Implications From The Resolve Study For Pharmacy

• By: MAIDMENT, Ian (Aston University, United Kingdom)
• Co-author(s): Prof Ian Maidment (Aston University, Birmingham, United Kingdom)
  Ms Hafsah Habib (Aston University, Birmingham, United Kingdom)
  Professor Maura Macphee (UBC, Vancouver, Canada)
  Ms Emilia Piwowarczyk (UBC, Vancouver, Canada)
  Dr Jo Howe (Aston University, Birmingham, United Kingdom)
  Dr Geoff Wong (Oxford University, Oxford, United Kingdom)
  
• Abstract:

  Title: Implications from the RESOLVE study for pharmacy.
  
  Ian Maidment (Aston University on behalf of the RESOLVE Team)
  
  Introduction: One of the main treatment options for severe mental illnesses (SMIs), such as schizophrenia, are second-generation antipsychotics. It is well known that these medications are associated with significant weight gain, often leading to the development of or worsening of physical illnesses, such as cardiovascular disease and diabetes. Many pharmacological and non-pharmacological interventions have been tried to limit weight gain, but there is not a clear understanding of what works, by whom and in which circumstances.
  
  The NIHR-funded RESOLVE study (Reference: HSDR131871) is currently investigating non-pharmacological interventions for obesity management of antipsychotic-induced weight gain in service users (SU) with SMI living in the community. Pharmacy can play a key role in the management of harmful physical side effects associated with antipsychotics in SMI in the community. Here we report implications for pharmacy from RESOLVE.
  
  Purpose: A key aim of RESOLVE was to understand the role of different practitioners in evidence-based obesity management for this complex population.
  
  Method: RESOLVE has used realist methodology that combines secondary data from the literature with stakeholder interviews. Using realist approaches, a program theory of comprehensive obesity management for SUs with SMI was developed, accompanied by a series of causal explanations or testable hypotheses of what works for this population, under what circumstances, including mode of delivery by whom. Secondary data from the literature was validated with interviews that included 11 Service Users, 29 Healthcare Professionals and 6 Family Carers.
  
  Results: A key finding from the literature was the limited role, in general, that community-based pharmacists currently play in obesity management for SUs with SMI. The key multi-pronged interventions cited in the literature are nutrition counselling, exercise and behaviour therapy. Although several literature sources described the importance of ongoing physical health tracking, monitoring and management, these roles were often ascribed to general practitioners and nurses. The practitioner group in the RESOLVE study identified the potential for the more active involvement of community-based pharmacy teams; to lessen the burden on other practitioners, and to develop more accessible, community-based, professional contacts for SUs who need regular, ongoing physical health monitoring, physical health information updates and reinforcement.
  
  Physical health support must be tailored to individual SUs’ specific needs and challenges. Pharmacists are often in a position to forge therapeutic relationships with SUs, resulting in collaborative treatment planning that pharmacists can coordinate with other practitioners, including primary and secondary care services. Community pharmacy, in particular, can play a key-signposting role.
  
  Conclusion: This review highlights the potential role that pharmacy, especially community pharmacy, could play in obesity management for community-dwelling SUs with SMI. RESOLVE plans to produce guidance for practitioners, including pharmacists, on the most appropriate ways to limit and manage antipsychotic-induced weight gain in this population.