Advancing Mental Health Provision in Pharmacy (AMPLIPHY)
Authors: Gorton H C , Riste L , Armitage C J , Ashcroft D M 
Published: March 2021

Abstract

Introduction
Improvement of mental health is a priority in the NHS Long Term Plan (1), and pharmacists and their teams could provide enhanced support for people who take medicines for anxiety or depression, two of the most common mental health problems in the UK. However, a recent Cochrane review (2) identified no community pharmacy services focused on mental health.

Aim
We aimed to pilot a mental health support service, in community pharmacy: Advancing Mental Health Provision in Pharmacy (AMPLIPHY) to assess its feasibility and potential benefit

Methods
The AMPLIPHY service was codesigned through a workshop involving people with lived experience, pharmacists and researchers. The resultant programme is a series of consultations, beginning at the presentation of the qualifying prescription for an antidepressant, after a further 1–2 weeks and then as further prescriptions are presented, up to 3 months. People are eligible to enter the service if they are newly prescribed antidepressants for depression or anxiety, or have a change in medication, dose or quantity. Pharmacists and their teams identified people who met this criterion and invited them to participate. The service was intended to be patient-led, with the pharmacist helping the patient to define tangible aims and/or outcomes that they wanted to focus on, and providing sign-posting where required. Following brief one-day training, the pilot ran across ten pharmacies in Greater Manchester from November 2019 through March 2020. We triangulated results from: a) quantitative analysis of consultation data; b) content analysis of consultation records; and c) template analysis of semi-structured interviews with participating pharmacists at the start and end of the service. We aimed to obtain feedback from people on exit from the AMPLIPHY service, but this was curtailed due to the coronavirus pandemic. Consultations were recorded via the Pharmoutcomes system (a,b) and interviews were recorded and transcribed, with NVivo used to manage the interview dataset (c).

Results
Seventy-six patients participated in the service, across 9 of the 10 pharmacies. Seventy-five percent of patients had just one consultation. The median age was 39 (IQR 28–47) and 62% of patients were women. Most patients entered the service due to new prescription of antidepressant (74%), 17% due to a change in dose and the remainder due to change in medication or quantity. Sertraline was the most commonly prescribed medication (46%). The content analysis is indicating that consultations centred around one of five areas: health (n=31), lifestyle (n=62), medication (n=45), support (n=37) and patient’s descriptions of their feelings (n=31).

Conclusion
AMPLIPHY was accessed by a range of people, mainly on initiation of a new antidepressant. Parallels might be drawn with the New Medicines Service in England, but this does not currently extend to antidepressants. Consultations were not restricted to health and medication, but extended to other social and lifestyle aspects thus indicated that participants felt comfortable to disclose their personal situations to the pharmacist. This could support tailored interactions. However, more work is warranted to understand why most patients did not attend multiple consultations, and the immediate/ long-term impact from the patient’s perspective.

References
1. NHS. NHS Long Term Plan [online]. 2019 [cited 09 October 2020]. Available at: https://www.england.nhs.uk/long-term-plan/
2. de Barra M, Scott CL, Scott NW, Johnston M, de Bruin M, Nkansah N, Bond CM, Matheson CI, Rackow P, Williams AJ, Watson MC. Pharmacist services for non-hospitalised patients. Cochrane Database of Systematic Reviews 2018, Issue 9. Art. No.: CD013102. DOI: 10.1002/14651858.CD013102.