Pharmacist-led medicines optimisation service in an inpatient mental health setting.

Medicines optimisation ensures that people get the best possible outcomes from their medicines. As those with severe mental illness (SMI) are frequently prescribed psychotropic medicines with potentially significant side-effects, poor adherence to treatment and physical morbidity are common. This results in suboptimal symptom control, physical health problems and negative health outcomes. The specialist mental health pharmacist (SMHP) is best placed to provide leadership for medicines optimisation in the inpatient mental health setting. By adopting a patient-centred approach to providing information, improving adherence, screening, initiating and maintaining medicines, and supporting self-advocacy, the SMHP can ensure the patients' experience of taking medicines is optimised. As there is currently limited understanding of what a baseline clinical pharmacy service in a mental health setting looks like, we aim to outline a framework for pharmacist-led medicines optimisation for those with SMI. This framework is suitable to be scaled and adapted to other settings.

Patients and Caregivers Helping to Shape the Undergraduate Pharmacy Mental Health Curriculum.

Objective. To develop a model system for involving patients and caregivers in curriculum development of mental health education in an undergraduate pharmacy program. Methods. Purposive recruitment was used to convene a focus group of nine people with experience in using mental health services from either the patient or caregiver perspective. Group members were asked about their experience with using pharmacy services and their suggestions for enhancement of the undergraduate curriculum. Thematic analysis was conducted independently by two researchers. Results. Patients and caregivers believed that pharmacists could contribute to the care of people who experience mental health conditions by supporting shared decision making, providing information, actively managing side effects of psychotropic medication, and conducting regular medication review. Subjects suggested that the pharmacy undergraduate curriculum should introduce mental health from the beginning, include self-care for students, integrate mental and physical health education, and enhance students' communication skills. The curriculum should include broader issues relevant to mental health beyond the use of medication, such as stigma, the recovery approach, and interprofessional cooperation. These changes could support graduates in engaging proactively with people experiencing mental health difficulties. Conclusion. Involving patients and caregivers in the design of an undergraduate pharmacy curriculum in mental health resulted in a more person-centered and student-centered approach to mental health education at our university. Ultimately, the changes made to the undergraduate curriculum will improve the ability of pharmacy graduates to better meet the needs of patients.

Venous thromboembolism prophylaxis in mental health in-patient services: a qualitative study.

Background Venous thromboembolism (VTE) is an important and potentially preventable cause of morbidity and mortality in hospitalised patients. It is a significant, international patient safety issue affecting medical, surgical and mental health in-patients. There is a paucity of published evidence on the incidence of VTE, and the role of VTE risk-assessment and prophylaxis, in mental healthcare settings. Epidemiological evidence indicates that antipsychotic medications are an independent risk factor for VTE. Objective To explore healthcare practitioners' experiences and perspectives regarding VTE prophylaxis for in-patients in mental health services in Ireland. Setting This study was conducted in two national teaching hospitals in Dublin, Ireland. Method This experiential, qualitative study was conducted using face-to-face, semi-structured interviews. Purposive sampling was used to allow strategic selection of participants from the pharmacy, medical and nursing disciplines. Data was analysed using inductive thematic analysis. Consolidated criteria for reporting qualitative studies guidelines were used as a reporting framework. Main outcome measure Participants' views on VTE prophylaxis for mental health in-patients. Results Five key themes were derived: risk factors in mental health, attitudes to risk-assessment, challenges with VTE prophylaxis, lack of awareness, and lack of evidence in mental health. Conclusion The results indicate considerable diversities in perceived risk of VTE, and in experiences with VTE risk-assessment and prophylaxis. VTE risk was considered in practice specifically for immobile, older adults and eating disorder patients on bed rest. Specific research is required to address this area of clinical uncertainty in mental health.

A Mixed-Methods Study of Patient Views on Reflux Symptoms and Medication Routines.

OBJECTIVES: Gastroesophageal reflux disease is a chronic disorder often accompanied by laryngopharyngeal reflux. Speech-language pathologists are tasked with treating these patients with voice, dysphagia, and/or reflux therapy. This study investigated patient-reported reasons for reduced compliance with recommended reflux treatment and the top symptoms in patients with reflux, dysphagia, and voice symptoms. STUDY DESIGN: This study used a cross-sectional qualitative and quantitative mixed-methods design to identify and describe patients' reflux symptoms and reflux medication routines. METHODS: Fifty-one patients completed a face-to-face, semistructured interview, a questionnaire, and the Reflux Symptom Index (RSI). Interview transcripts were coded by authors for concepts in two cycles. RESULTS: During the 51 interviews, the top four reported symptoms were heartburn (n = 17), mucous (n = 11), dysphagia, and globus (n = 10). Further, 62.7% (n = 32/51) described an incorrect routine in taking their proton pump inhibitor (PPI): taking it with other pills, taking it with food/drink, and uncertainty about which pill is for reflux. RSI scores were moderately correlated with patient-reported reflux severity (r = 0.62, P < 0.0001, r2 = 0.34). Correct compliance with PPI timing was not enough to significantly lower RSI scores more than those who did not comply (an average RSI of 20.0 vs. 25.9, P = 0.1252). CONCLUSIONS: Literature has not described the most relevant reflux-related symptoms and why PPI compliance is notoriously poor, from the patients' perspective. The results of this study confirm that PPI compliance is poor, and the reasons for poor compliance could have been prevented with patient education. Even when PPI compliance was adequate, symptoms like globus, mucous, voice dysfunction, and dysphagia persisted. Other interventions such as evidence-based diet and behavioral changes should be a part of voice/dysphagia/reflux therapy.