Clinical pharmacist interventions in psychiatric hospitals in patients with mental disorders: impact on the medication-related problems

1) Scientific background. Patients with mental disorders are often comorbid and, on average, receive many medications. Thus, medication-related problems represent a significant challenge in treatment (e.g. psychotropic selection, polypharmacy, drug-drug interactions, potentially inappropriate medications for the elderly, and treatment of comorbidity). According to research results, psychotropics are the drugs that often enter into serious drug-drug interactions and potentially inappropriate medications for the elderly (PIMs) (50% of them are associated with psychotropics). The prevalence of polypharmacy in these patients is also high. 2)Problem identification. Patients with mental disorders have several medication-related problems, which reduce their quality of care and life. Medication-related problems are often excluded from randomised trials. One possibility to reduce medication-related problems in practice is to involve a clinical pharmacist specialist within the psychiatric inpatient team on the ward in daily activities (daily ward rounds and medication reviews). 3)Review of research in this area. The impact of the clinical pharmacist is significant in reducing drug-drug interactions, polypharmacy, reducing PIM and improving quality of life. The impact of clinical pharmacist interventions in psychiatric inpatient settings (hospitals) has not been well-researched in Europe. We have only a few data (mainly from the UK), but the data are methodologically flawed. In this part of Europe, we have no data on the impact of the clinical pharmacist in a psychiatric hospital. Nor do we have any systematic review on this topic in Europe that would give an insight into state of the art in this field. This information is urgently needed to plan appropriate strategies in this field. 4)Objectives. The aim is to investigate whether clinical pharmacists interventions in a psychiatric hospital reduce the number of medication-related problems through two different clinical studies and a systematic review. The specific objectives will be: 1) to conduct a clinical retrospective study to examine the impact of a clinical pharmacist on the reduction of medication-related problems in daily ward rounds (1st year), 2) to conduct a clinical retrospective study to examine the impact of a clinical pharmacist on the reduction of medication-related problems in the form of medication reviews (2nd year), 3) to conduct a systematic review on the impact of clinical pharmacist interventions in psychiatric hospitals (3rd year). We hypothesise that clinical pharmacist interventions will lead to fewer medication-related problems (hypothesis). 5)Work programme. We will follow a pre-defined work programme (detailed in the application form) to achieve our objectives. The team will conduct two retrospective clinical studies in a psychiatric hospital and a substantial systematic review using current recommendations for conducting systematic reviews (PRISMA 2020). The team includes renowned researchers with publications and clinical experience in this field (clinical pharmacy specialist, psychiatrist, and systematic review specialists). It will collaborate internationally with the European Society of Clinical Pharmacy (ESCP) and the European Psychiatric Association (EPA). 6)Impact of the project. Our proposed project will be the first to offer an ambitious project of clinical pharmacist interventions in the form of daily rounds and medication reviews in a psychiatric hospital in the European Union and the first systematic review in this field. This will substantially contribute to national access to clinical pharmacists in psychiatric hospitals and will provide important data for evaluating new healthcare programmes in European Union.