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St Vincent’s Mental Health Medication Information Program
Ms Nga
Tran1,2,3
Prof. David Castle1,2
1: St. Vincent’s Mental Health2: Department of Psychiatry, University of Melbourne
3: Faculty of Pharmacy & Pharmaceutical Sciences, Monash University
The Healthcare Innovation Victoria: 2010 Showcase Conference
Melbourne23.2.2010
OVERVIEWBackground
Medicine Awareness Project (MAP)
StV
Medication Information Forum (MIF)
Development of the Booklet
Outcomes
Conclusions
“I medicate first and ask questions later.”
Lack of opportunity to discuss with clinicians
Non-adherence IssuesLack of knowledge regarding psychotropic medications
Limited understanding regarding side effects
FACTSPsycho-education interventions without medication adherence as a key treatment element are generally less likely to improve adherence (1)
.
MH consumers often report their dissatisfaction with the quality & quantity of information provided about their psychotropic medications.
Drug information adapted to consumers’
needs may empower them & increase their confidence in drug therapy (2)
.
1.
Zygmunt
A, Olfson
M, Boyer C, Mechanic D: Interventions to improve medication adherence in schizophrenia. Am J Psychiatry 2002;159:1653-
1664.2.
Zwaenepoel
L, Bilo
R, De Boever
W, De Vos
M, Reyntens
J, Hoorens
V, Sermeus
W, Laekeman
G: Desire for information about drugs: a survey of the need for information in psychiatric in-patients. Pharmacy World Science 2005; 27:47-53.
Medication is only one part of treatment, but it’s a very important part!
5
Medicine Awareness Project (MAP)
Ms Kathryn Weedon(St. Vincent’s Mental Health and University of Melbourne)
Professor David Castle (St. Vincent’s Mental Health and University of Melbourne)
Ms Nga Tran (St. Vincent’s Mental Health and University of Melbourne)
Dr Alison Brookes (University of Melbourne)
ACKNOWLEDGMENT:Miss Katie Weedon for the Unpublished findings
MAPAims and Objectives
To investigate and explore barriers that may prevent consumers obtaining information about their medicines.
Method
Surveys about attitudes and behaviours towards seeking or providing comprehensive information about psychotropic medications to:
consumers with schizophrenia using our service
psychiatrists at St. Vincent's
community pharmacists in our catchment area
Data collection
39 consumers, 20 psychiatrists and 7 pharmacists
took part in the questionnaires.
Weedon K, MAP, unpubl, 2007
Quantitative Trends (1)
Consumer demographics (total 36)
Gender:
Male 61% (22)Female 39% (14)
Single 78% (28)
Age range: 20 -
70 years
Median 43 years and 66.6% were between 31-50 years
One antipsychotic 72.2%
(26)
Two antipsychotics 19.4%
(7)
Three antipsychotics 5.6% (2)
Zero antipsychotics 2.8% (1)
Years on medication: average 16.3 years.
Weedon K, MAP, unpubl, 2007
Quantitative Trends (2)
A surprising difference was found between consumers & psychiatrists in terms of attitudes to the overall benefits and harms of medications.
Q: “The benefits of antipsychotic medication for mental illness always outweigh the side effects and risks.”
Consumers (n= 36) : MEAN = 2.79 AGREE
Psychiatrists(n= 20) : MEAN = 1.95 DISAGREE
Where: 1=strongly disagree 2=disagree 3=agree 4=strongly agree.
Weedon K, MAP, unpubl, 2007
Quantitative Trends (3) Consumers knowledge of CMIs
Do you know what a Consumer Medicine Information (CMI) leaflet is?NO 58.3%
YES 41.7%
Have you ever received a Consumer Medicine Information (CMI) leaflet from a pharmacist (local chemist)?
NO 69.4%
YES 30.6%
Have you ever asked your pharmacist (local chemist) for a Consumer Medicine Information (CMI) leaflet?
NO 94.3%
YES 5.7%
If you wanted information about your medication(s) for mental illness how would you like the information presented to you?
75%
Written 69%
Verbal 33%
On a video or DVD that I can take home22%
On a CD that I can take home
47% of consumers ticked both written & verbal options
Weedon K, MAP, unpubl, 2007
St V - Medication Information Forum
INPATIENT SERVICE:•Registrars•OT/Program Nurse•Allied Health•Students•Started in 2003, formalised in Feb 2006 when Prof. Castle came aboard.
Weekly session. Duration: 30-60 mins.
Facilitators: Pharmacists, Professor of Psychiatry.
Selection of participants:
• Invitations, self-referral.
• Referrals from treating teams due to non-adherence leading to current admission.
Open forum format: a constructive discussion is generated between medical professionals and participants.
Forum discussion is generalised
not personalised.
Copy of St V –
Medication Information fact sheets are distributed
to each participant at the beginning of the forum.
St V - Medication Information Forum
12
Medication Discussion Group Survey RESULTS
(Mar-Jun07) N=48Questions Responses
1 92%: were given opportunity to be heard & listened by pharmacist/doctor.
2 90%: found information related to their medications to be useful.
3 91%: were given opportunity to communicate with the pharmacist/doctor.
4 84%: were comfortable participating in the group discussion.
5a 87%: learned something new about the medications they’re currently taking
5b 90%: found the new information they learned to be important.
6a 82%: learned something new about other medications related to their treatment
6b 88%: found the new information they learned to be extremely
important.
7 84%: found the opportunity to share & learn new information
about medications withwith other participants useful.
8 45%: indicated +ve
view of medications before the group.
9 96%: indicated +ve
view of medication after the group.
10 61%: would come back for another session
11 100%: found the “StV-Psychiatric Medication Information”
Fact Sheets very useful.
FACT SHEET-MAY 07
1st EDITION-AUG 07
2st
EDITION-AUG 09
Development of the BOOKLET
•Overview of different types of medication, including brand & generic names•“simple language”
explaining how each class of medication works•Possible side-effects and tips on how to manage them•Tips on how to remember to take medication•Information on general health & the importance of maintaining good physical health.
VIETNAMESE-Jun 08
ARABIC-Jul 09
ITALIAN-Aug 08GREEK-Jul 08
CHINESE-Aug 08
In recognition of the significance of this program,
financial support from various organisations has enabled the Booklet to be
translated into 5 other languages: Vietnamese,
Chinese, Greek, Italian and Arabic.
Development of the translated versions
SCANLON FOUNDATION Project
Production, rollout and evaluation of psychoeducation
material in
Vietnamese &Chinese to CALD mental health consumers, carers, support workers, GP & community pharmacists within St Vincent’s catchments.
Regular tailored Vietnamese and Chinese MIFVietnamese SBS Radio Interview: resulted in the distribution of ~200 copies of both versions of the booklet.
MAIN FINDINGS:both Vietnamese & Chinese consumers find it difficult to access medication information in their languages (81% & 75%, respectively).
97 to 100% participants indicated the MIF made them feel more comfortable about taking medications and found the translated medication booklets were very useful .
16
Society of Hospital Pharmacists of Australia The 17th
& 19th
Mental Health Services –
Australia & New Zealand Conferences.
Word Psychiatry Association International Congress 2007. UK Psychiatric Pharmacists Group Newsletter
December 08 Edition The 4th
Consumer Workforce Conference, 2009. The 3rd
WA Transcultural Mental Health conference, 2009.
The 22nd
European College of Neuropsychiatry (ECNP) conference, Istanbul, 2009.
Medication Safety in MH committee-WA, Pharmacy Guild, National Prescribing Service, Therapeutic Guidelines Working Group
Australian Commission on Safety & Quality in Health Care Various Medication information forums throughout Melbourne
Communicating our work…
17
The 22nd
European College of Neuropsychiatry Poster, Istanbul, 2009
18
MH SERVICES: State-wide: VIC, NSW, QL, ACT, WA, SA
NGO: MIND Australia, Melbourne; Victorian Mental Illness Awareness Council (VMIAC);
Victorian Mental Health Carers Network Inc.; Indochina Elderly Refugees Association of Victoria (ICERA)
INTERNATIONAL: Campbelltown Community Mental Health Service (NZ); Prince of
Wales/Shatin
Hospitals (HK); Mayo Mental Health, & St. John of God Hospital (Ireland);
Universiti
Teknologi
MARA (Malaysia)
INTERNET SHARE RESOURCES:
The Australian Indigenous HealthInfoNet
Society of Hospital Pharmacists of AustraliaMeth group: Australia and New Zealand Victorian Transcultural Psychiatric Unit (VTPU)Victorian Mental Illness Awareness Council
(VMIAC) St. Vincent’s Health
OTHERS:
Gordon Institute of TAFE, Geelong
Universities: Melbourne, Monash, Ballarat, Monash, Queensland
Cross Cultural Centre, The Children Hospital’s at Westmead, NSW
Mental Health First Aid Training and Research Program, ORYGEN
Vietnamese AMA & Medicine modern life magazine, Sydney
Sharing the Booklet across the communities …..
19th
The MHS 2009 -
Silver Award:
MH Promotion/ Illness Prevention Program or Project Awards:“Empowering patients to make informed choices about medication”
The 2009 Victorian Public Healthcare -
Gold Award:
Safer Care Award: "Mental
Health Medication Information Program”
ACKNOWLEDGEMENTS
Action on Disability within Ethnic Communities (ADEC): Fitzroy, Preston, Mount Waverley
SBS Radio Broadcast, Victorian PDRSS, VMIAC, VTPU
OUTLOOKS, Western Region Health Centre, Doutta Galla CHS, Mercy Women MH Program
Mental Health First Aid Training and Research Program
Scanlon Foundation, Pierce Armstrong Foundation
SHPA, The Australian Indigenous HealthInfoNet
Janssen-Cilag, Pfizer (funding for translated versions of booklet)
Various MHS & Organisations who have been involved with this project
ACHIEVEMENTS
19th
The MHS 2009 Silver Award -
Category 6: Mental Health Promotion and Illness Prevention
Empowering consumers to make informed Empowering consumers to make informed choices about medicationchoices about medication
“I appreciated the fact that the pharmacist asked all new patients if they had any questions. That helps me to ask my
question & the fact that she made time for me”
Enabling consumers to make informed decisions about their own mental health management, particularly about
psychotropic medication, is a key to recovery. As a result, in order to improve the provision of information about commonly prescribed medications, since 2003
staff at St. Vincent’s Mental Health has commenced the weekly Medication Information Forums (MIF) at the Acute
Inpatient Services which then extended to community mental health services within St. Vincent’s catchment
areas
As a result of the Medicine Awareness Project, conducted by our consumer consultant in 2007
and the positive feedback from the MIF, a Medication Information Booklet written in accessible language with information that
consumers wanted, was developed to supplement the Forums.
“I feel great, I have a lot of sanity and stability. I feel and know that I can
do things. The medication gave me my
life back, made me strong and health, and brought
me back into the community.”
The high level of satisfaction from our survey & the positive feedback from the “Psychiatric Information”
booklet highlight:
the significance of regular psychoeducation
session between MH clinicians & consumers/carers.
the importance of availability of appropriate written psychotropic information for MH consumers/carers.
Targeted drug information services such as Medication Information Program can lead to increased satisfaction with therapy as well as increase in QOL in MH consumers (1)
.
1.
Zwaenepoel
L, Bilo
R, De Boever
W, De Vos
M, Reyntens
J, Hoorens
V, Sermeus
W, Laekeman
G: Desire for information about drugs: a survey of the need for information in psychiatric in-patients. 21212121Pharmacy World Science 2005; 27:47-53.
CONCLUSIONS
BOOKLET - ACKNOWLEDGEMENTSPRODUCTION
Miss Malinda Edwards:-design, production -
administration of this bookletPierce-Armstrong Foundation (Vietnamese)Scanlon Foundation (Italian)Pfizer (Greek & Arabic)Janssen-Cilag
(Chinese)
VIETNAMESE: Dr Neil Tran, Dr Vu Van, Dr Tung Nguyen, Mr. Minh Vo, Mr. Hai
Nguyen CHINESE: Dr Joshua Tsoh
(HK), Ms Angie Chan, Prof. Eng-Seong
TanGREEK: Dr George Kalogerakis, Miss Penie
SkondreasITALIAN: Daniela & Mathew Speers, Miss Lisa DesideratoARABIC: Ms Hadia
Baassiri, Ms Miranda Kaisar
TRANSLATIONS
Dr Adam Pastor for his contribution to the Substance abuse & dependence and
Alcohol & Opiate dependence sections (2nd
Edition)
