Table 2 Summary of study characteristics and results

MacHaffie^b, 2002, UK [105]

Sources of health promotion information of those with serious and persistent mental illness obtain

Reliability of health promotion information from different sources as perceived by persons with serious and persistent mental illness

Pharmacist (not further specified)

Mental health outpatient

Quant

Questionnaire and structured interview, descriptive

41 adult (age > 18 years) patients with a 12 month prevalence of serious and persistent mental illness (12 with schizophrenia, 11 schizoaffective disorder, 9 bipolar I, 4 bipolar II, 1 psychotic disorder not otherwise specified (NOS), 3 major depressive disorder, 1 panic disorder) or a lifetime prevalence of these disorders accompanied by evidence that they would have been symptomatic in the last 12 months if it were not for treatment.

Ranked non-psychiatrist physicians, psychiatrists, nurse and pharmacists (in that order) as providing the greatest amount of health promotion information.

Reliability of health promotion information in order (highest to lowest) non-psychiatrist physicians, psychiatrists, nurse and pharmacists

Ohlsen, 2005, UK [77]

Nurse-led delivery system: physical problems identified and appropriate treatment and monitoring initiated by prompt referral to suitable specialist services or general practitioners

Joint working agreement with other teams including pharmacy put in place prior to starting the service.

Pharmacist (not further specified)

Community mental health team.

Mixed methods

Pre and post measurements of metabolic parameters and self-esteem.

Qualitative description of management issues.

134 adult (18-65 years old) patients with either schizophrenia or schizoaffective disorder.

Results from study relate to the intervention of the nurse advisor. Direct impact of pharmacist was not reported in the findings.

Runcie, 2007, UK [100]

Impact of a protocol for monitoring weight and blood glucose in psychiatric inpatients receiving antipsychotics.

Hospital pharmacist.

Psychiatric inpatients

Quant

Pre and post measurements: quasi

Adults aged > 18 years .61 patients pre and 59 post intervention with schizophrenia, schizoaffective disorder, persistent delusional disorder, acute and transient psychotic disorder or induced delusional disorder

No significant improvement in recording of admission weight or blood glucose was observed.

Ongoing monitoring of weight after admission was significantly more common.

For only 29% of patients studied in 2004 was there complete adherence to the protocol.

Barnes, 2008, UK [101]

Quality improvement programme designed to increase screening for the metabolic syndrome in community psychiatric patients prescribed antipsychotics.

Hospital chief pharmacist

Community mental health team.

Quant

Audit pre and post intervention: quasi

Adults aged > 16 years. Pre intervention: 1616 (82.2%) had psychotic spectrum disorder (International Classification of diseases (ICD)-10 F20-29), 260 (13.2) had bipolar disorder (ICD-10 F30-39), 90 (4.6%) other (not stated). Post intervention: 1277 (84.3%) psychotic spectrum disorder, 182(12.0) bipolar disorder, 54 (3.7%) other.

Measurement or test result was recorded in the clinical records in the previous year (2005):

Baseline -BP in 26% of this sample, for BMI (or other obesity measure) in 17%, for plasma glucose (or glycosylated haemoglobin (HbA1c)) in 28% and for plasma lipids in 22%.

1 year after intervention—BP in 43% of this sample, for BMI (or other obesity measure) in 34%, for plasma glucose (or HbA1c) in 38% and for plasma lipids in 35%

Predictors of what clinical factors might be related to full metabolic screening:

- At baseline, age and a known diagnosis of dyslipidaemia

- At 1 year re-audit: known diagnosis of diabetes and type of antipsychotic, relating specifically to clozapine treatment

Taveira, 2008, USA [81]

Compare the efficacy of a pharmacist led cardiovascular risk reduction clinic (CRRC) in the lowering of cardiovascular risk between those with and without mental health conditions.

Clinical pharmacist.

Primary care clinic.

Quant

Retrospective cross sectional cohort analysis.

Adults aged >  18 years; total of 297 of whom 176 had no mental health condition (MHC); 121 had a MHC of which 92 (76.0%) had a non-severe MHC diagnosis and 29 (24.0%) had a severe MHC (schizophrenia, schizoaffective disorder, bipolar disorder, psychosis not otherwise specified or posttraumatic stress disorder with psychosis).

The mean United Kingdom Prospective Diabetes Study cardiovascular risk score change from baseline is comparable for those without a mental health condition vs those with a non-severe mental health condition and those with a severe mental health condition

Schneiderhan, 2009, USA [89]

Usefulness of a metabolic risk screening program, including point-of-care glucose testing, to quantify baseline metabolic risk in outpatients receiving antipsychotics.

Board certified psychiatric pharmacist.

Psychiatric outpatient clinic outpatient

Quant

Retrospective, cross-sectional, cohort study

Adults aged >  18 years. Total participants (92) all of whom were on an antipsychotic. Diagnoses were recorded in 88, 53 (60%) schizophrenia or schizoaffective disorder, 18 (20%) bipolar disorder and 17 (19%) major depressive disorder.

63 (71%) met criteria for level 1 metabolic risk (abdominal obesity); of these 63 patients, 38 (60%) met criteria for level 2 risk (abdominal obesity plus hypertension).

Patients with a random glucose level greater than 140 mg/dl had a higher likelihood for being at level 2 risk than level 1 risk

Women had a significantly higher likelihood for level 1 metabolic risk compared with men

African-Americans had a significantly higher likelihood of level 1 risk and BMI greater than 30 kg/m² compared with Caucasians.

Patients with a BMI greater than 30 kg/m² had a significantly higher likelihood of diabetes, hypertension, and hyperlipidaemia.

Overall, 5 (5%) of the 92 patients met criteria for prediabetes risk

Gable, 2010, USA [90]

Demonstrate the role of pharmacist reviewing the recommendations and interventions a clinical pharmacist made over a 6 month period in an Assertive Community Treatment team by

Board certified psychiatric pharmacist

Community mental health team

Quant

Retrospective chart review.

Total participants (34)—who had at least one active Axis I Diagnostic and Statistical Manual (DSM)-IV-TR SMI  such as schizophrenia, bipolar disorder, or major depressive disorder.

Physical health assessments, review of blood glucose logs, BP undertaken when appropriate (e.g. recent development of diabetes or hypertension). Labs recommended by pharmacist to monitor for adverse effects and disease states (15 times). Coordinate care with other healthcare providers, including those not part of the mental health care team - included recommendations made to primary healthcare providers on non-psychiatric issues including blood pressure, diabetes control (12 times). The interventions/recommendations were part of a study involving a comprehensive medicines management service provided by a pharmacist

Lizer, 2011, USA [102]

Pharmacist assisted psychiatric clinic to improve adherence to medications and quality of life over 6 months.

Pharmacist (not further specified)

Psychiatric outpatient clinic

Quant

Prospective single centre pilot study: quasi

27 individuals >  18 years with axis I diagnosis: 11 (41%) bipolar disorder 9 (33%) depression, 7 (26%) other (not stated) receiving at least one scheduled medication for mental illness.

Quantitative

WHOQOL-BREF (abbreviated generic quality of life scale developed through the World Health Organisation) showed statistically significant changes in both the physical capacity

Secondary Study Endpoints

Overall, there were no significant changes in the metabolic parameters measured except for total cholesterol and low density lipoprotein

Other results

Other pharmacist recommendations included an increase in exercise, education for a decrease in tobacco use. Qualitative analysis of pharmacists’ interventions included recommendations (number of times) to: increase exercise to promote weight loss and reduce stress (12), calcium and vitamin D supplementation (12), smoking cessation education (9). Patient self-reported acceptance of these recommendations was exercise (50%); smoking cessation (22%).

Taylor^a, 2011, UK [73]

Different models for the delivery of clozapine to people with Treatment Resistant Schizophrenia (TRS)

Mental health pharmacists (including senior pharmacists)

Community mental health team (clozapine clinic)

Mixed method

Prospective.

TRS (any age); 23 patient participant questionnaire 10 patients’ clinic visit observed; 9 interviewed. 23 healthcare professional survey,

Participants in the clinics with a pharmacist reported no difference in health, wellbeing, self-efficacy and ability to manage their own health than clinics without pharmacist input.

In terms of the most favourable behaviours:

- Doctors scored favourably in 12 of the 19 areas, with nurses and pharmacists equal in 4 of 19 and phlebotomists 2 of the 19.

- Pharmacists demonstrated the least favourable consultation behaviours in 8 of the 19 areas, with nurses in 5 and doctors and phlebotomists in 4 of the 19. However when the scores across all 19 domains were averaged the findings demonstrated with greater clarity the participants’ perception of the HCP communication skills within a consultation

DelMonte, 2012, USA [88]

Computerised physician order entry (CPOE) pop-up alert for laboratory metabolic monitoring of patients treated with second generation antipsychotics

Clinical psychiatric pharmacist.

Inpatient psychiatric unit

Quant

Single-centre, retrospective chart review: quasi

Before and after alert (respectively):62 (36.3%) and 44 (28%) schizophrenia, 43 (25.1%)and 47 (29.9%)depressive disorders, 35 (20.5%) and 39 (24.8%) bipolar disorder, 9 (5.3%) and 11 (7.0%) mood disorder NOS, 6 (3.5%) and 4 (2.5%) personality disorders, 2 (1.2%) and 2 (1.3%) dementia, 2 (1.3%) and 6 (2.8%) anxiety disorders, 5 (2.9%) and 0 substance related disorders, 4 (2.3%) and 1 (0.6%) adjustment disorder, 3 (1.8%) and 2 (1.3%) other. Age >  18 years.

Patients with glucose level available pre-alert 158 (92.4%) and post alert 157 (100) p = 0.001. Blood glucose level ordered at the same time as the SGA ordered on the computer system 9 (5.7%) and 31 (19.7%) p < 0.0001. Patients with fasting glucose level available (overall) 80 (46.8%) and 110 (70.0%) p < 0.0001.

Patients with lipid panel available 49 (28.7%) 117 (74.5%) p < 0.001. Patients with both glucose level and lipid panel available 47 (27.5%) 117 (74.5%) p < 0.0001. Patients with fasting a lipid panel available (overall) 32 (18.7%) 94 (59.9%) p < 0.0001

Blood glucose level ordered at the same time as the SGA ordered on the computer system 4 (8.2%) 38 (32.5%) p = 0.002.

Koffarnus, 2012, USA [97]

Adherence to American Diabetes Association recommendations for diabetes monitoring following an educational Intervention for physicians in an inpatient psychiatric hospital.

PharmD pharmacist.

Inpatient psychiatric unit

Quant

Retrospective chart review: quasi

60 patients pre-intervention and 60 patients post intervention with a diagnosis of schizophrenia (3.3% pre and 13.3% post), schizoaffective disorder (33.3% pre and 30% post), bipolar disorder (40% pre and 23.3% post) and major depressive disorder (16.7% pre and 21.7% post)

The physician education program was successful in significantly increasing the assessment of HbA1c values and lipid profiles for patients with diabetes mellitus in a psychiatric institution.

McCleeary-Monthei, 2012, USA [103]

Metabolic monitoring form for antipsychotics initiated by pharmacists and adherence to American Diabetic Association/ American Psychological Association guidelines.

Pharmacist (not further specified)

Inpatient psychiatric unit

Quant

Retrospective quasi

Pre-intervention total of 33 patients of whom 7 (22%) schizophrenia, 9 (27%) bipolar, 13 (39%) psychoses. Post-intervention total of 30 patients of whom had 6 (20%) schizophrenia, 10 (33%) bipolar, 5 (17%) psychoses. Aged 18-65 years on inpatient ward ≥ 48 h.

In the pre-intervention group. Patients with schizophrenia were significantly more likely to have baseline lipid monitoring. In the post-intervention group in combined data, patients with a diagnosis of diabetes were more likely to have baseline lipid and glucose/HbA1c.

All other results were not statistically significant.

Ramanuj, 2012, UK [104]

Implementation of a high-visibility prompt and an educational programme

Head of pharmacy.

Inpatient psychiatric unit

Quant

Quasi

Total of 36 patients in the first audit cycle of whom 14 (38.9%) schizophrenia/schizoaffective disorder, 5 (13.9%) bipolar disorder, 7 (19.4%) unipolar depression and 7 (19.4%) dementias. Second cycle (after the intervention) total of 38 of whom 12 (31.6%) schizophrenia/schizoaffective disorder, 9 (23.7%) bipolar, 6 (15.8%) unipolar depression, 2 (5.3%) dementias

Glucose and cholesterol levels were monitored at baseline in only 44% and 16%, respectively, of patients in the first audit, although both of these showed significant improvement by the second audit.

The proportion of patients in whom random plasma glucose and fasting cholesterol levels were measured 3 monthly after starting antipsychotic medication increased from 41.7% and 25%, respectively, in the first audit to 66.7% for both in the second audit.

Baseline and annual monitoring rates for metabolic dysfunction and cardiovascular risk were not significantly affected by the risk profile of the antipsychotic prescribed either in 2008 or in 2010, except for the annual cholesterol monitoring rate, which was paradoxically lower for the high-risk antipsychotics than the all-antipsychotic rate in 2010.

Watkins, 2012, USA [78]

Medication monitoring system based on current guidelines for pharmacotherapy

Clinical pharmacist

Community mental health team (university based service)

Mixed methods

Analysis of information from database for psychotropic monitoring

68 adults (> 18 years) with a primary diagnosis of schizophrenia or other psychotic disorders limited to schizoaffective disorder or bipolar disorder with psychotic features.

Orders for fasting blood glucose were discontinued and changed to ‘attempt fasting status’ and ‘obtain HbA1c’ and scheduled for every 6 months.

Annual lipid panels were changed to every 6 months, if applicable

Kjeldsen, 2013, USA [92]

Outreach visit by clinical pharmacists (providing education to mental health staff)

Clinical pharmacist

Inpatient psychiatric ward

Quant

Retrospective: quasi

A total of 205 adult (≥ 18 years) patients were included – 93 active implementation and 112 passive dissemination. Individuals with SMI (ICD-10 criteria for schizophrenia (F20.0—20.99) or affective (bipolar) disorder (F30.0—31.99).

A significant improvement of the use of the screening sheet from in the passive dissemination group to active intervention group was found.

Consequently, the quality of the screening increased significantly resulting

Cohen, 2014, USA [82]

Follow up study of Taveira—maintenance of glycaemic control and blood pressure control in patients with diabetes following successful completion of a cardiovascular risk reduction clinic

Clinical pharmacist.

Primary care

Quant

Retrospective

Total of 231 adults, 108 of whom had mental health conditions—breakdown not given for diagnoses

There was no significant difference between diabetic patients with and without mental health conditions in maintenance of HbA1c and systolic blood pressure after discharge from the cardiovascular risk reduction clinic.

Lucca, 2014, India [91]

Adverse drug reactions (ADRs) to antipsychotics and its management in psychiatric patients.

Clinical pharmacist.

Tertiary care (inpatient) psychiatric hospital

Quant

Prospective interventional study: descriptive

517 patients receiving antipsychotics, of which 89 (29.66%) psychosis, 88 (29.33% bipolar affective disorder, 59 (19.6%) depression, 42 (14%) schizophrenia (22 (7.33%) other diagnoses—not stated))

Approximately 90% of the patients with weight gain (n = 30) were enrolled into weight management program (nonpharmacological intervention). If it exceeded 7% of the initial weight after 10 weeks, then switching to another antipsychotic was considered.

Schneiderhan, 2014, USA [84]

Pharmacist comprehensive medication management services using point-of-care tests to reduce of metabolic syndrome risk parameters at 6 and 12 months.

Pharmacists qualified who were certified Minnesota medication therapy management services

Community – mental health team

Quant

Prospective, multisite, randomised, controlled study.

Total 120 patients (60 received pharmacist intervention  and 60 no pharmacist intervention). Anxiety disorders (76.7%, n = 89) (including posttraumatic stress disorder [n = 12] and obsessive-compulsive disorders [n = 3]), depressive disorders (65.8%, n = 79), bipolar disorders (47.5%, n = 57), schizophrenia (30.8%, n = 37), and schizoaffective disorder (22.5%, n = 27).

No statistical differences in metabolic syndrome based on point-of-care tests were observed between the 2 groups (PCS and NCS)  at baseline or at 12 months

Barnes, 2015, UK [98]

Programme of screening for the metabolic syndrome in people prescribed continuing antipsychotic medication

(Follow on study from Barnes 2008).

Hospital chief pharmacist.

Community mental health team

Quant

National quality improvement audit: quasi

Adults > 16 years. Total of 1519 patients.72% schizophrenia, schizotypal and delusional disorders, 13% mood/affective disorders, 6% disorders of adult personality and behaviour, 9% unknown or other diagnoses including mental retardation and organic disorders

Over the 6 years of the programme, there was a statistically significant increase in the proportion of patients for whom measures for all 4 aspects of the metabolic syndrome had been documented in the clinical records in the previous year, from just over 1 in 10 patients in 2006 to just over 1 in 3 by 2012. The proportion of patients with no evidence of any screening fell from almost ½ to 1 in 7 patients over the same period.

Bozymski, 2015, USA [83]

Collaborative drug therapy management protocol at a community mental health centre.

Board certified psychiatric pharmacist

Psychiatric outpatient clinic

Quant

Retrospective chart review: quantitative non-randomised with a control group.

Schizophrenia 49% (n = 89) and schizoaffective disorder 23% (n = 42).

Age > 18 years on an antipsychotic.88% (n = 180) from community support services and 12% (n = 24) from primary care clinics.

Monitoring of weight, blood pressure, fasting blood glucose and fasting lipid panels was significantly better at the two primary care clinics than the outpatient psychiatric clinic.

Family history monitoring took place at 57% of primary care clinic visits was not a statistically significant different.

With the limited amount of continuous data obtained, the only statistically significant differences were weight and blood pressure.

Waist circumference was not measured or documented at any study visit.

Fischler, 2016, Canada [99]

Clinical practice guidelines National Institute of Health and Care Excellence guideline for schizophrenia.

Manager of pharmacy.

Inpatient psychiatric

Quant

Retrospective: quasi

Adults with primary diagnosis of schizophrenia or schizoaffective disorder. Number of patients not stated

Adherence to guidance for metabolic monitoring (March 2014, 76.7%; March 2015, 81.6%),

Cognitive behaviour therapy for psychosis referral (March 2014, 6.5 %; March 2015, 11. 4 %) and vocational rehabilitation referral (March 2014, 36.6 %; March 2015, 49.1 %) were increased after clinical practice guideline implementation.

There was an initial increase in adherence to antipsychotic monotherapy (March 2014, 53.4%; November 2014, 62.7%), which decreased back towards baseline (March 2015, 55.1%).

Lee, 2016, USA [79]

Computerised physician order entry pop-up alert for laboratory metabolic monitoring of patients treated with second generation antipsychotics.

Interventions carried out by the psychiatry team to manage metabolic abnormalities found on screening were also identified. (Follow on study from DelMonte 2012).

Board certified psychiatric pharmacist.

Inpatient psychiatric unit.

Mixed methods

Retrospective chart review

This is a follow on study from DelMonte and reports a third set of results. In this group there were a total of 129 patients of whom 47 (36.4%) schizophrenia, 34 (26.4%) depressive disorders, 21 (16.3%) bipolar disorder, 10 (7.8%) mood disorder NOS, 4 (3.1%) personality disorders, 1 (0.8%)dementia, 6 (4.7%) anxiety disorders, 4 (3.1%) substance related disorders, none with adjustment disorder, 2 (1.6%) other. Age > 18 years.

Quantitative

No significant decrease in monitoring of glucose levels and lipid panels (fasting or random).

Nine patients with abnormally elevated laboratories were identified. Interventions by the psychiatry team included referrals to appropriate healthcare professionals and initiation of medication.

Qualitative

The interventions made by the psychiatry team to manage metabolic abnormalities were not analysed using statistical tests, but instead reviewed and described through a case series format.

McMorris, 2016, USA [74]

Dietary teaching tools for a select population diagnosed with a severe mental illness and limited financial ability.

A clinical pharmacist (certified in diabetes management) and a first-year pharmacy resident

Community mental health team—assertive community treatment team.

Qual

Questioning and identification of themes. Focus groups

1st phase: 5 Healthcare professionals (mix of psychiatrist, psychiatry resident, clinical social worker, professional counsellor, behavioural health case manager, recovery support specialist, nurse, administrative assistant, clinical pharmacist). Second patients who have a primary diagnosis of schizophrenia, schizoaffective disorder, or bipolar disorder (number of patients not stated).

Phase one: Ten cards were created and distributed to the healthcare professionals (HCPs). A focus group was conducted. HCPs reported the cards were useful in opening dietary choices dialogues and were able to give more specific information on alternative choices.

Phase two: From focus group feedback, specific cards for disease states, calorie guidelines, and budget limitations were developed. HCPs immediately utilised them

Porras-Segovia, 2016, UK [93]

Case of an individual with refractory schizophrenia who developed rapid-onset insulin dependence at the commencement of his clozapine therapy.

Clinical pharmacist.

Inpatient psychiatric unit

Quant

Case report

One individual with  TRS

Case report of an individual with refractory schizophrenia who developed rapid-onset insulin dependence at the commencement of his clozapine therapy and in whom diabetes was treated successfully without discontinuing clozapine

Quirk^b, 2016, UK [75]

Pilot study of process and impact of implementation of the Lester tool (cardiometabolic health resource) in 4 mental health trusts

Assess the extent to which the Lester tool may be transferable to other groups of patients.

Pharmacy team and pharmacist (not further specified).

Psychiatric inpatients/(mental health trust)

Mixed methods

Questionnaire based survey.

Focus group

Adult patients with schizophrenia, bipolar disorder or other psychotic disorders. Focus group with 5 service users

Questionnaire based survey:195 individuals

Focus group: 5 individuals

Implementation of electronic tool developed by pharmacy team: 52 patients baseline 29 at follow-up

Qualitative data asked service users various questions about their physical/cardiometabolic health

Questionnaire-based survey of inpatients

(1) Which health care professional(s) would you speak to if you thought your medication for your mental health was having a bad effect on your physical health? Of 533 only 3 (0.6%) stated pharmacist

(2) Where do you get information about how to be physically fit and healthy? Of 564 none stated a pharmacist

One hospital NHS trust were involved in a pilot study to implement the cardiometabolic screening tool:

(1) Pharmacy department within that hospital developed an electronic tool for collection of cardiometabolic health data. Data entry was completed by ward clerk Informants attributed the shift in the types of interventions offered (e.g. reduction in medication reviews, and increase in offers of advice regarding exercise and diet) to improved confidence amongst ward staff, meaning that they were more likely to offer to intervene themselves, rather than to refer service users to other professionals (doctors or pharmacists).

One trust had a Physical Health Strategy Group is the governance group for physical health care

Focus group activity with 5 service users

(1) To what extent did you feel you were given information about potential adverse physical effects of medication and were empowered to make a decision weighing up the risks and benefits? The mental health trust has a good pharmacy website—but it is not clear how many people are aware of this, and access this.

Shanker, 2016, UK [76]

New model of care—integrated care programme approach review involving both primary and secondary care team members.

Clinical pharmacist.

Primary care—GP surgery

Mixed methods

Prospective

Individuals on care program approach who have severe mental illness (schizoaffective disorder, schizophrenia, bipolar disorder, drug-induced psychosis). Numbers not given.

No specific outcomes regarding monitoring. Patient feedback about the whole service was positive (waiting time, involvement in decision making, management plan explained)

Bozymski, 2017, USA [87]

Completion of cardiometabolic interventions at a coordinated specialty care clinic through a retrospective chart review of enrolled clients.

Psychiatric pharmacist.

Community clinic

Quant

Retrospective: descriptive

163 in total - 90 subjects schizophrenia (55.2%), 45 with psychosis not otherwise specified (27.6%), 19 with schizophreniform disorder, (11.7%), and 9 with schizoaffective disorder (5.5%).

One-third of subjects reported tobacco use, and 47 subjects admitted to illicit drug use (primarily marijuana). Nearly one-fourth of subjects also met diagnostic criteria for dyslipidaemia or obesity at some point in the study, with lesser degrees of hypertension and diabetes mellitus; no subjects met criteria for a cardiometabolic abnormality according to baseline data.

As a result of the use of the tool the following interventions were made—referral to dietician or health program n = 29 (17.8%), start diabetes medication n = 13 (8.0%), adjust diabetes medication 2 (1.2%), start dyslipidaemia 1 (0.6%).

Dyslipidaemia and obesity were (later) found after use of clinical decision support tool found in 37 (22.7%) and 35 (21.5%) clients, respectively

Sud, 2017, UK [86]

Pharmacist led metabolic monitoring service for individuals with severe mental illness.

Senior Specialist Mental Health Clinical Pharmacist

Psychiatric inpatients. Community mental health team. Early intervention

Quant

Retrospective: quasi

Individuals with severe mental illness schizophrenia, bipolar disorder, schizoaffective disorder, drug induced psychosis and any other diagnosis.

Data for inpatient audits 252 patients per year for 3 years 2014-2017, early intervention audit 150 patients per year for 2 years 2016-2017, 900 community mental health patient.

Improvement in rate of screening and monitoring

Rate of screening alone in 2013 was 24% (average)

Rate of screening and related interventions (total) was 87% as measured 2015 inpatient only

In 2016 99% for inpatients and 95% for early intervention team

In 2017, 100% for inpatient, 97% for early intervention and 87% for community mental health team patients on care programme approach

Sasson, 2017, USA [94]

Psychopharmacology rounds in a nursing home will decrease overall rates antipsychotic use. This study also measured HbA1c done in past year and lipid panel within 2 years as a secondary outcome.

Clinical pharmacist

Nursing home

Quant

Prospective single centre: quasi

81 patients in total who were residents at the nursing home, of these 14 had a concomitant diagnosis of dementia and at least one of the following diagnoses: schizophrenia, bipolar, or depression; 31 had dementia and 36 had other diagnoses (not stated).

Metabolic laboratory monitoring improved from 58% (33/57) to 83% (45/54) (p = 0.003), however, not broken down for each diagnoses.

Practices and attitudes of Australian mental health practitioners towards assisting their clients to stop smoking and their beliefs about potential Tobacco Harm Reduction strategies for people with SMI.

Pharmacist (not further specified)

Public and private covering urban and non-urban settings.

Quant

Online, cross-sectional, national survey

267 mental health professionals: Medical practitioners 37 (13.85), Nurses 61 (22.84), Allied health practitioners (occupational therapist, psychologists, pharmacists and social workers) 66 (24.7), community mental health practitioners 74 (22.84), others (not defined) 29 (3.4).

77.5% asked their clients about smoking

66.7% provided health education

31.1–39.7% provided direct assistance

88.4% believed that tobacco harm reduction strategies are effective for reducing smoking related risks

77.9% believed abstinence from all nicotine should not be the only goal discussed with smokers with SMI

56.9% were unsure about the safety 39.3% efficacy of e-cigarettes.

Practitioners trained in smoking cessation were more likely to help their clients to stop smoking.

Community mental health practitioners and practitioners who were current smokers were less likely to adhere to the 5As (5As = ask, assess, advise, assist, arrange) of smoking cessation intervention.

The results of this study emphasise the importance and need for providing smoking cessation training to mental health practitioners especially community mental health practitioners.

Pena, 2018, USA [95]

Pharmacist run metabolic syndrome monitoring clinic

Clinical pharmacist

Mental health outpatient.

Quant

Pre and post study of metabolic parameter measurements: quasi

Survey of Mental health professionals

Referral rate to pharmacist clinic was 24 patients prior to intervention, and 33 patients post intervention. However, outcome data only reported for 17 (51.5%) of the 33 referred post intervention. No breakdown given as to how many have SMI – but authors report that at the facility 85.9% of patients with a diagnosis of schizophrenia had an active prescription for an antipsychotic.

9 mental health professionals completed the survey.

There was a 37.5% increase in overall referral rates to the clinic after intervention, but only 51.5% of patients attended appointments as scheduled.

Monitoring of vital signs increased, but monitoring of laboratory parameters decreased.

60% (9 of 15) of providers completed a survey, of which one third indicated they still forget to refer patients to the clinic

Health foundation, 2018, UK [80]

A collaborative project between primary care, community pharmacy and secondary care for physical health checks for those with psychotic illness and provide health coaching for these patients.

Community pharmacist (and mention of community pharmacy but not clear if members of staff other than the community pharmacist were involved or not)

Community pharmacy

Mixed methods

Results of health screening before and after intervention; patient activation measure (PAM) and health coaching compared to treatment as usual (TAU). Information regarding satisfaction with service collected from patients and care programme approach (CPA) coordinator. Community pharmacists feedback on service provision and benefit to patients

180 patients with psychotic illness were referred to undertake the research pathway/protocol.

10 community pharmacies

Number of care coordinators/community psychiatric nurses not stated

70% attended the community pharmacy. 71% of those that attended had all four screening parameters measured (BP, BMI, glucose, lipids) compared to 36% before the intervention was implemented.

100% of patients received health coaching for smoking, exercise and diet (22—stop smoking; 56—exercise; 78—weight loss or healthy eating).

PAM questionnaire: 1^st appointment 120 patients completed with average score of 52.72; 2nd appointment 41 patients completed with an average score 57.26 and at the 3rd appointment 15 patients completed with an average score of 58.46.

100% of CPA coordinators—data on satisfaction was unclear; 100% of patients agreed/strongly agreed with the time taken to get an appointment and support received.

Qualitative data from 4 community pharmacists—data presented could not be used.

Raynsford, 2018, UK [85]

Specialist mental health pharmacist and pharmacy technician on individuals with SMI in primary care (GP practices).

Specialist mental health pharmacist and mental health pharmacy technician.

GP surgery in primary care

Quant

Prospective

Primary care (GP) severe mental illness registers of 5 GP surgeries were reviewed by pharmacy technicians (total 472 patients). 316 (67%) of these patients were prescribed mood stabiliser or antipsychotics. Pharmacists received referral for 197 patients and undertook interventions for physical health issue (blood tests or electrocardiogram) in 22 of these.

Blood tests were overdue in 16 (73%) cases and out of range in 6 (27%).

Out of range and overdue bloods were followed up with the appropriate team.

Reasons for overdue include: failure to attend despite requests, patient being out of the country for a long period of time or query regarding whether tests were to be done in secondary or primary care.