Public Health Pharmacists: Critical Analysis and Job Description

Public health is known as promoting and protecting health and well-being, preventing ill-health and prolonging life through the organised efforts and society (Bridge, 2020). The main goal of public health is prevention. Preventive measures can be applied at any stage along the natural history of a disease, with the goal of preventing further progression of the condition, to achieve this, public health pharmacists play an important part (Gurney, 2009).

Public health pharmacists aims to improve the quality of life though prevention and treatment of diseases, including mental health, such as depression. Depression a common mental health problem which is widespread throughout all sectors of society and affects all ages and cultures, with an estimate that more than 300 million people worldwide are affected (Solomon, Park, & Zarate, 2019). Public health pharmacist may work across primary (community pharmacy or general practice) and secondary care (specialised care) setting. Community-based pharmacist are based centrally in a local community, highly accessible to consumers as they generally do not operate on an appointment based schedule. They can provide consumers the opportunity to seek advice for the management of their diagnose of clinical depression, often before seeking help from their general practitioner (GP) (Dixon, Holoshitz, & Nossel, 2016).

Moreover, primary public health pharmacists are in an ideal position to provide the first point of contact within the health care system, knowing who to contact if someone has stopped taking their medication or acting out of character. Furthermore, the collaboration of pharmacists with other health care providers has shown to have a positive impact. In one study, monthly meetings between a psychiatrist and pharmacist about the implementation of benzodiazepine guidelines led to a significant reduction in the daily dose of benzodiazepines for those in prison (Lerat, Cabelguenne, Lassia, Meunier, & Zimmer, 2011). In reference to Ms AC, if she is prescribed with an antidepressant, the pharmacists can compare the dosage to the recommended dose, in which if there is any concerns, the pharmacist can contact her GP.

Pharmacists working in secondary care, such as mental health hospitals, are specialist mental health pharmacists who work closely within a multidisciplinary team to tailor medications to individuals whose depression has relapsed, or who are experiencing depression for the first time. They help to simplify complex medication regimens, providing education and training on medicines to patients and careers. A review conducted of hospital pharmacy services in mental health, highlighted the importance of pharmacist in hospital settings, especially due to the increase education they provide to patient and careers (Wheeler et al., 2012).

Clinically experienced pharmacists are now undertaking Collaborative Drug Therapy Management (CDTM) specialising in mental health, pharmacists will assess Ms AC or any patient diagnosed with clinical depression, select the correct antidepressant, titrate dosages to achieve treatment adherence and provide education to the patient regarding their antidepressant medication (Hammond et al., 2003). This can be based in community, mental hospital or acute hospitals. Richardson, O’Reilly and Chen (2014) conducted a review on 18-hospitals based services in a mental health setting, where he examined the pharmacy roles that come under the umbrella term of CDTM. The study demonstrated evidence of pharmacist minimising patient safety errors and playing a significant role in patient mental healthcare (Richardson, O’Reilly, & Chen, 2014).

Furthermore, it is vital for pharmacist to inform patients on all the important aspect of their antidepressant medication, correspondingly, being certain that the patients have understood all the pathway regarding their condition. Thornicroft, Deb and Henderson (2016) identified 22 community-based studies exploring a broad range of professionals services offered to consumers with depression. The review showed the role of the pharmacist in providing medication review services lead to patients having a greater understanding of their medication and their disorder. Which subsequently lead to greater safety in patients medication, and improve antidepressant medication adherence (Thornicroft, Deb, & Henderson, 2016). Medication review is not only successful in England, but also in other countries. An Australian study conducted examined the impact of pharmacist performing Residential Medication Management Review (RMMR) and Home Medicine Review (HMR) on antidepressant medication. The study demonstrated the actual impact of pharmacist conducting RMMRs on significantly reducing exposure of drug interactions, by 60 per cent (Nishtala, Hilmer, McLachlan, Hannan, & Chen, 2009).

Many people struggle to access help from family, friends or services, partly due to the stigma still associated with depression. Likewise, Ms AC is described as an introvert and shy, an international student living alone, which could mean she has no one to speak to.

Additionally, there may be a lack of recognition from consumers on the availability of mental health care services. Fernandez et al (2010), found patients are more willing to go to GPs to speak regarding mental health than other healthcare professionals (Fernández et al., 2010). However, the promotion of mental health can have a positive impact in terms of reducing the stigma associated with poor mental health within a local community. Depression Awareness week is a time where pharmacist provide information to patients regarding depression, and direct people to Depression Alliance, the national charity for people with depression. A study conducted to examine the effect on depression awareness week, a local public health campaign, pharmacist did not only improve the local public health but also contribute to reducing the stigma of having a depressive illness. The latter may increase individuals confidence in seeking help and thereby reduce associated morbidity and mortality (Taylor, Donoghue, & Bleakley, 2011).

People with depression have been shown to have poor lifestyle, inadequate physical health, leading to an increase chance of morbidity and mortality associated with a range of physical conditions (De Hert et al., 2011). Pharmacists working in all settings can support people with depression by promoting basic physical and oral health through promotion of healthy eating, providing services such as smoking cessation services, and encouraging exercise (Thomas, 2016). In relation with Ms AC, due to the alcohol she has stated to consume, she should be advised on the safe use of alcohol. It is advised not to drink more than 14 units a week (NSH, 2009). A randomised clinical trial was conducted between 2002 and 2005 with patients diagnosed with clinical depression. The trial included two groups, one group who received alcohol intervention and those who received no intervention. At the six month follow-up, there was a significant reduction in depression for those who received alcohol intervention, whilst there was no significant reduction in depressive symptomatology to those who did not have the alcohol intervention (Wilton, Moberg, & Fleming, 2009). Thus, pharmacists providing alcohol screening for patients who are suffering from depression demonstrated to be helpful.

Consequently, pharmacists should inform Ms AC, or any patients diagnosed with clinical depression the different managements available for clinical depression. National and Institute for Health and Care Excellence (NICE) recommends cognitive behavior therapy (CBT) for patients with mild to moderate depression (NICE, 2009). CBT is a talking therapy that can help people manage their problems by changing the way they think and behave. A systematic review conducted to examine the effectives of CBT, the study specified CBT significantly reduced depression and anxiety symptoms. Also, the study showed CBT to be more effective than interpersonal psychotherapy in clinical depression (Luty et al., 2007).

Almost all mental health problems are associated with an increased risk of suicide. Pharmacy Times, published an article outlining four interventions pharmacist can carry out to help prevent suicide (Marotta, 2018). These include;

1. Monitoring medication and mental health
2. Collaborating with the healthcare team
3. Referring to suicide prevention resources
4. Being encouraging and empathetic.

A study conducted to examine the role of pharmacist prevention of suicide in patients with depression, from the 150 participants that look place, 70% of the patients had a significant reduction in the thought of suicide (Murphy et al., 2020).