Implementation of a pharmacist-led physical health monitoring program for mental health consumers on a regular second generation antipsychotic.

Stage 1: Pharmacist Training The study will be conducted at community pharmacies in Australia, these pharmacies will vary in demographic population and physical location and will include both metropolitan and rural sites. Prior to the commencement of the study, site pharmacists will be required to complete an online training. The training will be facilitated by researcher TB and content will be delivered by multiple personnel who are professionals within the area (dietician, psychologist, diabetes educator and peer practitioner). Contents will be pre-recorded (4 x 1 hour sessions) short videos. Site pharmacists will be required to complete an assessment upon the completion of the training program. Pharmacist will have access to the pre-recorded online training materials for the entire duration of the project and can complete the training at their own pace. They can also re-visit the content if required even after they have successfully completed the training. Training content was designed by the research team specifically for this study. This was done through the review of existing literature and collaboration with trainers. Content includes: 1. Understanding of study procedures and aims - How to use the electronic templates provided (i.e data collection sheet and referral letter) - Familiarisation with the physical health monitoring procedure guidelines - Familiarisation with the STOP-Bang Questionnaire for sleep apnoea risk assessment - When referral is required and need for documentation 2. Effective communication with mental health consumers - Understanding of consumer’s experiences - What to do in case of a mental health crisis - Identifying online resources and support hotlines - Counselling and strategic goal planning in lifestyle and behavioural factors for consumers with mental health - Motivational interviewing skills including open-ended questions, affirmations, reflection and summaries 3. Monitoring of metabolic parameters - Antipsychotics and their effect on metabolism and glycaemic management. - Confidence in collection of plasma glucose and serum lipid levels - Safe disposal of sharps - Interpretation of results 4. Provision of basic nutritional advice - Identifying available online nutrition resources for patient information? - Identifying challenges in behavioural changes and strategies to support patients - Introduction to Australian guidelines to healthy eating Overall duration of Stage 1 is two months, pharmacists must notify principal researcher (TB) of their completion, TB will then grant approval for stage 2 to commence. Pharmacists are expected to complete Stage 1 at least 24 hours prior to start of Stage 2. Stage 2: Implementation of the program Consumers (age 18 years or older) with a diagnosis of a mental health condition and taking at least one second generation antipsychotic medication long term can participate in this program. Participants will be required to attend a total of five consultations with the pharmacist (baseline review then every 3 months thereafter for a total duration of 12 months). The sessions will involve an assessment of medical history, lifestyle factors and measurement of blood glucose and cholesterol level involving finger prick tests. Blood pressure, height, weight, waist circumference and measure body mass index. As obstructive sleep apnoea (OSA) is a manifestation of the metabolic syndrome, participants will also be screened for OSA during their physical health monitoring (at the first appointment only). All of these parameters will be measured by a pharmacist who has completed the training (mentioned above). Findings from each session will be discussed with the consumer by the pharmacist and tailored verbal and written health information consistent with the patient’s needs (including lifestyle) will be offered where necessary. Tailored verbal and written information will be provided by the pharmacists and will be based on the pharmacist's professional judgement and practice expertise. Community pharmacists are already involved in providing health information to customers on a day to day basis. Should it be required, referral to participant’s regular doctor will be made and the pharmacist will communicate the findings with participant’s nominated doctor and arrange for a follow-up appointment. Anticipated duration of each session may vary depending on whether it's a baseline review or a follow-up review. It is anticipated that the first session (baseline review) may take longer (approx 40 minutes) and subsequent follow ups may be shorter in duration (20 mins). Participant's adherence to the intervention (e.g following set lifestyle goals) will be assessed at each follow-up session by the pharmacists. This will be achieved through discussion with the participants and monitoring of metabolic parameters. Pharmacist's recruitment progress will be assessed by researcher TB monthly via face to face and/or email correspondence. Pharmacists will have a session attendance checklists that they can mark off once participants have attended the session. Reminder emails will be sent to the pharmacists 2 weeks prior to when the participant is due for their follow up sessions (at 3,6,9 and 12 months) by researcher TB.