Bridging the gap between physical and mental illness in community pharmacy (<i>PharMIbridge</i>): protocol for an Australian cluster randomised controlled trial

Wheeler, Amanda; O’Reilly, Claire; El-Den, Sarira; Byrnes, Joshua; Ware, Robert S.; McMillan, Sara Sinclair

doi:10.1136/bmjopen-2020-039983

Cited by 25 publications

(36 citation statements)

References 67 publications

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“…Pharmacists in every sector need to communicate with people with mental health problems. With the exception of mental health specialties, there is a lack of service provision in pharmacy for mental health [ 7 , 8 ]. It is possible that this is reflected onto priorities in pharmacy curricula.…”

Section: Introductionmentioning

confidence: 99%

UK and Ireland survey of MPharm student and staff experiences of mental health curricula, with a focus on Mental Health First Aid

Gorton

Macfarlane

Edwards

et al. 2021

J of Pharm Policy and Pract

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Background One in four people experience a mental health problem every year and improving mental health care is an international priority. In the course of their work, pharmacists frequently encounter people with mental health problems. The experience of mental health teaching, including Mental Health First Aid (MHFA) training, in undergraduate pharmacy (MPharm) students in the UK and Ireland is not well documented. Students’ viewpoints, contextualised with curricular overviews provided by staff, were analysed to understand their experience. Methods An anonymous, online questionnaire was distributed to MPharm students and staff in the UK and Ireland. Students were asked closed questions regarding their course and exposure to MHFA, which were analysed using descriptive statistics. Open questions were included to enable explanations and these data were used to contextualise the quantitative findings. One member of staff from each university was invited to answer a modified staff version of the questionnaire, to provide a curriculum overview and staff perspective. Results 232 students and 13 staff, from 22 universities, responded. Three-quarters of students did not agree with the statement that ‘mental health was embedded throughout the MPharm’. Most students (80.6%) stated that they were taught neuropharmacology whilst 44.8% stated that their course included communicating with people about their mental health. One-third (33.2%) of students stated that their degree ‘adequately prepared them to help people with their mental health’. Twenty-six students (11.6%) had completed MHFA training of which 89% would endorse inclusion of this within the MPharm. Of those who had not completed the training, 81% expressed a desire to do so. Those who completed MHFA training self-reported greater preparedness than those who did not, but student numbers were small. Conclusions Mental health teaching for pharmacy undergraduates is more focussed on theoretical aspects rather than applied skills. MHFA was viewed by students as one way to enhance skill application. The association of the increased self-reported preparedness of those who completed MHFA could be confounded by a positive environmental cultural. MPharm programmes need sufficient focus on real-world skills such as communication and crisis response, to complement the fundamental science.

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Section: Introductionmentioning

confidence: 99%

UK and Ireland survey of MPharm student and staff experiences of mental health curricula, with a focus on Mental Health First Aid

Gorton

Macfarlane

Edwards

et al. 2021

J of Pharm Policy and Pract

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“…Our findings are consistent with several meta-analysis and primary studies emphasising treatment gap and unmet needs in psychiatry. 25 First, acceptability of medications by people living with severe and persistent mental illness has been described as problematic, and adherence to medications is poor. 26 Second, these issues are often overlooked and/or dismissed by healthcare professionals and policy makers.…”

Section: Discussionmentioning

confidence: 99%

Assessing the physical healthcare gap among patients with severe mental illness: large real-world investigation from Italy

et al. 2021

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Background One critical barrier to the uptake of mental health programmes is the so-called physical healthcare gap, a concern raised by the unattended physical comorbidity and early mortality of persons with severe mental illness. Aims To evaluate the extension of physical healthcare gap among persons with severe mental illness under chronic drug therapies. Method A population-based cohort study was carried out, using Lombardy healthcare utilisation databases. Prevalent patients treated with blood pressure-, lipid- or glucose-lowering agents were identified in January 2017. Among these, those who were receiving care for depression, schizophrenia, bipolar disorder or personality disorder formed the study cohort. A reference cohort was randomly selected from prevalent patients treated with chronic therapies without signs of severe mental disorders, to be matched with study cohort members for gender, age and number of previous contacts with the National Health System. One-year adherence to healthcare was measured through the proportion of days covered (drug adherence), and exposure to selected recommendations (clinical control adherence). Results The 55 162 patients with severe mental illness were less likely to have high adherence to blood pressure-lowering, lipid-lowering or antidiabetic agents than the reference cohort by −24% (95% CI −26 to −22%), −10% (95% CI −14 to −6%) and −25% (95% CI −29 to −21%), respectively. The 9250 patients with diabetes and severe mental illness had −18% (95% CI −22% to −13%) reduced likelihood to meet recommendations for the clinical management of diabetes, compared with the reference cohort. Conclusions Adherence to chronic drug therapies was sensibly worse among patients living with mental illness than those without signs of mental disorders.

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“…Participants were recruited into the Bridging the Gap between Physical and Mental Illness in Community Pharmacy Randomised Controlled Trial ( PharMIbridge RCT) from three Australian states/territories, if they were aged 16 years or over, had used an antipsychotic or a mood stabiliser for SPMI continuously for the six months prior to recruitment, and had current medication problems and/or physical health concerns. All participants completed a medication review with a trained community pharmacist at baseline; the PharMIbridge RCT protocol is reported elsewhere [ 23 ]. A total of 318 participants were recruited between September 2020-July 2021 from Victoria, New South Wales, and the Australian Capital Territory, and are included in the analysis presented here.…”

Section: Methodsmentioning

confidence: 99%

Psychotropic medication use in people living with severe and persistent mental illness in the Australian community: a cross-sectional study

McMillan

Theodoros

et al. 2022

BMC Psychiatry

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Background Psychotropic polypharmacy and high-dose prescribing may play a role in therapy, however, with associated risks. The aim of this study was to describe current prescribing practices and use of four psychotropic medication groups (antipsychotics, antidepressants, mood stabilisers and benzodiazepines), focusing on polypharmacy (across and within groups) and high-dose prescribing in adults experiencing severe and persistent mental illness (SPMI) in the Australian community. Methods 318 people taking psychotropic medication for SPMI had a medication review undertaken by a community pharmacist. Participants were recruited as part of an RCT from three Australian states/territories between September 2020-July 2021. All psychotropic medication and daily doses were recorded and reviewed for alignment with current clinical guidelines. Univariate and multiple logistic regression models investigated factors associated with antipsychotic, antidepressant, and mood stabiliser polypharmacy, and antipsychotic and antidepressant high-dose therapy. Variables included age, gender, geographic location, self- reported mental illness(es), hospital admission(s) in previous 6-months and prescriber type. Results 806 psychotropic medications were prescribed for the 318 participants. Mood stabiliser polypharmacy was recorded in 19.0% of participants prescribed mood stabilisers; antipsychotic polypharmacy in 18.4% of participants prescribed antipsychotics; antidepressant polypharmacy in 11.3% of those prescribed antidepressants; and three participants (5.1%) were prescribed two benzodiazepines concurrently. Almost 18.6% of the cohort was receiving high-dose treatment; 18 participants were prescribed high-dose antipsychotics and 39 high-dose antidepressants, with two participants prescribed both. Adjusted logistic regression for polypharmacy found male gender, psychiatrist as sole prescriber, or multiple prescribers, were associated with antipsychotic polypharmacy. The adjusted model for high-dose therapy found psychiatrist as sole prescriber was significantly associated with antipsychotic and antidepressant high-dose prescribing. Conclusion Psychotropic polypharmacy was common in this community cohort experiencing SPMI. Whilst polypharmacy is not always inappropriate, it is a complex construct with potential benefits alongside potential risks. Benefits and harms need to be balanced however this practice is not supported by clear guidance to assist health practitioners. This study highlights the important need for regular medication reviews and strengthened communication between consumers and all healthcare professionals involved in community mental health care, to support safe and effective use of psychotropic medications.

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Bridging the gap between physical and mental illness in community pharmacy (PharMIbridge): protocol for an Australian cluster randomised controlled trial

Cited by 25 publications

References 67 publications

UK and Ireland survey of MPharm student and staff experiences of mental health curricula, with a focus on Mental Health First Aid

UK and Ireland survey of MPharm student and staff experiences of mental health curricula, with a focus on Mental Health First Aid

Assessing the physical healthcare gap among patients with severe mental illness: large real-world investigation from Italy

Psychotropic medication use in people living with severe and persistent mental illness in the Australian community: a cross-sectional study

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