This study assessed North Carolina community pharmacists' attitudes towards working with patients with severe and persistent mental illnesses (SPMI) like schizophrenia and bipolar disorder. The majority of pharmacists feel SPMI are real diseases but require more time than other conditions. While lack of time was a key barrier, pharmacists were most interested in receiving more training on screening, referrals, and engaging with patients. The study concludes that providing additional resources could help pharmacists better care for those with mental illnesses.

1. INTRODUCTION
•Severe and persistent mental illnesses (SPMI) are
mental, behavioral, or emotional disorders that cause
serious functional impairment1
•Common SPMI include schizophrenia, bipolar
disorder and severe treatment-resistant depression
•4.2% of all adults in the U.S. were diagnosed with
SPMI in 2013 and cost about $300 billion per year2,3
•Community pharmacists are uniquely placed to
monitor patients’ medications and preemptively
screen for problems such as medication side effects,
adherence, and early signs of decompensation
•Little data exists examining community pharmacists’
attitudes or perceived barriers towards working with
this population
RESULTS
• Community pharmacists recognize SPMI as real diseases that can affect anyone
but also feel that this population requires more time to manage than patients with
complex physical conditions
• Perceived barriers for providing care for this population are similar to those for
patients with other medical conditions4
• While the majority of community pharmacists listed lack of time and competing
priorities as a barrier to providing care to patients with SPMI, they also recognized
training and information on referrals, screening and patient engagement techniques
as top resources desired
• Increasing availability of these resources in the future may be useful in improving
care for patients with SPMI
CONCLUSIONS
Community Pharmacists’ Attitudes towards Providing Care and Services
to Patients with Mental Illness
Alicia Watkins, PharmD1,2; Jerry McKee, PharmD, MS2; Caitlin Hughes, PharmD2, Trista Pfeiffenberger, PharmD, MS2
1 UNC Eshelman School of Pharmacy, Chapel Hill, NC, 2 Community Care of North Carolina, Raleigh, NC
OBJECTIVE
Assess North Carolina community pharmacists’
attitudes towards working with patients with SPMI and
identify potential barriers to providing care
Desired Resources to Better Manage SPMI*
Confidence in Treating SPMI
0
50
100
150
200
250
Screening for
pharmacotherapy
problems in
medications used to
treat SPMI
Monitoring efficacy
of medications used
to treat SPMI
Monitoring for and
recognizing adverse
effects in
medications used to
treat SPMI
Providing medication
counseling for
medications used to
treat SPMI
Following up on
adherence to
medications used to
treat SPMI
#OfRespondentsforEachValue
1 (Not Confident at All) 2 3 4 5 (Very Confident)
Barriers to Providing Care*
Barrier
# Of
Respondents
% Of
Respondents
1 Competing priorities/lack of time 317 66%
2 Lack of communications between providers 232 48%
3 Needs are outside the scope of my training or practice 205 43%
4 Uninsured/under insured patients 186 39%
5 Lack of privacy in the pharmacy to discuss personal issues 169 35%
6 Reimbursement/sustainability barriers 110 23%
7 Other 16 3%
8 None 13 3%
*Respondents were asked to select their top 3 perceived barriers to providing optimal care
Perceptions of SPMI
0
50
100
150
200
250
300
350
Severe and persistent
mental illnesses (SPMI)
are real diseases
It is easy to recognize
someone who has
SPMI
Anyone can suffer from
SPMI
Patients with SPMI
require more time than
patients with complex
physical conditions
Patients with SPMI do
not want to talk about
their illness with
pharmacists
#OfRespondentsforEachValue
0
50
100
150
200
250
300
350
Patients with SPMI
receive all necessary
information about their
medication from their
prescriber
Patients with SPMI often
misunderstand
information about their
medication
Patients with SPMI can
independently manage
their medications
Patients with SPMI have
the ability to
independently navigate
the health care system.
Most patients with SPMI
are dangerous
#OfRespondentsforEachValue
Strongly Disagree (1) Disagree (2) Neither Agree nor Disagree (3) Agree (4) Strongly Agree (5)
Resource
# Of
Respondents
% Of
Respondents
1
Information regarding how to make referrals to
community mental health specialists/agency
317 66%
2
Information regarding routine referrals to
community mental health specialists/agency with
regular feedback
264 55%
3
Training on routine mental health screening (e.g.,
PHQ-2, PHQ-9, SBIRT, etc.)
257 54%
4
Patient engagement techniques and training
assistance
241 51%
5 Nothing 44 9%
6 Other 22 5%
*Respondents were asked to select all that applied
METHODS
Design
• Cross-sectional survey
Setting
• 5,582 community pharmacists registered
in North Carolina (NC)
Procedure
• Electronic survey distributed via email to all
registered pharmacists in NC through Board
of Pharmacy listserv
• Survey open for 30 days (Jan 21, 2016-Feb
20, 2016) with reminder email on day 15
Data
Analysis
• Descriptive statistics
Population
19 wrong
email address or
full inbox
4,998 did not
initiate survey
• 27 not employed in
community pharmacy
• 57 did not finish
5,582 5,563 565 481
Gender:
• Male: 47%
• Female: 52%
Years in Practice:
• 0-5 years: 22%
• >5-10 years: 12%
• >10-20 years: 14%
• >20 years: 51%
References:
1. NIH. Serious Mental Illness (SMI) Among U.S. Adults. http://www.nimh.nih.gov/health/statistics/prevalence/serious-mental-illness-smi-among-us-adults.shtml.
Accessed November 23, 2015.
2. SAMHSA. Results from the 2013 National Survey on Drug Use and Health: Mental Health Findings. NSDUH Series H-49, HHS Publication No. (SMA). 2014.
3. NIH. Annual Total Direct and Indirect Costs of Serious Mental Illness (2002). http://www.nimh.nih.gov/health/statistics/cost/index.shtml. Accessed November
23, 2015.
4. Pharmacotherapy.1992;12(4):358-64.