Barriers to medication counselling for people with mental health disorders: a six country study
Provision of medication information may improve adherence and prevent medication related problems. People with mental health disorders commonly receive less medication counselling from pharmacists than people with other common long term and persistent disorders.
Objective: The objective of this study was to compare and contrast barriers pharmacy students perceive toward providing medication counselling for people with mental health disorders in Australia, Belgium, Estonia, Finland, India and Latvia.
Methods: Barriers identified by third-year pharmacy students as part of the International Pharmacy Students’ Health Survey were content analysed using a directed approach. Students’ responses were categorised as pharmacist related, patient related, health-system related, or social or cultural related. Quantitative data were analysed using SPSS version 14.0.
Results: Survey instruments were returned by 649 students. Of the respondents, 480 identified one or more barriers to medication counselling for people with mental health disorders. Patient related factors accounted for between 25.3% and 36.2% of barriers identified by the pharmacy students. Pharmacist related factors accounted for between 17.6% and 45.1% of the barriers identified by the pharmacy students. Students in India were more likely to attribute barriers to pharmacist and social and cultural related factors, and less likely to health-system related factors, than students studying in other countries.
Conclusion: The nature of barriers identified by pharmacy students differed according to the country in which they studied. Undergraduate and postgraduate pharmacy education programs may need to be amended to address common misconceptions among pharmacy students.
2. World Health Organization. The World Health Report 2001: Mental health - new understanding, new hope. 2001 Available from: http://www.who.int/whr/2001/en/ [Accessed 21.10.09]
3. Thornicroft G, Maingay S. The global response to mental illness. BMJ. 2002;325:608-609.
4. World Health Organization Regional Office for Europe. Mental Health Action Plan for Europe: facing the challenges, building solutions. 2005 Available from: http://www.euro.who.int/Document/MNH/edoc07.pdf [Accessed 21.10.09]
5. Linden M, Wurzendorf K, Ploch M, Schaefer M. Self medication with St John's wort in depressive disorders: an observational study in community pharmacies. J Affect Disord. 2008;107:205-210.
6. Bell S, McLachlan AJ, Aslani P, Whitehead P, Chen TF. Community pharmacy services to optimise the use of medications for mental illness: a systematic review. Aust New Zealand Health Policy. 2005;2:29.
7. Gisev N, Bell JS, O'Reilly CL, Rosen A, Chen TF. An expert panel assessment of comprehensive medication reviews for clients of community mental health teams. Soc Psychiatry Psychiatr Epidemiol 2009; Oct 15 [Epub ahead of print] DOI 0.1007/s00127-009-0148-8
8. Bell JS, Rosen A, Aslani P, Whitehead P, Chen TF. Developing the role of pharmacists as members of community mental health teams: perspectives of pharmacists and mental health professionals. Res Social Adm Pharm. 2007;3:392-409.
9. Bell JS, Whitehead P, Aslani P, McLachlan AJ, Chen TF. Drug-related problems in the community setting: pharmacists' findings and recommendations for people with mental illnesses. Clin Drug Investig. 2006;26:415-425.
10. Sajatovic M, Valenstein M, Blow F, Ganoczy D, Ignacio R. Treatment adherence with lithium and anticonvulsant medications among patients with bipolar disorder. Psychiatr Serv. 2007;58:855-863.
11. Valenstein M, Blow FC, Copeland LA, McCarthy JF, Zeber JE, Gillon L, Bingham CR, Stavenger T. Poor antipsychotic adherence among patients with schizophrenia: medication and patient factors. Schizophr Bull. 2004;30:255-264.
12. Akincigil A, Bowblis JR, Levin C, Walkup JT, Jan S, Crystal S. Adherence to antidepressant treatment among privately insured patients diagnosed with depression. Med Care. 2007;45:363-369.
13. Gandhi TK, Weingart SN, Borus J, Seger AC, Shu K, Federico F, Leape LL, Bates DW. Adverse drug events in ambulatory care. N Engl J Med. 2003;348:1556-1564.
14. Roughead EE, Lexchin J. Adverse drug events: counting is not enough, action is needed. Med J Aust. 2006;184:315-316.
15. Jesson J, Bissell P. Public health and pharmacy: a critical review. Critical Public Health. 2006;16:159-169.
16. Brook OH, Van Hout HPJ, Stalman W, Nieuwenhuyse H, Bakker B, Heerdink E, De Haan M. A pharmacy based coaching program to improve adherence to antidepressant treatment among primary care patients. Psychiatr Serv. 2005;56:487-489.
17. Valenstein M, Kavanagh J, Lee T, Reilly P, Dalack GW, Grabowski J, Smelson D, Ronis DL, Ganoczy D, Woltmann E, Metreger T, Wolschon P, Jensen A, Poddig B, Blow FC. Using A pharmacy-based intervention to improve antipsychotic adherence among patients with serious mental illness. Schizophr Bull 2009; Nov 21 [Epub ahead of print] DOI:10.1093/schbul/sbp121:
18. Vainio KK, Airaksinen M, Hyykky TT, Enlund H. Effect of therapeutic class on counselling in community pharmacies. Ann Pharmacother. 2002;36:781-786.
19. Young HN, Bell RA, Epstein RM, Feldman MD, Kravitz RL. Types of information physicians provide when prescribing antidepressants. J Gen Intern Med. 2006;21:1172-1177.
20. Bell JS, Väänänen M, Ovaskainen H, Närhi U, Airaksinen MS. Providing patient care in community pharmacies: practice and research in Finland. Ann Pharmacother. 2007;41:1039-1046.
21. Christensen DB, Farris KB. Pharmaceutical care in community pharmacies: practice and research in the US. Ann Pharmacother. 2006;40:1400-1406.
22. Phokeo V, Sproule B, Raman-Wilms L. Community pharmacists' attitudes toward and professional interactions with users of psychiatric medication. Psychiatr Serv. 2004;55:1434-1436.
23. Maslen CL, Rees L, Redfern PH. Role of the community pharmacist in the care of patients with chronic schizophrenia in the community. Int J Pharm Pract. 1996;4:187-195.
24. Happell B, Manias E, Roper C. Wanting to be heard: mental health consumers' experiences of information about medication. Int J Ment Health Nurs. 2004;13:242-248.
25. Bell JS, Whitehead P, Aslani P, Sacker S, Chen TF. Design and implementation of an educational partnership between community pharmacists and consumer educators in mental health care. Am J Pharm Educ. 2006;70:28.
26. Tully M, Beckman-Gyllenstrand A, Bersten CB. Differences in counselling for different prescribed medicines in Swedish community pharmacies. Int J Pharm Pract. 2008;16(Suppl 2):B34-35.
27. Volmer D, Mäesalu M, Bell JS. Pharmacy students' attitudes toward and professional interactions with people with mental disorders. Int J Soc Psychiatry. 2008;54:402-413.
28. Wilson S, Eagles JM, Platt JE, McKenzie H. Core undergraduate psychiatry: what do non-specialists need to know? Med Educ. 2007;41:698-702.
29. Gardner DM, Murphy AL, Woodman AK, Connelly S. Community pharmacy services for antidepressant users. Int J Pharm Pract. 2001;9:217-224.
30. Lee DTS, Kleinman MA, Kleinman A. Rethinking depression: an ethnographic study of the experiences of depression among the Chinese. Harv Rev Psychiatry. 2007;15:1-8.
31. Kleinman A. Culture and depression. N Engl J Med. 2004;351:951-953.
32. Hwang W-C, Myers HF, Abe-Kim J, Ting JY. A conceptual paradigm for understanding culture's impact on mental health: the cultural influences of mental health (CIMH) model. Clin Psychol Rev. 2008; 28: 211-227.
33. Assemi M, Cullander C, Hudmon KS. Implementation and evaluation of cultural competency training for pharmacy Students. Ann Pharmacother. 2004;38:781-786.
34. Evans E. An elective course in cultural competence for healthcare professionals. Am J Pharm Educ. 2006;70:55.
35. Bell JS, Aaltonen SE, Airaksinen MS, Volmer D, Gharat MS, Muceniece R, Vitola A, Foulon V, Desplenter FA, Chen TF. Determinants of mental health stigma among pharmacy students in Australia, Belgium, Estonia, India, Finland and Latvia. Int J Soc Psychiatry. 2010;56:3-14.
36. European Commission. The Bologna Declaration on the European Space for Higher Education: an explanation. 2000 Available from: http://ec.europa.eu/education/policies/educ/bologna/bologna.pdf [Accessed 21.10.09]
37. Angermeyer MC, Breier P, Dietrich S, Kenzine D, Matschinger H. Public attitudes toward psychiatric treatment: an international comparison. Soc Psychiatry Psychiatr Epidemiol. 2005;40:855-864.
38. Cavanagh S. Content analysis: concepts, methods and applications. Nurse Researcher. 1997;4:5-16.
39. Hsieh H-F, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15:1277-88.
40. Ngo-Metzger Q, Telfair J, Sorkin DH, Weidmer B, Weech-Maldonado R, Hurtado M, Hays RD. Cultural Competency and Quality of Care: Obtaining the Patient's Perspective. The Commonwealth Fund. 2006 Available from: http://www.cmwf.org/publications/publications_show.htm?doc_id=414116 [Accessed 21.10.09]
41. Landers M, Blenkinsopp A, Pollock K, Grime J. Community pharmacists and depression: The pharmacist as intermediary between patient and physician. Int J Pharm Pract. 2002;10:253-265.
42. Bell JS, Johns R, Chen TF. Pharmacy students' and graduates' attitudes towards people with schizophrenia and severe depression. Am J Pharm Educ. 2006;70:77.
43. Rijcken CAW, Van der Veur H, Knegtering H, De Jong-van den Berg LTW. Schizophrenia care and the Dutch community pharmacy: The unmet needs. Int J Pharm Pract. 2003;11:97-104.
44. Powell J, Clarke A. Internet information-seeking in mental health: population survey. Br J Psychiatry. 2006;189:273-277.
45. Pohjanoksa-Mäntylä M, Saari JK, Närhi U, Pylkkänen K, Airaksinen MS, Bell JS. How and why do people with depression access and utilize online drug information: a qualitative study. J Affect Disord. 2009;114:333-339.
46. Pohjanoksa-Mäntylä M, Antila J, Eerikäinen S, Enäkoski M, Hannuksela O, Pietilä K, Airaksinen MS. Utilization of a community pharmacy operated national drug information call-center in Finland. Res Social Adm Pharm. 2008;4:144-152.
47. Angermeyer MC, Dietrich S. Public beliefs about and attitudes towards people with mental illness: a review of population studies. Acta Psychiatr Scand. 2006;113:163-179.
48. Littlewood R. Cultural variation in the stigmatisation of mental illness. Lancet. 1998;352:1056-1057.
49. Stanhope V. Culture, control and family involvement: a comparison of psychosocial rehabilitation in India and the United States. Psychiatric Rehabilitation Journal 2002;25:273-280.
50. Wasan AD, Neufeld K, Jayaram G. Practice patterns and treatment choices among psychiatrists in New Delhi, India. Soc Psychiatry Psychiatr Epidemiol. 2009;44:109-119.
51. Srinivasan TN, Thara R. Management of medication non-compliance in schizophrenia by families in India. Schizophr Bull. 2002;28:531-535.
52. Tanskanen P, Airaksinen M, Tanskanen A, Enlund H. Counselling patients on psychotropic medication: physicians' opinions on the role of community pharmacists. Pharm World Sci. 2000;22:59-61.
53. Desplenter FAM, Simoens S, Laekeman G. The impact of informing psychiatric patients about their medication: a systematic review. Pharm World Sci. 2006;28:329-341.
54. Ay P, Save D, Fidanoglu O. Does stigma concerning mental disorders differ through medical education? Soc Psychiatry Psychiatr Epidemiol. 2006;41:63-67.
55. Bell JS, Johns R, Rose G, Chen TF. A comparative study of consumer participation in mental health pharmacy education. Ann Pharmacother. 2006;40:1759-1765.
56. Floor-Schreudering A, De Smet PA, Buurma H, Egberts AC, Bouvy ML. Documentation quality in community pharmacy: completeness of electronic patient records after patients' first visits. Ann Pharmacother. 2009;43:1787-1794.
57. Mai A, Aslani P. Impact of Vietnamese written and verbal medicine information on Vietnamese-speaking Australians' knowledge and satisfaction. Br J Clin Pharmacol. 2007;64:527-535.
58. Shaya FT, Gbarayor CM. The case for cultural competence in health professions education. Am J Pharm Educ. 2006;70:124.
59. Volmer D, Kureoja L, Kõiv I, Trahhatsjova M. Opinions and wishes of pharmacy customers of South-Estonia towards drug information [in Estonian]. Perearst. 2007;21:36-40.
60. World Health Organization. Investing in Mental Health. 2003 Available from: www.who.int/entity/mental_health/media/investing_mnh.pdf [Accessed 21.10.09]
61. Hickey G, Kipping C. A multi-stage approach to the coding of data from open-ended questions. Nurse Researcher. 1996;4:81-91.
62. Cates ME, Monk-Tutor MR, Drummond SO. Mental health and psychiatric pharmacy instruction in US colleges and schools of pharmacy. Am J Pharm Educ. 2007;71:4.
63. Koski I, Heikkila A, Bell JS. Mental health pharmacy education at 16 European universities. Am J Pharm Educ. 2009; 73:139.
64. Pohjanoksa-Mäntylä MK, Kulovaara H, Bell JS, Enäkoski M, Airaksinen MS. Email medication counseling services provided by Finnish community pharmacies. Ann Pharmacother. 2008;42:1782-1790.
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