Introduction Medication represents a significant part of the care of people with severe mental health problems and is often complex, sometimes causing disturbing side effects. In the community, although a number of different professionals are involved in their care, patients report a lack of information about their medication, and other medication-related problems.1 Community pharmacists are health professionals with specialist medication-related knowledge and experience, and they are easily accessible for the public.
Method Each participating community pharmacist (n=9) provided the service to between 1 and 5 clients (n=27). The pharmacists were also linked to each client's CMHT key-worker (a professional co-ordinating the client's care (n=21) including community psychiatric nurses, occupational therapists, social workers). A combination of four quantitative and qualitative research methods was applied in three phases, and with three types of respondents (see Table 1). The methods allowed collection of comprehensive data, which were triangulated in order to validate the findings and to enhance their robustness and credibility. |
Focal points
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Table 1: Summary of methods |
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| Respondent | Pre-intervention phase | Intervention phase | Post-intervention phase |
| Clients | Structured interview | Calendars | Semi-structured interview Consensus development panel (selected group) |
| Key workers | Structured questionnaire | Logbook | Semi-structured interview Consensus development panel (selected group) |
| Pharmacists | Structured questionnaire | Logbook | Semi-structured interview Consensus development panel (selected group) |
Results The logbooks held by pharmacists contained records of 144 contacts; 79 (55 per cent) represented dispensing of medication, while the remaining 45 per cent were mostly concerned with the exchange of information between the pharmacists and clients. These contacts resulted in, for example, discontinuation of a medicine taken by a client for several years, "first aid" for a client who experienced side-effects of medication and was unable to contact any other professional, increase in the clients' knowledge of medication and the opportunity to access a health professional. The post-intervention interviews illustrated that the clients highly valued the interventions.
Compared with pre-intervention data, the logbooks revealed that the service did not improve communication between professionals; post-intervention interviews provided some explanations. The interview data further identified limitations of the service and difficulties with its provision including lack of private space in pharmacies, sensitivity of issues relating to the provision of the clients' personal information to pharmacists, variations in the pharmacists' approaches, and lack of communication between professionals.
Discussion The community pharmacists involved in this study made positive contributions to the care of people with mental health problems by providing them with easy access to additional information and help. The findings suggest that successful wider implementation of a similar service would require a revision of the current structure of community pharmacies to allow pharmacists to develop extended services, and a formal acceptance of community pharmacists as members of multidisciplinary teams. Drug information needs proved complex, and must be recognised and addressed in order to design an effective service. The results will be used by the health authority that originally commissioned the study, and demonstrate that an evidence-based approach is appropriate for developing primary care pharmaceutical services.
Centre for practice and policy, School of Pharmacy, University of London
| 1. Donoghue JM. Problems with psychotropic medicines in the community. Pharm J 1993;251:350-2. |