Could community pharmacy teams enhance mental health support through the Advancing Mental HeaLth Provision In PHarmacY (AMPLIPHY) service? A protocol and preliminary findings.

Problem

The improvement of mental health support is a priority for the NHS, and primary care services. Community pharmacists and their teams are well-placed to contribute to this agenda. Yet, a recent Cochrane review did not identify any formal mental health services which are being delivered by community pharmacists. (1) Given that 1.6 million people visit a pharmacy in England every day (2) and adherence to antidepressants is often poor (3), community pharmacies could be an underutilised resource. We therefore aim to test the feasibility of implementing a service that has been co-designed with service-users to enhance support related to depression and anxiety.

Approach

We worked with a patient and public involvement group, pharmacists and leadership at LloydsPharmacy to design a service to support people who are prescribed new medications for depression or anxiety, or have a change in medication, dose or quantity. The resultant programme is a series of consultations, beginning at the presentation of the qualifying prescription, after a further 1-2 weeks and then as further prescriptions are presented, up to 3 months. The participating pharmacists undertook a one-day training programme led by researchers from the Universities of Huddersfield and Manchester. This included review of service development, documentation, embedded research, suicide prevention, safeguarding and identification of local referral pathways. The service has been piloted since November 2019 and will continue to May 2020 in 10 pharmacies across Greater Manchester. We will evaluate the service through triangulation of data obtained through the following methods: 1) Monitor service uptake through audit kept by pharmacy teams when identifying eligible patients. 2) Review and monitoring of anonymous consultations, which are recorded on PharmOutcomes. Descriptive statistics will be reported and we will use content analysis to describe the content of consultation. 3) Semi-structured interviews prior to and after implementation of the service with the participating pharmacists, which we will analyse using the Theoretical Domains Framework. (4) 4) Anonymous qualitative surveys of patients as they leave the service, which we will analyse thematically.

Findings

The first patient was recruited into the service on 11/11/2019, to date 74 patients have been recruited (62% target). Patients range from age 18 to 72 (39 median) and 45 (61%) are female. 54 (73%) entered the service due to a new medication, 13 (18%) due to a change in dose and the remainder had a change in medication or quantity. Female pharmacists were more likely to recruit female patients than male patients (71% vs. 29%; p<0.05). The initial qualitative interviews with pharmacists were undertaken in November/December 2019, were audio-recorded, and are in the process of being transcribed.

Consequences

By July 2020, we will be able to comment on the feasibility of this service as indicated from the methods described above. These findings will support potential funding applications to evaluate a wider roll-out of the service across other community pharmacy providers and a wider geographical area.