Pharmacist-led interventions for people living with severe and persistent mental illness: A systematic review

Abstract

Objective: People living with severe and persistent mental illness experience poorer physical health, often due to medication and preventable lifestyle factors, and exacerbated by barriers to accessing healthcare services. Pharmacists are well-positioned to improve the physical and mental health of this population. However, little is known about pharmacists’ current practices when providing services to this population nor the impact of pharmacist-led interventions on consumer health outcomes. We undertook a systematic review to identify, describe and assess the effectiveness of pharmacist-led interventions for supporting people living with severe and persistent mental illness and the impact on consumer outcomes. Methods: MEDLINE, Embase, PsycINFO, CINAHL, Web of Science, Scopus, Cochrane Library, International Pharmaceutical Abstracts and ProQuest Dissertations and Theses were searched between January 1990 and April 2020. Full-text studies exploring pharmacist-led interventions in any setting for people living with severe and persistent mental illness were included. A risk of bias assessment was conducted. Results: A total of 37 studies were included. More than half of the pharmacist interventions were multifaceted. The most common components of pharmacist-led interventions included education and/or patient counselling, providing recommendations to healthcare professionals and conducting medication reviews. Multifaceted interventions demonstrated improvements in clinical outcomes, whereas single interventions focused mostly on consumer-reported outcomes. The methodological quality of included studies was moderate-to-high risk of bias and there was considerable heterogeneity in the study design, interventions described, and outcomes reported. Conclusion: There is evidence that pharmacist-led interventions improve consumer-reported and clinical outcomes for people living with severe and persistent mental illness. Pharmacists are capable and have a role in supporting people living with severe and persistent mental illness, either individually or as interprofessional collaborators with other healthcare professionals. Future research should attempt to better understand which particular intervention components have the greatest impact and also evaluate the implementation and long-term sustainability of such interventions.

A qualitative exploration of mental health services provided in community pharmacies

“…Pharmacists’ specific skills and drug knowledge were highlighted key facilitators in providing quality mental health care. The positive clinical impact of pharmacists’ role in mental health has been previously demonstrated in the literature [ 42 – 44 ]. Consequently, another study found that pharmacist-led mental health adherence interventions for consumers with type 2 diabetes significantly improved psychotropic medication adherence in adult consumers [ 45 ].…”

Impact of a clinical pharmacist on medication safety in mental health Hospital-in-the-Home: a retrospective analysis

“…To our knowledge, this is the first study to evaluate the contribution of a CP to medication safety within an MH-HiTH program. While CP home visits improve patient outcomes [ 26 ] and CP interventions improve outcomes specifically in patients with severe and persistent mental illness [ 27 ], there is still no published evidence of the value of the CP in MH-HiTH setting, which involves various pharmacist interventions including home visits. This study found that the MH-HiTH program incorporating a CP had a higher rate of achievement of most medication safety KPIs evaluated than the MH-HiTH program without a CP.…”

“…A recent systematic review by Abbott, et al [ 26 ], reviewing RCTs from various settings but none relating to mental health, found no evidence that pharmacist home visits to patients at risk of medication-related problems improved hospital admission or mortality rates; Abbott, et al remarked that medication-related hospital admissions would have been a more appropriate outcome measure. Yet, a more recent systematic review by Ng et al [ 27 ] found that pharmacist-led interventions improve MH patient outcomes. Even though this systematic review searched for RCTs from all healthcare settings, none from MH-HiTH were presented in it.…”

“…MH-HiTH has evolved in recent times as a “non-traditional” practice setting for CPs. While there has been recent evidence to demonstrate the value of CP home visits on improving patient outcomes [ 26 ] and other robust evidence to demonstrate the utility of CP interventions in improving clinical outcomes in patients with severe and persistent mental illness [ 27 ], there is still a gap of published evidence relating specifically to the MH-HiTH setting [ 21 ], which involves elements of both home visits and other pharmacist interventions in people with mental illness. Hence this study was undertaken to compare achievement of medication safety key performance indicators (KPIs) between 2 similar MH-HiTH programs: 1 incorporating a CP and 1 without.…”

Workforce development for better management of physical comorbidities among people with serious mental illness

“…Australian and international evidence suggests that introducing structured pharmacist interventions in different settings can improve the effectiveness and cost‐effectiveness of managing chronic diseases 12‐15 . Common intervention components for patients with serious mental illness include medication reconciliation, patient education, adherence and self‐monitoring interventions to support prescribing, medication reviews followed by medication‐related recommendations to prescribers, therapeutic drug monitoring, dose titration, and screening and monitoring for cardiometabolic risk factors 12 . There is strong evidence that interventions by pharmacists are feasible and acceptable for people with serious mental illness in Australia and elsewhere 16‐18 .…”