Evaluating Monitoring Guidelines of Clozapine-Induced Adverse Effects: a Systematic Review.

BACKGROUND AND OBJECTIVES: Despite the evidence that no other antipsychotic is effective as clozapine for the treatment of resistant schizophrenia, it is associated with various metabolic, neuroendocrine, cardiovascular, and gastrointestinal adverse effects. Guidelines aiming to address the monitoring of clozapine's (serious) adverse effects can be helpful to prevent and treat these effects. However, many of these guidelines seem to lack one or more important monitoring recommendations. We aimed to systematically review the content and quality of existing monitoring guidelines/recommendations for clozapine-induced adverse effects. METHODS: A comprehensive and systematic literature search, using the MEDLINE, Embase, Web of Science, and Cochrane databases, was conducted for guidelines/recommendations on the monitoring of clozapine-induced adverse events, published between January 2004 and April 2023 (last search 16 April 2023). Only peer-reviewed published guidelines reporting on the comprehensive monitoring of all major clozapine-induced adverse effects and including evidence-based recommendations, developed after the year 2004, were included. Studies reporting on the monitoring of adverse effects of clozapine without being a formal guideline, guidelines reporting on the monitoring of one or a limited number of adverse effects of clozapine, guidelines that were not peer reviewed or published, expert opinion papers without formal consensus guideline development, or guidelines developed before the year 2004, were excluded. The Appraisal of Guidelines for Research and Evaluation II (AGREE-II) tool was used to evaluate the guidelines/recommendations' quality. RESULTS: Only one guideline met the inclusion criteria. This consensus statement made recommendations for hematological monitoring, and the monitoring of metabolic, cardiac, and three other adverse effects. Highest scores for the qualitative assessment were found for the domains "scope and purpose" (66.7%), "clarity of presentation" (44.4%), and "editorial independence" (66.7%). Lowest scores were found for "rigor of development" (14.6%) and "applicability" (0%). CONCLUSIONS: Future guidelines should develop more comprehensive recommendations about specific clozapine-induced adverse effects, including constipation, myocarditis, tachycardia, and seizures, as well as include a rechallenge policy. There is an urgent need for well-developed, methodologically stringent, guidelines. REGISTRATION: PROSPERO registration number, CRD42023402480.

Prevalence and characteristics of registered falls in a Belgian University Psychiatric Hospital.

Objectives: Falls in elderly patients treated in general hospitals have already been the focus of several studies. Research within psychiatric settings, however, remains limited, despite the fact that this population has a number of characteristics that could increase the fall risk. The aim of this retrospective study was to estimate the prevalence of falling in patients with a psychiatric hospital setting. Methods: A retrospective descriptive chart review of falls registered in the period July 1, 2013 until June 30, 2019 in a Belgian University Psychiatric Hospital was conducted. Data were collected from the "patient related incident report and management system" (PiMS) of the hospital. All registered falls of all hospitalized patients were included in the study. Results: During the 6-year study period an incidence of 4.4 falls per 1,000 patient days was found. Only 0.5% of the falls resulted in severe injury and none of these falls were fatal. Eighty percent of falls involved a patient over the age of 65. Only 25.0% of the elderly patients suffered physical consequences, while injuries were present in 31.4% of adults and 68.2% of young patients. The two most common causes of a fall were the health status (63.3%) and the behavior (55.1%) of the patient. Conclusion: The estimated prevalence of falls in our study was generally in line with the rates found in literature on falls in psychiatric settings. Falls in psychiatric settings occur both in younger and older patients, suggesting that all age categories deserve sufficient attention in fall prevention policies. However, more research is necessary to improve fall prevention policies.

Defining polypharmacy: in search of a more comprehensive determination method applied in a tertiary psychiatric hospital.

AIMS: This cross-sectional pharmacoepidemiologic study examined the prevalence of polypharmacy and psychotropic polypharmacy among inpatients in a tertiary psychiatric hospital in Belgium. METHODS: Current prescriptions of all inpatients suffering from mental disorders were extracted from the hospital Computerized Physician Order Entry. Two methods were used to examine definitive polypharmacy (defined as the concomitant use of at least five medicines): number of medicines per active component and per prescription. Psychotropic polypharmacy was defined as the concomitant use of at least two psychotropic medicines, based on the first counting, i.e., per active component. RESULTS: In 292 included patients, the prevalence of definitive polypharmacy was 65.8%, with a mean number of 6.8 ± 4.2 medicines per patient. The most prevalent medicines were related to the central nervous system (55.7%), followed by medicines related to the gastro-intestinal (17.6%) and cardiovascular (9.4%) systems. A prevalence of psychotropic polypharmacy of 78.1% was observed, with a mean of 3.0 ± 1.7 psychotropic medicines per patient. Psychotropic polypharmacy was classified in same-class (71.5%), multi-class (82.5%), augmentation (20.6%), and adjuvant (35.5%) polypharmacy. CONCLUSION: These findings are consistent with previous reports of highly prevalent polypharmacy in patients with mental disorders. Although, in some cases, polypharmacy can be an important part of good clinical practice, the high prevalence of both polypharmacy and psychotropic polypharmacy emphasizes that attention must be paid to the potentially associated risks. Consensus on the definition and method of determination of polypharmacy is needed to support further research.

COVID-19 Vaccination Rates in a Cohort Study of Patients With Mental Illness in Residential and Community Care.

Background: Patients with mental illness are at increased risk for COVID-19-related morbidity and mortality. Vaccination against COVID-19 is important to prevent or mitigate these negative consequences. However, concerns have been raised over vaccination rates in these patients. Methods: We retrospectively examined vaccine uptake in a large sample of Belgian patients admitted to or residing in a university psychiatric hospital or community mental health care setting between 29th of March 2021 and 30th of September 2021 in the Flanders Region. All patients were offered vaccination. Descriptive statistics were used to analyse the data. Logistic regression was used to examine factors associated with vaccine uptake. Results: 2,105 patients were included in the sample, of which 1,931 agreed to be vaccinated, corresponding with a total vaccination rate of 91.7%. Logistic regression showed an effect of the diagnosis "other disorders" (OR = 0.08, CI = 0.005-0.45), age (OR = 1.03, CI = 1.02-1.04) and residing in the psychosocial care center (OR = 0.50, CI = 0.32-0.80) on vaccination status. Conclusion: Vaccine uptake among people with mental illness is high and comparable to the general population, when implementing a targeted vaccination program.

Problems in continuity of medication management upon transition between primary and secondary care: patients' and professionals' experiences.

BACKGROUND AND OBJECTIVES: Patients often experience drug-related problems at admission or after discharge from hospital. The objective of this study was to identify the main problems in medication management at transition between settings of care, as experienced by health care professionals (HCPs) and patients. METHODS: Focus group discussions were organised between December 2009 and February 2010; nine focus groups with primary and secondary care HCPs and patients and two with stakeholders. Focus group discussions were audiotaped and observation files were constructed. For the analysis, a thematic framework approach was used. Between November 2015 and April 2016, 19 additional interviews and 1 focus group were performed with general practitioners (GP) and community pharmacists (CP). RESULTS: This qualitative study provided a long list of problems that could be summarised in five clusters: (1) problems at admission, e.g. incomplete list of medication, absence of information in case of emergency admission; (2) problems at discharge, e.g. lack of communication with GP, insufficient supplies of medication for the weekend; (3) problems as to professions, e.g. GP's opinion different to that of the medical specialist; (4) problems as to patients and family, e.g. failure to understand treatment; (5) problems as to processes, e.g. medication substitutions. CONCLUSION: HCPs and patients experience many problems in medication management at transition between settings of care. The fact that these problems occur at different stages and persist over time stresses the necessity for multilevel solutions.

Information on antidepressants for psychiatric inpatients: the divide between patient needs and professional practice.

BACKGROUND: Medicine information is an integral part of patient care and a patient right. In particular, patients with a mental health diagnosis have a need for information on medicines. OBJECTIVE: This study aims to describe the current practice on information provision on antidepressants to inpatients in psychiatric hospitals. METHODS: A qualitative study was conducted consisting of semi-structured interviews with health care professionals (n=46) and patients (n=17) in 11 Flemish psychiatric hospitals. Two topic guides were designed for conducting the interviews with these respective stakeholders. The issues addressed in the topic guides related to: organization of information provision in the hospital, information on demand of the patient, information provision by health care professionals, information for relatives, evaluation of provided information, interdisciplinary contacts on information provision and satisfaction on current practice of information provision. The interviews were analysed according to the five stages of the framework analysis. RESULTS: Psychiatrists and nurses are the key players to provide information on antidepressants. Their approach depends on patient characteristics and mental state. Information is provided mainly orally. Health care professionals consider non-verbal cues of patients to verify if information has been understood. Health care professionals reported lack of time and lack of interdisciplinary contacts as negative aspects. Patients indicated that health care professionals take too little initiative to provide medicine information. CONCLUSIONS: Patients are informed about their antidepressants through various pathways. Although the awareness is present of the importance of the individual approach and efforts are done to tailor information to the individual patient, improvement is still possible. Tailoring communication; assessing patient needs and preferences; matching of health care professional style and patient needs; and achieving concordance, is a complex and challenging task for health care professionals in mental health care.

Information on antidepressants for psychiatric inpatients: the divide between patient needs and professional practice / Información sobre antidepresivos para pacientes psiquiátricos hospitalizados: el espacio entre las necesidades del paciente y la práctica profesional

Background: Medicine information is an integral part of patient care and a patient right. In particular, patients with a mental health diagnosis have a need for information on medicines. Objective: This study aims to describe the current practice on information provision on antidepressants to inpatients in psychiatric hospitals. Methods: A qualitative study was conducted consisting of semi-structured interviews with health care professionals (n=46) and patients (n=17) in 11 Flemish psychiatric hospitals. Two topic guides were designed for conducting the interviews with these respective stakeholders. The issues addressed in the topic guides related to: organization of information provision in the hospital, information on demand of the patient, information provision by health care professionals, information for relatives, evaluation of provided information, interdisciplinary contacts on information provision and satisfaction on current practice of information provision. The interviews were analysed according to the five stages of the framework analysis. Results: Psychiatrists and nurses are the key players to provide information on antidepressants. Their approach depends on patient characteristics and mental state. Information is provided mainly orally. Health care professionals consider non-verbal cues of patients to verify if information has been understood. Health care professionals reported lack of time and lack of interdisciplinary contacts as negative aspects. Patients indicated that health care professionals take too little initiative to provide medicine information. Conclusions: Patients are informed about their antidepressants through various pathways. Although the awareness is present of the importance of the individual approach and efforts are done to tailor information to the individual patient, improvement is still possible. Tailoring communication; assessing patient needs and preferences; matching of health care professional style and patient needs; and achieving concordance, is a complex and challenging task for health care professionals in mental health care (AU)

Antecedentes: La información sobre medicamentos es parte integral de la atención al paciente y un derecho del paciente. En particular, los pacientes con diagnóstico de enfermedad mental necesitan información sobre los medicamentos. Objetivo: Este estudio intenta describir la práctica actual de provisión de información sobre antidepresivos a pacientes psiquiátricos hospitalizados. Métodos: Se realizó un estudio cualitativo consistente en entrevistas semi-estructuradas con profesionales de la salud (n=46) y pacientes (n=17) en 11 hospitales psiquiátricos flamencos. Se diseñaron dos guías de asuntos para realizar las entrevistas con los respectivos decisores. Los asuntos tratados en las guías estaban relacionados con: la organización de la provisión de información en el hospital, información a demanda del paciente, provisión de información por los profesionales de la salud, información para familiares, evaluación de la información proporcionada, contactos interdisciplinarios en la provisión de información, y satisfacción con la práctica actual de provisión de información. Las entrevistas se analizaron de acuerdo a los cinco etapas del análisis contextual. Resultados: Los psiquiatras y enfermeras son los actores principales en la provisión de información sobre antidepresivos. Su abordaje depende de las características del paciente y de su estado mental. La información se proporciona fundamentalmente oral. Los profesionales de la salud tienen en cuenta señales no verbales para verificar si la información fue entendida. Los profesionales reportaron falta de tiempo y falta de contactos interdisciplinarios como aspectos negativos. Los pacientes indicaron que los profesionales de la salud tienen demasiado poca iniciativa en proporcionar información sobre medicamentos. Conclusiones: Los pacientes están informados sobre sus antidepresivos por varios caminos. Aunque existe una conciencia de la importancia del abordaje individual y se realizan esfuerzos para adaptar la información a cada paciente, es posible mejorar. Adaptar la comunicación; evaluar las necesidades y las preferencias del paciente; alcanzar la concordancia son tareas complejas y desafiantes para los profesionales de la salud en cuidados de salud mental (AU)

Differentiated information on antidepressants at hospital discharge: a hypothesis-generating study.

OBJECTIVES: This hypothesis-generating study examined the clinical, humanistic and economic impact of providing differentiated medication information depending on the patient's information desire as compared with undifferentiated information to patients with a major depressive episode at hospital discharge. METHODS: A longitudinal multi-centre study with quasi-experimental design comprised two experimental groups ((un)differentiated antidepressant information) and one 'no information' group. Patients were followed up for 1 year assessing adherence, economic outcomes (i.e. costs of medicines, consultations, productivity loss and re-admissions), clinical outcomes (i.e. depressive, anxiety and somatic symptoms and side effects) and humanistic outcomes (i.e. quality of life, satisfaction with information). A linear model for repeated measures was applied to assess differences over time and between groups. KEY FINDINGS: Ninety-nine patients participated. Still participating 1 year later were 78. No beneficial effect was observed for adherence. Lower productivity loss (P = 0.021) and costs of consultations with healthcare professionals (P = 0.036) were observed in the differentiated group. About one-third of patients were re-admitted within 1 year following discharge. Patients in the 'no information' group had significantly more re-admissions than patients in the undifferentiated group (P = 0.031). CONCLUSIONS: The hypothesis of differentiated information could be supported for economic outcomes only. Future medication therapy intervention studies should apply a more rigorous study design.

Analgesic use and frailty among community-dwelling older people: a population-based study.

BACKGROUND: Frail older people have a decreased ability to respond to stressors and may therefore be more susceptible to adverse events related to inadequately treated pain. Conversely, aging- and frailty-related changes in pharmacokinetics and pharmacodynamics may predispose frail older people to adverse events of analgesics. OBJECTIVE: The aim of this study was to explore whether analgesic use is associated with frailty status and whether there are differences in the types of analgesics used between frailty groups among community-dwelling older people. METHODS: The study population consisted of 605 community-dwelling people aged >75 years. Demographic, diagnostic and drug use data were collected during standardized nurse interviews. Participants were classified as frail, pre-frail or robust using the Cardiovascular Health Study frailty criteria (weight loss, weakness, exhaustion, slowness and low physical activity). RESULTS: Overall, 11.4 % (n = 69) of the study participants were frail and 49.4 % (n = 299) were pre-frail. The prevalence of prescription and non-prescription analgesic use was higher among frail (68.1 %) than among pre-frail (54.5 %) and robust (40.5 %) older people (p < 0.001). In multivariate analyses, frailty was positively associated with analgesic use (odds ratio 2.96; 95 % CI 1.38-6.36). However, frail analgesic users (46.7 %) were more likely to want their physicians to pay greater attention to pain management than robust (23.2 %) analgesic users. The most prevalent analgesic was acetaminophen (paracetamol) among frail (78.7 %) and pre-frail (63.2 %), and NSAIDs among robust (60.4 %) analgesic users. Frail (60.3 %) and pre-frail (58.1 %) participants were more likely to report musculoskeletal pain than robust (44.7 %) participants. Of robust, pre-frail and frail older people 33.0 %, 23.1 % and 4.9 % (respectively) did not use any analgesics to treat their pain. CONCLUSIONS: Frailty was associated with a higher prevalence of analgesic use. As frail older people may be more susceptible to adverse events, careful selection of analgesics is warranted. Clinicians should pay more attention to pain management to ensure adequate pain relief.

Sedative use and incident cognitive decline among persons aged 75 years and older: a population-based longitudinal study.

BACKGROUND: Acute exposure to sedative drugs may induce memory impairment, but there is mixed evidence that long-term sedative use may result in incident cognitive decline. The objective of this study was to investigate the use of sedative drugs and incident cognitive decline in a population-based sample of persons aged 75 years and older. METHODS: The study sample comprised 781 participants in the Geriatric Multidisciplinary Strategy for the Good Care of the Elderly (GeMS) study in Kuopio, Finland. Data on health status, drug use, and sociodemographic factors were elicited during annual nurse interviews from 2004 to 2007. A linear mixed model was used to compare change in Mini-Mental State Examination (MMSE) scores (2005-2007) among users of sedative drugs in 2004 and 2005 (n = 139) to non-users of sedative drugs from 2004 to 2007 (n = 310). The model was adjusted for covariates including age, gender, education, depressive symptoms and antipsychotic use. RESULTS: Unadjusted mean MMSE scores were 27.50 in 2005, 26.58 in 2006, and 25.95 in 2007 among users of sedative drugs. Unadjusted mean MMSE scores were 28.05 in 2005, 27.61 in 2006, and 27.09 in 2007 among non-users of sedative drugs. Adjusted mean MMSE scores were 0.31 points lower in 2005, 0.62 points lower in 2006, and 0.93 lower in 2007 among users compared to non-users of sedative drugs (P = 0.051). CONCLUSIONS: Sedatives were not associated with statistically significant cognitive decline. However, clinicians should maintain a judicious approach to prescribing sedative drugs given the risk of adverse drug events.

Following up patients with depression after hospital discharge: a mixed methods approach.

BACKGROUND: A medication information intervention was delivered to patients with a major depressive episode prior to psychiatric hospital discharge. METHODS: The objective of this study was to explore how patients evolved after hospital discharge and to identify factors influencing this evolution. Using a quasi-experimental longitudinal design, the quantitative analysis measured clinical (using the Hospital Anxiety and Depression Scale, the somatic dimension of the Symptom Checklist 90 and recording the number of readmissions) and humanistic (using the Quality of Life Enjoyment and Satisfaction Questionnaire) outcomes of patients via telephone contacts up to one year following discharge. The qualitative analysis was based on the researcher diary, consisting of reports on the telephone outcome assessment of patients with major depression (n = 99). All reports were analyzed using the thematic framework approach. RESULTS: The change in the participants' health status was as diverse as it was at hospital discharge. Participants reported on remissions; changes in mood; relapses; and re-admissions (one third of patients). Quantitative data on group level showed low anxiety, depression and somatic scores over time. Three groups of contributing factors were identified: process, individual and environmental factors. Process factors included self caring process, medical care after discharge, resumption of work and managing daily life. Individual factors were symptom control, medication and personality. Environmental factors were material and social environment. Each of them could ameliorate, deteriorate or be neutral to the patient's health state. A mix of factors was observed in individual patients. CONCLUSIONS: After hospital discharge, participants with a major depressive episode evolved in many different ways. Process, individual and environmental factors may influence the participant's health status following hospital discharge. Each of the factors could be positive, neutral or negative for the patient.

Change in psychotropic drug use among community-dwelling people aged 75 years and older in Finland: repeated cross-sectional population studies.

BACKGROUND: Older people are at high risk of experiencing psychotropic-related adverse drug events. The objective of this study was to compare and contrast the use of psychotropic drugs among community-dwelling people aged ≥ 75 years in 1998 and 2004. METHODS: Comparable random samples of people aged ≥ 75 years were extracted from the population register in Kuopio, Finland, in 1998 (n = 700) and 2003 (n = 1000). In 1998 and 2004, 523 and 700 community-dwelling people respectively participated in nurse interviews, during which demographic, diagnostic and drug use data were elicited. Logistic regression was used to compute unadjusted and adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for the prevalence of psychotropic drug use in 2004 compared to 1998. RESULTS: The unadjusted prevalence of total psychotropic (37.3% and 38.4%, OR 1.05; 95% CI 0.83-1.33), anxiolytic, hypnotic and sedative (29.6% and 31.3%, OR 1.08, 95% CI 0.85-1.38), and antidepressant (10.7% and 11.9%, OR 1.12, 95% CI 0.78-1.61) use were similar in 1998 and 2004. There was a decrease in the unadjusted prevalence of antipsychotic use (9.2% and 5.7%, OR 0.60; 95% CI 0.39-0.93). After adjusting for socioeconomic and health status differences, there was an increase in the prevalence of total psychotropic (adjusted OR 1.31, 95% CI 1.01-1.70) and antidepressant (OR 1.59, 95% CI 1.06-2.40) use. CONCLUSION: The unadjusted prevalence of psychotropic drug use remained stable between 1998 and 2004. However, in adjusted analyses there was a small increase in the prevalence of any psychotropic drug use and antidepressant use specifically.

Constraints and perspectives of pharmacists counseling patients with depression at hospital discharge.

OBJECTIVE OF THE STUDY: This study aims to explore experiences, barriers and enabling factors during an antidepressant counseling study as well as to explore future initiatives. SETTING: 11 Flemish psychiatric hospitals. METHOD: Focus group discussions were organized. Pharmacists who could not be present at a focus group discussion answered the questions of the interview guide on paper. The focus group discussions were tape recorded, verbatim transcribed and analyzed using NVivo7-software applying a framework approach. MAIN OUTCOME MEASURE: Evaluation of barriers, enabling factors, negative and positive experiences during the study. Suggestions for future initiatives. RESULTS: For experiences, barriers and enabling factors, five categories were identified: individual patient contacts, interdisciplinary contacts, hospital management, study performance and study support. There existed differences in culture between hospitals on how they appreciated the role of the clinical pharmacist. A major difference between hospitals was the interdisciplinary relations. Negative experiences and barriers were: the absence of openness for a role for the pharmacist in the team, difficult interdisciplinary communication, the uncertainty about the time of discharge, the need of patients to tell their story and the timing of the intervention. Positive experiences and enabling factors included the individual focus of the intervention, the position of the pharmacist as a reliable health care professional, the pharmacist as the key person in this study, the integration of the pharmacist in the team, the gained knowledge and skills of the pharmacist and the professional study support. Future initiatives depend upon human and other resources. There is a demand for more information by the patient. A more structured way of working is necessary. The provision of medication information can be performed at different points in time using different formats. CONCLUSION: Participation in a clinical pharmacy study was well appreciated by the pharmacists. Future initiatives were welcomed if they remain feasible within actual job responsibilities.

Discharge management for patients in Flemish psychiatric hospitals.

RATIONALE AND AIMS: At the end of the 1990 s, a case management service called 'discharge management' was implemented in Belgian psychiatric hospitals. This study aimed to describe the profile of patients receiving discharge management in Flemish psychiatric hospitals as well as to analyse the discharge management indicators of these hospitals on micro and meso level. METHODS: Ten Flemish psychiatric hospitals participated. A descriptive analysis of the profile of patients receiving discharge management (gender, age, length of stay, family situation, assistance at home, living environment and Global Assessment of Functioning) and of the indicators of discharge management (screening, interdisciplinary patient file, interdisciplinary meeting, timely announcement of discharge date, transfer of discharge documents, readmission and institutionalization) were carried out. RESULTS: Of the 1306 patients included in the database, one-fourth received discharge management. In general, patients (54% were male) were about 45 years old, stayed for 55 days in hospital, were single and had no aid at home. Most of them came from and returned to their own home. On the micro level of discharge management, nearly all patients were screened and half of them were positively screened. Half of these patients received discharge management. Of the discharged patients who received discharge management (meso level), 13.5% were institutionalized after discharge, 37.6% had been previously admitted and 27.2% received discharge management during that previous admission. Differences between diagnostic groups occurred. CONCLUSION: Hospitals have made efforts to support and prepare patients for discharge, although a number of improvements are suggested for different indicators.

Barriers to medication counselling for people with mental health disorders: a six country study / Barreras al consejo sobre medicamentos para personas con desordenes mentales: un estudio en seis países

Provision of medication information may improve adherence and prevent medication related problems. People with mental health disorders commonly receive less medication counselling from pharmacists than people with other common long term and persistent disorders. Objective: The objective of this study was to compare and contrast barriers pharmacy students perceive toward providing medication counselling for people with mental health disorders in Australia, Belgium, Estonia, Finland, India and Latvia. Methods: Barriers identified by third-year pharmacy students as part of the International Pharmacy Students' Health Survey were content analysed using a directed approach. Students' responses were categorised as pharmacist related, patient related, health-system related, or social or cultural related. Quantitative data were analysed using SPSS version 14.0. Results: Survey instruments were returned by 649 students. Of the respondents, 480 identified one or more barriers to medication counselling for people with mental health disorders. Patient related factors accounted for between 25.3% and 36.2% of barriers identified by the pharmacy students. Pharmacist related factors accounted for between 17.6% and 45.1% of the barriers identified by the pharmacy students. Students in India were more likely to attribute barriers to pharmacist and social and cultural related factors, and less likely to health-system related factors, than students studying in other countries. Conclusion: The nature of barriers identified by pharmacy students differed according to the country in which they studied. Undergraduate and postgraduate pharmacy education programs may need to be amended to address common misconceptions among pharmacy students (AU)

La provisión de información sobre medicamentos puede mejorar la adherencia y prevenir problemas relacionados con los medicamentos. Las personas con desordenes mentales normalmente reciben menos consejos sobre medicación de los farmacéuticos que la gente con otras enfermedades comunes de larga duración. Objetivo: El objetivo de este estudio fue comparar y contrastar las barreras que los estudiantes de farmacia perciben hacia proporcionar consejos de medicación para personas con desordenes mentales en Australia, Bélgica, Estonia, Finlandia, India y Letonia. Métodos: Se realizó un análisis de contenido de abordaje directo de las barreras identificadas pro estudiantes de tercero de farmacia como parte de la Encuesta de Salud de los Estudiantes de Farmacia. Las respuestas de los estudiantes se categorizaron como relativas al farmacéutico, relativas al paciente, relativas al sistema de salud, o relativas a aspectos sociales o culturales. Los datos cuantitativos se analizaron utilizando un SPSS versión 14.0. Resultados: Las encuestas fueron retornadas por 649 estudiantes. De los respondentes, 480 identificaron una o más barreras al consejo sobre medicación para personas con desordenes mentales. Los factores relativos al paciente representaron entre el 25,3% y el 36,2% de las barreras identificadas por los estudiantes. Los factores relativos al farmacéutico alcanzaron el 17,6% a 45,1% de las barreras identificadas. Los estudiantes de India eran más proclives a atribuir barreras al farmacéutico y a los aspectos sociales y culturales, y menos a los factores del sistema de salud que los estudiantes de otros países. Conclusión: La naturaleza de las barreras identificadas por los estudiantes de farmacia difirió entre los países estudiados. Los programas de formación pre y postgraduados en farmacia podrían tener que corregirse para encarar los malos entendidos comunes entre los estudiantes de farmacia (AU)

Barriers to medication counselling for people with mental health disorders: a six country study.

UNLABELLED: Provision of medication information may improve adherence and prevent medication related problems. People with mental health disorders commonly receive less medication counselling from pharmacists than people with other common long term and persistent disorders. OBJECTIVE: The objective of this study was to compare and contrast barriers pharmacy students perceive toward providing medication counselling for people with mental health disorders in Australia, Belgium, Estonia, Finland, India and Latvia. METHODS: Barriers identified by third-year pharmacy students as part of the International Pharmacy Students' Health Survey were content analysed using a directed approach. Students' responses were categorised as pharmacist related, patient related, health-system related, or social or cultural related. Quantitative data were analysed using SPSS version 14.0. RESULTS: Survey instruments were returned by 649 students. Of the respondents, 480 identified one or more barriers to medication counselling for people with mental health disorders. Patient related factors accounted for between 25.3% and 36.2% of barriers identified by the pharmacy students. Pharmacist related factors accounted for between 17.6% and 45.1% of the barriers identified by the pharmacy students. Students in India were more likely to attribute barriers to pharmacist and social and cultural related factors, and less likely to health-system related factors, than students studying in other countries. CONCLUSION: The nature of barriers identified by pharmacy students differed according to the country in which they studied. Undergraduate and postgraduate pharmacy education programs may need to be amended to address common misconceptions among pharmacy students.