The role of pharmacists in supporting service users to optimise antipsychotic medication

Implementing interprofessional education in the nursing and pharmacy curricula: An evaluation of a workshop focused on optimising of medicines prescribed for mental health problems

BACKGROUND

An inter-professional education (IPE) workshop centred around mental health scenarios was attended and assessed by 70 Nursing and Pharmacy students at the University of Huddersfield.

AIM

The aim of this study was to evaluate the implementation of a curricula IPE workshop for undergraduate nursing and pharmacy students, focussing on the optimal use of medicines with mental health problems utilising clinically based scenarios.

METHODS

The workshop was evaluated using an internally produced cross-sectional questionnaire completed by student participants from both pharmacy and mental health nursing disciplines, scoring on Process/Knowledge and Relationships domains.

RESULTS

70 participants (41 Mental Health Nursing students; 29 Pharmacy students) completed the questionnaire, who rated the content highly. Scores indicative of positive perception were reported by 65 respondents (92.9 %) on the Process/Knowledge domain and by 66 respondents (94.3 %) on the Relationships domain. Qualitative analysis of student evaluations demonstrated that both cohorts highly valued the workshop, with a shared appreciation of what each student group contributed. There was strong overall positivity toward working inter-professionally.

CONCLUSION

IPE workshops act as a useful tool for promoting positive working relationships and collaboration to aid the effective sharing of knowledge and skills between differing professions.

Community pharmacists' perceptions of their challenges in relation to older adults prescribed psychotropic medications: a focus-group study

BACKGROUND

The management of psychotropic medication in older adults is a challenge for every healthcare professional, but data concerning community pharmacists are scarce in the literature.

AIM

Our objectives were i) to understand the difficulties encountered by community pharmacists in managing older adults on psychotropic medication, and ii) to identify potential solutions to the difficulties discussed.

METHOD

A qualitative study by focus group was proposed to all community pharmacists in the vicinity of the university hospital of Angers, France, between May and June 2023. An interview guide was established based on data from literature, with open-ended questions covering 5 categories: management of adverse drug reactions, patient counselling and dispensing, management of psychotropic misuse, pharmacological knowledge, professional relationship and communication. Data were analysed using thematic analysis with an inductive approach.

RESULTS

Four consecutive focus groups were conducted with 17 community pharmacists. Three themes emerged from the various discussions: communication-related issues (e.g. patients refusing to discuss or consider the pharmacist's advice, lack of care-continuity between hospital and community pharmacy); system-related issues (e.g. limitation of time available for patient counselling, lack of access to the patient's clinical details); and psychotropic-related issues (e.g. different perceptions of the risk-benefit ratio between patients and pharmacists, suspected dependence leading to overuse).

CONCLUSION

The challenges of managing psychotropic medications in older people in community pharmacies are many, but there are solutions. They mainly revolve around interprofessional collaboration, improving the patient pathway, particularly the link between hospital and community pharmacy, and improving training for pharmacists in optimising psychotropic medication.

Pharmacist-led Si-care (schizophrenia care) model to improve medication adherence and symptom management in schizophrenia

Introduction

Schizophrenia is a chronic mental disorder that requires long-term treatment, particularly antipsychotic medications. However, medication adherence among patients with schizophrenia is often suboptimal, leading to symptom relapse and poor outcomes. The Si-Care (Schizophrenia Care) program was developed as a pharmacist-led home intervention to improve medication adherence and support symptom control in patients with schizophrenia. This study aimed to evaluate the effectiveness of the Si-Care intervention in improving medication adherence and maintaining stability of symptoms among schizophrenia patients.

Methods

A quasi-experimental study was conducted in three community health centers or Puskesmas in Banjarmasin, Indonesia. A total of 57 participants were recruited according to the sampling criteria. The Si-Care intervention consisted of seven home visits by trained pharmacists over four months, providing education, counseling, and medication monitoring. Adherence to medication was evaluated using the pill count method and severity of symptoms was measured using the Positive and Negative Syndrome Scale (PANSS) pre- and post-intervention. Data were analyzed using the Friedman test for adherence and the Wilcoxon test for PANSS scores.

Results

Mean medication adherence improved significantly from 77.38 % ± 25.85 at baseline (T0) to 97.57 % ± 11.09 at the final visit (T4) (p = 0.000). However, the decrease in PANSS scores from 38.03 ± 9.14 to 37.81 ± 9.15 was not statistically significant (p = 0.089). Despite the lack of significant change in PANSS scores, symptoms remained stable throughout the intervention, suggesting effective symptom management.

Conclusions

The Si-Care intervention significantly improved medication adherence among people with schizophrenia, contributing to the maintenance of stable symptoms. Pharmacist-led home interventions provide valuable support to address adherence challenges and should be considered a critical component in schizophrenia care. Future studies should consider a more rigorous design, a larger sample size, and longer follow-up to better evaluate the sustainability, scalability, and applicability of the intervention in diverse healthcare settings.

Community pharmacists' views and experiences of delivering in-pharmacy medication reviews for people living with severe and persistent mental illness: a qualitative study

BACKGROUND

People living with severe and persistent mental illness (SPMI) often take multiple medications and are at risk of experiencing medication related problems. Medication review services have the potential to reduce inappropriate use of psychotropic medications and improve adherence. However, there is limited research regarding pharmacists' perspectives when providing such services.

AIM

To explore community pharmacists' views and experiences of providing an in-pharmacy medication review (MedsCheck) for people living with SPMI.

METHOD

Semi-structured interviews were conducted between November 2021 and May 2022 with community pharmacists participating in the comparator group of the PharMIbridge Randomised Controlled Trial (RCT), which aimed to improve medication adherence and manage physical health concerns for people living with SPMI. Interviews were recorded, transcribed, and analysed using inductive thematic analysis.

RESULTS

Fifteen semi-structured interviews were conducted with community pharmacists including pharmacy owners, managers and employee pharmacists. Most pharmacist participants who were interviewed (n = 10) were aged under 39 and more than half (n = 8) had 10 or more years of pharmacy experience. Five key themes were identified: 1) Pharmacists' roles in the management of SPMI in community pharmacy; 2) Mental health education and training; 3) Pharmacy resources; 4) Challenges with interprofessional collaboration and 5) Impact on professional relationships and consumer outcomes.

CONCLUSION

Pharmacists are motivated to support people living with SPMI. Mental health training, as well as arrangements regarding pharmacy workflow and appropriate remuneration are needed to enable pharmacists to better support people living with SPMI. Referral pathways should be directly accessible by community pharmacists to assist interprofessional collaboration.

Antipsychotic prescribing and drug-related readmissions in multimorbid older inpatients: a post-hoc analysis of the OPERAM population

BACKGROUND

Limited data are available on characteristics associated with antipsychotic use in multimorbid older adults.

AIM

Primary: to identify patient characteristics associated with antipsychotic prescribing in a multimorbid population of older inpatients with polypharmacy. Secondary: (1) to observe if antipsychotics use during an index hospitalisation was associated with a drug related admission (DRA) within one year, and (2) to describe these cases of antipsychotic-related readmissions.

METHOD

This was a secondary analysis of the OPERAM randomized controlled trial. Multivariate analysis assessed the association between characteristics and comorbidities with antipsychotic use. An expert team assessed DRA occurring during the one-year follow-up.

RESULTS

Antipsychotics were prescribed to 5.5% (n = 110) patients upon admission while 7.7% (n = 154) inpatients received antipsychotics at any time (i.e. upon admission, during hospitalisation, and/or at discharge). The most frequently prescribed antipsychotics were quetiapine (n = 152), haloperidol (n = 48) and risperidone (n = 22). Antipsychotic prescribing was associated with dementia (OR = 3.7 95%CI[2.2;6.2]), psychosis (OR = 26.2 [7.4;92.8]), delirium (OR = 6.4 [3.8;10.8]), mood disorders (OR = 2.6 [1.6;4.1]),  ≥ 15 drugs a day (OR = 1.7 [1.1;2.6]), functional dependency (Activities of Daily Living score < 50/100) (OR = 3.9 [2.5;6.1]) and < 2 units of alcohol per week (OR = 2.2 [1.4;3.6]). DRA occurred in 458 patients (22.8%) within one year. Antipsychotic prescribing at any time was not associated with DRA (OR = 1.0 [0.3;3.9]) however contributed to 8 DRAs, including 3 falls.

CONCLUSION

In this European multimorbid polymedicated older inpatients, antipsychotics were infrequently prescribed, most often at low dosage. Besides neuro-psychiatric symptoms, risk factors for inhospital antipsychotic prescribing were lower functional status and polymedication.

Effectiveness of clinical pharmacist interventions in optimizing pharmacotherapy for somatic comorbidities in serious mental illness: A clinical audit

Background

Clinical pharmacists significantly improve pharmacotherapy outcomes. Patients with serious mental illness (SMI) represent a group particularly vulnerable to medication mismanagement, potentially benefiting from pharmaceutical care targeting medication appropriateness.

Objective

This study aimed to assess the prevalence of inappropriate medication for somatic comorbidities in SMI patients and to evaluate the impact of clinical pharmacist-led interventions.

Methods

A pre-post intervention audit involving clinical pharmacist intervention was conducted on SMI patients with somatic comorbidities in a psychiatric clinic in Greece. A comprehensive medication review was undertaken by a clinical pharmacist. The Medicines Appropriateness Index (MAI) and Assessment of Underutilization of medication (AOU) instruments were used to gauge pharmacotherapy appropriateness before and after intervention. Physician acceptance rates and clinical significance were also noted. Statistical analysis employed descriptive and inferential methods, with a significance level set at α = 0.05.

Results

A total of 58 patients were reviewed. Most patients (75.86%) were being inappropriately treated at baseline, versus 15.52% post-intervention. The pharmacist proposed 107 interventions of which 104 (97.2%) were physician-accepted. Changes in MAI and AOU identified improved medication appropriateness post-intervention [χ2 = 33.029, p < 0.005]. Pharmacist interventions resulted in more (52.1%, n = 25), less (16.7%, n = 8) and no changes (31.2%, n = 15) in the total number of prescribed medicines [median difference:1, p < 0.005]. From 49 medication initiation recommendations, the most prescribed medicines were statins for primary or secondary prevention (n = 21, 42.8%), aspirin for primary or secondary prevention (n = 9, 18.36%) and metformin (n = 4, 8.2%).

Conclusion

SMI patients had a high prevalence of physical comorbidities, mainly cardiovascular disease, and a high ratio of inappropriate medication treatment. Intervention by a clinical pharmacist significantly improved medication appropriateness and led to the adoption of a new standard of care, to be checked with re-auditing.