The impact of a person-centred community pharmacy mental health medication support service on consumer outcomes

Figures & data

Table 1. Key professional services available in Australian community pharmacies (The 6CPA, 2015).

Medication adherence programmes
Clinical Interventions	Identifying, resolving and documenting medication-related issues in the pharmacy (e.g. when dispensing and supplying medication).
Compliance Aids (Dose Administration Aids)	The provision of a well-sealed, tamper-evident device that allows individual medicine doses to be organised according to prescriber instructions.
Staged Supply	The provision of Pharmaceutical Benefits Schedule (subsidised) medication at specified time-frames as directed by the prescriber, e.g. daily, weekly etc.
Medication management programmes
MedsCheck	Discussion of medications and health goals in the community pharmacy. There is also a similar service for Type 2 Diabetes (Diabetes MedsCheck). This service is currently capped by the Australian Government to 10 services per month, per pharmacy.
Home Medication Review (HMR)	A specially trained (accredited) pharmacist undertakes a home visit to identify and resolve any medication-related problems. A written report with medication recommendations is provided to the person’s general practitioner. Consumers must meet specific eligibility requirements to obtain the service.
Residential Medication Management Review	Similar to a HMR but in a residential-aged care facility.
Other specific programs or services
Return Unwanted Medication (RUM)	Consumers can return any medication no longer used for safe disposal.
Opioid Substitution Program	The provision of a range of opioid replacement therapy to consumers with opioid dependence.
Needle and Syringe Program	The provision of injecting equipment and their safe disposal.
Immunisations	Trained pharmacists can supply and inject certain vaccinations (dependent on state and territory legislation).

Table 2. Intervention steps.

Steps	Tools used, information collected or tasks undertaken
Step 1	Project information, consumer recruitment and consent.
Step 2 (My Health Status)	Demographics, details of support network, frequency of pharmacy visits.Project information was provided to the consumers’ healthcare team, e.g. general practitioner, in the form of a letter.
Step 3 (Initial Health Review)	Baseline data (T1): illness perceptions, quality of life, medication beliefs and satisfaction, medication adherence and community pharmacy expectations (using the Australian Community Pharmacy Service Charter [The Pharmacy Guild of Australia & Australian Government Department of Health, 2014a]).
	Brief Illness Perception Questionnaire (BIPQ) (Broadbent et al., 2006)	8 questions (11-point scale) assessing dimensions of illness perception. The overall score represents the degree to which illness is perceived as benign or threatening. A higher score reflects a more threatening view of illness.
	Short Form 12 Health Survey v1 (Ware et al., 1996)	12 questions in which physical and mental health composite scores can be computed using the scores of the 12 questions (range from 0 to 100). Zero indicates the lowest level of health.
	Beliefs about Medication Questionnaire (BMQ) (Horne et al., 1999)	Two 5-item subscales (5-point scale) assessing consumer beliefs about the necessity of taking medication to manage their illness, and their concerns about adverse outcomes. Higher scores indicate stronger beliefs.
	Treatment satisfaction Questionnaire for Medication (TSQM^©) (Atkinson et al., 2004)	14 statements (7-point scale) which form four sub-scales (Effectiveness, Side effects, Convenience and Global Satisfaction). Lower scores indicate low satisfaction.
	Morisky Medication Adherence Scale (MMAS-8^©) (Krousel-Wood et al., 2009; Morisky et al., 2008; Morisky & DiMatteo, 2011)	8 questions with yes/no answers. An overall score can be computed to assess high, medium or low adherence. Consumer participants responded to this question for all of their medications.
Step 4 (Medication Support Plan)	A partnership between pharmacist and consumer to identify challenges, set goals and associated strategies.
Step 5 (Ongoing Support and Maintenance)	Provision of medication management services to the consumer over a suggested period of 3–6 months (tailored to each individual in terms of frequency and mode of follow-up contact, e.g. face-to-face). Documentation of consumer progress and review of goal strategies.
Step 6 (Final Health Review & Evaluation)	Post-intervention data (T2): similar to Step 3 to allow for a comparison of responses.

Table 3. Consumer participant characteristics.

	Total, n = 418	Completers, n = 295 (%)	Non-completers, n = 123 (%)	p value
Gender	400	293	107
Female	246 (61.5)	178 (60.7)	68 (63.6)	0.610
Male	154 (38.5)	115 (39.3)	39 (36.4)
Age (years)	376	277	99
up to 25	13 (3.5)	7 (2.5)	6 (6.1)	0.060
26-40	91 (24.2)	60 (21.7)	31 (31.3)
41-65	204 (54.3)	159 (57.4)	45 (45.4)
66 or over	68 (18.1)	51 (18.4)	17 (17.2)
Language	394	289	105
English	379 (96.2)	276 (95.5)	103 (98.1)	0.372
Other	15 (3.8)	13 (4.5)	2 (1.9)
Cultural background	397	290	107
Australian (White/Caucasian)	356 (89.7)	258 (89.0)	98 (91.6)	0.577
Other	41 (10.3)	32 (11.0)	9 (8.4)
Employment status	392	286	106
Employed^a	168 (42.9)	117 (40.9)	51 (48.1)	0.419
Unemployed	48 (12.2)	41 (14.4)	7 (6.6)
Retired	67 (17.1)	51 (17.8)	16 (15.1)
Disability support pension	63 (16.1)	48 (16.8)	15 (14.2)
Other^b	46 (11.7)	29 (10.1)	17 (16.0)
Mental health prescriber	388	283	105
General practitioner	338 (87.1)	246 (86.9)	92 (87.6)	0.489
Psychiatrist	46 (11.9)	35 (12.4)	11 (10.5)
Other	4(1.0)	2 (0.7)	2 (1.9)
Have a carer^c	397	291	106
Yes	30 (7.6)	22 (7.6)	8 (7.5)	0.997
See another health worker	355	255	100
No	202 (56.9)	143 (56.1)	59 (59.0)
Psychologist	89 (25.1)	64 (25.1)	25 (25.0)	0.864
Social worker	13 (3.7)	9 (3.5)	4 (4.0)
Occupational therapist	9 (2.5)	6 (2.3)	3 (3.0)
Other	42 (11.8)	33 (12.9)	9 (9.0)
Community pharmacy visits	394	288	106
Daily	54 (13.7)	50 (17.4)	4 (3.8)	<0.001
Weekly	85 (21.6)	70 (24.3)	15 (14.1)
2–3 times/month	106 (26.9)	77 (26.7)	29 (27.4)
Monthly	123 (31.2)	75 (26.0)	48 (45.3)
Other (every few months or other)	26 (6.6)	16 (5.6)	10 (9.4)

^aIncludes full-time, casual or part-time paid employment; ^bIncludes student, volunteer, homemaker or other; ^cIncludes relative, friend, paid employee or other. p < 0.01 indicates significant difference.

Table 4. Time spent working through steps of the medication support service.

Step number^a
Time (minutes)	2, n = 255	3, n = 268	4, n = 239	5, n = 236	6, n = 207	Total
Mean (SD)	11.7 (9.3)	23.8 (12.1)	21.1 (14.3)	14.3 (12.2)	24.7 (14.0)	95.6
Median	10	20	20	10	20	–
Range	1–60	4–75	1–90	1–75	1–120	–

^aStep 1 was recruitment and consent and a time was not recorded as it was often undertaken over more than one conversation/visit to allow for provision of study information and answering questions.

Table 5. Outcomes measured at baseline (T1) and at the completion of each intervention (T2).

	T1 score mean (SD)	T2 score mean (SD)	p value
Health-related outcomes
Brief Illness Perception Questionnaire (BIPQ)
How much does your illness affect your life? (n = 289)	6.3	5.6	<0.001
How long do you think your illness will continue?^a (n = 288)	7.8	7.4	0.002
How much control do you have over your illness?^b (n = 287)	5.2	6.1	<0.001
How much do you think your treatment can help your illness?^b (n = 284)	7.2	7.5	0.008
How much do you experience symptoms from your illness? (n = 290)	6.4	5.7	<0.001
How concerned are you about your illness? (n = 287)	6.7	5.7	<0.001
How well do you feel you understand your illness?^b (n = 289)	7.0	7.7	<0.001
How much does your illness affect you emotionally? (n = 287)	7.0	5.9	<0.001
Total score (n = 270)	44.8 (12.2)	38.8 (12.9)	<0.001
Short Form 12 Health Survey v1 (SF-12)
SF-12 physical domain (n = 267)	39.2 (7.3)	39.0 (7.3)	0.423
SF-12 mental domain (n = 267)	43.3 (10.1)	46.1 (10.3)	<0.001
Medication-related outcomes
Beliefs about Medication Questionnaire (BMQ)^‡
My health at present depends on my medicines (n = 287)	4.1	4.0	0.074
Having to take medicines worries me (n = 284)	2.8	2.6	0.011
My life would be impossible without my medicines (n = 284)	3.8	3.7	0.242
Without my medicines I would be very ill (n = 287)	3.8	3.8	0.326
I sometimes worry about long-term effects of my medicines (n = 287)	3.3	3.2	0.068
My medicines are a mystery to me (n = 288)	2.4	2.1	0.001
My health in the future will depend on my medicines (n = 281)	3.8	3.7	0.269
My medicines disrupt my life (n = 286)	2.4	2.4	0.685
I sometimes worry about becoming too dependent on my medicines (n = 289)	3.0	2.8	0.002
My medicines protect me from becoming worse (n = 289)	4.1	4.1	0.903
Necessity sub-scale (n = 271)	19.7 (3.8)	19.4 (4.1)	=0.276
Concerns sub-scale (n = 275)	13.9 (4.6)	13.1 (4.2)	=0.001
Treatment Satisfaction Questionnaire for Medication (TSQM^©)^§
Effectiveness (n = 276)	74.8 (17.3)	78.8 (16.0)	<0.001
Side effects (n = 88)	55.6 (14.4)	57.1 (15.3)	0.681
Convenience (n = 285)	89.8 (14.1)	90.9 (12.9)	0.186
Global satisfaction (n = 286)	80.9 (17.0)	84.2 (16.5)	<0.001
Morisky Medication Adherence Scale (MMAS-8^©)	n (%)	n (%)
High adherence	18 (51.4)	17 (48.6)	=0.005
Medium adherence	106 (42.4)	144 (57.6)
Low adherence	158 (56.6)	121 (43.4)

^aRated from a very short time to forever; ^bRated in reverse so lower score indicates less threat;

^‡Higher scores indicate stronger beliefs, rated from 1 = strongly disagree to 7 = strongly agree, paired t-test; ^§Lower scores indicate lower levels of satisfaction; p < 0.01 indicates significant change.

n relates to the number of participants reporting at T1 and T2.

Figure 1. Morisky Medication Adherence Scale (MMAS-8)^© (Krousel-Wood et al., 2009; Morisky et al., 2008; Morisky & DiMatteo, 2011). Use of the ©MMAS is protected by US copyright laws. Permission for use is required. A license agreement is available from: Donald E. Morisky, ScD, ScM, MSPH, Professor, Department of Community Health Sciences, UCLA School of Public Health, 650 Charles E. Young Drive South, Los Angeles, CA 90095-1772, [email protected].

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