Investigating the pharmacist prescriber service within a mental health setting from the perspective of the service user
Rhian Jones, DN John and PN Deslandes, Welsh School of Pharmacy, Cardiff University and Cardiff and Vale NHS Trust
Pharmacist supplementary prescribing (SP) was first suggested in the Crown Report in 19991 . SP authorised pharmacists who had undertaken appropriate training to manage patients under the direction of a clinical management plan (CMP) in partnership with their patient and independent prescriber. Since its introduction, a number of pharmacists have undertaken this extended role within the mental health secondary care setting. The aim of this study was to investigate a pharmacist SP service provided in a secondary care mental health setting from the perspective of the service user.
Approval was granted from an NHS Research Ethics Committee and NHS Trust R&D Committee. A multi-staged methodology was utilised. Patients were recruited via their SP pharmacist and written consent obtained. The first stage explored the interaction between pharmacist and patient through non-participant observation and audio-recording of consultations. A semi-structured interview was conducted following the consultation and patients were provided with a diary to record their views of the service over the subsequent six week period. A final semi-structured interview was then held to discuss the service as a whole.
Twelve patients were recruited, and eleven participated in data collection. For the majority of consultations a similar structure was identified, each lasted between 10 minutes and one hour. The purpose of the interaction was to discuss patient progress since the last meeting. The pharmacist gathered information from the patient regarding their experience of taking medication, identification of side effects and patients’ general well-being such as diet, sleeping habits and family life. The focus of the interaction was not solely on medication and included discussions of other non-pharmacological interventions. Patients were involved in the interaction to a great extent and their views sought on any suggested changes to therapy. Patients were also encouraged to ask questions and both parties shared common interests or experiences. At the end of the consultation a supply of medication was provided, if appropriate, and a further appointment arranged. The interactions showed similar features to some consultation frameworks; however, it is clear that a framework appropriate to pharmacist prescribers within the mental health setting is not readily available. Semi structured interviews revealed that patients were satisfied with the service and felt that they had a positive relationship with their pharmacist. They compared their current care to previous experiences and commented on the increased consistency and availability of care. The pharmacist was also felt to be more engaging with the patients and willing to take their views into consideration, leading patients to feel they were in a partnership. Both the personality and the knowledge of the pharmacist were deemed to be important in developing their relationship. Patients believed that a different approach to the consultation was required when caring for those with a mental rather than physical illness and that this was successfully achieved within the service. Patient views were unchanged throughout the multiple stages undertaken.
This study has highlighted that it is possible to carry out a multi method study over a period of several weeks to explore the views of patients with mental illness on a pharmacist prescribing service. It is encouraging that the predicted benefits of such a role have been fulfilled in practice, albeit in a small sample of patients.