Laetitia Hattingh

Difficult-to-treat pediatric obsessive-compulsive disorder: Feasibility and preliminary results of a randomized pilot trial of D-cycloserine-augmented behavior therapy

This study examined the feasibility and preliminary effectiveness of d‐cycloserine (DCS)–augmented cognitive behavioral therapy (CBT) for children and adolescents with difficult‐to‐treat Obsessive Compulsive Disorder, in a double‐blind randomized controlled pilot trial (RCT).

Mental health consumer and caregiver perceptions of stigma in Australian community pharmacies

Background: The stigma of mental illness can be a barrier to effective medication management in the community pharmacy setting. This article explored mental health consumers’ or caregivers’ experiences of stigma in Australian community pharmacies. Materials: Semi-structured interviews and focus groups were conducted with a purposive sample of consumers or caregivers (n = 74). Interview transcripts were analysed using a general inductive approach. Discussion: Stigma presented a barrier to effective mental health management. Self-stigma impeded consumers’ community pharmacy engagement. Positive relationships with knowledgeable staff are fundamental to reducing stigma. Conclusions: Findings provide insight into the stigma of mental illness in community pharmacies.

Review of community pharmacy staff educational needs for supporting mental health consumers and carers

Development of a mental health education package for community pharmacy staff should be informed by mental health consumers/carers’ needs, expectations and experiences, and staff knowledge, skills and attitudes. This review (1) explored research on community pharmacy practice and service provision for mental health consumers/carers, and (2) identified validated methods for assessing staff knowledge, skills and attitudes about mental illness to inform the development of a training questionnaire. A literature scan using key words knowledge, skills, attitudes, and beliefs combined with community pharmacy, pharmacist, and pharmacy support staff, and mental illness, depression, anxiety was conducted. A small number of studies were found that used reliable methods to assess pharmacists’ training needs regarding mental illness and treatment options. There was little published specifically in relation to depression and anxiety in community pharmacy practice. No studies assessed the training needs of pharmacy support staff. A systematic analysis of pharmacy staff learning needs is warranted.

Using an Intervention Mapping Framework to Develop an Online Mental Health Continuing Education Program for Pharmacy Staff

Introduction: Current mental health policy in Australia recognizes that ongoing mental health workforce development is crucial to mental health care reform. Community pharmacy staff are well placed to assist people with mental illness living in the community; however, staff require the knowledge and skills to do this competently and effectively. This article presents the systematic planning and development process and content of an education and training program for community pharmacy staff, using a program planning approach called intervention mapping. Methods: The intervention mapping framework was used to guide development of an online continuing education program. Interviews with mental health consumers and carers (n = 285) and key stakeholders (n = 15), and a survey of pharmacy staff (n = 504) informed the needs assessment. Program objectives were identified specifying required attitudes, knowledge, skills, and confidence. These objectives were aligned with an education technique and delivery strategy. This was followed by development of an education program and comprehensive evaluation plan. The program was piloted face to face with 24 participants and then translated into an online program comprising eight 30‐minute modules for pharmacists, 4 of which were also used for support staff. The evaluation plan provided for online participants (n ≅ 500) to be randomized into intervention (immediate access) or control groups (delayed training access). It included pre‐ and posttraining questionnaires and a reflective learning questionnaire for pharmacy staff and telephone interviews post pharmacy visit for consumers and carers. Results: An online education program was developed to address mental health knowledge, attitudes, confidence, and skills required by pharmacy staff to work effectively with mental health consumers and carers. Discussion: Intervention mapping provides a systematic and rigorous approach that can be used to develop a quality continuing education program for the health workforce.

Australian mental health consumers' and carers' experiences of community pharmacy service.

Many Australians with anxiety or depression experience issues accessing pharmacological treatment even though community pharmacies are remunerated to supply subsidized medicines and provide medicine management services.

Trust and Safe Spaces: Mental Health Consumers’ and Carers’ Relationships with Community Pharmacy Staff

BackgroundTrusting relationships between mental health consumers and health care providers are critical in the management and recovery process. Although community pharmacy staff are well placed to form relationships with mental health consumers and carers, little is known about the existence, nature or significance of consumer–staff relationships.ObjectivesThe aim of this study was to explore mental health consumers’ and carers’ perceptions of community pharmacy services, and describe the nature of their relationships with pharmacy staff.MethodsFocus groups and semi-structured interviews were conducted with a convenience sample of 74 mental health consumers or carers who self-selected into the study. Thematic analysis was undertaken to explore participants’ perspectives.ResultsPositive experiences of pharmacy services were perceived to encourage consumers’ and carers’ trust in pharmacists and promote relationship development. This was enhanced when participants felt that elements of patient-centred care were part of the pharmacy services provided. Although some participants perceived community pharmacy to have a limited role in mental health, those who had established relationships highlighted the current role of pharmacists in their care, and appeared to welcome further extensions of pharmacists’ role in mental health.ConclusionsTrusting relationships between consumers and carers and community pharmacy staff were deemed to be important in mental health care and contributed to consumers’ and carers’ views of pharmacy as a safe health care space. Community pharmacy services that included core elements of patient-centred care appeared to facilitate relationship formation and associated benefits. Education and training is needed for community pharmacy staff to improve mental health knowledge and promote positive engagement with consumers and carers.

Comparison between self-formulation and compounded-formulation dexamethasone mouth rinse for oral lichen planus: a pilot, randomized, cross-over trial.

AIM There is a lack of appropriate, commercially-available topical corticosteroid formulations for use in oral lichen planus (OLP) and oral lichenoid reaction. Current therapy includes crushing a dexamethasone tablet and mixing it with water for use as a mouth rinse. This formulation is unpleasant esthetically and to use in the mouth, as it is a bitter and gritty suspension, resulting in poor compliance. Thus, the present study was designed to formulate and pilot an effective, esthetically-pleasing formulation. METHODS A single-blinded, cross-over trial was designed with two treatment arms. Patients were monitored for 7 weeks. Quantitative and qualitative data was assessed using VAS, numeric pain scales, the Treatment Satisfaction Questionnaire for Medication-9, and thematic analysis to determine primary patient-reported outcomes, including satisfaction, compliance, quality of life, and symptom relief. RESULTS Nine patients completed the pilot trial. Data analysis revealed the new compounded formulation to be superior to existing therapy due to its convenience, positive contribution to compliance, patient-perceived faster onset of action, and improved symptom relief. CONCLUSION Topical dexamethasone is useful in the treatment of OLP. When carefully formulated into a compounded mouth rinse, it improves patient outcomes.

Education and training for community pharmacists in mental health practice: how to equip this workforce for the future

Purpose – The purpose of this paper is to explore the potential approaches to continuing education and training delivery for community pharmacists to equip them to support mental health consumers and carers with illnesses such as depression and anxiety. Design/methodology/approach – Review of national and international literature about community pharmacists’ roles, beliefs and attitudes towards mental health, continuing education delivery for the workforce and training recommendations to equip pharmacy workforce. Findings – Training involving consumer educators was effective in reducing stigma and negative attitudes. Interactive and contextually relevant training appeared to be more effective than didactic strategies. Narratives and role-plays (from the perspective of consumers, carers and health professionals) are effective in promoting more positive attitudes and reduce stigma. Flexible on-line delivery methods with video footage of expert and consumer narratives were preferable for a cost-effective pro...

An evaluation of the integration of standards and guidelines in community pharmacy practices

Objective To explore the usefulness and implementation of practice standards in community pharmacy practice regarding contemporary core services. Setting Community pharmacies in South East Queensland, Australia. Method During August and September 2006 semi-structured interviews with community pharmacists explored practice processes and procedures and the utilisation of endorsed standards and guidelines. Thematic content analysis of the interviews, inductive analysis and continual comparison of categories and concepts enabled common and distinct themes to be clarified. Main outcome measure Usefulness and integration of practice standards in the provision of core pharmacy services, utilisation of support staff, record keeping and overall risk management processes in community pharmacy. Results Seventeen community pharmacists participated, representing a wide range of demographics, experience and pharmacy types. Staff utilisation and record keeping practices were analysed as well as two core services, namely: (1) the supply of over-the-counter medicines, and (2) the dispensing of prescriptions. The procedures followed concerning the supply of over-the-counter medicines varied. The majority of participants did not regard this as a pharmacist’s immediate role, but rather relied on support staff to identify when the supply required a pharmacist’s intervention. Whilst all participants involved dispensary assistants in the dispensing process, the delegation of procedures differed. Most participants did not clearly differentiate between pharmacists’ and dispensary assistants’ activities. Dispensing processes and the involvement of pharmacists in the provision of patient advice varied. Pharmacist intervention record keeping was uncommon and records of ‘near misses’ were not routinely kept by any of the participants. Conclusion A lack of integration of practice standards indicated a need to review the standards for relevance. Additionally, pharmacists need to re-evaluate workflow models and the delegation of tasks in the light of new roles and responsibilities.

Medication supply and management in rural Queensland: Views of key informants in health service provision

BACKGROUND Rural settings challenge health care providers to provide optimal medication services in a manner that is timely and of high quality. Extending the roles of rural health care providers is often necessary to improve access to medication services; however, there appears to be a lack of pharmacy-based involvement and support within the medication system. OBJECTIVES This article explores medication supply and management issues in rural settings, based on the governance perspectives of key informants on regulatory aspects, policy, and professional practice. The specific objectives were to (1) identify the key issues and existing facilitators and (2) explore the potential roles of pharmacy to improve medication supply and management services. METHODS Semi-structured interviews were conducted with representatives within regulatory or professional organizations. The participants were key informants who held leadership and/or managerial roles within their respective organizations and were recruited to provide insights from a governance perspective before data collection in the community. An interview guide, informed by the literature, assisted the flow of interviews, exploring topics, such as key issues, existing initiatives, and potential pharmacy-based facilitators, in relation to medication supply and management in rural settings. RESULTS Issues identified that hindered the provision of optimal medication supply and management services in the rural areas centered on workforce, interprofessional communication, role structures, and funding opportunities. Legislative and electronic developments and support mechanisms aim to facilitate medication processes in rural areas. Potential initiatives to further enhance medication services and processes could explore extended roles for pharmacists and pharmacy support staff, as well as alternative service delivery models to enhance pharmacy workforce capacity. CONCLUSIONS The study provided an overview of key issues with medication supply and management and highlighted the potential for increased pharmacy involvement to improve and support medication services in rural areas. The governance views of these key informants could be used to inform policy and practice related to rural medication services.