Collaborative prescribing: a qualitative exploration of a role for pharmacists in mental health.

BACKGROUND: Collaborative prescribing has been proposed as an extension of practice for advanced pharmacist practitioners. A lack of research investigating how pharmacists might be most effective as prescribers in mental health was identified. OBJECTIVE: To explore health professionals' and consumers' attitudes and beliefs that relate to the role of specialist mental health pharmacists working as collaborative prescribers within their advanced scope of practice in secondary care. METHODS: Semistructured interviews were conducted with key informants in the New Zealand mental health sector. Participants were selected via a purposive sampling method, including health professionals (n=9) and consumers (n=3). NVivo software was used to analyze data, using a thematic analysis approach to develop a series of key themes from the interviews. Common themes were extracted, which were used to gather results and draw conclusions. RESULTS: The key findings include a widespread acknowledgment of the role of specialist pharmacists as collaborative prescribers in mental health and as integral members of the multidisciplinary team; however, consumers were unaware of pharmacists' role in secondary care. The role was seen to extend current practice particularly in medication management after assessment and diagnosis by a medical practitioner. Concerns regarding demonstrating competence, practitioner role/boundary confusion, insufficient training and workforce development, hesitancy by pharmacists to extend role, consumer awareness, and public perception of the traditional pharmacist role were identified. Solutions discussed included education by the profession; relationship building, training, and robust competency assessments; and a structured framework for implementing a collaborative prescribing model. CONCLUSIONS: This study suggests there was recognition and acceptance of the role that specialist pharmacist practitioners could play in contributing to the care of mental health consumers as collaborative prescribers; their medication expertise being regarded highly. Further research is necessary to investigate how current resource constraints will allow for collaborative prescribing to be implemented within the context of mental health practice.

New Zealand community pharmacists' views of their roles in meeting medicine-related needs for people with mental illness.

BACKGROUND: Mental illness is common among the New Zealand population. Several roles have been identified for community pharmacists in providing care to people with mental illness; however, the specifics of these roles have not been studied in New Zealand. OBJECTIVES: To explore the services currently provided by community pharmacists, the barriers that may be encountered, and possible solutions when providing care to people with mental illness. METHODS: Community pharmacists across the North Island of New Zealand, who expressed a special interest in mental health or had a clozapine-dispensing contract, were invited to participate. Eleven participants were interviewed using a semistructured format guided by principles of inductive analysis. Using a thematic approach, transcripts from the interviews were analyzed with the assistance of NVivo 7® (QSR International Pty Ltd 2007). RESULTS: Four major themes were identified: provision of care, relationships, challenges within the health care system and resources, and future roles for pharmacists. Provision of care was associated with the type of services pharmacists provided, patient-focused care, family involvement, education, psychological support, referrals, and culturally appropriate practice. Building effective relationships was described by participants as adopting a nonjudgmental and culturally sensitive manner, respecting patient privacy, spending more time with patients, and using varied communication techniques. Significant challenges involved working at the end of the health care chain, inadequate patient information and contact time, prescription and payment issues, and difficulties ensuring compliance with medication. Participants identified education, support, and funding as resources that needed to be improved. Their perspectives about future roles of the pharmacists included providing more education and acting as medicine managers for patients. CONCLUSIONS: Pharmacists provided a variety of services to people with mental illness despite the barriers they encountered. If the roles of community pharmacists within mental health were to be expanded, solutions to these barriers would need to be identified and implemented.