Community pharmacists as a resource in task-shifted interventions for depression

Integrated Primary Palliative Care in Nigeria- Perspectives of Patients, Families and Providers

BACKGROUND

Palliative care should be integrated into primary healthcare systems within low- and middle-income countries to achieve Universal Health Coverage goals. We aimed to identify preferences and expectations for primary palliative care among people living with serious illness and their families and the readiness of primary healthcare providers to deliver primary palliative care in Nigeria.

METHODS

Qualitative descriptive interview study with 48 participants: people living with serious illness (n=21) and their family caregivers (n=15), healthcare providers (n=12). Data were analysed using thematic analysis.

RESULTS

Three major themes were identified. 1.) Engaging patients and families. 2.) Managing patients and families' expectations and preferences. 3.) Addressing staffing-related issues. Patients and families have existing trust and bonds from using primary healthcare but lack individual agency necessary for person-centered care decisions. They expect an easily accessible service, opportunities for social interaction and adequate communication. Development of healthcare providers is needed to ensure an appropriate clinical response, manage interprofessional trust and ensure clear role delineation.

CONCLUSIONS

Our findings have identified specific approaches to implement the WHO policy on integrated primary palliative care. Palliative care integration within primary healthcare in Nigeria can be achieved through building information and communication skills of healthcare providers, engaging and empowering patients to exercise their agency in care decisions, and adequately delineating healthcare providers' roles to ensure staff work within their competencies and training.

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

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

Towards improving community pharmacy-based mental health services in Nigeria

In Nigeria, there is a prevalence of aversive life circumstances that frequently assail the mental health and well-being of the citizens, mitigating the impact of which necessitates the institution of psychotherapy and other mental health care methods. These responsibilities, however, appear to be much more for pharmacists in low-resource settings where they are the most accessible healthcare professional. Some of these responsibilities include patient confidentiality as well as counseling patients on medication use, lifestyle as well as other personal matters that may arise in relation to their health. Mental health services including psychotherapy provide a range of therapeutic techniques that enable the patients (individual or groups) to develop effective coping strategies towards emotional and psychological difficulties, via methodic interactions with a mental health expert. In this commentary, we share suggestions on how to improve community pharmacy-based mental health services in Nigeria. With the expanding roles and responsibility for pharmacists beyond medication-related concerns comes the challenge of matching up the training of pharmacists with the broadening scope of practice in Nigeria. However, as pertinent as that might be, there are existing knowledge and competency gaps in keeping up with this trend. To correct these shortfalls, we contend that the training curricula for pharmacists in Nigeria be reviewed and/or expanded to provide adequate knowledge for pharmacy undergraduates and pharmacists about non-drug mental health care which will also impact psychotherapy services during their practice especially in the community settings.