Inequalities in health services delivery and utilization for people with mental illness has been widely documented.1 Subsequently this results in poorer outcomes for this population in regard to general health, such as circulatory diseases, mortality from natural causes, and access to interventions .2-4 Several issues have been identified as contributing to these disparities in health service access and delivery, including stigma.5-6Stigma associated with mental illness has been defined as negative attitudes formed on the basis of prejudice or misinformation that are triggered by markers of illness.1-5Illness markers include atypical behaviours, the types of medication prescribed and noticeable medication related adverse effects.5-7These markers allow for the continuation of stigma concerning people with mental illness, but they also allow community pharmacists to identify patients with a broad range of what are often unaddressed health related needs.1 Behavioural and mental disorders are estimated to account for 12% of the global burden of diseases. Mental health related medications account for >10% of all medications prescribed by general medical practitioners8, therefore, it is an inescapable fact that community pharmacists must interact with patients suffering from mental health problems.9 Mental illness is relevant to practising pharmacists who can play vital roles in the treatment of patients with mental illness.10 Throughout the latter half of the previous century, the diagnosis and pharmacological treatment of mental illness improved radically.9 1990-2000 was proclaimed the ï¿½Decade of the Brain. to promote the study of disorders of the brain, including mental illnesses.11 Despite these advances, the stigma associated with mental illness remains a compelling negative feature in society.10 Unfortunately health care professionals, including pharmacists are not invulnerable to such harmful attitudes.9 Pharmacists attitudes toward mental illness and the mentally ill are extremely important because they can affect their professional interactions and clinical decisions.12-13 In addition, they could ultimately affect the delivery of pharmaceutical care which has been defined as the pharmacist assuming the responsibility for positive patient outcomes.14 Activities like medication counselling and monitoring of therapy have been documented to improve both satisfaction and adherence to drug therapy in patients with mental illness.15 It has been pointed out that pharmacists must become more involved in such activities for patients with mental illness.9
Community care offers many advantages over institutional care; however, it can place extra demands on family, friends and primary health care practitioners.16 Health professionals have identified people with mental illness as the most challenging patients to manage.8 The quality and accessibility of community care for people with mental illness needs to be improved.17 The appropriate use of medicines plays an imperative role in the effective management of mental illness, nonetheless, there is evidence that psychotropic medicines are often used inappropriately.18-19 Elderly people are especially susceptible to the effects of psychotropic medicines, and may experience adverse effects such as cardio toxicity, confusion and unwanted sedation .8 Contributing factors to the high rates of non-compliance to psychotropic medicines include, psychosocial problems, the emergence of side effects, and the delayed onset of action of anti-depressant medication.20-21 Medical co-morbidity is also common, and polypharmacy increases the risk of medication misuse and drug-drug interactions.22 The World Health Organisation (WHO) has indicated that the inclusion of pharmacists as active members of the health care team can improve psychotropic medication use.23 The benefits of dynamically engaging mental health service users in their own management is supported by both clinical experience and research evidence.24 A systemic review of the role of pharmacists in mental health care, published in 2003, concluded that pharmacists can bring about improvements in the safe and effective use of psychiatric medicines.23 The wide range of pharmaceutical services provided by community pharmacists are potentially well suited to assisting patients and prescribers optimise the use of medications for mental illness.8
Pubmed (1965-March 2010), International Pharmaceutical Abstracts (1970-March 2010), Embase (1974-March 2010), Cinahl (1981-March 2010) and Psychinfo (1972-March 2010) were searched using text words and MeSH headings including: community pharmacist.s, pharmacist.s, pharmaceutical care, pharmaceutical services, mental illness, mental disorders, stigma and mental illness, mentally ill persons, depression, schizophrenia, bipolar disorder, psychotic disorders, psychotropic drugs, antidepressive agents, benzodiazepines, anxiety agents and antipsychotic agents. ~550 abstracts were read. Reference lists of retrieved articles were checked for any additional relevant published material. Exclusion criteria included articles not published in English, no service provided by pharmacists, not relevant to mental illness, and studies and surveys that were carried out to evaluate pharmacist.s services in hospital inpatient or acute care settings. The literature search identified 88 papers that reported or discussed community pharmacist.s involvement in the care of patients with mental illness.
For section 3.1 of the discussion, studies and surveys conducted into the attitudes of community pharmacists toward mental illness and the impact of stigma were considered. The literature review procedure for section 3.2 of the discussion, which deals with optimising the use of medication for mental illness, differed from that of 3.1, as studies without control groups, results of postal surveys and qualitative interviews were excluded. Studies with a parallel control group that reported the provision of services by community pharmacists in community and residential aged care facilities were considered. This included trials specifically conducted for individuals with a mental illness, and studies of medication reviews and education initiatives to optimise the use of medication for mental illness. Papers that reported pharmacist.s interventions in nursing homes were included, because community pharmacists frequently provide services to nursing homes. Studies of pharmacist.s activities as part of multi-disciplinary teams were also included. The literature search identified 57 papers that reported or discussed community pharmacy services to optimise the use of medications for mental illness.
While the views of the public9 and of certain health care professionals25 and health care students26-28 toward mental illness have been well documented over the years, there are limited numbers of investigations accessing community pharmacists and pharmacy student.s attitudes. Crimson et al.12 examined the attitudes of 250 baccalaureate pharmacy students toward mental illness, Phokeo et al.29 studied the outlook of 283 community pharmacists toward users of psychiatric medication, Cates et al.9 detailed the attitudes of community pharmacists toward both mental illness and the provision of pharmaceutical care to patients with mental illness, and Black et al.1 studied the satisfaction that patients with mental illness have with services provided by community pharmacists.
In general, pharmacists express positive, unprejudiced attitudes toward mental illness,1, 9, 29, 30 and overall they show encouraging attitudes toward the provision of pharmaceutical care.9 Phokeo et al.29 reported that pharmacists feel uncomfortable inquiring about a patient.s use of psychiatric medication and discussing symptoms of mental illness compared to the medication and symptoms associated with cardiovascular problems. Pharmacists also monitor patients with mental disorders for compliance and adverse effects less frequently than patients with cardiovascular problems. Crimson et al.12 found an association between a personal or family history of mental illness and attitudes of pharmacists toward mental illness. Age and years in practice are also connected with attitudes toward providing pharmaceutical care to patients with mental illness. The older and more experienced pharmacists have more encouraging responses than their counterparts.9Pharmacists are of the opinion, however, that patients with mental illness do not receive adequate information about their medication from their physicians. These patients may also receive less attention from pharmacists compared to medically ill patients, which raises concerns that their drug-related needs are not being met.29
Consumers of mental health services generally have a positive perception of community pharmacists and their services, however, expectations are limited to standard pharmacy services, like providing patients with information about their medication and resolving prescription issues when dispensing medications.29 The majority of patients feel at ease while discussing their psychotropic medication and related illnesses with pharmacists.31 Clinically orientated services like working collaboratively with other health care providers, making dosing or treatment recommendations, monitoring response to treatment, and addressing the individuals physical and mental health needs have been found to be unavailable to patients.32 Patients with mental health problems, expectations of community pharmacists are low, and do not match the services that they can provide.33 Although stigma has been perceived to be similar with other health care professional, Black et al.1 revealed that 25% of patients with mental illness have experienced stigma at community pharmacies.
The prevalence of coexisting substance misuse and mental illness (dual diagnosis) has increased over the past decade, and the indications are that it will continue to do so.15 A patient with both a mental illness and a substance misuse problem can face prejudice and stigma from health care professionals, who might question the capacity of dually diagnosed individuals to respond to care.34 A Canadian survey into the attitudes of community pharmacist.s toward mental illness showed that only 55% of respondents agreed that substance misuse is a mental health problem. This finding reflects the perception that addiction represents poor self control or is a self inflicted problem.29 Over recent years, the capacity to intervene pharmacologically in substance misuse has increased greatly, pharmacotherapy is now available for opiate, alcohol and nicotine misuse.19 Some psychiatric patients with comorbid substance abuse achieve stabilisation rapidly, furthermore, severe mental illness does not necessarily predict worse outcomes.35 Socio-economic and emotional aspects are the main challenges to recovery, and case management in the context of integrated community and residential services has been shown to increase medication compliance over time.36 The contribution that community pharmacists have in the management of substance abuse has been well documented.37 Most general psychiatrists are only in the position to give patients 5-10 minutes of brief advise or intervention regarding a substance misuse problem,38 whereas community pharmacist.s are easily accessible to the public and are in a central position to provide specific advice about substance misuse.37 Community pharmacists currently provide dispensing services to drug addicts,38 and they are also the first point of contact for people misusing substances who are not in touch with the substance misuse services.39
Studies have indicated that patients prefer to go to the same pharmacy for their medication and other pharmacy needs and a significant number of patients favour to interact with the same pharmacist, which suggests that the relationship they have with their pharmacist plays an imperative role in their health and well being.1 A lack of privacy from failure to use an available private counselling room in the pharmacy contributes to patients feelings of discomfort regarding talking about their medication and their illness.31 Pharmacists are trained to educate and support patients regarding psychotropic medications, including how a drug works, monitoring for treatment response and adverse effects, and guiding patients through the process of stopping treatment, however, there are inconsistencies in the provision of these services.29 The potential for discrimination and stigma in community pharmacies has been well documented and initiatives to improve exposure of pharmacists to persons with mental illnesses in practice and in training has been suggested.23, 29 Pharmacists experience an increased level of discomfort in this therapeutic area as they receive inadequate undergraduate training in mental health.9 Adequate training in mental health is needed to improve the professional interactions of community pharmacists toward users of psychiatric medication.1
Community pharmacists are one of the primary health care providers in the community and have the opportunity to influence patient.s perception of their mental illness. Patients are far less likely to adhere to medications for mental health problems outside the hospital setting. Community pharmacists can significantly contribute to optimising medication use in mental illness through counselling, 40-42 patient education and treatment monitoring, 43-36 medication review services, 30, 47-49 pharmacotherapy meetings with general medical practitioners, 50-54 delivering services to community mental health centres and outpatient clinics,55-57 improving the transfer of information between health care settings,58-60 and being active members of community mental health teams.61-63
In the Netherlands, three studies were carried out to highlight the impact of community pharmacist.s medication counselling sessions for people commencing non-tricyclic antidepressant therapy.40, 42 Intervention patients participated in three consecutive counselling sessions which lasted between 10 and 20 minutes each. They also received a take-home video that reiterated the importance of adherence. Throughout the counselling session, pharmacists informed patients about the appropriate use of their medications, which included, providing information about the benefits of taking the medication, informing patients about potential side effects, informing patients about the onset of action for antidepressant medication and explaining the crucial importance of taking their medication on a daily basis. Medication compliance was measured using an electronic pill container that recorded the time and frequency that the cover was opened.41 At the three month follow up the intervention patients had significantly more positive attitudes compared to the controls.40 At six months greater medication compliance was observed with the intervention patients that remained in the study25 55, also apparent improvements in symptoms were noted.41 Research on adherence shows that the patient.s knowledge and beliefs about the benefits of adhering to their medication regime plays a critical role in compliance.64 Non-adherence is not an irrational act but rather a product of poor communication.65 Patient compliance to health care recommendations is more likely when communication is optimal.66 The results of these studies indicated improvements in depressive symptoms,41 more positive attitudes,40 and better compliance to their medication.42 A limitation of this method was that the same pharmacist provided counselling services to both the intervention and the control group. As the intervention studied was multifactorial, it is inconclusive whether the three face-to-face counselling sessions or the take home video were primarily responsible for changes in drug attitude, adherence and the symptom scores.40-42
Four studies have reported results from pharmacist conducted patient education and treatment monitoring services for people prescribed antidepressant medications in the United States.43-46 These services involved the pharmacist taking a medication history, providing information about the prescribed antidepressant medications, and conducting telephone and face-to-face follow-ups. In two of the investigations, one of which was controled43 and the other randomised controlled, 62 medication adherence was calculated by reviewing prescription dispensing data, and reported using an intention-to-treat analysis. Both studies also demonstrated that involvement of the pharmacist was associated with a decrease in the number of visits to other primary health care providers; however, statistical significance was only achieved in one of the studies. Improved adherence to antidepressant medication was reported in both studies, 43-44 although patient satisfaction was only evident in one.44 The other two studies were randomised controlled.45-46 One of the studies was conducted using a self administered health survey,45 while in the other study antidepressant adherence was measured by asking patients how many times a day they took their medication in the past month. The results obtained from these investigations45-46 showed that patients who were taking their medication at the six month follow-up exhibited better antidepressant compliance and improved symptoms. However, antidepressant adherence and depression symptoms scores were similar for both the intervention and control group.46 Given the high rates of antidepressant discontinuation during the first three months of treatment, pharmacists have a potentially crucial role in providing medicines information and conducting treatment monitoring for those patients at high risk of non-compliance. Studies need to be conducted to compare outcomes of pharmacist.s treatment monitoring of people commencing antidepressant medication and other health professionals monitoring.8 An investigation into the impact of nurses treatment monitoring, also demonstrated improved medication adherence.67
Pharmacist conducted medication management reviews are crucial in identifying potential medication related problems among people taking medications for mental illness.8 Medication review services provided by pharmacists comprise of comprehensive medication history taking, patient home interviews, medication regimen reviews, and patient education.68 A randomised controlled study of pharmacist conducted domiciliary medication reviews was carried out in the United States. The patients involved in the study were individuals living independently in the community that were identified to be at high risk of medication misadventure. The results showed a significant decline in the in the overall numbers and monthly costs of medication, however, there was no major difference in cognitive or affective functioning between the intervention and control group. The majority of patients were unwilling to follow the pharmacist.s recommendations to discontinue benzodiazepines and narcotic analgesics.47 The great potential of pharmacist conducted medication reviews for people with mental illness may not be limited to optimising the use of mental health medication.8 Physical health care for people with mental illness is generally less than adequate. This is caused by the tendency among health professionals to focus solely on the management of the mental illness among people with both mental and physical illnesses. Pharmacist conducted medication reviews may be a comprehensive strategy to improve medication use for both mental and physical illness.68
Older people who are cared for in nursing homes are arguably the most vulnerable patient group, and the useful contribution that pharmacists can make to the care of these patients has been documented.30 Older people are particularly sensitive to the effects of medication,69 regular use of psychotropic medication is associated with an increased risk of recurrent falls,70 and also long term usage is linked with tardive dyskinesia.71 Psychotropic medication use may also be connected with an increased rate of cognitive decline in dementia.72 The beneficial effects of psychotropic medication must be balanced against extrapyramidal and other side effects.73 In 1995 it was reported that psychotropic drug use in Australian nursing homes was 59%, although this figure has fallen in recent years.74 In Ireland, 19% of older people in nursing homes were reported to be taking phenothiazines,75 however, this figure is lower now following a tightening of the licensing indications of thiordazine. In the England, a study showed that 30% of residents in nursing homes were taking antipsychotics.76 Two studies have looked at the appropriateness of psychotropic medication prescribing in the United Kingdom. In Scotland antipsychotic medication use in nursing homes is 24%, it was found that 88% of these prescriptions were inappropriate if the United States criteria for use were applied. In England, 54% of prescriptions were found to be inappropriate according to the United States criteria.77 A study conducted in Denmark suggested that behavioural problems were a determinant for the use of antipsychotics and benzodiazepines, irrespective of the psychiatric diagnosis of the resident.78 A randomised controlled study of pharmacist-led multidisciplinary initiative to optimise prescribing in 15 Swedish nursing homes was carried out. The study involved pharmacists participating in multidisciplinary team meetings with nurses and physicians at regular intervals within a 12 month period. A significant decline in the use of antipsychotics, benzodiazepines and antidepressants by 19%, 37% and 59%, respectively was observed in the intervention facilities.79 A follow-up investigation of the same intervention and control facilities three years later indicated that the intervention facilities maintained a significantly higher quality of drug use, with far fewer residents being prescribed more than three drugs that could lead to confusion, not-recommended hypnotics and combinations of interacting drugs.48 An additional randomised controlled study showed that pharmacist.s medication reviews in residential care facilities demonstrated significant reductions in the number and cost of medications prescribed. 10.2% fewer residents were administered psychoactive medications and 21.3% fewer hypnotic medications. The impact of medication reviews on mortality was also measured and a noteworthy reduction was observed.49 One study indicated that one hour per week of a pharmacist.s time can make a significant contribution to patient care in nursing homes. It was found that this input was well received by nursing staff and prescribers and that general medical practitioners accepted the pharmacist.s advice in 78% of cases.30 Physician.s recognition was 91% in south Manchester, where 55% of interventions resulted in treatment modifications. Community pharmacist.s in Northamptonshire analysed prescriptions of nursing home residents and provided prescribing advice to general medical practitioners. The advice was accepted in 73% of cases and it was estimated that pharmacist involvement could give a 14% reduction in the cost of prescribing.69 A randomised controlled trial in 14 nursing homes in England showed that a brief medication review reduced the quantity of medication overall with no detriment to the mental and physical functioning of the patients.58 A reduction in the use of primary and secondary care resources by pharmacist medication review services has also been shown.80 The recommendations provided by pharmacists included stopping and starting medicines, generic substitution, switching to another medicine, dose modification, changes in administration frequency, formulation change and requests for laboratory tests or nurse monitoring.30 Almost 50% of the recommendations were to stop medication and 66% of these were due to the fact that there was no indication for the drug prescribed. This suggested that medication regimes were not reviewed. Conversely, initiation of a new drug made up 8% of recommendations, which implied that indications were present but not always treated76. Pharmacists have an important part to play in multi-disciplinary health teams and they must be integrated into any proposed models of care. Nursing home residents are a vulnerable group of patients who deserve the same high-quality clinical care as people of any age living at home.30
Pharmacist.s educational visits to general medical practitioners have been shown to modify prescribing behaviour.54 Four studies have evaluated the impact of pharmacists educational visits to general medical practitioners to optimise the prescribing of benzodiazepines and other psychotropic medications prescribed for mental illness,50-53 two of which showed positive results.52-53 A cluster randomised controlled study carried out in the United States found that pharmacists educational visits to general medical practitioners were associated with a significant decline in the prescribing of potentially inappropriate psychotropic medications in intervention facilities.53 An Australian study of educational visits to general medical practitioners, conducted by three physicians and one pharmacist resulted in a noteworthy decline in the prescribing of benzodiazepines.52 In the Netherlands, groups of local pharmacists and general medical practitioners conduct inter-professional meetings to optimise prescribing. These pharmacotherapy meetings are undertaken as part of routine clinical practice. A cluster randomised study of pharmacotherapy meetings to discuss prescribing of antidepressant medications resulted in a 40% reduction in the prescribing of highly anticholinergic antidepressants, compared to a control group of practitioners that did not partake in these meetings39. The possible awareness of prescribing related issues generated by asking general medical practitioners to conduct a self-audit of their prescribing caused this overall reduction.52-53 Additionally, pharmacist.s initiatives to improve prescribing are most effective when both pharmacists and general medical practitioners have an opportunity to build rapport.39
Two studies were carried out to investigate the effect of pharmacist delivered services to community mental health centres and outpatient.s clinics.56-57 In a controlled trial, pharmacists managed patient cases in a community mental health centre in the United States. Significantly better personal adjustment scores were observed from patients receiving case management from a pharmacist in comparison to those receiving it from a nurse, social worker or psychologist.56The patients also rated themselves as healthier and were considerably less likely to seek help from other health care providers. The medication service provided allowed the pharmacist to adjust medication doses and dose timing, and prescribe or discontinue medications under supervision. The cost effectiveness of incorporating a pharmacist as part of the health care team was also measured. It was estimated that a 60% cost reduction can be achieved when medication monitoring is conducted by a pharmacists instead of a clinic psychiatrist. The pharmacist also performed more medication monitoring of patients per month than the clinic psychiatrist and had more contact with each individual patient .56 In Malaysia, a study of patients discharged from hospital after admission for relapse of schizophrenia, who were identified as having poor medication adherence were allocated to receive pharmacist medication counselling or standard care.57 The importance of compliance to medication was also reinforced by the patient.s psychiatrists at follow up visits. At the 12 month follow-up, patients receiving counselling from a pharmacist and who were exposed to daily or twice daily medication treatments, had significantly fewer relapses that required hospitalisation than patients receiving standard care.57
The needs of people with recurrent, severe mental illness fluctuate over time and services must be coordinated, and be able to anticipate, prevent and respond to crisis. Integrated mental health services across primary and specialist services should promote early interaction and allow the provision of continuous care to meet patients needs.58 Prescribed medication is an important component in the successful management of mental illness. Accurate information should be transferred seamlessly between primary and secondary sectors to ensure the optimum care of these patients.59 The simple delivery of information to community pharmacists regarding drugs prescribed at discharge enables comparison with general medical practitioners prescriptions and any discrepancies can be followed up and resolved.82 Discrepancies that may occur can be described as any changes observed between supplies of prescribed drugs, including a wide spectrum of observed events.83 These can range from simple changes between supplies of prescribed drugs to more complex errors that might result in adverse reactions.60 This information transfer enables a cost-effective reduction in all unintentional discrepancies, including those judged to have significant adverse effects on patient care.58 An investigation that evaluated the impact of providing mental health patients with a pharmacist generated medication care plan at the time of discharge found that patients with care plans were less likely to be readmitted to hospital than those without. Information contained in the care plan included lists of discharge medications, a summary of the patient education that was provided, and the potential adverse effects that need to be assessed. Community pharmacists who received copies of the care plan were also more likely to identify medication related problems for the discharged mental health patients than those pharmacists who were not provided with copies of the care plan, however, the results from this study are not significantly significant.57Other methods of transferring information such as electronic transfer have the potential to be of value in this patient population.84 People with mental illness have complex needs which are not recognised by organised boundaries.58When discussing discharge and after-care in the community, medication management must be prioritised.85Mentally ill patients are vulnerable and medication is a vital part of their well being. It is therefore essential that an accurate transfer of information between care settings minimises the potentially harmful discrepancies that can occur. Community pharmacist.s interaction in this area could prevent such incidents.58
Most people with bipolar mood disorders and psychotic illnesses in the United Kingdom and Australia are managed by interdisciplinary community mental health teams (CMHTs).86 The potential benefits of greater involvement by pharmacists in CMHTs have been documented and debated for over 30 years.87-90 The majority of clinical team meetings conducted by CMHTs do not involve a pharmacist. A review of CMHTs in New South Wales found that just 1 in 5 had a designated pharmacist.91 Pharmaceutical care programs provided by pharmacists working as members of CMHTs can fulfil an important public need.32 Psychotropic medications are frequently used for unapproved indications,92-94 outside recommended dosages,95-96 and are prescribed concurrently.97-99 Adverse drug reactions to psychiatric medications include extrapyramidal side effects, weight gain, sedation, orthostatic hypotension and antcholinergic effects.32 Patients taking psychotropic medications may have higher rates of mortality, hospitalisation, and experience more adverse drug reactions.100-101 Routine monitoring for potential metabolic and cardiovascular complications of antipsychotic treatment is suboptimal.102-103 In addition, patients with mental illnesses have reported their dissatisfaction with the quantity and quality of drug information provided by their health professionals.104 Potential roles for community pharmacist.s in CMHTs in the United Kingdom have been investigated, with 7 possible pharmaceutical care roles being identified, they included, patient facilitating, instalment dispensing, domiciliary visiting, provision of medication education and advice, adherence monitoring, medication reviews, and inter-professional liaison.61 A survey of pharmacist.s interventions at 12 mental health trusts in the United Kingdom reported the detection of 579 cases of less than ideal prescribing of which 60% were clinical in nature.105 Between 35% and 81% of pharmacists recommendations for patients of CMHTs have been judged clinically significant by expert panels.62-63 Pharmacists participation in CMHTs could be facilitated by the formation of collaborative working relationships with community pharmacists working in the same locality as CMHTs. An Australian study into the impact of community pharmacists being active members of CMHTs was carried out, in one case the study pharmacist was also the local community pharmacist, this was perceived as a factor that contributed to the success of the collaboration. New models of pharmaceutical care proposed from focus groups comprising of psychiatrists, indicated the new level of awareness and recognition of the potential of community pharmacy services. Most of the studies conducted in this area raised the important issue of whether pharmacists should be considered as essential and legitimate members of interdisciplinary CMHTs.32
Herein, I have discussed the contribution that community pharmacist.s can make to the care of patients with mental illness. The provision of community pharmacist.s services are limited by a lack of specific training to counsel this patient population, and pharmacist.s attitudes toward people with mental illness. Community pharmacist.s need to examine an address factors that can predispose, enable, and reinforce activities and behaviours associated with stigma toward people with mental illnesses in their practice setting. I believe that the wide range of pharmaceutical services provided by community pharmacist.s are potentially well suited to assisting patients and prescribers optimise the use of medications for mental illness. The review of the international literature highlights that medication counselling and treatment monitoring conducted by community pharmacist.s can improve medication adherence. Community pharmacist.s performed medication reviews and resulting recommendations to optimise medication regimens may reduce the numbers of potentially inappropriate medications for mental illness prescribed to elderly people. This review of the available published evidence supports the continued expansion of pharmaceutical service delivery to people with mental illness. I am of the opinion that, community pharmacist.s services are seriously under utilised in the mental health sector of the health system. Community pharmacists should be considered as essential and legitimate members of multi-disciplinary health and social services teams, and they must be integrated into any proposed model of care.
1. Black, E.; Murphy, A. L.; Gardner, D. M. ï¿½Community pharmacist.s services for people with mental illnesses: preferences, satisfaction, and stigmaï¿½. Psychiatric Services 60, (2009): 1123-1127 2. Kisley, S.; Smith, M.; Lawrence, D. ï¿½Inequitable access for mentally ill patients to some necessary proceduresï¿½. Canadian Medical Association Journal 176, (2007): 779-784 3. Hiroech, U.; Kapur, N.; Webb, R. ï¿½Deaths from natural causes in people with mental illness: a cohort studyï¿½. Journal of Psychosomatic Research 64, (2008): 275-283 4. Kisley, S.; Smith, M.; Lawrence, D. ï¿½Mortality in individuals who have had psychiatric treatment: population based study in Nova Scotiaï¿½. British Journal of Psychiatry 187, (2005): 552-558 5. Schulze, B. ï¿½Stigma and mental health professionals: a review of the evidence on an intricate relationshipï¿½. International Review of Psychiatry 19, (2007): 137-155 6. Stuber, J.; Meyer, I.; Link, B. ï¿½Sigma, prejudice, discrimination and healthï¿½. Social Science and Medicine 67, (2008): 351-357 7. Schulze, B.; Augermeyer, M. C. ï¿½Subjective experiences of stigma: a focus group study of schizophrenic patients, their relatives and mental health professionalsï¿½. Social Science and Medicine 56, (2003): 299-312 8. Bell, S.; McLachlan, A. J.; Aslani, P.; Whitehead, P.; Chen, T. F. ï¿½Community pharmacy services to optimise the use o medications for mental illness: a systemic reviewï¿½. Australia and New Zealand Health Policy 70, (2005): 77-88 9. Cates, M. E.; Burton, A. R.; Woolley, T. W. ï¿½Attitudes of pharmacists toward mental illness and providing pharmaceutical care to the mentally illï¿½. The Annals of Pharmacotherapy 39, (2005): 1450-1455 10. Hitchens, K. ï¿½The pharmacist.s role in mental healthï¿½. Drug Topics 14, (1997): 28-37 11. Byrne, P. ï¿½Stigma of mental health and ways of diminishing itï¿½. Advanced Psychiatric Treatment 6, (2000): 65-72 12. Crimson, M. L.: Jermain, D. M.; Torian, S. J. ï¿½Attitudes of pharmacy students toward mental illnessï¿½. American Journal of Hospital Pharmacy 47, (1990): 1368-1373 13. Crimson, M. L.: Jermain, D. M. ï¿½Students attitudes toward the mentally ill before and after clinical rotationsï¿½. American Journal of Pharmacy Education 55, (1999): 45-48 14. Wells, B. G. ï¿½Under recognised and under treatment of depression: what is the pharmacist.s culpability?ï¿½ Pharmacotherapy 19, (1999): 1237-1239 15. Bultman, D. C.; Svarstad, B. L. ï¿½Effects of pharmacist monitoring on patient satisfaction with antidepressant medication therapyï¿½. Journal of the American Pharmaceutical Association 42, (2002): 36-43 16. Meadows, G. N. ï¿½Overcoming barriers to reintegration of patients with schizophrenia: developing a best-practice model for discharge from specialist careï¿½. Medical Journal of Australia 178 (2003): 53-56 17. Chang, E.; Daly, J.; Bell, P.; Brown, T.; Allan, J.; Hancock, K. ï¿½A continuing educational initiative to develop nurse.s mental health knowledge and skills in rural and remote areasï¿½. Nursing Education Today 22, (2002): 542-551 18. ï¿½Improving access and use of psychotropic medicinesï¿½. Geneva, World Health Organisation (2004) 19. Mort, J. R.; Aparasu, R. R. ï¿½Prescribing of psychotropic.s in the elderly: Why is it so often inappropriate?ï¿½ CNS Drugs 16, (2002): 99-109 20. Lambert, M.; Conus, P.; Elde, P.; Mass, R.; Karrow, A.; Moritz, S.; Golks, D.; Naber, D. ï¿½Impact of present and past antipsychotic side effects on attitude toward typical antipsychotic treatment and adherenceï¿½. European Psychiatry 19, (2004): 415-422 21. Rettenbacher, M. A.; Holder, A.; Eder, U.; Hummer, M.; Kemmier, G.; Weiss, E. M.; Fleischhacker, W. W. ï¿½Compliance in schizophrenia: psychopathology, side-effects, and patients attitudes toward the illness and medicationï¿½. Journal of Clinical Psychiatry 65, (2004): 1211-1218 22. Lambert, T. J. R.; Velakoulis, D.; Pantelis, C. ï¿½Medical comorbidity in schizophreniaï¿½. Medical Journal of Australia 178, (2003): 67-70 23. Finley, P. R.; Crimson, M. L.; Rush, A. J. ï¿½Evaluating the impact of pharmacists in mental health: a systemic reviewï¿½. Pharmacotherapy 23, (2003): 1634-1644 24. Blenkiron, P.; Hong Mo, K.; Cuzen, J.; Hamill, A. C. ï¿½Involving service users in their mental health care: the CUES projectï¿½. Psychiatric Bulletin 27, (2003): 334-338 25. Cohen, J.; Struening, E. L. ï¿½Opinions about mental illness in the personnel of two large mental hospitalsï¿½. Journal of Abnormal Social Psychology 64, (1962): 349-360 26. Roskin, G.; Carsen, M. L.; Rabiner, C. J.; Lenon, P. A. ï¿½Attitudes toward patientsï¿½. Journal of Psychiatric Education 10, (1986): 40-49 27. Bairan, A.; Farnsworth, B. ï¿½Attitudes toward mental illness: does a psychiatric nursing course make a difference?ï¿½ Archives of Psychiatric Nursing 3, (1989): 351- 357 28. Drolen, C. S. ï¿½The effect of educational setting on student opinions of mental illnessï¿½. Community Mental Health 29, (1993): 223-234 29. Phokeo, V.; Sproule, B.; Raman-Wilms, L. ï¿½Community pharmacist.s attitudes toward and professional interaction with users of psychiatric medicationï¿½. Psychiatric Services 55, (2004): 1434-1436 30. Furniss, L. ï¿½Use of medicines in nursing homes for older peopleï¿½. Advances in Psychiatric Treatment 8, (2002): 198-204 31. Bell, J. S.; Aaltonen, S. E.; Bronstein, E. ï¿½Attitudes of pharmacy students toward people with mental disorders, a six country studyï¿½. Pharmacy World and Science 30, (2008): 595-599 32. Bell, J. S.; Rosen, A.; Aslani, P. ï¿½Developing the roles of pharmacists as members of community mental health teams: perspectives of pharmacists and mental health professionalï¿½. Research in Social and Administrative Pharmacy 3, (2007): 392-409 33. Bell, J. S.; Whitehead, P.; Aslami P. ï¿½Drug related problems in the community setting: pharmacist.s findings and recommendations for people with mental illnessesï¿½. Clinical Drug Investigation 26, (2006): 415-425 34. Crawford, V.; Clancy, C.; Crome, I. B. ï¿½Co-existing problems of mental health and substance misuse (dual diagnosis): a literature reviewï¿½. Drugs: Education, Prevention and Policy 10, (2003): 1-74 35. Hunt, G. E.; Bergin, J.; Bashir, M. ï¿½Medication compliance and comorbid substance abuse in schizophrenia: impact on community survival 4 years after a relapseï¿½. Schizophrenia Research 54, 253-264 36. Tyrer, P.; Weaver, T. ï¿½Desperately seeking solutions: the search for appropriate treatment for comorbid substance misuse and psychosis (editorial)ï¿½. Psychiatric Bulletin 28, (2004): 1-2 37. Gath, A. ï¿½The pharmacist.s contribution to the management of substance misuseï¿½. Psychiatric Bulletin 15, (1991): 314-315 38. Howarth, W. H. ï¿½The pharmacist.s role in misuse of medicinesï¿½. Pharmaceutical Journal 237, (1986): 76-77 39. Cherry, P.; Tredree, R.; Streeter, H.; Brain, K. ï¿½The development of an addiction treatment serviceï¿½. Pharmaceutical Journal 236, (1986): 329-331 40. Brook, O.; van Hout, H. P. J.; Nieuwenhuysea, H.; Heerdink, E. ï¿½Impact of coaching by community pharmacists on drug attitude of depressive primary care patients and accessibility to patients; a randomised controlled studyï¿½. European Neuropsychopharmacology 13, (2003): 1-9 41. Brook, O. H.; van Hout, H. P. J.; Nieuwenhuysea, H.; De Haan, M. ï¿½Effects of coaching by community pharmacists on psychological symptoms of antidepressant users; a randomised controlled studyï¿½. European Neuropsychopharmacology 13, (2003): 347-354 42. Brook, O. H.; van Hout, H. P. J.; Stalman, W.; Nieuwenhuysea, H.; Bakker, B.; Heerdink, E.; De Haan, M. ï¿½A pharmacy based coaching programto improve adherence to antidepressant treatment among primary care patientsï¿½. Psychiatric Services 56, (2005): 487-489 43. Finley, P. R.; Rens, H. R.; Pont, J. T.; Gess, S. L.; Louie, C.; Bull, S. A.; Bero, L. A. ï¿½Impact of collaborative pharmacy practice model on the treatment of depression in primary careï¿½. American Journal of Health-System Pharmacy 59, (2002): 1518-1526 44. Finley, P. R.; Rens, H. R.; Pont, J. T.; Gess, S. L.; Louie, C.; Bull, S. A.; Lee, J. Y.; Bero, L. A. ï¿½Impact of collaborative care model on depression in a primary care setting: a randomised controlled trialï¿½. Pharmacotherapy 23, (2003): 1175-1185 45. Adler, D. A.; Bungay, K. M.; Wilson, I. B.; Pei, Y.; Supran, S.; Peckham, E.; Cynn, D. J.; Rogers, W. H. ï¿½The impact of a pharmacists intervention on 6-month outcomes in depressed primary care patientsï¿½. General Hospital Psychiatry 26, (2004): 199-209 46. Capoccia, K. L.; Boudreau, D. M.; Blough, D. K.; Ellsworth, A. J.; Clark, D. R.; Stevens, N. G.; Katon, W. J.; Sullivan, S. D. ï¿½Randomised trial of pharmacist interventions to improve depression care and outcomes in primary careï¿½. American Journal of Health-System Pharmacy 61, (2004): 364-372 47. Williams, M. E.; Puliam, C. C.; Hunter, R.; Johnson, T. M.; Owens, J. E.; Kincaid, J.; Porter, C.; Koch, G. ï¿½The short-term effect of interdisciplinary medication review on function and cost in ambulatory elderly peopleï¿½. Journal of American Geriatrics Society 52, (2004): 93-98 48. Coleman, E. A.; Grothaus, L. C.; Sandhu, N.; Wagner, E. H. ï¿½Chronic care clinics: a randomised controlled trial of a new model of primary care for frail older adultsï¿½. Journal of American Geriatrics Society 47, (1999): 775-783 49. Roberts, M. S.; Stokes, J. A.; King, M. A.; Lynne, T. A.; Purdie, D. M.; Glaziou, P. P.; Wilson, D. A. J.; McCarthy, S. T.; Brooks, G. E.; de Looze, F. J.; Del Mar, C. B. ï¿½Outcomes of a randomised controlled trial of a clinical pharmacy intervention in 52 nursing homesï¿½. British Journal of Pharmacology 51, (2001): 257-265 50. Hartlubb, P. P.; Barret, P. H.; Marine, W. M.; Murphy, J. R. ï¿½Evaluation of an intervention to change benzodiazepine-prescribing behaviour in a prepaid group practice settingï¿½ American Journal of Preventative Medicine 9, (2003): 346-352 51. Crotty, M.; Whitehead, C.; Rowett, C.; Halbert, J.; Weller, W.; Finucane, P.; Esterman, A. ï¿½An outreach intervention to implement evidence best practice in residential care: a randomised controlled trialï¿½. BMC Health Services Research 4, (2004): 6 52. de Burgh, S.; Mant, A.; Mattick, R. P.; Donnely, N.; Hall, W.; Bridges-Webb, C. ï¿½A controlled trial of educational visits to improve benzodiazepine prescribing in general practiceï¿½. Australian Journal of Public Health 19, (1995): 142-148 53. Avorn, J.; Soumeral, S. B.; Everitt, D. E.; Ross-Degnan, D.; Beers, M. H.; Sherman, D.; Salem-Schatz, S. R.; Fields, D. ï¿½A randomised controlled trial of a program to reduce the use of psychoactive drugs in nursing homesï¿½. New England Journal of Medicine 327, (1992): 168-173 54. Thomson O.Brien, M. A.; Oxman, A. D.; Davis, D. A.; Haynes, R. B.; Freemantle, N.; Harvey, E. L. ï¿½Educational outreach visits: effects of professional practice and health outcomesï¿½. Cochrane Database of Systemic Reviews (2005) 55. Rosen, C. E.; Holmes, S. ï¿½Pharmacist.s impact in chronic psychiatric outpatients in community mental healthï¿½. American Journal of Hospital Pharmacy 35, (1978): 704- 708 56. Razali, M. S.; Yahya, H. ï¿½Compliance with treatment in schizophrenia: a drug intervention program in a developing countryï¿½. Acta Psychiarica Scandinavia 91, (1995): 331-335 57. Shaw, H.; Mackie, C. A.; Sharkie, I. ï¿½Evaluation of effect of pharmacy discharge planning on medication problems experienced discharged acute admission mental health patientsï¿½. International Journal of Pharmacy Practice 8, (2000): 144-153 58. Morcos, S.; Francis, S, A.; Duggan, C. ï¿½Where are the weakest links? A descriptive study of discrepancies in prescribing between primary and secondary sectors of mental health provisionï¿½. Psychiatric Bulletin 26, (2002): 371-374 59. Cochrane, R. A.; Mandel, A. R.; Ledger-Scott, M. ï¿½Changes in drug treatment after discharge from hospital in geriatric patientsï¿½. British Medical Journal 305, (1992): 694-696 60. Lesar, T.; Briceland, L.; Stein, D. S. ï¿½Factors relating to errors in medication prescribingï¿½. Journal of the American Medical Association 277, (1997): 312-317 61. Ewan, M.; Greene, R.; Anderson, C. ï¿½A qualitative investigation of the potential role of the community pharmacist in the care of the long term mentally illï¿½. The Pharmaceutical Journal 261, (1998): 61-66 62. Harris, D.; Anderson, C. ï¿½Interventions of community pharmacists for older people with mental health problems: are they appropriate?ï¿½ International Journal of Pharmacy practice 11, (2003): 56-61 63. Ewan, M. A.; Greene, R. J. ï¿½Evaluation of mental health care interventions made by three community pharmacists ï¿½ a pilot studyï¿½. International Journal of Pharmacy practice 9, (2001): 225-243 64. DiMatteo, M. R.; Reiter, R. C.; Gambone, C. ï¿½Enhancing medication adherence through communication and informed collaborative choiceï¿½. Health Communication 6, (1994): 253-265 65. Donavan, J. L.; Blake, D. R. ï¿½Patient non-compliance: Deviance or reasoned decisioning?ï¿½ Social Science and Medicine 34, (1992): 507-513 66. Maguire, T. ï¿½Good communication ï¿½ How to get it rightï¿½. The Pharmaceutical Journal 268, (2002): 214-216 67. Aubert, R. E.; Fulop, G.; Xia, F.; Thiel, M.; Maldonato, D.; Woo, C. ï¿½Evaluation of a depression health management program to improve outcomes in first or recurrent episode depressionï¿½. American Journal of Managed Care 9, (2003): 374-380 68. Hocking, B. ï¿½Reducing a mental illness stigma and discrimination ï¿½ everybody.s businessï¿½. Medical Journal of Australia 178, (2003): 47-48 69. Lindley, J.; McNair, P.; Lund, B. ï¿½Inappropriate medication is a major cause of adverse drug reactions in elderly patientsï¿½. Age and Ageing 21, (1992): 294-300 70. Thapa, P. B.; Meador, K. G.; Gideon, P. ï¿½Effects of antipsychotic withdrawal in elderly nursing home residentsï¿½. Journal of American Geriatric Society 42, (1994): 280-286 71. Nygaard, H. A.; Bakke, K. J.; Breivik, K. ï¿½Mental and physical capacity and consumption of neuroleptic drugs in residents of nursing homesï¿½. International Journal of Geriatric Psychiatry 5, (1990): 303-308 72. McShane, R.; Keane, J.; Gedling, K. ï¿½Do neuroleptic drugs hasten cognitive decline in dementia? Prospective study with necropsy follow-upï¿½. British Medical Journal 314, (1997): 266-270 73. Granek, E.; Baker, S. P.; Abbey, H. ï¿½Medications and diagnoses in relation to falls in a long-term care facilityï¿½. Journal of the American Geriatric Society 35, (1987): 503- 511 74. Snowdon, J. ï¿½A follow-up survey of psychotropic drug use in Sydney nursing homesï¿½. Medical journal of Australia 170, (1999): 299-301 75. Panmore, A. P.; Crawford, V. L. S.; Beringer, T. R. O. ï¿½Determinants of drug utilisation in an elderly population in north and west Belfastï¿½. Pharmacoepidemiology and Drug Safety 4, (1995): 147-160 76. Furniss, L.; Burns, A.; Craig, S. K. L. ï¿½Effects of a pharmacist.s medication review in nursing homes. Randomised controlled trialï¿½. British Journal of Psychiatry 176, (2000): 563-567 77. McGrath, A. M.; Jackson, G. A. ï¿½Survey of neuroleptic prescribing in residents of nursing homes in Glasgowï¿½. British Medical Journal 312, (1996): 611-612 78. Sorensen, L.; Foldspang, A.; Gulmann, N. C. ï¿½Determinants for the use of psychotropics among nursing home residentsï¿½. International journal of Geriatric Psychiatry 16, (2001): 147-154 79. Schmidt, I. K.; Fastborn, J. ï¿½Quality of drug use in Swedish nursing homes ï¿½ A follow-up studyï¿½. Clinical Drug Investigation 20, (2000): 433-446 80. Hughes, C. M.; Lapane, K. L.; Mor, V. ï¿½Impact of the legislation on nursing home care in the United States: lessons for the United Kingdomï¿½. British Medical Journal 319 (1999): 1060-1063 81. Essex, B.; Doig, R.; Renshaw, J. ï¿½Pilot study of records of shared care for people with mental illnessesï¿½. British Medical Journal 300, (1990): 1442-1446 82. Duggan, C.; Bates, I.; Hough, J. ï¿½Discrepancies in prescribing ï¿½ where do they occur?ï¿½ Pharmaceutical Journal 256, (1999): 65-67 83. Bates, D. W.; Cullen, D. J.; Laird, N.; ï¿½Incidence of adverse drug events and potential adverse drug events: implications for preventionï¿½. Journal of the American Medical Association 274, (1995): 29-34 84. Young, A. ï¿½Improving information transfer from hospital to primary careï¿½. Hospital Pharmacist 13, (2006): 312-314 85. Warner, J. P.; King, M.; Blizard, R. ï¿½Patient-held shared care records for individuals with mental illness: randomised controlled evaluationï¿½. British Journal of Psychiatry 177, (2000): 319-324 86. Harvey, C. A.; Fielding, J. M. ï¿½The configuration of mental health services to facilitate care for people with schizophreniaï¿½. Medical Journal of Australia 178, (2003): 49-52 87. Stimmel, G. L. ï¿½Clinical pharmacy practice in a community mental health centreï¿½. Journal of the American Pharmaceutical Association 15, (1975): 400-401 88. Branford, D. ï¿½Is there a role for community pharmacists in community psychiatry?ï¿½ Pharmaceutical Journal 279, (2002): 842 89. Gray D. R.; Namikas, E. A.; Sax, M. J. ï¿½Clinical pharmacists as allied health care providers to psychiatric patientsï¿½. Contemporary Pharmacy Practice 2, (1972): 108- 116 90. Watson, P. J. ï¿½Community pharmacists and mental health: an evaluation of two pharmaceutical care programmesï¿½. Pharmaceutical Journal 258, (1997): 419-122 91. Buhrich, N.; Butchart, A.; Johnston, S. Lauchlaan, R. ï¿½Delivery of medication to psychiatric patients in community health services in New South Walesï¿½. Australian and New Zealand Journal of Psychiatry 30, (1996): 523-530 92. Keks, N. A.; Alston, K.; Hope, J. ï¿½Use of antipsychotics and adjunctive medication by an inner urban community psychiatric serviceï¿½. Australian and New Zealand Journal of Psychiatry 33, (1999): 896-901 93. Snowdon, J.; Days, S.; Baker, W. ï¿½Why and how antipsychotic drugs are used in 40 Sydney nursing homesï¿½. International Journal of Geriatric Psychiatry 20, (2005): 1146-1152 94. Obourne, C. A.; Hooper, R.; Chi Li, K.; Swift, C. G.; Jackson, S. H. D. ï¿½An indicator of appropriate neuroleptic prescribing in nursing homesï¿½. Age and Ageing 31, (2002): 435-439 95. Owen, P. R.; Thrush, C. R.; Kirchner, J. E.; Fischer, E. P.; Booth, B. M. ï¿½Performance measurement for schizophrenia: adherence to guidelines for antipsychotic doseï¿½. International journal of quality health care 12, (2000): 475-482 96. Meagher, D.; Moran, M. ï¿½Sub-optimal prescribing in an adult community mental health service: prevalence and determinantsï¿½. Psychiatric Bulletin 27, (2003): 266- 270 97. Harrington, M.; Lelliott, P.; Patton, C.; Okocha, R.; Duffet, R.; Sensky, T. ï¿½The results of a multi-centre audit of prescribing of antipsychotic drugs for inpatients in the UKï¿½. Psychiatric Bulletin 26, (2002): 414-418 98. Paton, C.; Lelliott, P. ï¿½The use of prescribing indicators to measure the quality of care in psychiatric inpatientsï¿½. International journal of quality health care 13, (2004): 40- 45 99. Callaly, T.; Trauer, T. ï¿½Patterns of use of antipsychotic medication in a regional community mental health serviceï¿½. Australia and New Zealandï¿½s Journal of Psychiatry 8, (2000): 220-224 100. Centorrino, F.; Goren, J. L.; Hennen, J. Salvatore, P.; Kelleher, J. P.; Baldessarini, R. J. ï¿½Multiple versus single antipsychotic agents for hospitalized psychiatric patients: case-control study of risks versus benefitsï¿½. American Journal of Psychiatry 161, (2004): 700-706 101. Centorrino, F.; Fogarty, K. V.; Sani, G. ï¿½Use of combinations of antipsychotics: McLean hospital inpatientsï¿½. Human Psychopharmacology 20, (2005): 485-492 102. Taylor, D.; Young, C.; Esop, R.; Paton, C.; Walwyn, R. ï¿½Testing for diabetes in hospitalised patients prescribed antipsychotic drugsï¿½. British Journal of Psychiatry 185, (2004): 152-156 103. Merrill, D. B.; Dec, G. W.; Goff, D. C. ï¿½Adverse cardiac effects associated with clozapineï¿½. Journal of Clinical Psychopharmacology 25, (2005): 32-41 104. Happel, B.; Manias, E.; Rooper, C. ï¿½Wanting to be heard: mental health consumer.s experiences of information about medicationï¿½. International Journal of Mental Health Nursing 13, (2004): 242-248 105. Paton, C.; Gill-Banham, S. ï¿½Prescribing errors in psychiatryï¿½. Psychiatric Bulletin 27, (2003): 208-210
A professional writer will make a clear, mistake-free paper for you!Get help with your assigment
Please check your inbox