A web-based mental health promotion intervention for pharmacy staff to reduce stigmatising and discriminating attitudes.

ISSUE ADDRESSED: Stigma and discrimination can have a significant impact on successful mental health recovery. This research evaluated the effectiveness of a web-based mental health promotion intervention on stigma and discrimination in community pharmacies via assessment of staff attitudes, confidence and skills. METHODS: Guided by the intervention mapping framework, we used experiential learning techniques, including pre-recorded consumer/carer narratives, role-plays and panel discussions accessed by participants in an innovative, flexible, web-based, program of modules. A quasi-experimental pre-post design was used to evaluate the intervention effectiveness. Participants completed pre- (T1) and post-intervention (T2) questionnaires that contained both validated measures and questions developed or adapted specifically for this evaluation. RESULTS: 566 pharmacy staff (357 pharmacists, 209 support staff) completed the intervention between September 2012 and May 2013; pharmacists completed eight online modules (4-hours total), support staff completed four (2-hours total). After participating, staff attitudes about mental health had changed in a positive direction; their confidence and skills when working with consumers and their carers had increased overall, although support staff remained less confident than pharmacists. CONCLUSION: These results suggest that the involvement of consumers and carers in the intervention development and delivery was integral to reducing pharmacy staff stigma and enhancing confidence and communication skills.

The impact of a person-centred community pharmacy mental health medication support service on consumer outcomes.

BACKGROUND: Mental illness is a worldwide health priority. As medication is commonly used to treat mental illness, community pharmacy staff is well placed to assist consumers. AIM: To evaluate the effectiveness of a multifaceted, community pharmacy medication support service for mental health consumers. METHOD: Pharmacists and pharmacy support staff in three Australian states were trained to deliver a flexible, goal-oriented medication support service for adults with mental illness over 3-6 months. Consumer-related outcome measures included perceptions of illness and health-related quality of life, medication beliefs, treatment satisfaction and medication adherence. RESULTS: Fifty-five of 100 trained pharmacies completed the intervention with 295 of the 418 recruited consumers (70.6% completion rate); 51.2% of consumers received two or more follow-ups. Significant improvements were reported by consumers for overall perceptions of illness (p < 0.001), the mental health domain of quality of life (p < 0.001), concerns about medication (p = 0.001) and global satisfaction with medication (p < 0.001). Consumers also reported an increase in medication adherence (p = 0.005). CONCLUSIONS: A community pharmacy mental health medication support service that is goal-oriented, flexible and individualised, improved consumer outcomes across various measures. While further research into the cost-effectiveness and sustainability of such a service is warranted, this intervention could easily be adapted to other contexts.

Exploring an increased role for Australian community pharmacy in mental health professional service delivery: evaluation of the literature.

BACKGROUND: Australian general practitioners primarily treat mental health problems by prescribing medication dispensed by community pharmacists. Pharmacists therefore have regular interactions with mental health consumers and carers. AIMS: This narrative review explored the potential role of community pharmacy in mental health services. METHOD: Medline, CINAHL, ProQuest, Emerald, PsycINFO, Science Direct, PubMed, Web of Knowledge and IPA were utilised. The Cochrane Library as well as grey literature and "lay" search engines such as GoogleScholar were also searched. RESULTS: Four systematic reviews and ten community pharmacy randomised controlled trials were identified. Various relevant reviews outlining the impact of community pharmacy based disease state or medicines management services were also identified. CONCLUSION: International studies involving professional service interventions for mental health consumers could be contextualised for the Australian setting. Australian studies of pharmacy professional services for chronic physical health conditions provided further guidance for the expansion of community pharmacy mental health professional services.

Australian mental health consumers' and carers' experiences of community pharmacy service.

BACKGROUND: Many Australians with anxiety or depression experience issues accessing pharmacological treatment even though community pharmacies are remunerated to supply subsidized medicines and provide medicine management services. OBJECTIVE: To obtain insight into the quality of community pharmacy services from the perspectives of mental health consumers and carers. METHODS: A computer-assisted telephone interview was used to gauge perceptions of pharmacy service using frameworks of service quality and patient-centred care. A convenience sample of 210 consumers and carers from three Australian states completed an interview comprising rating scales, multiple choice checklists and open-ended questions to explore their experience of pharmacy services. RESULTS: Participants were consumers experiencing on-going mental health condition(s) (n = 172), carers for someone who experienced a mental health condition (n = 15) or both (n = 23). For 60% of participants, medicines were dispensed within ten minutes of arriving at the pharmacy, and 36% received verbal advice. The majority of participants were not asked by pharmacy staff whether they experienced side-effects, and 60% reported rarely or never receiving written medicine information. However, the majority of participants reported that their expectations were met despite the absence of such services. Qualitative data showed that participants valued high-quality services that reflected patient-centred care, and they were inclined to engage with these services particularly if they perceived them as surpassing basic expectations. DISCUSSION AND CONCLUSIONS: Participants clearly valued high-quality pharmacy service yet did not routinely expect it. When service exceeded expectations, community pharmacies were viewed as safe health-care spaces to seek advice on mental health and well-being. This study has positive implications for the role of pharmacists.

Review of community pharmacy staff educational needs for supporting mental health consumers and carers.

Development of a mental health education package for community pharmacy staff should be informed by mental health consumers/carers' needs, expectations and experiences, and staff knowledge, skills and attitudes. This review (1) explored research on community pharmacy practice and service provision for mental health consumers/carers, and (2) identified validated methods for assessing staff knowledge, skills and attitudes about mental illness to inform the development of a training questionnaire. A literature scan using key words knowledge, skills, attitudes, and beliefs combined with community pharmacy, pharmacist, and pharmacy support staff, and mental illness, depression, anxiety was conducted. A small number of studies were found that used reliable methods to assess pharmacists' training needs regarding mental illness and treatment options. There was little published specifically in relation to depression and anxiety in community pharmacy practice. No studies assessed the training needs of pharmacy support staff. A systematic analysis of pharmacy staff learning needs is warranted.

Mentoring pharmacy staff to implement a medication support service: An evaluation of process and outcomes.

INTRODUCTION: To investigate the effectiveness of mentoring of pharmacy staff as they implemented a medication support service for mental health consumers. In particular, to show the relevance and applicability of Kram's four phases of mentoring to short-term mentoring relationships, the type of mentoring functions provided, and the value of utilising a pharmacist-consumer mentoring pair. METHOD: 163 pharmacy staff (mentees) each participated in a one-day workshop prior to implementing the service and being mentored over a period of six months. Data were collected from mentees via pre- and post-training questionnaires, and from mentors in the form of diaries, field notes, and a focus group. Quantitative and qualitative analyses were employed. RESULTS: Kram's 4-phase model is relevant and applicable to short-term mentoring relationships. Mentoring functions increased after initiation, peaked during cultivation, and decreased during separation and redefinition. According to the mentors, both mentees and mentors benefitted from utilising a pair of mentors, each of whom had particular knowledge, experience, and perspectives to share. CONCLUSIONS: This study extends mentoring research by showing that Kram's four phases could be intentionally integrated into the planning and implementation of mentoring relationships; moreover in short-term relationships. In addition, it has identified the particular mentoring functions that are sought and provided in different phases of relationships and that quantity of mentoring changes over the course of a relationship. Further, the study has found that mentees benefit from pairs of mentors (in this case a pharmacist and a consumer or carer) who provide different insights, knowledge and perspectives. Individuals and health-related organisations embarking on mentoring could use these findings as a guide to develop successful mentoring relationships, particularly when implementing a new service.

Mapping the terrain: A conceptual schema for a mental health medication support service in community pharmacy.

OBJECTIVE: Mental health-related problems pose a serious issue for primary care, and community pharmacy could make a significant contribution, but there is a dearth of information. METHODS: This article reports synthesis of the literature on mental health interventions across a range of pharmacy models, and pharmacy services in contexts beyond mental health. To best inform the design of a community pharmacy medication support intervention for mental health consumers, the literature was reported as a conceptual schema and subsequent recommendations for development, implementation and evaluation of the service. A broad conceptualisation was taken in this review. In addition to mental health and community pharmacy literature, policy/initiatives, organisational culture and change management principles, and evaluative processes were reviewed. Key words were selected and literature reviews undertaken using EMBASE, PubMed, CINAHL and Web of Science. RESULTS: Recommendations were made around: medication support intervention design, consumer recruitment, implementation in community pharmacy and evaluation. Surprisingly, there is a scarce literature relating to mental health interventions in community pharmacy. Even so, findings from other pharmacy models and broader medicines management for chronic illness can inform development of a medication support service for mental health consumers. Key learnings include the need to expand medicines management beyond adherence with respect to both intervention design and evaluation. CONCLUSION: The conceptual framework is grounded in the need for programmes to be embedded within pharmacies that are part of the health system as a whole.

Privacy and confidentiality: perspectives of mental health consumers and carers in pharmacy settings.

OBJECTIVES: The study aims to explore within the community pharmacy practice context the views of mental health stakeholders on: (1) current and past experiences of privacy, confidentiality and support; and (2) expectations and needs in relation to privacy and confidentiality. METHODS: In-depth interviews and focus groups were conducted in three states in Australia, namely Queensland, the northern region of New South Wales and Western Australia, between December 2011 and March 2012. KEY FINDINGS: There were 98 participants consisting of consumers and carers (n = 74), health professionals (n = 13) and representatives from consumer organisations (n = 11). Participants highlighted a need for improved staff awareness. Consumers indicated a desire to receive information in a way that respects their privacy and confidentiality, in an appropriate space. Areas identified that require improved protection of privacy and confidentiality during pharmacy interactions were the number of staff having access to sensitive information, workflow models causing information exposure and pharmacies' layout not facilitating private discussions. Challenges experienced by carers created feelings of isolation which could impact on care. CONCLUSIONS: This study explored mental health stakeholders' experiences and expectations regarding privacy and confidentiality in the Australian community pharmacy context. A need for better pharmacy staff training about the importance of privacy and confidentiality and strategies to enhance compliance with national pharmacy practice requirements was identified. Findings provided insight into privacy and confidentiality needs and will assist in the development of pharmacy staff training material to better support consumers with sensitive conditions.

Mental health consumer and caregiver perceptions of stigma in Australian community pharmacies.

BACKGROUND: The stigma of mental illness can be a barrier to effective medication management in the community pharmacy setting. This article explored mental health consumers' or caregivers' experiences of stigma in Australian community pharmacies. MATERIALS: Semi-structured interviews and focus groups were conducted with a purposive sample of consumers or caregivers (n = 74). Interview transcripts were analysed using a general inductive approach. DISCUSSION: Stigma presented a barrier to effective mental health management. Self-stigma impeded consumers' community pharmacy engagement. Positive relationships with knowledgeable staff are fundamental to reducing stigma. CONCLUSIONS: Findings provide insight into the stigma of mental illness in community pharmacies.