A Qualitative Evaluation Of A Community Pharmacist-led Support Service For People Living With Severe And Persistent Mental Illness – Experiences From Implementing The Pharmibridge Rct

• By: NG, Ricki (The University Of Sydney, Australia)
• Co-author(s): Ms Ricki Ng (The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia)
  Dr Sarira El-Den (The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia)
  Dr Jack Collins (The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia)
  Prof Amanda J Wheeler (Centre for Mental Health and Menzies Health Institute Queensland, Griffith University, Brisbane, Australia / Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand)
  Dr Sara S McMillan (Centre for Mental Health and Menzies Health Institute Queensland, Griffith University, Brisbane, Australia / School of Pharmacy and Medical Sciences, Griffith Health, Griffith University, Gold Coast, Australia)
  Ms Victoria Stewart (Centre for Mental Health and Menzies Health Institute Queensland, Griffith University, Brisbane, Australia)
  A/Prof Claire L O’Reilly (The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia)
  
• Abstract:

  Background information
  People living with severe and persistent mental illness (SPMI) have reduced life expectancy compared to the general population, which is often attributed to physical comorbidities, as well as disparities in healthcare access, utilisation and provision. Community pharmacists, as one of the most accessible healthcare professionals, can help support and manage mental and physical health problems experienced by people living with SPMI. The PharMIbridge (Bridging the Gap between Physical and Mental Illness in Community Pharmacy) Randomised Controlled Trial (RCT) aimed to evaluate the effectiveness of a pharmacist-led support service for this population. Fifty-one participating pharmacies were randomised to the Intervention Group (IG) or Comparator Group (CG). Pharmacists in the IG delivered the individualised, goal-oriented pharmacy service (PharMIbridge) while CG pharmacists delivered standard care (MedsCheck, a one-off medication management service). IG pharmacists were also supported by mentors who were experienced community pharmacists or mental health consumers, during PharMIbridge training and throughout the PharMIbridge service implementation.
  Purpose
  To explore pharmacists’ and mentors’ experiences of implementing the PharMIbridge service, explore supports needed for implementation and propose ideas for pharmacist-led services for people living with SPMI.
  Method
  Semi-structured interviews and focus groups were conducted with PharMIbridge participating IG pharmacists and mentors, respectively. Audio-recordings were de-identified and transcribed verbatim. Qualitative data was inductively analysed using thematic analysis, then deductively coded to the EPIS (Exploration, Preparation, Implementation and Sustainment) framework.
  Results
  Sixteen interviews were conducted with participating IG pharmacists. Six mentors participated in the focus group. Qualitative data was broadly classified into two main themes: external (healthcare system, mental health training and policy) and internal (pharmacy operations) barriers and facilitators affecting implementation. Themes generated from the interviews aligned closely with themes from the focus group. This study focuses on three of the four EPIS phases: Preparation, Implementation and Sustainment. The ‘Preparation’ phase focused on the suitability of work environments and training needs prior to service delivery. Challenges identified in the ‘Implementation’ stage included pharmacy operational difficulties including time constraints, pharmacy staffing requirements, inadequate referral pathways from pharmacies to mental health services and/or professionals and limited public awareness of pharmacists’ roles in mental healthcare. Concerns hindering the ‘sustainment’ phase included the lack of time and resources in the pharmacy, policy, funding and public awareness for pharmacist-led mental health services. Continued mental health education for pharmacists was thought to be a potential facilitator of sustainability of such a service.
  Conclusion
  Barriers and facilitators for implementing mental health services in community pharmacies were identified. Policy changes, adequate remuneration and adjustments to the current mental healthcare system are necessary to build and sustain functioning, integrated mental health pharmacy services. More public education is needed to raise consumers’ awareness about pharmacists’ potential roles in mental healthcare.
  Funding/Registration. This activity received grant funding from the Australian Government Department of Health and Aged Care. Registration: ACTRN12620000577910.