Pharmacy Practice Research Centre
Faculty of Pharmaceutical Sciences
Katholieke Universiteit Leuven
Mental illness is a major public health issue affecting a substantial number of people. One hundred and twenty-one million people worldwide are suffering from depression, and schizophrenia affects about 24 million people.(1) A survey carried out in 1997 showed a depression prevalence of 17% during the previous six months.(2) Schizophrenia has lifetime and six-month prevalence rates of 7 per 1,000 adults.(3)
The public’s belief about antidepressant and antipsychotic medication is in sharp contrast to the evidence from randomised controlled trials and the views of mental health professionals that these medicines are effective. The public’s negative views about psychotropic medication also contrast with their positive views about medication for common physical disorders.(4)
Medication information is important from several perspectives. First, medication information is one of the patient’s rights. Secondly, it is essential for obtaining informed consent. Thirdly, patients must be educated in order to comply with prescribed medication regimens. As pharmacological treatment plays a central role in the treatment of mentally ill patients, patients should be knowledgeable about their medicines, to enable them to make informed choices regarding their medication and to make successful treatment possible.(5) The importance of providing medication information to patients is underlined by the fact that lack of information about prescription drugs is one of the main reasons why 30-50% of patients fail to comply with prescribed regimens, leading to morbidity, hospital admissions and additional healthcare costs.(6) Since healthcare professionals want the best outcome possible, it is their duty to provide individualised comprehensive medication information.
The quality and quantity of information about drugs provided to patients seem to be inadequate.(7,8) A recent study demonstrated that 48% of psychiatric inpatients received medication information.(7) Only 46% of them stated that the information was helpful. Sixty-six percent of psychiatric outpatients indicated that they received medication information; 61% of these patients found the information helpful.(7)
Patients seem to have different views on the type of information they want. The kind of information psychiatric patients request is, first, information on side-effects. In a study by Zwaenepoel and colleagues, 43.9% of interviewed patients wanted side-effect information, followed by the mechanism of action (35.0%) and the indication of the drug (29.2%).(9) Almost 10% of the patients wanted no further information.(9) Pharmacists should discuss the following topics with patients:
- Reason for medication use.
- When and how to take medicines.
- Effect of the medicine.
- Possible side-effects.
- Possible interactions.
- Cautions and specific tips.
The format of medication information can mainly be classified in verbal and written information. Verbal information includes counselling, audiotapes, discussion groups or written information read aloud. Written information can also take several forms, from leaflets to extensive brochures, texts, computer programs and internet sites. Written information should fulfil several conditions: it should be scientifically accurate, comprehensive enough to be useful for patients, and easily readable and understandable. When used as an adjunct to verbal counselling, written information can reinforce specific instructions or warnings.(10)
Patients can ask questions about their medicines to various healthcare professionals such as doctors, pharmacists and nurses. Currently, patients draw their information primarily from doctors, mostly because of a relationship of trust. The majority of patients do not regard pharmacists as medication information providers.(9) Therefore, pharmacists should take initiative and encourage patients to ask questions and discuss their medicines. Informing psychiatric patients about their medicines is a challenge for pharmacists.
What can pharmacists expect from medication information given to psychiatric patients? Patient education can be evaluated by measurable outcomes:
- Economic, clinical and humanistic outcomes (ECHO).
Various attempts to improve patients’ compliance have been undertaken. One of the strategies is providing medication information to patients. Although there is evidence supporting the efficacy of medication information in improving compliance, the effects are not uniform.(11) Improved compliance is not an assured outcome. In addition, there is no consensus about what a clinically relevant increase of compliance is or what the optimum level of compliance should be in order to attain better clinical outcomes.
Several studies have demonstrated that medication information for the patient can be effective in improving patients’ knowledge about their medication.(5,12,13) Even though knowledge improves, it may not influence behaviour and compliance. Consequently, providing information is not the only requirement for an effective patient-pharmacist relationship. The quality of that relationship may affect behaviour and improve compliance.(14)
The economic impact of medication information interventions is virgin territory. To the best of our knowledge, no studies have been conducted on the cost-effectiveness of such interventions. It can be assumed that medication information results in better compliance, which consequently results in a decreased relapse risk. Fewer hospital admissions mean healthcare cost savings.
There is little or no evidence that patients who received medication information reported side-effects more frequently than those who did not.(11) A study suggests that providing instructions about side-effects does not result in increased incidence, but rather in a significant decline.(15) Perhaps informed patients feel less anxious and, thus, are less likely to report side-effects.
The humanistic impact of medication information focuses on quality of life and satisfaction. Quality of life is reported to improve across follow-up for all patient groups (ie, controls and informed patients).(16) In another study, patients who received leaflets were more satisfied than control patients.(5) Additionally, satisfied patients had a significantly higher mean total knowledge score than those who were not satisfied. Medication information has the potential to increase patients’ satisfaction.
Pharmacists should support patients with medication information to facilitate their medication use. Healthcare professionals, physicians and pharmacists have a clear responsibility to provide the information the patient needs in order to use drugs safely and effectively – the right kind of information as well as the right amount. Drug education must be tailored to the individual and must be comprehensive. Responding to the patients’ information needs has the potential to improve the outcome of mental health services. More well-designed and well-performed studies on the (cost-)effectiveness of medication interventions need to be performed in order to formulate definitive conclusions.
- World Health Organisation, Fact sheet Number 265. The World Health Report 2001 on mental and neurological disorders, December 2001. Availble from: http://www.who.int/mediacentre/factsheets/fs265/en/
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