Cardiometabolic risk, metabolic syndrome, and related diseases in severe mental illness: the role of pharmacy in the lived experience of patients

Abstract

Background: The thesis explores the role of pharmacy in the lived experience of patients with severe mental illness (SMI) who experience excess morbidity and mortality due to cardiometabolic risk (CMR), metabolic syndrome (MetS) and related diseases. Aims and objectives: To understand and explain the role of pharmacy in providing care for CMR, MetS and related diseases in patients with SMI; achieved by 1. systematically reviewing the published evidence 2. exploring and document the views, perceptions, and experiences of patients with SMI, their informal carers, caring dyads (caring dyad defined here as a patient and their informal carer), care and pharmacy professionals 3. providing strategic recommendations for pharmacy for clinical practice, policy, and research to improve care. Methods, results, and key findings: To address research objective 1. a systematic review of 33 articles found that face-to-face interactions of pharmacists with others consistently and significantly improved process outcomes such as the rate of blood tests 2. framework analysis of semi-structured interviews conducted with 16 patients, 8 informal carers, 21 care professionals and 11 pharmacists identified three themes: (i) CMR, MetS and related diseases, psychotropic medication, psychotropic medication side-effects and SMI (ii) barriers and (iii) facilitators to the role of pharmacy. Framework analysis contrasting and comparing data from each individual within 6 caring dyads identified three themes: (i) enhanced closeness (ii) dissonance, and (iii) balance within the caring dyad. In-depth meaningful impactful interactions between pharmacists and patients, informal carers, and caring dyads were infrequent. 3. Changes to pharmacy practice and policy could facilitate face-to-face interactions between pharmacists and other care professionals and more importantly patients, informal carers, and caring dyads. Conclusion: Patients’, informal carers’, and caring dyads’ desires and needs were not met. Changes to pharmacy practice could facilitate increased face-to-face interactions and encourage person-centred care with the goal of building long lasting trusting relationships which is key in this vulnerable population.