Research Article

A Survey of Community Pharmacists and Final-Year Student Pharmacists and their Perception of Psychotherapeutic Agents

Journal of Pharmacy Practice 2015, Vol. 28(2) 166-174 ª The Author(s) 2013 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/0897190013515709 jpp.sagepub.com

Brian D. McKee, PharmD1, Margareth Larose-Pierre, PharmD2, and Leonard R. Rappa, PharmD, BCPP, CPh3

Abstract Introduction: The World Health Organization has estimated that as many as 450 million people worldwide have mental disorders. More than 44 million people in the United States have a mental disorder annually, estimating the annual direct costs of mental illness to exceed US$69 billion. Psychotherapeutic agents are used to treat mental illnesses and improve quality of life. The purpose of the study is to assess the knowledge and knowledge perception of community pharmacists and final-year student pharmacists regarding psychotherapeutic agents dispensed to their community of patients with mental illness. Methods: A survey was distributed to pharmacists and final-year student pharmacists regarding psychotherapeutic agents. Results: In all, 100 pharmacists and 40 final-year student pharmacists completed the survey. Upon analysis of surveys returned by pharmacists, knowledge deficiency was assessed regarding anxiolytics and mood stabilizers. The analysis of student participant surveys demonstrated knowledge deficiency regarding antidepressants and anxiolytics. Conclusions: Final-year student pharmacists would benefit from the curricular incorporation of courses and advanced pharmacy practice experiences in Psychiatry. Community pharmacists caring for customers with psychiatric disorders should take advantage of continuing education series that highlight updates and new developments regarding psychotherapeutic agents in order to improve clinical outcomes of patients. Keywords psychotherapeutic agents, knowledge, perception, community pharmacist, student pharmacist

Introduction Psychotherapeutic medications are designed for the treatment of individuals diagnosed with mental disorders with the ultimate goal to improve quality of life. Practitioners, such as pharmacists, are involved in the management of psychiatric disorders through patient medication counseling, assessing potential for adverse reactions, and properly evaluating dosage regimens. Many studies have proven that the knowledge of health care practitioners is directly related to better pharmaceutical outcomes and lower overall health care costs.1-6 Approximately 89% of patients with depression who responded to the National Comorbidity Survey Replication showed depression symptoms that were moderate to very severe.1 It was estimated in 1990 that the costs associated with loss productivity due to workers with depression were approximately US$44 billion dollars, which is an excess of US$31 billion dollars of loss productivity when compared to persons without depression.2,7 Stewart et al analyzed questionnaires in their study assessing the number of patients with depression and their current treatment, which revealed that less than 30% of patients were being treated with an appropriate psychotherapeutic agent.2 This is consistent with previous study results from Wells et al.8

For all people in the United States having a mental illness, a total annual health care expenditure is estimated at US$69 billion dollars.3 This estimation does not include indirect costs such as lost work productivity, sick days from work and school, long-term disability, premature mortality, legal consequences, social and family problems, and substance abuse.9 The widespread incidence and cost associated with mental illnesses provide health care practitioners with a challenge, and an obligation, to properly manage these conditions. Furthermore, with the expansion of pharmacy services in the community, pharmacists have more opportunities to work directly with mental health care practitioners to improve pharmaceutical

1

Pharmacy Department, Atlanta VA Medical Center, Decatur, GA, USA Florida A&M University College of Pharmacy and Pharmaceutical Sciences, Crestview, FL, USA 3 Florida A&M University College of Pharmacy and Pharmaceutical Sciences, Davie Instructional Site, Davie, FL, USA 2

Corresponding Author: Brian McKee, Mental Health, Atlanta VA Medical Center, 1670 Clairmont Road, Decatur, GA, 30033, USA. Email: [email protected]

Downloaded from jpp.sagepub.com at UNIV OF CONNECTICUT on April 14, 2015

McKee et al

167

care outcomes and positively impact patient medication and psychotherapy adherence.4,6 The World Health Organization reported an estimated 877 000 worldwide deaths associated with suicide in 2003.10 Suicide was responsible for 32 559 deaths in the United States in 2007.11 Psychiatric disorders are prevalent among the majority of suicides committed, with more than 90% of suicides having a concurrent Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) psychiatric diagnosis.12-18 Furthermore, an excess of 80% of psychiatric patients who committed suicide were untreated at the time of their death.19,20 Mood disorders, bipolar disorder, and specifically major depressive disorder are accountable for approximately 60% of suicides.12,13,15,21,22 Without proper treatment, psychiatric disorders may result in one or more suicide attempts or suicide completion.19,20 It is imperative that pharmacists, and other health care professionals, actively seek and obtain knowledge about psychotherapeutic agents to ensure proper education to their patients and patient caregivers regarding potential risks and adverse effects. Ultimately, proper treatment of psychiatric disorders is an essential component of suicide prevention.19,20 Results of a research survey conducted in 2008 aimed to evaluate patient preferences, desired outcomes, and stigma regarding community pharmacists.23 This survey also assessed persons with psychiatric disorders and evaluated their subjective experience with psychotherapeutics on an outpatient basis. Of the participants, 76% specified that their pharmacist failed to provide them with advice needed to help them remember to take their medications.23 Collaboration with other practitioners, including primary care physicians, helps regulate medication issues, including those related to psychotherapeutic agents.24,25 Results from the latter studies directly showed that patients could benefit from collaborative health care services.23-25 In turn, patients with psychiatric disorders viewed these services delivered by pharmacists as vital to treatment success. Routine services, such as medication counseling and pharmaceutical care follow-up, were among the services offered.

Mental Illnesses Anxiety is a subjective sense of unease, dread, or worrying that can indicate a primary psychiatric condition or can be a constituent of a primary medical illness. Anxiety becomes a disorder when it is excessive, interferes with normal daily life, and threatens the safety of the individual.26 Anxiolytics are used to counteract these effects and can help the individual to feel in control of daily situations. Depression is a clinical mood disorder associated with melancholy mood or loss of interest as well as other symptoms that prevent a patient from leading a normal life.26 Antidepressants are utilized to treat the chemical imbalances hypothesized to cause the depressed mood.27,28 Along with psychotherapy, this ultimately allows the individual to cope with daily life. Mood stabilizers are used for bipolar disorder. Bipolar disorder is defined as unpredictable changes in mood from mania

(or hypomania) to depression.26 Bipolar disorder can be broken down into different categories depending on how frequent the mood changes occur. Antipsychotics are a class of medications used to treat psychosis and diseases such as schizophrenia.26 Many of the atypical antipsychotics carry Food and Drug Administration (FDA)approved indications for bipolar disorder and to augment refractory depression in major depressive disorder.29 Pharmacists knowledgeable in each psychotherapeutic class are able to provide necessary information that can positively improve mental illness response up to and including remission.4-6

Purpose The purpose of this study was to assess and compare the knowledge of community pharmacists and final-year student pharmacists on the uses, indications, interactions, drug-monitoring parameters, and other pertinent information regarding the psychotherapeutic medications that are commonly dispensed in community pharmacies. The competencies assessed through this study include knowledge of anxiolytics, antipsychotics, antidepressants, and mood stabilizers. Participants were additionally surveyed on their perception of knowledge regarding the competencies tested. This survey also seeks to assist health care professionals, not routinely or directly involved in the treatment of patients with psychiatric disorders, to become more aware of the prevalence of depression and other mental illnesses in the community and the importance and impact that psychiatric education can have in improving the mental health of consumers of psychotherapeutic agents.

Methods The study was approved by the institutional review board of Florida A&M University. The survey consisted of 3 parts: demographics, perception of knowledge, and knowledge of psychotherapeutic agents (Table 1). The first part of the survey contained 4 demographic questions that consisted of age, race, gender, and length of pharmacy practice. The second part of the survey contained 6 questions used to gauge the survey participant’s perception of his or her own knowledge regarding the use of psychotherapeutic agents. This portion incorporated a variety of different answer choices ranging from yes, no, and I’m not sure to a 5-point Likert-type scale ranging from strongly agree to strongly disagree, and very comfortable, comfortable to very uncomfortable. The final portion of the survey included 17 questions to assess knowledge regarding the different categories of psychotherapeutic agents (Figure 1). The surveys were distributed using 2 methods: the first being a manual distribution to licensed community pharmacists and final-year student pharmacists, and the second being an electronic distribution via a web-based survey application to final-year student pharmacists. Competency was assessed based on knowledge questions regarding each of the subcategories of psychotherapeutic agents: anxiolytics, antidepressants, antipsychotics, mood stabilizers, and opiates. The percentage of correct

Downloaded from jpp.sagepub.com at UNIV OF CONNECTICUT on April 14, 2015

168

Journal of Pharmacy Practice 28(2)

Table 1. Demographic and Knowledge Perception. Demographics

Students

Age 20-29 22 30-39 10 40-49 5 50-59 2 60 1 Race African American 12 Caucasian 11 Hispanic/Latino 9 Native American 1 Asian 7 Other 0 Sex Male 16 Female 24 Length of pharmacy practice 20 years 3 Number of patients utilizing agents 50 15 51-100 13 101-500 7 >500 0 N/A 5 Comfort with knowledge of agents Very comfortable 2 Comfortable 23 Neutral 15 Uncomfortable 0 Very Uncomfortable 0 Adequately trained to counsel patients Yes 20 No 14 I’m not sure 6 Completed a psychiatry elective rotation Yes 12 No 28 Learn about these agents in school Yes 39 No 1 Adequate education during pharmacy training Strongly agree 5 Agree 19 Neutral 13 Disagree 3 Strongly disagree 0

Pharmacists 28 42 12 8 10 26 26 14 2 25 7 49 51 36 30 15 19 38 32 23 1 6 10 49 39 2 0 51 32 17 46 54 95 5 13 50 30 7 0

Abbreviation: N/A, not applicable.

responses for students and pharmacists was compared to determine statistical significance (defined as a P value  .05). Knowledge perception of pharmacists and students was also compared to determine statistical significance (P  .05). Statistical significance was assessed using a 2-tailed t test. Participants were considered competent or knowledgeable if they answered a majority (>50%) of the knowledge questions

Figure 1. Demonstrates of the percentage of correct responses to knowledge questions for community pharmacists compared to student pharmacists.

correctly and deficient if a majority of questions were answered incorrectly. Results for both groups are compared based on competency and knowledge perception of the different classes of psychotherapeutic agents (Tables 2 and 3). The text of the survey is shown in Appendix A.

Results The survey was distributed to 100 licensed pharmacists and 50 student pharmacists. In all, 100 licensed pharmacists and 40 student pharmacists completed the survey (Table 1). The evaluation of the demographic data of pharmacist showed that most of the participants were in the age group of 30 to 39 (n ¼ 42), with the second largest group in the age range of 20 to 29 (n ¼ 28). In all, 12 pharmacists were between the age of 40 and 49 years, and 8 pharmacists were between the age of 50 and 59 years; 10 pharmacist participants were older than 60 years of age. In regard to race of pharmacist participants, African Americans (n ¼ 26) and caucasians (n ¼ 26) made up the majority of respondents, leaving 25 Asians, 14 Hispanics, 2 native Americans, and 7 others who completed the survey. There were 51 female participants and 49 male participants. A total of 36% of the pharmacist participants had less than 5 years of pharmacy practice experience and 64% (n ¼ 64) of the pharmacist participants had at least 5 to 20 years of pharmacy practice. Of the 40 student surveys collected, 32 respondents were between the age of 20 and 39 (80%) years, 5 (12.5%) were between the age of 40 and 49 years, 2 (5%) were between the age of 50 and 59 years, and 1 (2.5%) was older than 60 years. In all, 12 African American, 11 caucasian, 9 Hispanic, 7 Asian, and 1 native American student completed the survey. Of the students, 40% (n ¼ 16) were male. More than 85% of the students who answered the survey indicated that they had been in the field of pharmacy for 10 years or less (n ¼ 34). Perception. The majority (38%) of pharmacist participants reported filling less than 50 prescriptions for psychotherapeutic

Downloaded from jpp.sagepub.com at UNIV OF CONNECTICUT on April 14, 2015

McKee et al

169

Table 2. Pharmacist Knowledge Compared to Knowledge Perception. P Value Scale Very Comfortable Comfortable Neutral Uncomfortable a

Average Percent Correct

Very Comfortable

Comfortable

Neutral

65.36 55.88 45.15 35.3

.170 .01a .027a

.002a .139

.314

Uncomfortable

Statistical significance < .05.

Table 3. Student Knowledge Compared to Knowledge Perception. P Value Scale Very Comfortable Comfortable Neutral Uncomfortable Very Uncomfortable

Average Percent Correct

Very Comfortable

Comfortable

Neutral

Uncomfortable

55.85 64.22 52.61 48.74 52.9

.1337 .545 .184 .5

.047a .007a .0114a

.475 .945

.257

a

Statistical significance < .05.

agents on a regular basis at their community pharmacy, while 32% filled between 51 and 100 psychotherapeutic agents on a daily basis. Forty-nine pharmacist participants stated that they were comfortable with their knowledge of psychotherapeutic agents, while 51% were neutral or uncomfortable. Of the pharmacist participants, 51% felt that they were adequately trained to counsel patients about their psychotherapeutic medications, while 32% stated that they were inadequately trained, and 17% stated being unsure about their training in psychotherapeutic agents. Of the pharmacist participants, 54% did not complete a psychiatry rotation prior to graduation. The majority (95%) of pharmacist participants learned about psychotherapeutic medications during their pharmacy education. In all, 63%of pharmacists either strongly agreed or agreed that they received adequate psychotherapeutic training throughout their pharmacy education, while 37% were neutral or disagreed. In all, 5% of student participants were very comfortable with their knowledge of psychotherapeutic agents, 58% felt comfortable, and 38% were neutral. None of the students reported being uncomfortable or very uncomfortable with their knowledge; 50% of student participants felt that they were adequately trained to counsel patients about their psychotherapeutic medications, while 35% stated that they were inadequately trained and 15% were unsure of their training in psychotherapeutic agents. Only 30% of student participants had completed an advanced pharmacy practice experience (APPE) in psychiatry. All (98%) but 1 student participant learned about these agents during their pharmacy education. Of the students, 61% either strongly agreed or agreed that they received adequate psychotherapeutic training throughout their pharmacy education, while 41% were neutral or disagreed.

Knowledge Anxiolytics. Pharmacist participants were unable to accurately suggest the maximum recommended duration of benzodiazepine use (79%; n ¼ 79) and incorrectly identified benzodiazepines as the recommended psychotherapeutic drug class for the treatment of anxiety (68%; n ¼ 68). However, a majority (58%; n ¼ 58) of pharmacists correctly classified buspirone as a ‘‘miscellaneous category of medication.’’ Student surveys demonstrated similar results, with incorrect responses for the maximum duration of benzodiazepine use (75%, n ¼ 30) and the incorrect recommendation for benzodiazepines as treatment of choice in anxiety disorders (57.5%; n ¼ 23). Of the students, 69% (n ¼ 27) correctly classified buspirone. Antidepressants. The majority of pharmacist participants correctly associated a decreased incidence of suicide with appropriate antidepressant use (59%; n ¼ 59). Pharmacists were also aware that not all antidepressants are safe in adolescents (91%; n ¼ 91) and understood that selective serotonin reuptake inhibitors (SSRIs) have no effect on pain (52%; n ¼ 52). Pharmacists incorrectly agreed that treating anxiety with antidepressants takes longer than treating depression (63%; n ¼ 63) and were unaware that obsessive compulsive disorder (OCD) can be treated with doses higher than those recommended to treat depression (68%; n ¼ 68). Students were also unaware that higher antidepressant doses are recommended for OCD treatment than those recommended for depression (72.5%; n ¼ 29). Students correctly associated a decreased incidence of suicide in properly treated patients (65%; n ¼ 26), knew that not all antidepressants are approved for adolescents (95%; n ¼ 38), and understood that SSRIs do not alleviate pain (62.5%; n ¼ 25). More than half (57.5%; n ¼ 23) of

Downloaded from jpp.sagepub.com at UNIV OF CONNECTICUT on April 14, 2015

170

Journal of Pharmacy Practice 28(2)

the students inaccurately responded that treating anxiety with antidepressants takes longer than treating depression with antidepressants. Opiates. The majority of pharmacist participants inaccurately responded that patients with an addiction disorder should not be treated with opioid analgesics (60%; n ¼ 60). Most pharmacists knew that physicians were required to maintain a special license to prescribe buprenorphine/naloxone (80%; n ¼ 80). Students correctly responded that physicians require special licensure in order to prescribe buprenorphine/naloxone. However, student participants, like pharmacist participants, responded incorrectly that patients with an addiction disorder should not receive opioid analgesics (52.5%; n ¼ 21). Mood Stabilizers. Most pharmacists knew that lithium is unsafe in pregnancy (80%; n ¼ 80) and that using an antidepressant as monotherapy in bipolar disorder is not recommended (72%; n ¼ 72). Students also correctly responded that lithium is contraindicated in pregnancy (85%; n ¼ 34). Antipsychotics. Most (69%; n ¼ 69) pharmacist survey participants incorrectly answered that using 2 antipsychotics was more effective than using 1. The majority of pharmacists knew that patients on atypical antipsychotics required periodic lipid monitoring (75%; n ¼ 75) that olanzapine is the atypical antipsychotic agent most likely to cause weight gain (62%; n ¼ 62), and that patients can be monitored biweekly once stabilized on clozapine (53%; n ¼ 53). Students incorrectly indicated that the use of 2 antipsychotics is appropriate (52.5%; n ¼ 21). Only 35% (n ¼ 14) incorrectly answered that olanzapine is the least likely atypical antipsychotic to cause weight gain. Of the students, 78% responded correctly that it was important to periodically monitor lipid levels for patients on atypical antipsychotics (n ¼ 31) and understood that monitoring complete blood count every other week was acceptable for patients stabilized on clozapine (70%; n ¼ 28).

Comparison of Knowledge Between Pharmacists and Students When percentage of correct responses for students and pharmacists was compared (Figure 1), it was found that there was no statistically significant difference (P ¼ .257).

Comparison of Knowledge and Knowledge Perception for Pharmacists and Students Pharmacist respondents that indicated a very comfortable perception of knowledge regarding psychotherapeutic agents answered a significantly higher number of knowledge questions correctly when compared to pharmacist respondents that indicated a neutral (P ¼ .010) or uncomfortable (P ¼ .027) perception of knowledge (Table 2). Pharmacist respondents that indicated a comfortable perception of knowledge answered a significantly higher number of knowledge questions correctly

compared to those that indicated a neutral perception of knowledge (P ¼ .002). Student pharmacist respondents that indicated a comfortable perception of knowledge regarding psychotherapeutic agents had significantly more correct responses to knowledge questions when compared to student respondents that indicated a neutral (P ¼ .046) or uncomfortable (P ¼ .007) perception of knowledge (Table 3). No statistically significant differences existed for student pharmacists that indicated a very comfortable perception of knowledge and percentage of correct responses to knowledge questions.

Discussion The prevalence of psychotherapeutic agent prescribing is increasing, specifically following the new developments made in the treatment for patients with mental illness over the last 50 years, including the emergence of SSRIs and atypical antipsychotics.30,31 Furthermore, many of these agents require close monitoring for side effects, response, drug–drug, drug–food, and drug–disease interactions. Strict monitoring parameters place community pharmacists at a strategic position to increase pharmaceutical care outcomes in the patients with mental illness they serve. The importance of understanding the uses, advantages, and disadvantages of each class of medications is essential to a patient’s mental health needs. A pharmacist knowledgeable in psychotherapeutic agents is better able to counsel a patient based on his or her disease states and medications. Pharmacists aware of any black box warnings that exist with psychotherapeutic agents are also able to recognize the development and occurrence of life-threatening adverse effects. Counseling helps patients become more familiar with their medications and provides them with information to gauge therapeutic response. Pharmacists that successfully monitor mentally ill patients establish rapport and greatly decrease the incidence of nonadherence.4-6 Information gathered from the knowledge portion of this survey indicates that pharmacists and final-year student pharmacists have an average level of knowledge regarding psychotherapeutic agents. Overall, psychotherapeutic knowledge perception correlated with the percentage of knowledge questions with correct responses with the exception of student pharmacists with very comfortable perception of knowledge. However, only 2 student pharmacists felt very comfortable with their psychotherapeutic knowledge. All but 6 survey participants answered that they had learned about psychotherapeutic agents during their pharmacy education. Exposure through the pharmacy curriculum establishes a foundation, upon which knowledge regarding these agents can be expanded through continuing education, residencies, and other post-graduate programs. Ultimately, the survey indicates that current, licensed pharmacists, as well as final-year student pharmacists, could benefit from additional training in the application of psychotherapeutic agents. A comparable study assessing physician, pharmacist, and nurse’s knowledge on HIV medications concluded that health care practitioners who had more

Downloaded from jpp.sagepub.com at UNIV OF CONNECTICUT on April 14, 2015

McKee et al

171

knowledge were more comfortable in counseling patients and promoted better health outcomes.32 It was further suggested that continuing education courses would allow health care practitioners to stay updated on the new developments of emerging health issues, such as HIV and mental illnesses.32 The addition of continuing education courses, live and otherwise, regarding psychotherapeutic agents to biennial state pharmacy board requirements may provide an achievable solution to increase pharmacists’ knowledge. Studies assessing pharmacist barriers to providing adequate care to mental health patients suggest that inadequate psychotherapeutic knowledge of community pharmacists was a key factor.33-36 Of the pharmacists who responded to a Canadian study, 24% indicated they learned enough about mental health during their pharmacy training compared to 61% that learned enough about cardiovascular disorders.33 Pharmacy curricula have instituted changes to circumvent knowledge deficiencies. At Washington state, for example, pharmacy students observe simulated interactions with health care practitioners and patients expressing symptoms of psychiatric illnesses, such as depression. Actual patients with psychiatric disorders subsequently provide lectures to pharmacy students, where they address questions regarding their condition and medication failures and successes. The staff at these institutions has noticed an increase in mental health knowledge among the pharmacy students they teach.33 Certification for diabetes education was instituted to improve patient outcomes and promote self-management techniques that instill disease state management.37 Prior to diabetes education certificate programs, HIV/AIDS certifications for pharmacists were available.38 These certifications met a need established through growing epidemics of the respective disease states. With the advancement and proliferation of Medication Therapy Management programs, certifications in psychotherapeutic medication therapy for pharmacists, which are not currently available, could benefit another growing need for improving pharmaceutical outcomes by properly educating interested pharmacists.

the area of practice or the general importance of the study subject could not be proven. Finally, this research survey was capable of assessing only a minimal amount of psychiatric knowledge associated with the reviewed therapeutic classes.

Conclusion A survey of opinions, perceptions, and knowledge regarding psychotherapeutic agents was conducted among South Florida community pharmacists and South Florida final-year student pharmacists. Pharmacist survey participants showed knowledge deficiency regarding anxiolytics and mood stabilizers and competency regarding antidepressants and antipsychotics. Student surveys showed knowledge competency in antipsychotics and mood stabilizers, while deficiency was shown in anxiolytics and antidepressants. Deficiency in any 1 of the 4 psychotherapeutic drug classes increases the incidence of nonadherence and hospitalizations and unnecessarily decreases positive health outcomes. Although there is an observable lack of knowledge in psychotherapeutic agents, it has been reported that several universities are taking necessary approaches to increase student knowledge in the subject matter. In addition, postgraduate training and education can assist those whose professional goals intrinsically involve the care of patients with mental illness . Psychotherapeutic education is pertinent to the health of the patient with mental illness and, with the growing number of prescriptions for psychotherapeutic medications, community pharmacists would do well to take advantage of continuing education programs in psychiatric medication therapy. The incorporation of continuing education courses to pharmacist biennial-continuing education requirements would allow pharmacists to remain knowledgeable regarding the psychotherapeutic agents being dispensed to their mentally ill patients.

Appendix A Survey I. Demographics.

Study Limitations There are several limitations to this research survey. The study utilized a convenience sample of pharmacists and final-year pharmacy students located in South Florida. Therefore, extrapolation of the information obtained from this survey to other regions of the country may not be feasible. The questionnaire did not request information regarding schools or colleges of pharmacy where students were attending or wherefrom pharmacists graduated. In addition, it is the consensus among the researchers that the sample size was too small to have conclusive evidence of knowledge of pharmacists and pharmacy students. Ultimate results showed a lower response rate from the student participants, possibly secondary to utilization of the electronic, Internet-based survey tool. Although pharmacy students were less likely to answer the survey because of their perception of current knowledge in psychotherapy, their interest in

1. Age: I. 20-29 II. 30-39 III. 40-49 IV. 50-59 V. 60 2. Race: I. African American II. Caucasian III. Hispanic/Latino IV. Native American V. Asian VI. Other 3. Sex: I. Male II. Female

Downloaded from jpp.sagepub.com at UNIV OF CONNECTICUT on April 14, 2015

172 4.

Journal of Pharmacy Practice 28(2) How long have you been a pharmacist? I. 20 years

II. Personal Feeling About The Use of Psychotherapeutic Agents. 1.

2.

3.

4.

5.

6.

Approximately how many psychiatric patients are currently using your pharmacy in one month’s time? (For recent graduates not currently licensed or working, please circle ‘‘Not Applicable’’) I. 50 or less II. 51-100 III. 101-500 IV. More than 500 V. Not Applicable Do you feel comfortable with your knowledge of psychotherapeutic agents? I. Very Comfortable II. Comfortable III. Neutral IV. Uncomfortable V. Very Uncomfortable Do you feel that you have been adequately trained to counsel patients on psychotherapeutic agents? I. Yes II. No III. I’m not sure Did you complete an experiential rotation in psychiatry while in pharmacy school? I. Yes II. No Did you learn about psychotherapeutic agents in pharmacy school? I. Yes II. No I have received adequate education about psychotherapeutic agents during my pharmacy training. I. II. III. IV. V.

Strongly Agree Agree Neutral Disagree Strongly Disagree

III. Knowledge of Psychotherapeutic Agents. Please select one answer from each of the questions below: 1.

Please indicate the maximum length of time a benzodiazepine should be used: I. 1 week II. 2 weeks III. 2 months IV. 4 months V. I’m not sure

2.

The recommended treatment for anxiety disorders is currently through benzodiazepines. I. True II. False III. I’m not sure 3. Buspirone (Buspar1) is pharmacologically classified as: I. An antidepressant II. A ‘‘miscellaneous’’ category of drugs III. A benzodiazepine IV. I’m not sure 4. People who are appropriately treated with antidepressants are less likely to commit suicide than those who are depressed and are on no treatment. I. False II. True III. I’m not sure 5. Are all antidepressants useful and approved for the management of depression in children and adolescents? I. Yes II. No III. I’m not sure 6. Treating anxiety with antidepressants takes longer than treating depression with antidepressants. I. False II. True III. I’m not sure 7. For the treatment of Obsessive Compulsive Disorder (OCD), it is acceptable to exceed the maximum recommended doses of an antidepressant. I. No II. Yes III. I’m not sure 8. Selective-Serotonin-Reuptake-Inhibitors, like Sertraline (Zoloft1), are useful in treating pain. I. True II. False III. I’m not sure 9. Patients with an addiction disorder should not be treated with opioid analgesics. I. True II. False III. I’m not sure 10. Only physicians who have registered and obtained a specific license are able to prescribe the combination product Buprenorphine/Naloxone (Suboxone1). I. False II. True III. I’m not sure 11. Lithium has been proven safe in pregnant patients. I. True II. False III. I’m not sure 12. Please indicate which of the following medications are approved for the treatment of bipolar disorder: (You may CIRCLE MORE THAN ONE) I. Carbamazepine

Downloaded from jpp.sagepub.com at UNIV OF CONNECTICUT on April 14, 2015

McKee et al

13.

14.

15.

16.

17.

173

II. Topiramate (Topamax1) III. Oxcarbazepine (Trileptal1) IV. I’m not sure Using antidepressants, like Sertraline (Zoloft1) as monotherapy in bipolar patients is NOT recommended I. False II. True III. I’m not sure Current treatment recommendations indicate that using two antipsychotics is more effective than using one antipsychotic. I. True II. False III. I’m not sure A patient on an atypical antipsychotic, such as Quetiapine (Seroquel1), should have periodic lipid monitoring. I. False II. True III. I’m not sure Of all the atypical antipsychotics, Olanzapine (Zyprexa1) is the least likely to cause weight gain. I. True II. False III. I’m not sure After 6 months of a patient being on Clozapine (Clozaril1), his/her white blood cell count can be monitored every other week (instead of every week). I. False II. True III. I’m not sure

Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding The author(s) received no financial support for the research, authorship, and/or publication of this article.

References 1. Kessler RC, Berglund P, Demler O, et al. The epidemiology of major depressive disorder: results from the national comorbidity survey replication (NCS-R). JAMA. 2003;289(23):3095-3105. 2. Stewart WF, Ricci JA, Chee E, et al. Cost of lost productive work time among US workers with depression. JAMA. 2003;289(23): 3135-3144. 3. Soni A.Statistical Brief #248: The Five Most Costly Conditions, 1996 and 2006: Estimates for the U.S. Civilian Noninstitutionalized Population. July 2009. http://www.meps.ahrq.gov/mepsweb/data_files/publications/st248/stat248.pdf. Accessed August 3, 2013. 4. Bell JS, Whitehead P, Aslani P, et al. Design and implementation of an educational partnership between community pharmacists and consumer educators in mental health care. Am J Pharm Educ. 2006;70(2):28.

5. Chisholm Burns MA, Lee JK, Spivey CA, et al. US Pharmacists’ as team members on patient care; systematic review and metaanalyses. Med Care. 2010;48(10):923-933. 6. Koike AK, Unutzer J, Wells KB. Improving the care for depression in patients with comorbid medical illness. Am J Psychiatry. 2002;159(10):1738-1745. 7. Greenberg PE, Stiglin LE, Finkelstein SN, et al. The economic burden of depression in 1990. J Clin Psychiatry. 1993;54(11): 405-418. 8. Wells KB, Stewart A, Hayes RD, et al. The functioning and wellbeing of depressed patients: results from the medical outcomes study. JAMA. 1989;262(7):914-919. 9. Johnston K, Westerfield W, Momin S, et al. The direct and indirect costs of employee depression, anxiety, and emotional disorders-an employer case study. J Occup Environ Med. 2009; 51(5):564-577. 10. World Health Organization. World Health Report 2003: Shaping the Future. Geneva, Switzerland. http://www.who.int/whr/2003/ en/whr03_en.pdf. Accessed August 3, 2013. 11. Centers for Disease Control and Prevention. National Center for Health Statistics: Deaths: Final data for 2007. http://www.cdc. gov/NCHS/data/nvsr/nvsr58/nvsr58_19.pdf. Accessed August 3, 2013. 12. Barraclough B, Bunch J, Nelson B, et al. One hundred cases of suicide: clinical aspects. Br J Psychiatry. 1974;125(0): 355-373. 13. Dorpat TL, Ripley HS. A study of suicide in the Seattle area. Compr Psychiatry. 1960;1:349-359. 14. Rich CL, Fowler RC, Fogarty LA, et al. San Diego suicide study, III: relationships between diagnoses and stressors. Arch Gen Psychiatry. 1988;45(6):589-592. 15. Robins E, Murphy GE, Wilkinson RH Jr, et al. Some clinical considerations in the prevention of suicide based on a study of 134 successful suicides. Am J Public Health Nations Health. 1959; 49(7):888-899. 16. Shaffer D, Gould MS, Fisher P, et al. Psychiatric diagnosis in child and adolescent suicide. Arch Gen Psychiatry. 1996; 53(12):339-348. 17. Drake RE, Bartels SJ, Torrey WC. Suicide in schizophrenia: clinical approaches. In: Williams R, Dalby JT, eds. Depression in Schizophrenics. New York, NY: Plenum Press; 1989:171-186. 18. Brent DA, Johnson BA, Perper J, et al. Personality disorder, personality traits, impulsive violence, and completed suicide in adolescents. J Am Acad Child Adolesc Psychiatry. 1994;33(8): 1080-1086. 19. Henriksson S, Boethius G, Isacsson G. Suicides are seldom prescribed antidepressants: findings from a prospective prescription database in Jamtland County, Sweden, 1985-95. Acta Psychiatr Scand. 2001;103(4):301-306. 20. Lonnqvist JK, Henriksson MM, Isometsa ET, et al. Mental disorders and suicide prevention. Psychiatry Clin Neurosci. 1995; 49(1):S111-S116. 21. Isometsa¨ E, Henriksson M, Marttunen M, et al. Mental disorders in young and middle aged men who commit suicide. BMJ. 1995; 310(6991):1366-1367.

Downloaded from jpp.sagepub.com at UNIV OF CONNECTICUT on April 14, 2015

174

Journal of Pharmacy Practice 28(2)

22. Bertolote JM, Fleischmann A, De Leo D, et al. Suicide and mental disorders: do we know enough? Br J Psychiatry. 2003;183: 382-383. 23. Black E, Murphy AL, Gardner DM. Community pharmacist services for people with mental illnesses: preferences, satisfaction, and stigma. Psychiatr Serv. 2009;60(8):1123-1127. 24. Bell JS, Rosen A, Aslani P, et al. Developing the role of pharmacists as members of community mental health teams: perspectives of pharmacists and mental health professionals. Res Soc Admin Pharm. 2007;3(4):392-409. 25. Mental Health in a Primary Care Context: Collaboration Is the Key. Mississauga, Ontario, Canadian Collaborative Mental Health Initiative. www.ccmhi.ca. Accessed April 12, 2011. 26. Reus VI. Mental Disorders. In: Fauci AS, Braunwald E, Kasper DL, eds. Harrison’s Principles of Internal Medicine. 17th ed. New York, NY: McGraw-Hill; 2008:2710-2724. 27. Schildkraut JJ.The catecholamine hypothesis of affective disorders: A review of supporting evidence. J Neuropsychiatry Clin Neurosci. 1965;7(4):524-533. 28. Coppen A. The biochemistry of affective disorders. Br J Psychiatry. 1967;113(504):1237-1264. 29. Glick ID, Murray ST, Vasudevan P, et al. Treatment with atypical antipsychotics: new indications and new populations. J Psychiatr Res. 2001;35(3):187-191. 30. Hanion JT, Handler SM, Castle NG. Antidepressant prescribing in US nursing homes between 1996 and 2006 and its relationship to

31.

32.

33. 34.

35.

36.

37.

38.

staffing patterns and use of other psychotropic medications. J Am Med Dir Assoc. 2010;11(5):320-324. Sclar DA, Robinson LM, Skaer TL, et al. Trends in prescribing of antidepressant pharmacotherapy: office-based visits, 1990-1995. Clin Ther. 1998;20(4):871-84. Liljestrand P. HIV Care: continuing medical education and consultation needs of nurses, physicians, and pharmacists. J Assoc Nurs AIDS Care. 2004;15(2):38-50. Levin A. Pharmacists often uneasy with psychiatric patients. Psychiatr News. 2005;40(1):8. Bostwick JR, Diez HL. Optimizing care for patients with depression in the community pharmacy setting. U.S. Pharmacist. 2008; 33(11):24-28. Aaltonen SE, Laine NP, Volmer D, et al. Barriers to medication counseling for people with mental health disorders: a six country study. Pharm Pract. 2010;8(2):122-131. Al-Arifi MN. Community pharmacists’ attitudes towards mental health illness and providing pharmaceutical care to mentally ill patients. Neurosciences (Riyadh). 2008;13(4):412-420. Eligibility Requirements. National Certification Board for Diabetes Educators. November 2010. http://www.ncbde.org/eligibility.cfm. Accessed April 7, 2011. Goldbaum E.Certifying HIV Specialists: UB launches the nation’s first program for practicing pharmacists. University of Buffalo: The Reporter 2002;33(26). http://www.buffalo.edu/ubreporter/archives/vol33/vol33n26/n2.html. Accessed April 7, 2011.

Downloaded from jpp.sagepub.com at UNIV OF CONNECTICUT on April 14, 2015

A survey of community pharmacists and final-year student pharmacists and their perception of psychotherapeutic agents.

The World Health Organization has estimated that as many as 450 million people worldwide have mental disorders. More than 44 million people in the Uni...
188KB Sizes 0 Downloads 0 Views