Skip to main content

Advertisement

SpringerLink
Log in

An expert panel assessment of comprehensive medication reviews for clients of community mental health teams

  • Original Paper
  • Published:
Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

Abstract

Background

Few studies have investigated strategies to identify and resolve drug-related problems among clients of community mental health teams (CMHTs).

Objective

The objective of this study was to evaluate the clinical impact and appropriateness of comprehensive medication reviews for clients of CMHTs.

Methods

Trained pharmacists conducted interviews (30–45 min each) with clients of CMHTs to identify actual and potential drug-related problems. The pharmacists prepared medication review reports that detailed their findings and recommendations to optimize drug therapy. An expert panel comprising a psychiatrist, general medical practitioner, mental health pharmacist and medication review pharmacist evaluated reviews for 48 clients of 5 CMHTs. Panelists independently assessed review findings, review recommendations, likelihood of recommendation implementation and the overall expected clinical impact.

Results

Two hundred and nine medication review findings and 208 medication review recommendations were evaluated. Panelists agreed with 76% of findings and considered that 81% of recommendations were appropriate. Collectively, 69% of recommendations were considered likely to be implemented. Thirty-seven (77%) reviews were deemed potentially to have a positive clinical impact. The agreement between panelists was statistically significant (P < 0.01) for the assessment of the findings, recommendations and likelihood of recommendation implementation.

Conclusions

Pharmacists’ findings and recommendations to optimize drug therapy were considered appropriate and likely to result in improved clinical outcomes. Comprehensive medication reviews may be a valuable strategy to identify and resolve drug-related problems among clients of CMHTs.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Australian Institute of Health and Welfare (2008) Mental health services in Australia 2006–2007. http://www.aihw.gov.au/publications/index.cfm/title/10686 Accessed 14 September 2009

  2. Barnes TRE, Paton C, Cavanagh M-R, Hancock E, Taylor DM (2007) A UK audit of screening for the metabolic side effects of antipsychotics in community patients. Schizophr Bull 33:1397–1403

    Article  PubMed  Google Scholar 

  3. Bates DW, Cullen DJ, Laird N et al (1995) Incidence of adverse drug events and potential adverse drug events: implications for prevention. JAMA 274:29–34

    Article  CAS  PubMed  Google Scholar 

  4. Bell JS, Rosen A, Aslani P, Whitehead P, Chen TF (2007) Developing the role of pharmacists as members of community mental health teams: perspectives of pharmacists and mental health professionals. Res Social Adm Pharm 3:392–409

    PubMed  Google Scholar 

  5. Bell JS, Whitehead P, Aslani P, McLachlan AJ, Chen TF (2006) Drug-related problems in the community setting: pharmacists’ findings and recommendations for people with mental illnesses. Clin Drug Investig 26:415–425

    Article  PubMed  Google Scholar 

  6. Bell JS, Whitehead P, Aslani P, Sacker S, Chen TF (2006) Design and implementation of an educational partnership between community pharmacists and consumer educators in mental health care. Am J Pharm Educ 70:28

    PubMed  Google Scholar 

  7. Bell S, McLachlan AJ, Aslani P, Whitehead P, Chen TF (2005) Community pharmacy services to optimise the use of medications for mental illness: a systematic review. Aust New Zealand Health Policy 2:29

    Article  PubMed  Google Scholar 

  8. Cohen J (1988) Statistical power analysis for the behavioral sciences, 2nd edn. Lawrence Erlbaum, New Jersey, pp 75–83

    Google Scholar 

  9. Ellitt GR, Brien JA, Aslani P, Chen TF (2009) Quality patient care and pharmacists' role in its continuity—a systematic review. Ann Pharmacother 43:677–691

    Google Scholar 

  10. Ewan MA, Greene RJ (2001) Evaluation of mental health care interventions made by three community pharmacists—a pilot study. Int J Pharm Pract 9:225–234

    Google Scholar 

  11. Gilbert AL, Roughead EE, Beilby J, Mott K, Barratt JD (2002) Collaborative medication management services: improving patient care. Med J Aust 177:189–192

    PubMed  Google Scholar 

  12. Gisev N, Bell JS, McLachlan AJ, Chetty M, Chen TF (2006) Psychiatric drug use among patients of a community mental health service: patterns and implications. Dis Manag Health Outcomes 14:369–376

    Article  Google Scholar 

  13. Harris D, Anderson C (2003) Interventions by community pharmacists for older people with mental health problems: are they appropriate? [abstract]. Int J Pharm Pract 11:R56

    Google Scholar 

  14. Hawksworth GM, Corlett AJ, Wright DJ, Chrystyn H (1999) Clinical pharmacy interventions by community pharmacists during the dispensing process. Br J Clin Pharmacol 47:695–700

    Article  CAS  PubMed  Google Scholar 

  15. Heiman GW (2001) Understanding research methods and statistics: an integrated introduction for psychology, 2nd edn. Houghton Mifflin, Boston, pp 257–262

    Google Scholar 

  16. Holland R, Lenaghan E, Harvey I et al (2005) Does home based medication review keep older people out of hospital? The HOMER randomised controlled trial. Br Med J 330:292–298

    Article  Google Scholar 

  17. Institute of Medicine (2000) To err is human: building a safer health system

  18. Kaboli PJ, Hoth AB, McClimon BJ, Schnipper JL (2006) Clinical pharmacists and inpatient medical care: a systematic review. Arch Intern Med 166:955–964

    Article  PubMed  Google Scholar 

  19. Krass I, Smith C (2000) Impact of medication regimen reviews performed by community pharmacists for ambulatory patients with general medical practitioners. Int J Pharm Pract 8:111–120

    Google Scholar 

  20. Krska J, Avery AJ, Community Pharmacy Medicines Management Project Evaluation Team (2008) Evaluation of medication reviews conducted by community pharmacists: a quantitative analysis of documented issues and recommendations. Br J Clin Pharmacol 65:386–395

    Article  CAS  PubMed  Google Scholar 

  21. Maidment ID, Lelliott P, Paton C (2006) Medication errors in mental healthcare: a systematic review. Qual Saf Health Care 15:409–413

    Article  PubMed  Google Scholar 

  22. Mann K, Rothschild JM, Keohane CA, Chu JA, Bates DW (2008) Adverse drug events and medication errors in psychiatry: methodological issues regarding identification and classification. World J Biol Psychiatry 9:24–33

    Article  PubMed  Google Scholar 

  23. Mannheimer B, Ulfvarson J, Eklof S et al (2006) Drug-related problems and pharmacotherapeutic advisory intervention at a medicine clinic. Eur J Clin Pharmacol 62:1075–1081

    Article  PubMed  Google Scholar 

  24. Meagher D, Moran M (2003) Sub-optimal prescribing in an adult community mental health service: prevalence and determinants. Psychiatr Bull 27:266–270

    Article  Google Scholar 

  25. Mitchell AJ (2007) Adherence behaviour with psychotropic medication is a form of self-medication. Med Hypotheses 68:12–21

    Article  PubMed  Google Scholar 

  26. Morcos S, Francis S-A, Duggan C (2002) Where are the weakest links? A descriptive study of discrepancies in prescribing between primary and secondary sectors of mental health service provision. Psychiatr Bull 26:371–374

    Article  Google Scholar 

  27. Nathan A, Goodyer L, Lovejoy A, Rashid A (1999) Brown bag medication reviews as a means of optimizing patients’ use of medication and identifying potential clinical problems. Fam Pract 16:278–282

    Article  CAS  PubMed  Google Scholar 

  28. Nguyen A, Yu K, Shakib S et al (2007) Classification of findings in the home medicines reviews of post-discharge patients at risk of medication misadventure. J Pharm Pract Res 37:111–114

    Google Scholar 

  29. Nishtala PS, McLachlan AJ, Bell JS, Chen TF (2008) Psychotropic prescribing in long-term care facilities: impact of medication reviews and educational interventions. Am J Geriatr Psychiatry 16:621–632

    Article  PubMed  Google Scholar 

  30. Pirkis J, Burgess P, Coombs T et al (2005) Routine measurement of outcomes in Australia’s public sector mental health services. Aust New Zealand Health Policy 2:8

    Article  PubMed  Google Scholar 

  31. Pirmohamed M, James S, Meakin S et al (2004) Adverse drug reactions as cause of admission to hospital: prospective analysis of 18820 patients. Br Med J 329:15–19

    Article  Google Scholar 

  32. Roberts MS, Stokes JA, King MA et al (2001) Outcomes of a randomized controlled trial of a clinical pharmacy intervention in 52 nursing homes. Br J Clin Pharmacol 51:257–265

    Article  CAS  PubMed  Google Scholar 

  33. Rosen A (2006) The community psychiatrist of the future. Curr Opin Psychiatry 19:380–388

    Article  PubMed  Google Scholar 

  34. Rosen A, Callaly T (2005) Interdisciplinary teamwork and leadership: issues for psychiatrists. Australas Psychiatry 13:234–240

    PubMed  Google Scholar 

  35. Rothschild JM, Mann K, Keohane CA et al (2007) Medication safety in a psychiatric hospital. Gen Hosp Psychiatry 29:156–162

    Article  PubMed  Google Scholar 

  36. Roughead EE, Barratt JD, Gilbert AL (2004) Medication-related problems commonly occurring in an Australian community setting. Pharmacoepidemiol Drug Saf 13:83–87

    Article  CAS  PubMed  Google Scholar 

  37. Roughead EE, Barratt JD, Ramsay E et al (2009) The effectiveness of collaborative medicine reviews in delaying time to next hospitalization for patients with heart failure in the practice setting: results of a cohort study. Circ Heart Fail 2:424–428

    Google Scholar 

  38. Ruschena D, Mullen PE, Burgess P et al (1998) Sudden death in psychiatric patients. Br J Psychiatry 172:331–336

    Article  CAS  PubMed  Google Scholar 

  39. Sheskin DJ (2007) Handbook of parametric and nonparametric statistical procedures, 4th edn. Chapman & Hall/CRC, Boca Raton, pp 1387–1401

    Google Scholar 

  40. Siegal S, Castellan NJ Jr (1988) Nonparametric statistics for the behavioural sciences, 2nd edn. McGraw-Hill, New York, pp 262–272

    Google Scholar 

  41. Smith MA, Simpson JM, Benrimoj SI (2002) General practitioner acceptance of medication review in Sydney nursing homes. J Pharm Pract Res 32:227–231

    Google Scholar 

  42. Soendergaard B, Kirkeby B, Dinsen C, Herborg H, Staehr P (2006) Drug-related problems in general practice: results from a development project in Denmark. Pharm World Sci 28:61–64

    Article  PubMed  Google Scholar 

  43. Sorensen L, Stokes JA, Purdie DM et al (2004) Medication reviews in the community: results of a randomized, controlled effectiveness trial. Br J Clin Pharmacol 58:648–664

    Article  PubMed  Google Scholar 

  44. Spinewine A, Schmader KE, Barber N et al (2007) Appropriate prescribing in elderly people: how well can it be measured and optimised? Lancet 370:173–184

    Article  PubMed  Google Scholar 

  45. Tranulis C, Skalli L, Lalonde P, Nicole L, Stip E (2008) Benefits and risks of antipsychotic polypharmacy: an evidence-based review of the literature. Drug Saf 31:7–20

    Article  CAS  PubMed  Google Scholar 

  46. WHO Collaborating Centre for Drug Statistics Methodology (2008) The anatomical therapeutic chemical classification system. WHO Collaborating Centre for Drug Statistics Methodology. Norwegian Institute of Public Health, Oslo

    Google Scholar 

  47. World Health Organization (2007) International statistical classification of diseases and related health problems (10th revision). http://apps.who.int/classifications/apps/icd/icd10online/ Accessed 14 September 2009

Download references

Acknowledgments

The authors are grateful to the reviewing pharmacists, staff and clients of the CMHTs for their enthusiastic participation. The authors thank the four panelists for their contribution to the study. The study was supported by a research grant from the Pharmacy Research Trust of New South Wales.

Conflict of interest statement

The authors declare that they have no direct conflict of interest.

Author information

Authors and Affiliations

  1. Faculty of Pharmacy, University of Sydney, Sydney, NSW, Australia

    Natasa Gisev, J. Simon Bell, Claire L. O’Reilly & Timothy F. Chen

  2. Kuopio Research Centre of Geriatric Care, University of Kuopio, Kuopio, Finland

    J. Simon Bell

  3. Department of Pharmacology and Toxicology, University of Kuopio, Kuopio, Finland

    J. Simon Bell

  4. Greater Western Area Health Service, Dubbo, NSW, Australia

    Alan Rosen

  5. School of Public Health, Faculty of Health and Behavioural Sciences, University of Wollongong, Wollongong, Australia

    Alan Rosen

  6. Department of Psychological Medicine, University of Sydney, Sydney, Australia

    Alan Rosen

Authors
  1. Natasa Gisev
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. Simon Bell
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Claire L. O’Reilly
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Alan Rosen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Timothy F. Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J. Simon Bell.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gisev, N., Bell, J.S., O’Reilly, C.L. et al. An expert panel assessment of comprehensive medication reviews for clients of community mental health teams. Soc Psychiat Epidemiol 45, 1071–1079 (2010). https://doi.org/10.1007/s00127-009-0148-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00127-009-0148-8

Keywords

Search

Navigation