Int J Pharm Pract 2001:9:225-234
Department of Pharmacy, King's College London, England
Marilyn A. Ewan, PhD, MRPharmS, postgraduate research pharmacist
Russell Greene, PhD, MRPharmS, senior lecturer in clinical pharmacy
Correspondence:
Dr Ewan, c/o Dr R. J. Greene, Department of Pharmacy, King's College London, Franklin-Wilkins Building, 150 Stamford Street, London, England SE1 8WA
Original Papers
Evaluation of mental health care interventions made by three community pharmacists - a pilot study
M. A. Ewan and R. J. Greene
Objective — To assess the clinical significance of drug-related interventions made by three community pharmacists (CPs) in the pharmaceutical care of 30 long-term mentally ill patients in the UK.Method — Three CPs ("study pharmacists") participated in a nine-month study in which they collaborated with the community mental health team (CMHT) to provide pharmaceutical care for long-term mentally ill patients in the community. In particular, they liaised with the patients' keyworkers, accompanying them on home visits. The pharmacists had previously attended a specially organised training course. Their primary tasks were to assess patient need and identify medication-related problems, intervene as appropriate and document patient outcome. An expert review panel (two specialist hospital mental health pharmacists and a consultant psychiatrist) evaluated the appropriateness of the interventions and the level of clinical significance of the interventions (using a validated four-point rating scale).
Key findings — Thirty-eight patients consented to participate in the study and 35 were contactable. Ninety-four medication-related problems were identified involving 30 patients (mean number of recorded problems per patient=3), of which full data were available for 92. Eighty-four problems (91 per cent; n=92) were said to have had appropriate interventions, and eight (9 per cent) inappropriate interventions. In 35 per cent of problems the three reviewers agreed that the interventions were clinically significant. Inter-rater agreement for paired agreements (assessed by the kappa statistic) was fair in all cases except one, where it was poor.
Conclusion — The reviewers considered the study pharmacists to have made a valuable pharmaceutical contribution to mental health care through clinically significant interventions, although they identified cases in which further clinically significant interventions could have been made. The reviewers saw the work undertaken as providing a positive way forward in primary mental health care.