Faculty of Health Studies, University of Bradford, Bradford, UK.
Pharmacy, Leeds and York Partnership NHS Foundation Trust, Leeds, UK.
Eur J Hosp Pharm. 2020 Jan;27(1):31-35. doi: 10.1136/ejhpharm-2018-001514. Epub 2018 Jul 2.
Medication arrangements for patients with severe mental illness (SMI), including schizophrenia and bipolar disorder, can be complex. Some have shared care between primary and secondary services while others have little specialist input. This study investigated the contribution a specialist mental health clinical pharmacy team could make to medicines optimisation for patients on the SMI register in primary care. Research shows that specialist mental health pharmacists improve care in inpatient settings. However, little is known about their potential impact in primary care.
Five general practice surgeries were allocated half a day per week of a specialist pharmacist and technician for 12 months. The technician reviewed primary and secondary care records for discrepancies. Records were audited for high-dose or multiple antipsychotics, physical health monitoring and adherence. Issues were referred to the pharmacist for review. Surgery staff were encouraged to refer psychotropic medication queries to the team. Interventions were recorded and graded.
316/472 patients on the SMI register were prescribed antipsychotics or mood stabilisers. 23 (7%) records were updated with missing clozapine and depot information. Interventions by the pharmacist included clarifying discharge information (12/104), reviewing high-dose and multiple antipsychotic prescribing (18/104), correcting errors (10/104), investigating adherence issues (16/104), following up missing health checks (22/104) and answering queries from surgery staff (23/104). Five out of six interventions possibly preventing hospital admission were for referral of non-adherent patients.
The pharmacy team found a variety of issues including incomplete medicines reconciliation, adherence issues, poor communication, drug errors and the need for specialist advice. The expertise of the team enabled timely resolution of issues and bridges were built between primary and secondary care.
严重精神疾病（SMI）患者的药物治疗安排可能很复杂，包括精神分裂症和双相情感障碍。一些患者在初级和二级服务之间共享护理，而另一些患者则很少得到专科医生的治疗。本研究调查了精神科临床药剂师团队在初级保健中对 SMI 登记册上的患者进行药物优化方面的作用。研究表明，专科精神科药剂师可改善住院患者的护理。然而，人们对他们在初级保健中的潜在影响知之甚少。
为五家全科诊所分配了一名专科药剂师和一名技术员，每周工作半天，为期 12 个月。技术员审查初级和二级护理记录中的差异。记录接受了高剂量或多种抗精神病药物、身体健康监测和遵医嘱情况的审核。将问题提交药剂师审查。鼓励手术人员向该团队提出精神药物查询。记录并分级干预措施。
SMI 登记册上的 472 名患者中有 316 名患者开了抗精神病药或情绪稳定剂。23 份记录更新了氯氮平和长效抗精神病药的信息。药剂师的干预措施包括澄清出院信息（12/104）、审查高剂量和多种抗精神病药物处方（18/104）、纠正错误（10/104）、调查遵医嘱情况（16/104）、跟进未进行的健康检查（22/104）以及回答手术人员的查询（23/104）。可能防止住院的六次干预中的五次是为不遵医嘱的患者转诊。
药剂师团队发现了多种问题，包括药物治疗不完整、药物依从性问题、沟通不畅、用药错误以及需要专科医生的建议。团队的专业知识使问题能够得到及时解决，并在初级保健和二级保健之间建立了桥梁。
