The impact of a pharmacist assisted clinic upon medication adherence and quality of life in mental health patients

Abstract

*Objectives: To determine if a pharmacist assisted psychiatric clinic would improve adherence to medications and quality of life over 6 months. The primary study endpoints were the change from baseline in Medication Adherence Rating Scale (MARS), Brief Evaluation of Medication Influences and Beliefs (BEMIB), World Health Organization Quality of Life -BREF (WHOQOL-BREF) scales as well as hospitalizations and emergency room visits. Secondary endpoints included metabolic and physiologic parameters. Methods: A prospective, single-center study conducted at an outpatient psychiatric clinic. Subjects were required to attend 3 clinic visits (baseline, 3 and 6 months) with the pharmacist. Subject and medication histories were obtained at each visit. Subjects' records within the local health system were reviewed for emergency room visits and hospitalizations. Metabolic parameters were assessed at each visit. Results: Twenty-seven subjects enrolled and twenty subjects completed. Total MARS score at baseline and study end were 7.90 and 8.65, respectively. At baseline, 10 (50%) were nonadherent based on the BEMIB and 9 (45%) were nonadherent at 6 months. Statistically significant improvements were seen in 2 domains of the WHOQOL-BREF. Reductions in both ER visits and hospitalizations were achieved. There were significant improvements in total cholesterol and LDL. Conclusions: Improvements were seen in two domains of the WHOQOL-BREF -physical capacity and psychological well-being over the 6 month period. While improvements were seen in various rating scales, due to small sample sizes, these were insignificant improvements. Reductions in hospitalizations and ER visits were also seen during the study and up to 6 months post study. Statistically significant improvements were also seen in both total cholesterol and LDL. The lack of improvement in many of the study outcomes reflects Se solicitó a las personas que acudiesen a 3 visitas a la clínica con el farmacéutico (inicio, 3 y 6 meses). En cada visita se recogió las historias clínicas y medicamentosas. Se revisaron las fichas de los pacientes en el sistema local de salud para las visitas a urgencias y hospitalizaciones. En cada visita se evaluaron los parámetros metabólicos. Resultados: Se evaluó a 27 individuos y 20 completaron el estudio. Las puntuaciones del MARS al inicio y al final fueron 7,90 y 8,65, respectivamente. En el inicio, 10 (50%) eran incumplidores, basándose en el BEMIB y 9 (45%) fueron incumplidores a los 6 meses. Se encontraron mejoras estadísticamente significativas en 2 dominios del WHOQOL-BREF. Se consiguieron reducciones tanto en visitas a urgencias como hospitalizaciones. Hubo mejoras significativas en colesterol total y LDL. Conclusiones: Se encontraron mejoras en dos dominios del WHOQOL-BREF -capacidad física y bienestar psicológico durante el periodo de 6 meses. Aunque se encontraron mejora en varias escalas, debido a los pequeños tamaños de muestra, no fueron significativas. Se vieron reducciones en Lizer MH, Parnapy Jawaid SA, Marsh W, Mogi...

Photovoice as an intervention for college students living with mental illness: A pilot study

“…The MARS was chosen due to its simplicity as well as its prior use and validation in psychiatric patient populations. 26 - 28 Higher scores are associated with higher likelihood of medication adherence. An exit questionnaire was also completed.…”

The role of pharmacy in the management of cardiometabolic risk, metabolic syndrome and related diseases in severe mental illness: a mixed-methods systematic literature review

“…Coordinate care with other healthcare providers, including those not part of the mental health care team - included recommendations made to primary healthcare providers on non-psychiatric issues including blood pressure, diabetes control (12 times). The interventions/recommendations were part of a study involving a comprehensive medicines management service provided by a pharmacist Lizer, 2011, USA [ 102 ] Pharmacist assisted psychiatric clinic to improve adherence to medications and quality of life over 6 months. Pharmacist (not further specified) Psychiatric outpatient clinic Quant Prospective single centre pilot study: quasi 27 individuals > 18 years with axis I diagnosis: 11 (41%) bipolar disorder 9 (33%) depression, 7 (26%) other (not stated) receiving at least one scheduled medication for mental illness.…”

“…Figure 2 shows the key components of the healthcare pathway for CMR, MetS and related diseases and the role of pharmacy at each key component; fourteen studies [ 73 , 79 – 81 , 83 , 84 , 86 , 87 , 89 – 91 , 93 , 100 , 102 ] included pharmacists in more than one key component. Twenty-seven [ 75 , 79 – 81 , 83 , 84 , 86 , 87 , 89 – 91 , 93 – 95 , 97 – 102 , 104 ] of the 33 studies included direct (e.g. pharmacist undertaking screening such as weight measurements or blood tests) and indirect (e.g.…”

“…MetS [ 73 , 79 – 81 , 83 , 84 , 86 , 87 , 89 , 100 ]. Ten studies [ 73 , 79 – 81 , 86 , 87 , 90 , 91 , 93 , 102 ] included a clinical intervention for health promotion or risk reduction delivered directly by pharmacist to the patient. Five [ 79 , 81 , 86 , 90 , 91 ] also included pharmacists referring to external care professional/service as a result of identification of risk, abnormal result or diagnosis of disorder.…”

“…The randomised controlled study [84] identified for this review scored poorly (25%) due to lack of description of participant allocation, < 80% reporting of outcome data and a high rate participant attrition (> 20%). Quasi experimental approaches were utilised in thirteen [86,88,92,94,95,[97][98][99][100][101][102][103][104] of the quantitative, outcome studies, (n=12) [86, 88, 92, 94, 95, 97-101, 103, 104] of these scored more than 50%. Seventy-one percent [71,85,87,90,91,93] (n = 5) of the quantitative descriptive studies scored 50% or more.…”