Impact of a specialist mental health pharmacy team on medicines optimisation in primary care for patients on a severe mental illness register: a pilot study

Abstract

Word Count: 2960 words. Abstract 274 words. ABSTRACT ObjectiveMedication arrangements for patients with severe mental illness (SMI), including schizophrenia and bipolar disorder, can be complex. Some have shared care between primary and secondary services whilst others have little specialist input. This study investigated the contribution a specialist mental health clinical pharmacy team could make to medicines optimisation for patients on the SMI register in primary care. Research shows that specialist mental health pharmacists improve care in inpatient settings. However little is known about their potential impact in primary care. MethodFive General Practice (GP) Surgeries were allocated half a day per week of a specialist pharmacist and technician for 12 months. The technician reviewed primary and secondary care records for discrepancies. Records were audited for high dose or multiple antipsychotics, physical health monitoring and adherence. Issues were referred to the pharmacist for review. Surgery staff were encouraged to refer psychotropic medication queries to the team. Interventions were recorded and graded.Results 316/472 patients on the SMI register were prescribed antipsychotics or mood stabilisers. 23 (7%) records were updated with missing clozapine and depot information. Interventions by the pharmacist included clarifying discharge information (12/104), reviewing high dose and multiple antipsychotic prescribing (18/104), correcting errors (10/104), and investigating adherence issues (16/104), following up missing health checks (22/104) and answering queries from surgery staff (23/104). Five out of six interventions possibly preventing hospital admission were for referral of non-adherent patients. ConclusionThe pharmacy team found a variety of issues including incomplete medicines reconciliation, adherence issues, poor communication, drug errors and the need for specialist advice. The expertise of the team enabled timely resolution of issues and bridges were built between primary and secondary care.

The role of pharmacy in the management of cardiometabolic risk, metabolic syndrome and related diseases in severe mental illness: a mixed-methods systematic literature review

“…Qualitative data from 4 community pharmacists—data presented could not be used. Raynsford, 2018, UK [ 85 ] Specialist mental health pharmacist and pharmacy technician on individuals with SMI in primary care (GP practices). Specialist mental health pharmacist and mental health pharmacy technician.…”

“…a Taylor [ 73 ], Quirk [ 75 ], Shanker [ 76 ] and Raynsford [ 85 ] included some work and results that were completely irrelevant objectives of this literature review: we will only consider those aspects pertinent to our review question…”

“…Table 3 shows that the most common setting for study intervention was a community mental health/psychiatric outpatient clinic ( n = 15), followed by psychiatric inpatient wards ( n = 12). Four studies were based in primary care settings (community pharmacy ( n = 1)) [ 80 ], one in a General Practitioner (GP) surgery [ 85 ] and two in a primary care clinic [ 81 , 82 ]. One study was based in early intervention/psychosis services [ 86 ] and one based in other (mix of urban, non-urban and metropolitan centres) [ 71 , 72 ].…”

“…One study was based in early intervention/psychosis services [86] and one based in other (mix of urban, non-urban and metropolitan centres) [71,72]. Pharmacists were involved to some extent in delivering the interventions across all studies, and those involved were mostly commonly specialist mental health/psychiatric pharmacists (n = 9) [73,79,83,[85][86][87][88][89][90] or clinical pharmacists (n = 9) [76,78,81,82,[91][92][93][94][95] (Table 4). Differences in terminology across studies due to differences in country of origin did not allow us to differentiate grades or qualification of pharmacists.…”

“…2) The mapping review included all 33 studies (quantitative, qualitative and mixed methods). Figure 2 shows the key components of the healthcare pathway for CMR, MetS and related diseases and the role of pharmacy at each key component; fourteen studies [73, 79-81, 83, 84, 86, 87, 89-91, 93, 100, 102] included pharmacists in Taylor [73], Quirk [75], Shanker [76] and Raynsford [85] included some work and results that were completely irrelevant objectives of this literature review: we will only consider those aspects pertinent to our review question b Asked the opinion/views of an individual with SMI Please note that none of the studies included informal carers of those with SMI The dataset was heterogeneous for many characteristics including participant characteristics such as definition of SMI and age, study setting, outcomes measured and data collected and did not allow for quantitative data to be pooled or examined by meta-analysis. The authors (DS, EL, RM) used the following methods to analyse the data: (i) a mapping review and (ii) implementation strategies used to implement the study intervention were classified using the Cochrane EPOC taxonomy Clinical pharmacist with extra /additional qualifications 2…”