willingness to provide services to those with mental illnesses. The aim of this study is to determine the effects of a consumer-led continuing education program on pharmacists' attitudes toward and willingness to provide services to consumers with mental illnesses.

Methods:

Fifty pharmacists participated in the program with 2 parts: discussion on the history of mental health care and consumers sharing their experiences. Pharmacists completed 1 survey before and after the program. Surveys asked about pharmacists' attitudes toward mental illness and willingness to provide services to individuals with schizophrenia compared to asthma. Data were analyzed using descriptive and paired t tests.

Results:

Paired t tests showed a significant decrease in social distance and increase in positive attitudes and willingness to provide services to patients with mental illnesses immediately after the program.

Discussion:

The immediate increase in positive attitudes and willingness to provide services to consumers with mental illnesses indicates that consumer-led interventions may be an effective way to improve the provision of pharmacy services to patients with mental illnesses.

Stigmatizing beliefs: How leading patient medication education groups on an inpatient psychiatric unit impacts pharmacy learners

Introduction

Stigma is an important challenge facing patients with mental illness. Stigmatizing attitudes may impact the quantity and quality of care patients receive. Interaction with these patients may reduce stigmatizing attitudes in pharmacy learners. Patient medication education groups (PMEGs) provide learners with an opportunity for this interaction. The objectives of the study were to evaluate pharmacy learner's attitudes toward patients with mental illness and their comfort and ability to provide pharmaceutical services to this population before and after leading a PMEG on an adolescent inpatient psychiatric unit and to evaluate the feasibility of a larger, future trial.

Methods

Third- or fourth-year student pharmacists or first-year pharmacy residents observed a postgraduate year-2 (PGY2) pharmacy specialty resident in psychiatry leading PMEGs on the adolescent unit of an inpatient psychiatric hospital. Then, they discussed their own ideas for design and delivery of a group (with feedback from the PGY2 resident) and, under observation of the PGY2, led their own group. The study used a mixed-methods approach consisting of a presurvey and postsurvey learning experience survey as well as reflective statements. The presurvey consisted of 2 previously validated measures that evaluate stigma toward people with mental illness—the Social Distance Scale (SDS) and the Opening Minds Scale for Health Care Providers (OMS-HC). The postsurvey also consisted of the SDS and OMS-HC and included program evaluation questions that examined the learners' impression of patients with mental illness, their ability and comfort with providing pharmaceutical services to patients with mental illness, and their reflections on the experience.

Results

Seven pharmacy learners participated, and 5 completed both the prelearning and postlearning experience survey for a 71% response rate. There was a median decrease in stigmatizing beliefs of 1 point on the SDS, and a median 5-point drop in the OMS-HC scale. The postintervention questions yielded results primarily of strongly agree or agree with the statements evaluating the other objectives, and the reflection statements brought up the additional value of the educational intervention. Finally, the feasibility and value of a larger trial were confirmed.

Discussion

The value of pharmacy learners teaching PMEGs on stigmatizing beliefs toward patients with mental illness was confirmed. The effectiveness of a model of observing, designing, and delivering a PMEG was also postulated and will be further examined with a larger trial. Future research will also focus on examining the impact of this model on patient outcomes.

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

BACKGROUND

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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

BACKGROUND

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Mental health curricula at schools of pharmacy in the United Kingdom and recent graduates' readiness to practice

OBJECTIVE

To assess mental health education in the undergraduate pharmacy curricula in the United Kingdom and gauge how well prepared graduates are to manage mental health patients.

METHOD

The authors conducted semi-structured telephone interviews with pharmacy educators and administered an electronic self-administered survey instrument to pharmacy graduates.

RESULTS

The mental health conditions of depression, schizophrenia, bipolar disorder, and Parkinson disease were taught, in detail, by all schools, but more specialized areas of mental health (eg, personality disorder, autism) were generally not taught. Just 5 of 19 schools attempted to teach the broader social aspects of mental health. A third of the schools provided experiential learning opportunities. Graduates and recently registered pharmacists stated that undergraduate education had prepared them adequately with regard to knowledge on conditions and treatment options, but that they were not as well prepared to talk with mental health patients and deal with practical drug management-related issues.

CONCLUSION

The mental health portion of the undergraduate pharmacy curricula in colleges and schools of pharmacy in the United Kingdom is largely theoretical, and pharmacy students have little exposure to mental health patients. Graduates identified an inability to effectively communicate with these patients and manage common drug management-related issues.

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

OBJECTIVE

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

DESIGN

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

ASSESSMENT

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

CONCLUSION

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