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1.  Validation of a survey tool to assess the patient safety attitudes of pharmacy students 
BMJ Open  2015;5(9):e008442.
Patient safety education is a key strategy to minimise harm, and is increasingly being introduced into junior pharmacy curricula. However, currently there is no valid and reliable survey tool to measure the patient safety attitudes of pharmacy students. This study aimed to validate a modified survey tool, originally developed by Madigosky et al, to evaluate patient safety attitudes of junior pharmacy students.
A 23-item cross-sectional patient safety survey tool was utilised to evaluate first and second year pharmacy students’ attitudes during May 2013 with both exploratory and confirmatory factor analyses performed to understand the psychometric properties of the survey tool and to establish construct validity.
Undergraduate university students in Sydney, Australia
245 first year and 201 second year students enrolled in the Bachelor of Pharmacy Programme at The University of Sydney, Australia in May 2013.
After exploratory factor analysis on first year student responses (55.76% variance explained) and confirmatory factor analysis on second year responses, a 5-factor model consisting of 14 items was obtained with satisfactory model fit (χ2 (66)=112.83, p<0.001, RMSEA=0.06, CFI=0.91) and nesting between year groups (Δχ2(7)=3.079, p=0.878). The five factors measured students’ attitudes towards: (1) being quality improvement focused, (2) internalising errors regardless of harm, (3) value of contextual learning, (4) acceptability of questioning more senior healthcare professionals’ behaviour and (5) attitude towards open disclosure.
This study has established the reliability and validity of a modified survey tool to evaluate patient safety attitudes of pharmacy students, with the potential for use in course development and evaluation.
PMCID: PMC4567665  PMID: 26359285
PRIMARY CARE; EDUCATION & TRAINING (see Medical Education & Training)
4.  New Roles for Pharmacists in Community Mental Health Care: A Narrative Review 
Medicines are a major treatment modality for many mental illnesses, and with the growing burden of mental disorders worldwide pharmacists are ideally positioned to play a greater role in supporting people with a mental illness. This narrative review aims to describe the evidence for pharmacist-delivered services in mental health care and address the barriers and facilitators to increasing the uptake of pharmacist services as part of the broader mental health care team. This narrative review is divided into three main sections: (1) the role of the pharmacist in mental health care in multidisciplinary teams and in supporting early detection of mental illness; (2) the pharmacists’ role in supporting quality use of medicines in medication review, strategies to improve medication adherence and antipsychotic polypharmacy, and shared decision making; and (3) barriers and facilitators to the implementation of mental health pharmacy services with a focus on organizational culture and mental health stigma. In the first section, the review presents new roles for pharmacists within multidisciplinary teams, such as in case conferencing or collaborative drug therapy management; and new roles that would benefit from increased pharmacist involvement, such as the early detection of mental health conditions, development of care plans and follow up of people with mental health problems. The second section describes the impact of medication review services and other pharmacist-led interventions designed to reduce inappropriate use of psychotropic medicines and improve medication adherence. Other new potential roles discussed include the management of antipsychotic polypharmacy and involvement in patient-centered care. Finally, barriers related to pharmacists’ attitudes, stigma and skills in the care of patients with mental health problems and barriers affecting pharmacist-physician collaboration are described, along with strategies to reduce mental health stigma.
PMCID: PMC4211017  PMID: 25337943
pharmacist; mental health care; quality use of medicines; community pharmacy; service implementation
5.  Drug Burden Index in older adults: theoretical and practical issues 
Anticholinergic and sedative medications are commonly used in older adults and are associated with adverse clinical outcomes. The Drug Burden Index was developed to measure the cumulative exposure to these medications in older adults and its impact on physical and cognitive function. This narrative review discusses the research and clinical applications of the Drug Burden Index, and its advantages and limitations, compared with other pharmacologically developed measures of high-risk prescribing.
Video abstract
PMCID: PMC4166346  PMID: 25246778
Drug Burden Index; anticholinergics; sedative medications; high-risk prescribing; older adults; pharmacological risk assessment tools; deprescribing
6.  Adherence to antidepressant medications: an evaluation of community pharmacists’ counseling practices 
Recent studies have shown that pharmacists have a role in addressing antidepressant nonadherence. However, few studies have explored community pharmacists’ actual counseling practices in response to antidepressant adherence-related issues at various phases of treatment. The purpose of this study was to evaluate counseling practices of community pharmacists in response to antidepressant adherence-related issues.
A simulated patient method was used to evaluate pharmacist counseling practices in Sydney, Australia. Twenty community pharmacists received three simulated patient visits concerning antidepressant adherence-related scenarios at different phases of treatment: 1) patient receiving a first-time antidepressant prescription and hesitant to begin treatment; 2) patient perceiving lack of treatment efficacy for antidepressant after starting treatment for 2 weeks; and 3) patient wanting to discontinue antidepressant treatment after 3 months due to perceived symptom improvement. The interactions were recorded and analyzed to evaluate the content of consultations in terms of information gathering, information provision including key educational messages, and treatment recommendations.
There was variability among community pharmacists in terms of the extent and content of information gathered and provided. In scenario 1, while some key educational messages such as possible side effects and expected benefits from antidepressants were mentioned frequently, others such as the recommended length of treatment and adherence-related messages were rarely addressed. In all scenarios, about two thirds of pharmacists explored patients’ concerns about antidepressant treatment. In scenarios 2 and 3, only half of all pharmacists’ consultations involved questions to assess the patient’s medication use. The pharmacists’ main recommendation in response to the patient query was to refer the patient back to the prescribing physician.
The majority of pharmacists provided information about the risks and benefits of antidepressant treatment. However, there remains scope for improvement in community pharmacists’ counseling practice for patients on antidepressant treatment, particularly in providing key educational messages including adherence-related messages, exploring patients’ concerns, and monitoring medication adherence.
PMCID: PMC3754825  PMID: 23986631
simulated patients; antidepressant medications; medication adherence; community pharmacist
7.  Consumer-led Mental Health Education for Pharmacy Students 
To evaluate a consumer-led teaching intervention to reduce pharmacy students' stigma towards depression and schizophrenia, and improve attitudes toward providing pharmaceutical care for consumers with mental illness.
Third-year bachelor of pharmacy degree students were given a series of mental health lectures, undertook supervised weekly placements in the community pharmacy setting, and attended a tutorial led by trained mental health consumer educators.
A previously validated 26-item survey instrument was administered at baseline, 6 weeks postintervention, and 12 months postintervention, and 3 focus groups were conducted. Survey instruments were completed by 225 students at baseline, 230 students postintervention, and 228 students at 12 months. Students' stigma decreased (p < 0.05) and their attitudes toward the provision of pharmaceutical services to consumers with a mental illness showed significant improvements (p < 0.05). These improvements were maintained at the 12-month follow-up. Four themes emerged from the focus groups: knowledge and experience of mental illness, mental health stigma, impacts on attitudes and self-reported behavior, and the role of the pharmacist in mental healthcare.
Consumer-led education for pharmacy students may provide a sustainable reduction in stigma and improve attitudes towards providing pharmaceutical services to consumers with a mental illness.
PMCID: PMC2996757  PMID: 21301601
consumer; attitude; stigma; depression; schizophrenia; mental health; pharmacy student
8.  Barriers to medication counselling for people with mental health disorders: a six country study 
Pharmacy Practice  2010;8(2):122-131.
Provision of medication information may improve adherence and prevent medication related problems. People with mental health disorders commonly receive less medication counselling from pharmacists than people with other common long term and persistent disorders.
The objective of this study was to compare and contrast barriers pharmacy students perceive toward providing medication counselling for people with mental health disorders in Australia, Belgium, Estonia, Finland, India and Latvia.
Barriers identified by third-year pharmacy students as part of the International Pharmacy Students’ Health Survey were content analysed using a directed approach. Students’ responses were categorised as pharmacist related, patient related, health-system related, or social or cultural related. Quantitative data were analysed using SPSS version 14.0.
Survey instruments were returned by 649 students. Of the respondents, 480 identified one or more barriers to medication counselling for people with mental health disorders. Patient related factors accounted for between 25.3% and 36.2% of barriers identified by the pharmacy students. Pharmacist related factors accounted for between 17.6% and 45.1% of the barriers identified by the pharmacy students. Students in India were more likely to attribute barriers to pharmacist and social and cultural related factors, and less likely to health-system related factors, than students studying in other countries.
The nature of barriers identified by pharmacy students differed according to the country in which they studied. Undergraduate and postgraduate pharmacy education programs may need to be amended to address common misconceptions among pharmacy students.
PMCID: PMC4133066  PMID: 25132880
Mental Disorders; Community Pharmacy Services; Attitude of Health Personnel; Australia; Belgium; Estonia; Finland; India; Latvia
9.  Concordance is not synonymous with compliance or adherence 
PMCID: PMC2203263  PMID: 17875196
10.  When pharmacotherapeutic recommendations may lead to the reverse effect on physician decision-making 
Pharmacy World & Science   2007;30(1):3-8.
For long the medical literature has shown that patients do not always receive appropriate care, including pharmacotherapeutic treatment. To achieve improved patient care, a number of physician-oriented interventions are being delivered internationally in an attempt to implement evidence based medicine in routine daily practice of medical practitioners. The pharmacy profession has taken an active role in the delivery of intervention strategies aimed at promoting evidence based prescribing and improved quality and safety of medicine use. However, the medical literature also supports the notion that valid clinical care recommendations do not always have the desired impact on physician behaviour. We argue that the well-established theory of psychological reactance might at least partially explain instances when physicians do not act upon such recommendations. Reactance theory suggests that when recommended to take a certain action, a motivational state compels us to react in a way that affirms our freedom to choose. Often we choose to do the opposite of what the recommendation is proposing that we do or we just become entrenched in our initial position. The basic concepts of psychological reactance are universal and likely to be applicable to the provision of recommendations to physicians. Making recommendations regarding clinical care, including pharmacotherapy, may carry with it implied threats, as it can be perceived as an attempt to restrict one’s freedom of choice potentially generating reactance and efforts to avoid them. By identifying and taking into account factors likely to promote reactance, physician-oriented interventions could become more effective.
PMCID: PMC2082656  PMID: 17588161
Pharmacist; Physician; Psychological reactance; Medication review; Professional behavior change; Interventions; Continuing medical education; Health psychology; Decision support systems
11.  Pharmacy Students' and Graduates' Attitudes Towards People With Schizophrenia and Severe Depression 
To compare the attitudes of third-year pharmacy students and pharmacy graduates towards people with schizophrenia and severe depression.
Third-year pharmacy students (n = 216) and pharmacy graduates (n = 232) completed a survey instrument with 21 common items. The third-year students had not yet received any mental health lectures or tutorials as part of their pharmacy course. The graduates had completed their university education, including mental health lectures and tutorials, plus 6 months of supervised clinical practice in the pharmacy workplace.
There were no significant differences between the third-year students and pharmacy graduates in terms of social distance from people with schizophrenia. The rates of stigmatization of people with schizophrenia and severe depression were also similar between the groups.
Mental health lectures and tutorials delivered by pharmacists and supervised clinical practice in the pharmacy workplace may not decrease students' social distance or stigmatization of people with mental illness. The results of our study suggest that more comprehensive education and training programs are needed to improve the ability of pharmacists to meet the needs of people with mental illness.
PMCID: PMC1636970  PMID: 17136196
schizophrenia; depression; mental illness
12.  Design and Implementation of an Educational Partnership Between Community Pharmacists and Consumer Educators in Mental Health Care 
To design and implement an interactive education program to improve the skill and confidence of community pharmacists in providing pharmaceutical services to people with mental illnesses.
A literature review was conducted and key stakeholders were consulted to design a partnership that involved community pharmacists and consumer educators. The partnership was designed so that all participants shared equal status. This facilitated mutual recognition of each others' skills.
Four 2-hour training sessions were conducted over a 2-week period in March 2005. Seven pharmacists, 5 consumer educators, and 1 caregiver educator participated in the partnership. Pharmacists indicated that their participation caused them to reflect on their own medication counseling techniques. Consumer educators reported that speaking about their experiences aided their recovery.
Developing a better understanding and improved communication between community pharmacists and people with mental illnesses is an important aspect of facilitating a concordant approach to patient counseling. Implementing mental health education programs utilizing consumer educators in pharmacy schools is a promising area for further research.
PMCID: PMC1636921  PMID: 17149408
continuing education; patient counseling; community pharmacy; mental health care
13.  Community pharmacy services to optimise the use of medications for mental illness: a systematic review 
The objective of this systematic review was to evaluate the impact of pharmacist delivered community-based services to optimise the use of medications for mental illness. Twenty-two controlled (randomised and non-randomised) studies of pharmacists' interventions in community and residential aged care settings identified in international scientific literature were included for review. Papers were assessed for study design, service recipient, country of origin, intervention type, number of participating pharmacists, methodological quality and outcome measurement. Three studies showed that pharmacists' medication counselling and treatment monitoring can improve adherence to antidepressant medications among those commencing treatment when calculated using an intention-to-treat analysis. Four trials demonstrated that pharmacist conducted medication reviews may reduce the number of potentially inappropriate medications prescribed to those at high risk of medication misadventure. The results of this review provide some evidence that pharmacists can contribute to optimising the use of medications for mental illness in the community setting. However, more well designed studies are needed to assess the impact of pharmacists as members of community mental health teams and as providers of comprehensive medicines information to people with schizophrenia and bipolar disorder
PMCID: PMC1345690  PMID: 16336646

Results 1-13 (13)