KEY POINTS
• People with severe mental illness ( SMI ) such as bipolar affective disorder , schizophrenia , schizoaffective disorder , and other nonorganic psychotic disorders , are at a substantially higher risk of premature death , in that they die 10 – 20 years earlier than the general population .
• Many factors contribute to this excess mortality ; people with SMI receive a poor quality of care for their physical health when compared to the general population . Despite having twice as many contacts with healthcare services , individuals with SMI receive less physical health screening , fewer prescriptions for cardiovascular medication such as beta-blockers and statins and fewer procedures and lower rates of cardiovascular disease diagnosis .
• The mainstay of treatment for most people with SMI is antipsychotic medication . Judicious prescribing can reduce excess mortality in individuals with SMI , and recent studies and evidence summaries highlight the positive impact on mortality of continuous treatment ), appropriate dose ranges , and current and long-term use .
• Pharmacy is increasingly being highlighted as a profession that has the potential to contribute to comorbid physical and mental healthcare in both primary and secondary care settings .
• Exploration of the views , experiences and perspectives of patients and informal carers indicates unmet need in the care they receive including lack of in depth , significant and meaningful interactions with pharmacists , lack of information exchange about CMR , MetS and related diseases as side effects of medication . The first step for pharmacy practice to impact on this is to increase pharmacist – patient facing interactions to facilitate the formation of long-lasting trusting relationships . individuals with SMI continue to be an important global public health problem . The excess morbidity and mortality in this population are mainly due to preventable physical health illnesses related to CMR , MetS and related diseases . Despite identified and established risk factors for morbidity and premature mortality , evidence for effective interventions for CMR , MetS and related diseases in people with SMI is limited . Pharmacy is increasingly being highlighted as a profession that has the potential to contribute to comorbid physical and mental healthcare in both primary and secondary care settings . However , robust high-quality research supporting the role of pharmacy providing care for CMR , MetS and related diseases in individuals with SMI is lacking .
The role of pharmacy A literature review explored the use of pharmacy in the management of CMR , MetS and related diseases in SMI . 54 An important focus of this review was to explore implementation strategies to improve physical health screening , such as HbA1c for diabetes , and related interventions such as smoking cessation or reduction . This review reported that face-to-face interactions of pharmacists with others , such as patients or healthcare professionals , is a specfic aspect that is important in achieving a statistically significant impact on health screening and related interventions . This might be , for example , a pharmacist-led multidisciplinary ward round or pharmacist outreach visits .
This literature review identified gaps in the current evidence base . This included , for example , screening of waist circumference and weight / weight change , cardiovascular and diabetes risk assessment using formal risk assessment tools / calculators or high-dose antipsychotic or polypharmacy with antipsychotics . Currently , guidance within the UK recommends the use of QRISK ® to assess the risk of CVD in people with schizophrenia . 55 , 66 Also lacking were studies involving pharmacy technicians in any patient facing roles . A lack of data was found about the role / involvement of community pharmacy or pharmacy professionals other than pharmacists ( i . e ., pharmacy technicians ) within primary care , follow up of individuals after implementation of a study intervention , utilisation of behaviour change , or selfmanagement techniques community or family support . 54
Also absent from the data was an in-depth exploration of the views , perceptions , or experiences of patients , ( their ) informal carers or caring dyads , pharmacy and care professionals where formal qualitative data synthesis had been undertaken . This is critical as it might inform the acceptability of service developments . Furthermore , such evidence would be central in establishing an agreed set of standards to assess and understand patients ’ experiences of care in in facilitating and identifying those things that matter the most to patients . To address this specific gap , a PhD study was undertaken and completed in 2021 . 57
The PhD study reported many areas of unmet need . In particular , patients ’ experiences of a lack of in depth , significant and meaningful interactions with pharmacists . Furthermore , patients have a desire for information exchange about CMR , MetS and related diseases as side effects of medication , rather than being informed and / or just simply being provided with a leaflet . A key step for pharmacy practice to impact on this is to increase pharmacist – patient facing interactions to facilitate the formation of long-lasting trusting relationships .
A starting point for this could be to build these practices
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