Pharmacist-led Primary Care Team Improves Clinical Outcomes in Severe Mental Illness

Individuals with severe mental illness (SMI) may die 15 to 20 years earlier than the general population, and some deaths may be due to preventable or treatable conditions. Antipsychotics are commonly prescribed to manage a range of mental health conditions but may cause adverse cardiometabolic effects. Individuals with SMI may already have a higher risk of some cardiometabolic diseases due to lifestyle choices.

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A study from the United Kingdom indicates that a pharmacy-led approach in general practice may be successful at monitoring patients to identify and reduce cardiometabolic risk factors. The study results were published in the January 2024 issue of Family Practice.

A prospective intervention study took place from January to December 2022 at 3 urban general practices. General practice clinical pharmacists led 2 practices with a total of 152 patients, and the third practice provided typical care without a pharmacist intervention to 58 patients. The pharmacists monitored patients, prescribed oral antipsychotics for cardiometabolic parameters, conducted medication review, and offered referrals or interventions. The researchers compared the 3 practices.

Two-thirds (92/152) of patients in the intervention arm participated in medication reviews, requiring pharmacologic and/or non-pharmacologic clinical actions. The majority of actions were graded as moderate importance. Seven percent of patients were identified as new pre-diabetic/diabetic and 6% were at high risk of cardiovascular disease requiring statin initiation.

The pharmacy-led practices increased their cardiometabolic monitoring by 19% to 58%, compared to 7% at the practice without pharmacist support. Pharmacists were able to perform medication reviews and identify physical and mental health issues. Pharmacist-led clinics were able to optimize treatment for long-term conditions, recommend prescription changes to reduce adverse drug effects, and work within multidisciplinary teams to change antipsychotic medications to reduce cardiometabolic effects. In the pharmacy-led clinics, pharmacists referred 1 in 4 patients to other health care professionals to address their concerns.

A pharmacist-led primary care team can help address the cardiometabolic complications of individuals with SMI and a multidisciplinary team may help lower risks associated with polypharmacy. This approach may help prevent premature deaths attributed to preventable or treatable cardiovascular disease.

Source

Johnson CF, Ingram F, Thomson F, Srireddy P, Jani BD, Greenlaw N. General practice pharmacist-led antipsychotic physical health monitoring: A prospective intervention scoping study. Family Practice. Published online 2024. doi:10.1093/fampra/cmad120