Patient care activities by community pharmacists in a capitation funding model mental health and addictions program

Abstract

BackgroundCommunity pharmacists are autonomous, regulated health care professionals located in urban and rural communities in Canada. The accessibility, knowledge, and skills of community pharmacists can be leveraged to increase mental illness and addictions care in communities.MethodsThe Bloom Program was designed, developed, and implemented based on the Behaviour Change Wheel and a program of research in community pharmacy mental healthcare capacity building. We evaluated the Bloom Program as a demonstration project using mixed methods. A retrospective chart audit was conducted to examine outcomes and these are reported in this paper.ResultsWe collected 201 patient charts from 23 pharmacies in Nova Scotia with 182 patients having at least one or more follow-up visits. Anxiety (n = 126, 69%), depression (n = 112, 62%), and sleep disorders (n = 64, 35%) were the most frequent mental health problems. Comorbid physical health problems were documented in 57% (n = 104). The average number of prescribed medications was 5.5 (range 0 to 24). Sixty seven percent (n = 122) were taking multiple psychotropics and 71% (n = 130) reported taking more than one medication for physical health problems. Treatment optimization was the leading reason for enrollment with more than 80% seeking improvements in symptom management and daily functioning. There were a total of 1233 patient-care meetings documented, of which the duration was recorded in 1098. The median time for enrolling, assessing, and providing follow-up care by pharmacists was 142 min (mean 176, SD 128) per patient. The median follow-up encounter duration was 15 min. A total of 146 patient care encounters were 60 min or longer, representing 13.3% of all timed encounters.ConclusionsPharmacists work with patients with lived experience of mental illness and addictions to improve medication related outcomes including those related to treatment optimization, reducing polytherapy, and facilitating withdrawal from medications. Pharmacists can offer their services frequently and routinely without the need for an appointment while affording patient confidentiality and privacy. Important roles for pharmacists around the deprescribing of various medications (e.g., benzodiazepines) have previously been supported and should be optimized and more broadly implemented. Further research on the best mechanisms to incentivize pharmacists in mental illness and addiction’s care should be explored.

Current and potential contributions of community pharmacy teams to self-harm and suicide prevention: A qualitative interview study

“…A good, long-term relationship between pharmacist and patient was cited as a mechanism to achieve resolution of problems related to mental health and medication in a mental health and addictions programme in Nova Scotia (Bloom Program). The private consultation room was the main location for these discussions [19]. In the UK, despite the requirement for a private consultation rooms in the community pharmacy contract, patients are often unaware that this facility is available [20].…”

“…There have been recommendations for follow-up and monitoring in MURs [25]. The Bloom Program, previously described [19], could fit this specification from a mental health perspective. However, this would require remuneration, something seen as a barrier by participants.…”

Pharmacists’ acceptability of a men’s mental health promotion program using the Theoretical Framework of Acceptability

“…The development of Headstrong was underpinned by the Behaviour Change Wheel (BCW) [26]. We have used this theoretical foundation in other mental health programs [28],[29] to determine influences on pharmacists' and pharmacy staff behaviours as well as to design programs and services. The BCW was developed from frameworks of behaviour change and includes the behaviour system known as COM-B at the centre [26].…”

“…We also believe in the importance of donating resources such as volunteering time and fundraising for non-governmental, community-based mental health organizations. A significant pillar in our program of research, in which we consistently use mixed methods, focuses on the design, implementation, and evaluation of programs, such as Headstrong and the Bloom Program [29], to enhance community pharmacists' care of people with experience of mental illness and addictions. As part of this process, we attempt to understand the experiences of pharmacists and other pharmacy team members and people with lived experience of mental illness and addictions who use pharmacists' services.…”

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

“…A Canadian study demonstrated that pharmacy staff supported mental health consumers by providing follow-up care which focused on medication management and improving health service navigation and most study participants were using multiple psychotropic medications, few were living with SPMI (n=36; 17.9%). 32 33 Additionally, results from an Australian community-based, pharmacist-led medication support service for participants living with depression and anxiety were positive with significant improvements in relation to participants illness perceptions, medication satisfaction and medication adherence. 6 Our proposed Randomised Controlled Trial (RCT) builds and expands on this evidence to test the effectiveness of a person-centred, goal-oriented and flexible, pharmacist-led support service for people living with SPMI, with a specific focus on improving medication adherence and managing physical comorbidities.…”