The relationship between medication-related problems and behavioural health condition among patients served by a health care for the homeless centre

Abstract

Objectives To evaluate the association between behavioural health conditions and the presence of a medication‐related problem (MRP) and the association between the type of MRP and the presence of a dual diagnosis. Methods We used an existing database from a behavioural health clinic for homeless persons. Logistic regression was used to assess the relationship between the type of behavioural health condition and MRP presence, and whether the type of MRP varied with the presence of a dual diagnosis. Key findings A total of 426 patients were eligible. The majority were black (61%) and women (53%). Patients were 44.7 ± 10.2 years old, taking 3.4 ± 2.4 medications and had 2.3 ± 0.9 behavioural health conditions. The majority (53%) had a dual diagnosis, 44% had depression, 30% had a bipolar disorder, 26% had a personality disorder and 12% had an anxiety disorder. Bipolar [odds ratio (OR) 4.0, 95% confidence interval (CI) 1.8–8.9] and anxiety disorders (OR 3.1, CI 1.0–9.2) and a dual diagnosis (OR 2.1, CI 1.2–3.8) were independently associated with the presence of an MRP. Patients with a dual diagnosis were more likely to have ineffective drug therapy (OR 1.7, CI 1.1–2.8) and less likely to have an adverse effect (OR 0.5, CI 0.3–0.9). Conclusions Patients with bipolar or anxiety disorders and/or a dual diagnosis may benefit from a pharmacist intervention to address MRPs. Pharmacists can make recommendations to improve the effectiveness of patients' medication therapy and help to resolve adverse effects.

Medication adherence challenges among patients experiencing homelessness in a behavioral health clinic

“…24,25 The database included sociodemographic, health-related information, and the number and type of medication-related problems identified during a pharmacist-provided medication review conducted between October 2008–September 2009. Clinical faculty pharmacists and community pharmacy practice residents who practiced in this HCH’s behavioral health clinic provided the medication review.…”

“…Patients experiencing or at risk of homelessness who were ≥ 18 years old with at least one behavioral health condition who had a medication review were eligible for the study. 24,25 …”

“…24,25 A patient was considered nonadherent to medications if they self-reported during the interview that they were not taking the medication as prescribed and nonadherence was included in the final problem list in the pharmacist’s note. 24,25 …”

Homeless people: a review of personality disorders

“…In addition, the presence of PD in the homeless is linked to several factors: poorer rates of adherence and completion of psychiatric and therapeutic treatment ( 63 ), worse outcomes for treatment of depression, and an increased risk of deliberate self-harm ( 8 ), insecure types of attachment that may impact intervention strategies ( 10 ), acting as a barrier to the formation of a therapeutic alliance ( 64 ), influencing the benefits of therapeutic approaches ( 19 ), and contributing to comorbidity in dual diagnosis that may benefit from pharmacist intervention to address medication-related problems ( 65 ).…”

Concordance of Pharmacist Assessment of Medication Nonadherence With a Self-Report Medication Adherence Scale

“…This retrospective, cross-sectional study examined the electronic medical records (EMRs) of patients who received a medication review by a pharmacist from October 2008 to September 2009 and used portions of an existing database. 14,15 Eligibility criteria included patients 18 years and older with a mental health and/or substance abuse diagnosis who received at least 1 medication review by a pharmacist in the behavioral health clinic at a health care for the homeless center and had recorded responses to at least the first 4 questions of the 6-item MMS.…”