Evaluation of mental health care interventions made by three community pharmacists — a pilot study

Abstract

Abstract 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 % 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. Conclusions 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.