Establishment and evolution of a clinical pharmacy mental health hospital-in-the-home service: An autoethnography

Mechaiel Farag; Kreshnik Hoti; Jeff Hughes; Leanne Chalmers

doi:10.1016/j.sapharm.2022.03.013

Establishment and evolution of a clinical pharmacy mental health hospital-in-the-home service: An autoethnography

Res Social Adm Pharm. 2022 Sep;18(9):3550-3559. doi: 10.1016/j.sapharm.2022.03.013. Epub 2022 Mar 26.

Authors

Mechaiel Farag¹, Kreshnik Hoti², Jeff Hughes³, Leanne Chalmers⁴

Affiliations

¹ Curtin Medical School, Faculty of Health Sciences, Curtin University, Kent Street, Bentley, Western Australia, 6102, Australia; North Metropolitan Health Service - Mental Health Pharmacy, Brockway Road, Mount Claremont, Western Australia, 6010, Australia. Electronic address: Mechaiel.Farag@postgrad.curtin.edu.au.
² Division of Pharmacy, Faculty of Medicine, University of Prishtina, Pristina, Republic of Kosovo. Electronic address: Kreshnik.Hoti@curtin.edu.au.
³ Curtin Medical School, Faculty of Health Sciences, Curtin University, Kent Street, Bentley, Western Australia, 6102, Australia. Electronic address: J.D.Hughes@curtin.edu.au.
⁴ Curtin Medical School, Faculty of Health Sciences, Curtin University, Kent Street, Bentley, Western Australia, 6102, Australia. Electronic address: Leanne.Chalmers@curtin.edu.au.

PMID: 35398004
DOI: 10.1016/j.sapharm.2022.03.013

Abstract

Background: Hospital-in-the-Home (HiTH) services provide "inpatient-style" care for patients at home. While relatively well known in non-psychiatric settings, little is known about mental health (MH)-HiTH services, with even less known about the role of a clinical pharmacist (CP) within a MH-HiTH multidisciplinary team (MDT).

Objective: The aim of this paper is to describe the evolution of the first MH-HiTH MDT in Western Australia and the various facets of the CP's role integrated within the service.

Method: The integration of a CP into a non-traditional practice setting represents a cultural change in the pharmacy profession. Hence, this paper utilised a descriptive-realistic style of the autoethnographic method, with the narrative written in the first-person point of view of the first author (M.F.). It specifically focused on the tasks performed by the team's CP. A narrative analysis approach was used to reflect on the reason these tasks are performed, the potential benefits and limitations of integrating a CP into the team and subsequent cultural influence on the pharmacy profession.

Findings: The service commenced in 2014, consisting of an MDT of a consultant psychiatrist, a psychiatric registrar, clinical nurses, an occupational therapist, a social worker and a CP. Starting with 4 then 8 "virtual beds", it was gradually increased to 16 virtual beds. The MH-HiTH CP combined hospital clinical tasks - e.g. medication reconciliation and therapeutic drug monitoring - with home medication reviews as part of the MH-HiTH MDT. Lessons learnt include proactively integrating and flexibly adapting into a novel practice setting.

Conclusion: There is scope to embed a CP within an MH-HiTH MDT; the major advantage is the inclusion of a comprehensive medication management service. While this is a promising new area where the pharmacy profession is becoming engaged, more studies are needed to quantify and confirm the stated benefits of such service.

Keywords: Autoethnography; Clinical pharmacist; HiTH; Hospital-in-the-Home; Mental health; Service evolution.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Hospitalization
Hospitals, Psychiatric
Humans
Mental Health
Pharmacy Service, Hospital*
Pharmacy*