Introduction

In a previous study, experts reviewed the interventions made by 3 community pharmacists to 30 mentally ill adults. 84 (91%) problems had appropriate interventions and in 35% of problems the 3 reviewers agreed that the interventions were clinically significant (1).

This study aims to evaluate the appropriateness and clinical significance of interventions by pharmacists to 53 older people under the care of a Community Mental Health Team.

Method

24 pharmacists received 2½ days of specialised training. They made one/more joint domiciliary visit(s) with the patient's key worker. As well as assessing needs, they reviewed the older patient's medication, counselled on the use of medicines, side effects and adherence. A pharmaceutical care plan was developed and clinical interventions were made where necessary.

Three experts (one lead consultant psychiatrist and two specialist psychiatry 'elderly' hospital pharmacists) assessed the appropriateness and degree of clinical significance of the interventions.

Results

54 patients received one/more domiciliary visit(s) from a pharmacist.

183 interventions were made for a total of 53 patients. 60 interventions involved the prescriber (GP or Psychiatrist) and 51 (85%) were accepted and actioned i.e. changes were made.

The visiting pharmacists classed 16 interventions as of major clinical significance including: the use of a NSAID in a patient with asthma and gastric irritation, mistaken double dosing of antidepressant medication and taking warfarin from a bottle containing 1mg and 3mg tablets.

The 3 expert peer reviewers considered that all 183 interventions were appropriate, with the exception of one reviewer who was uncertain about one intervention. They graded 54% to 60% of the interventions as medium (III) or major (IV) clinical significance. However, the specialist pharmacists made nine comments concerning opportunities missed by the visiting pharmacists. These included not querying a large dose of one medication, not suggesting a change in frequency of dosage of carbamazepine and not rationalising two different brands of lithium.

Table 1: Peer Reviewing of the Clinical Significance of the Interventions

Conclusions

These results are comparable with a previous study (1). All three expert reviewers agreed that the pharmacists had made appropriate interventions for all patients. However, they identified a few cases where opportunities, for making further interventions, had been missed. They commented that the interventions had improved safety and reliability with administration of medicines to a vulnerable group of people and a few had addressed potentially serious problems.

References

1 Ewan MA, Greene RJ. Evaluation of mental health care interventions made by three community pharmacists - a pilot study. Int J Pharm Pract 2001;9: 225-234

2 Altman DG. Practical Statistics for Medical Research. Chapman and Hall, 1991.