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Depression Screening in Community Pharmacy: A Feasibility Study
Abstracts / Research in Social and Administrative Pharmacy 10 (2014) e1–e64 DRPs (iMAP, Norwegian and DOCUMENT) were mapped to the PCNE sub-categories identified as causes of DRPs. The PCNE system was chosen as the index system because it had informed the development of three of the systems Results: We found large system variations in developmental methods, number and type of (sub) categories, validation methods and number of DRPs reported per patient in different healthcare settings, together with intermingling of categories identified as causes of DRPs and DRPs. A DRP classification system was constructed from the seven systems. It consisted of nine categories identified as causes, 34 subcategories identified as causes, and 73 sub-sub-categories identified as causes of DRPs, and included instructions on correct choice of subcategory, and clinical examples to guide users. Ten Home Medicines Reviews (HMRs) containing 114 causes of DRPs were rated against a gold standard, using the proposed system. Interrater agreement for subcategories identified as causes was 74.6%, and interrater agreement for sub-sub-categories identified as causes was 58.8% Conclusions: Due to our developmental process, the proposed system may provide the most comprehensive and acceptable system for classification of causes of DRPs. Delphi Study of Pharmacology Experts to Derive International Recommendations for Medicine Use in Lactation K. Ryan1, L.H. Amir2, C. Barnett2, 1School of Nursing and Midwifery, La Trobe University, Melbourne, Australia, 2Judith Lumley Centre, La Trobe University, Melbourne, Australia Although most medicines are compatible with breastfeeding, pharmaceutical companies often state that the medicine is not recommended during lactation, leading to confusion amongst prescribing clinicians. Our objective was to gain international consensus on the key parameters experts use to inform decisions and to develop a user-friendly, evidence-based safety hierarchy for medicine use during breastfeeding. Methods: A 3-round web-based Delphi research design was used. Sixteen experts were identified based on their international prominence in the field, with a further 12 recruited through snowballing. Questionnaires were distributed electronically by a secure program (Qualtrics). Round 1 explored experts’ opinions of current medicines and breastfeeding classification systems and identified key clinical, social and pharmacological parameters used to inform decisions. Round 2 and 3 built consensus around these parameters using a 5-point Likert scale and prioritisation. Results: Twenty-eight experts with professional appointments in breastfeeding and pharmacotherapy from Australia, UK, USA and Norway participated. They identified 15 infant, maternal and medicine parameters
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routinely used in the decision-making process. The balance between ‘the benefits of breastfeeding and advantages of medicine versus the risks of formula and the potential adverse effects of medicine’ was the most important consideration. Age of infant and safety profile of the medicine were the most important objective parameters. Participants believed advice should be tailored around the mother, infant and medicine, and one stated that clinicians should “. . . read full monographs/case reports in references and avoid using letter or number classifications to make quick decisions.” Conclusions: Experts agreed that prescribing medicines in lactation requires health professionals to balance the risks and benefits of both medicine and breastfeeding. Consensus was reached on the importance of 15 key clinical and pharmacological parameters that inform decision-making and could be used to develop a risk assessment tool for medicine use during lactation. Depression Screening in Community Pharmacy: A Feasibility Study C.L. O’Reilly, E. Wong, T.C. Chen, Faculty of Pharmacy, The University of Sydney, NSW, Australia To test the feasibility of Australian community pharmacists performing screening and risk assessment services for depression. The specific objectives were to investigate the barriers and facilitators to pharmacists performing this service and to assess the feasibility of pharmacists using a screening tool for depression in the community pharmacy setting. Methods: Twenty pharmacists from 12 pharmacies were recruited. A training program on depression was developed and delivered to the pharmacists, followed by an eight week data collection period. During this period pharmacists identified consumers at risk of depression in the pharmacy and conducted screening and risk assessments using previously validated screening tools. Semistructured interviews were conducted at the end of the data collection period to gather pharmacists’ reflection on the intervention and to explore the barriers and facilitators to depression screening and risk assessment. Results: Forty two screening and risk assessments were conducted from 76 consumers who were approached. The majority of consumers screened were female, less than 40 years old and previously known to the pharmacy, with more than 70% of consumers screened being referred to a GP or psychologist. Barriers to implementation of the service included time, stigma and a lack of awareness of the pharmacists’ role. Facilitators to the service included the accessibility of the pharmacist, having a private consultation area in the pharmacy, awareness campaigns and mental health resources on display. Conclusions: Pharmacists are capable of performing screening and risk assessment services for depression and making referrals to appropriate healthcare professionals when required. Pharmacy based depression
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Abstracts / Research in Social and Administrative Pharmacy 10 (2014) e1–e64
screening programs have the potential to increase the early detection of depression which may lead to early intervention, and potentially contribute to easing the enormous disease burden associated with depression. Depression Training for Pharmacists Significantly Improves Patients’ Concerns and Feelings about Side Effects Regarding Antidepressant Therapy S. Liekens1, T. Smits2, G. Laekeman1, V. Foulon1, 1KU Leuven, Department of Pharmaceutical & Pharmacological sciences, Leuven Belgium, 2KU Leuven, Institute for Media Studies, Leuven Begium The objective of the SIMCA study was to Study the Impact of structured Medication Counseling on patients starting a new treatment with Antidepressants. Methods: A controlled RCT was set up in the Surplus Pharmacy chain, with 53 pharmacists in the control group (delivered standard care) and 46 in the intervention group (trained to counsel patients with a new prescription for antidepressants with use of pharmacy software). Telephone survey interviews based on validated scales were used to collect data at the start of treatment, after 1 month, 3 months and 6 months of treatment. Patient data were compared between the intervention and control group at the different time points. Mann-Whitney U tests were used to compare the median scores of the different scales between intervention and control group. Results: Significantly more patients, who started treatment with antidepressants for mood disorders and visited an intervention pharmacy were satisfied with the information regarding treatment (p¼ 0.003) and side effects (p¼ 0.014), compared to patients with the same condition who visited control pharmacies. Both after one month and after three months of treatment, significantly fewer patients of the intervention pharmacies had concerns about the negative effects of antidepressants (p¼ 0.026 resp. p¼ 0.004) compared to patients of control pharmacies. After three months of treatment significantly more patients of the intervention pharmacies had positive feelings about side effects of antidepressants (p¼ 0.004) compared to patients of control pharmacies. Conclusion: Structured medication counseling for patients starting a new treatment with antidepressants had a positive impact on patients’ satisfaction with the information regarding treatment and side effects, concerns about the negative effects of antidepressants and feelings about side effects. Design of an Educational Intervention in Portuguese Community Pharmacists to Improve Antibiotics Use Fa´tima Roque1,2,3, Sara Soares2, Anto´nio TeixeiraRodrigues2, Luiza Breitenfeld1, Adolfo Figueiras4, M.T. Herdeiro2,5,6, 1Health Sciences Research Centre, University of Beira Interior (Centro de Investigac¸a˜o em Cieˆncias da Sau´de- CICS/UBI);, 2Centre for Cell Biology, University of Aveiro (Centro de Biologia Celular
- CBC/UA), 3Research Unit for Inland Development, Polytechnic Institute of Guarda (Unidade de Investigac¸a˜o para o Desenvolvimento do Interior - UDI/IPG), Portugal, 4Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiologı´a y Salud Pu´blica - CIBERESP), University of Santiago de Compostela, Spain, 5Centre for Health Technology & Information Systems Research (Centro de Investigac¸a˜o em Tecnologias e Sistemas de Informac¸a˜o em Sau´de CINTESIS/FMUP), Portugal;, 6Health Technology Research Centre (CITS/Cooperativa de Ensino Superior Polite´cnico e Universita´rio - CESPU), Portugal Improve antibiotics use by an educational intervention in community pharmacists towering their attitudes related to microbial resistances and antibiotic misuse. Methods: The study included four phases: (1) a focus group study with community pharmacists; (2) questionnaire design and reliability assessment; (3) a crosssectional study with 1197 pharmacists, and (4) design and implementation of educational intervention, a cluster-randomized controlled trial, with 4 cluster in control group and 4 cluster in intervention group. The study was approved by Portuguese Data Protection Authorities (Comissa˜o Nacional de Protec¸a˜o de Dados/CNPD) (Permit No. 2886/2013). Results: Situations explored during focus group sessions, were helpful to construct a questionnaire with 17 statements about attitudes and knowledge of pharmacists to microbial resistance and antibiotics misuse, followed in each case by a continuous visual analogue scale (VAS), and 4 statements identifying situations where pharmacists, recognized that sometimes antibiotics could be dispensed without medical prescription, a measure of propensity to dispense antibiotics without medical prescription. Questionnaire internal consistency and reliability was demonstrated. The rate of response during cross-sectional study was 64,8 %. Propensity to dispense antibiotics without prescription among respondents was 48,6 %. It was identified three major attitudes as influencing propensity to dispense antibiotics without medical prescription: complacency with patients, responsibility of others (patients and health-care systems) and fear/precaution. Attending this attitudes, educational outreach visits were made with: (1)interactive educational meeting by PowerPoint presentation (IEM); (2)printed educational materials (pharmacists reminders and a poster to display in pharmacy facilities); (3)selected articles referenced during IEM. A participation pharmacist in the educational interventions was around 55% within the cluster intervention group. Conclusions: Interventions were well accepted by pharmacists and, all of them demonstrated motivation to promote rational use of antibiotics of their patients. This work was supported by Foundation for Science & Technology (Fundac¸a˜o para a Cieˆncia e Tecnologia FCT) grants [PTDC/SAU-ESA/105530/2008] and [PestOE/EGE/UI4056/2014] from the Portuguese Ministry of Science & Education.
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routinely used in the decision-making process. The balance between ‘the benefits of breastfeeding and advantages of medicine versus the risks of formula and the potential adverse effects of medicine’ was the most important consideration. Age of infant and safety profile of the medicine were the most important objective parameters. Participants believed advice should be tailored around the mother, infant and medicine, and one stated that clinicians should “. . . read full monographs/case reports in references and avoid using letter or number classifications to make quick decisions.” Conclusions: Experts agreed that prescribing medicines in lactation requires health professionals to balance the risks and benefits of both medicine and breastfeeding. Consensus was reached on the importance of 15 key clinical and pharmacological parameters that inform decision-making and could be used to develop a risk assessment tool for medicine use during lactation. Depression Screening in Community Pharmacy: A Feasibility Study C.L. O’Reilly, E. Wong, T.C. Chen, Faculty of Pharmacy, The University of Sydney, NSW, Australia To test the feasibility of Australian community pharmacists performing screening and risk assessment services for depression. The specific objectives were to investigate the barriers and facilitators to pharmacists performing this service and to assess the feasibility of pharmacists using a screening tool for depression in the community pharmacy setting. Methods: Twenty pharmacists from 12 pharmacies were recruited. A training program on depression was developed and delivered to the pharmacists, followed by an eight week data collection period. During this period pharmacists identified consumers at risk of depression in the pharmacy and conducted screening and risk assessments using previously validated screening tools. Semistructured interviews were conducted at the end of the data collection period to gather pharmacists’ reflection on the intervention and to explore the barriers and facilitators to depression screening and risk assessment. Results: Forty two screening and risk assessments were conducted from 76 consumers who were approached. The majority of consumers screened were female, less than 40 years old and previously known to the pharmacy, with more than 70% of consumers screened being referred to a GP or psychologist. Barriers to implementation of the service included time, stigma and a lack of awareness of the pharmacists’ role. Facilitators to the service included the accessibility of the pharmacist, having a private consultation area in the pharmacy, awareness campaigns and mental health resources on display. Conclusions: Pharmacists are capable of performing screening and risk assessment services for depression and making referrals to appropriate healthcare professionals when required. Pharmacy based depression
e16
Abstracts / Research in Social and Administrative Pharmacy 10 (2014) e1–e64
screening programs have the potential to increase the early detection of depression which may lead to early intervention, and potentially contribute to easing the enormous disease burden associated with depression. Depression Training for Pharmacists Significantly Improves Patients’ Concerns and Feelings about Side Effects Regarding Antidepressant Therapy S. Liekens1, T. Smits2, G. Laekeman1, V. Foulon1, 1KU Leuven, Department of Pharmaceutical & Pharmacological sciences, Leuven Belgium, 2KU Leuven, Institute for Media Studies, Leuven Begium The objective of the SIMCA study was to Study the Impact of structured Medication Counseling on patients starting a new treatment with Antidepressants. Methods: A controlled RCT was set up in the Surplus Pharmacy chain, with 53 pharmacists in the control group (delivered standard care) and 46 in the intervention group (trained to counsel patients with a new prescription for antidepressants with use of pharmacy software). Telephone survey interviews based on validated scales were used to collect data at the start of treatment, after 1 month, 3 months and 6 months of treatment. Patient data were compared between the intervention and control group at the different time points. Mann-Whitney U tests were used to compare the median scores of the different scales between intervention and control group. Results: Significantly more patients, who started treatment with antidepressants for mood disorders and visited an intervention pharmacy were satisfied with the information regarding treatment (p¼ 0.003) and side effects (p¼ 0.014), compared to patients with the same condition who visited control pharmacies. Both after one month and after three months of treatment, significantly fewer patients of the intervention pharmacies had concerns about the negative effects of antidepressants (p¼ 0.026 resp. p¼ 0.004) compared to patients of control pharmacies. After three months of treatment significantly more patients of the intervention pharmacies had positive feelings about side effects of antidepressants (p¼ 0.004) compared to patients of control pharmacies. Conclusion: Structured medication counseling for patients starting a new treatment with antidepressants had a positive impact on patients’ satisfaction with the information regarding treatment and side effects, concerns about the negative effects of antidepressants and feelings about side effects. Design of an Educational Intervention in Portuguese Community Pharmacists to Improve Antibiotics Use Fa´tima Roque1,2,3, Sara Soares2, Anto´nio TeixeiraRodrigues2, Luiza Breitenfeld1, Adolfo Figueiras4, M.T. Herdeiro2,5,6, 1Health Sciences Research Centre, University of Beira Interior (Centro de Investigac¸a˜o em Cieˆncias da Sau´de- CICS/UBI);, 2Centre for Cell Biology, University of Aveiro (Centro de Biologia Celular
- CBC/UA), 3Research Unit for Inland Development, Polytechnic Institute of Guarda (Unidade de Investigac¸a˜o para o Desenvolvimento do Interior - UDI/IPG), Portugal, 4Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiologı´a y Salud Pu´blica - CIBERESP), University of Santiago de Compostela, Spain, 5Centre for Health Technology & Information Systems Research (Centro de Investigac¸a˜o em Tecnologias e Sistemas de Informac¸a˜o em Sau´de CINTESIS/FMUP), Portugal;, 6Health Technology Research Centre (CITS/Cooperativa de Ensino Superior Polite´cnico e Universita´rio - CESPU), Portugal Improve antibiotics use by an educational intervention in community pharmacists towering their attitudes related to microbial resistances and antibiotic misuse. Methods: The study included four phases: (1) a focus group study with community pharmacists; (2) questionnaire design and reliability assessment; (3) a crosssectional study with 1197 pharmacists, and (4) design and implementation of educational intervention, a cluster-randomized controlled trial, with 4 cluster in control group and 4 cluster in intervention group. The study was approved by Portuguese Data Protection Authorities (Comissa˜o Nacional de Protec¸a˜o de Dados/CNPD) (Permit No. 2886/2013). Results: Situations explored during focus group sessions, were helpful to construct a questionnaire with 17 statements about attitudes and knowledge of pharmacists to microbial resistance and antibiotics misuse, followed in each case by a continuous visual analogue scale (VAS), and 4 statements identifying situations where pharmacists, recognized that sometimes antibiotics could be dispensed without medical prescription, a measure of propensity to dispense antibiotics without medical prescription. Questionnaire internal consistency and reliability was demonstrated. The rate of response during cross-sectional study was 64,8 %. Propensity to dispense antibiotics without prescription among respondents was 48,6 %. It was identified three major attitudes as influencing propensity to dispense antibiotics without medical prescription: complacency with patients, responsibility of others (patients and health-care systems) and fear/precaution. Attending this attitudes, educational outreach visits were made with: (1)interactive educational meeting by PowerPoint presentation (IEM); (2)printed educational materials (pharmacists reminders and a poster to display in pharmacy facilities); (3)selected articles referenced during IEM. A participation pharmacist in the educational interventions was around 55% within the cluster intervention group. Conclusions: Interventions were well accepted by pharmacists and, all of them demonstrated motivation to promote rational use of antibiotics of their patients. This work was supported by Foundation for Science & Technology (Fundac¸a˜o para a Cieˆncia e Tecnologia FCT) grants [PTDC/SAU-ESA/105530/2008] and [PestOE/EGE/UI4056/2014] from the Portuguese Ministry of Science & Education.