Henry Rebecca, Baldwin David S
Southern Health NHS Foundation Trust, Avalon House, Southampton SO230HU, UK.
School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK.
Ther Adv Psychopharmacol. 2024 Sep 21;14:20451253241247368. doi: 10.1177/20451253241247368. eCollection 2024.
The benefit of generalist pharmacists working within primary care networks (PCNs) and with general practitioners (GPs) is established. We wished to evaluate the contributions and potential benefits of a specialist mental health care prescribing pharmacist within PCNs.
We prospectively collected data, on clinical and demographic characteristics, referral sources, interventions, outcomes (objective and subjective), and patient feedback, from 466 completed patients, in one PCN by one specialist mental health pharmacist (working 0.5 whole time equivalent), over 15 months.
Referrals originated from multiple sources, including GPs, other members of the PCN mental health team, and community mental health teams (CMHTs). Two-thirds of treated patients were female; the most frequent age band was 18-30 years; the most common diagnosis was mixed depression and anxiety. Patients with diagnoses of mixed anxiety with depression or personality disorder needed more appointments than those with anxiety or depression. A range of evidence-based treatments were prescribed, including non-formulary medicines, and those medicines are more typically initiated or recommended in secondary care settings. The most frequently started medications were antidepressants (principally fluoxetine and duloxetine), followed by antipsychotics (principally quetiapine and aripiprazole): the most common dosage increases were for sertraline and quetiapine. Common non-medication recommendations were for cognitive behavioral therapy, cognitive behavioral therapy for insomnia, and other psychological therapies. Patient feedback was generally positive.
Developing and implementing a service incorporating a specialist mental health pharmacist within a PCN mental health team is potentially valuable in improving patient care quality, reducing workload for GPs and CMHTs, and enabling faster access to secondary care initiated and recommended medications. This innovative service addressed several national targets, including prevention, early intervention, and access to quality compassionate care.
全科药剂师在基层医疗网络（PCN）中与全科医生（GP）合作的益处已得到证实。我们希望评估在PCN中配备一名精神卫生专科处方药剂师的贡献和潜在益处。
在15个月内，由一名精神卫生专科药剂师（相当于0.5个全时工作量）在一个PCN中，前瞻性收集了466名已完成治疗患者的临床和人口统计学特征、转诊来源、干预措施、结果（客观和主观）以及患者反馈的数据。
转诊来源多样，包括全科医生、PCN精神卫生团队的其他成员以及社区精神卫生团队（CMHT）。三分之二接受治疗的患者为女性；最常见的年龄组为18至30岁；最常见的诊断是混合性抑郁和焦虑。诊断为混合性焦虑抑郁或人格障碍的患者比患有焦虑或抑郁的患者需要更多的预约。开出了一系列循证治疗方案，包括非处方药物，而这些药物通常在二级医疗机构中更常启动或推荐使用。最常开始使用的药物是抗抑郁药（主要是氟西汀和度洛西汀），其次是抗精神病药（主要是喹硫平和阿立哌唑）：最常见的剂量增加药物是舍曲林和喹硫平。常见的非药物建议是认知行为疗法、失眠认知行为疗法和其他心理疗法。患者反馈总体积极。
在PCN精神卫生团队中发展并实施一项纳入精神卫生专科药剂师的服务，对于提高患者护理质量、减轻全科医生和CMHT的工作量以及更快获得二级医疗机构启动和推荐使用的药物可能具有重要价值。这项创新服务实现了几个国家目标，包括预防、早期干预以及获得高质量的关怀护理。
