Evaluating the Impact of Pharmacists on Clinical Outcomes and Adherence in Patients with Mental Illness: A Literature Review

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Dalia Mekeel

Abstract

Purpose: The purpose of this literature review is to investigate the role of pharmacists in improving clinical outcomes and adherence to psychotropic medications in patients with mental illness. The majority of patients tend to stop taking their medications due to the delayed effects or adverse events. It has been established that pharmacists have a positive effect on patients’ clinical outcomes in different chronic disease states other than mental illness. There is also a stigma associated with how comfortable pharmacists are on counseling patients about psychotropic medications. This literature review will evaluate the level of pharmacists’ involvement in treating patients with mental illness as well as strategies used to achieve persistence and compliance with therapy.
Methods: A PubMed search was conducted to identify articles related to mental illness and pharmacists. MeSH terms included “antidepressants”, “adherence”, “pharmacists”, and “bipolar disorder”. A free-text search was conducted using the same terms and to search for the most updated American Psychiatric Association practice guidelines. The National Institute of Mental Health database was searched for current mental health statistics in the United States. Collectively, 62 results returned for the MeSh search. This review included studies on adults with mental disorders who were evaluated by pharmacists for adherence and clinical outcomes between the years of 1995-2019. The results of five clinical trials assessing the role of pharmacists in adherence to psychotropic medications will be discussed in this literature review.
Results: The clinical trials included in this review showed a statistically significant increase in adherence to psychotropic medications associated with pharmacists’ interventions. The results were not statistically significant for the clinical outcomes in most studies but presented positive improvements in the inpatient and outpatient settings. Canales et al. results showed that patients receiving pharmacists’ interventions in the inpatient setting had >30% improved clinical outcomes measured by different rating scales. The results of Valenstein et al. study conducted at Veteran Affairs clinics were statistically significant for adherence improvement presented by a 25% increase in medication possession ratio. Aljumah et al. clinical trial had a 18% increase in adherence associated with pharmacist interventions. The EMDADER-TAB trial resulted in a statistically significant decrease in ER visits, significant improvement of the depression symptoms, and overall improvement of severity of symptoms.
Conclusion: Mental illness should be treated as any other medical condition that requires interventions whenever clinical outcomes are not optimal. Pharmacists have the skills to evaluate clinical symptoms of different psychiatric disorders as well as the knowledge on therapeutic treatments necessary for the optimization of medication use.

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Review Article