Community pharmacists can liaise and have a collaborative role with Community Mental Health Teams, making joint domiciliary visits with the key worker, to assist elderly patients and carers with the management of medicines and related problems.

Background
In 1997 the Department of Health funded pilot projects to examine the wider role of community pharmacists. The aim of this project is to investigate if pharmacists, liaising with Community Mental Health Teams, can improve the management of medicines and compliance with treatment of mental illness in elderly patients.

Method
It is a randomised controlled study and 24 pharmacists received 2½ days of specialised training. The Community Mental Health Teams (CMHT) have referred patients into the study. Patient interviews of open questions, an Abbreviated Mental Test (AMT) and a HONOS (Health of the Nation Outcome Scales) score sheet was completed by the key worker. At this point two groups of patients were randomised. An active group - where the patients received one/more domiciliary visits(s) from a pharmacist. A control group - where patients received no additional input other than the care normally received from the CMHT.

The pharmacist liaised with the CMHT, GP and dispensing pharmacist before making a joint domiciliary visit with the patient's key worker. The pharmacist reviewed the patient's medication, counselled on the use of medicines, side effects and the importance of adherence. A pharmaceutical care plan was developed and given to the parent and/or carer, key worker and GP. Any clinical interventions were made where necessary.

A repeat of the interview and assessments were completed at the end of the study.

Results
52 patients have been entered into the study of whom 21 have dementia, 27 have depression and/or anxiety and 4 patients have other illnesses. The mean age was 75years and the average number of regular oral medicines was 5 (range from 2 to11). Approximately half of the patients lived alone and half of the patients were confused. Over three-quarters of the patients had no contact with a pharmacist or pharmacy. Over half of the patients were self medicating and many of these were complying poorly with medication. 26 patients were randomised into the active group and received one/more visits from a community pharmacist.

A total of 100 interventions were made for 26 patients (30 of these involved the prescriber and 90% were accepted) and those of major clinical significance included:
Omission of lunch time doses of medications, the use of a NSAID in a patient with asthma and gastric irritation, mistaken double dosing of antidepressant medication by a patient, the use of a hormone preparation causing side effects, informing the GP of a potentially hazardous drug interaction and reassuring a severely depressed non- compliant patient.

Discussion
The results show that these patients benefited from the visits and there is a role for pharmacists to liaise with the CMHTs and assist patients and carers with the management of medicines. All the key workers would like a domiciliary visiting service provided on a long- term basis. The Psychiatrists with patients in the study have all stated that pharmacists are a very valuable addition to the CMHTs. Patient numbers were not as high as expected due to the inhibiting presence of a control group and a second phase of the study, without a control group, is due to start soon. This project was recently the runner up in the community care section of the 1998 Pharmaceutical Care Awards.