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An initiative to help pharmacists better connect with patients with mental health and addictions issues has taken root in Nova Scotia.

By donalee Moulton

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Launched as a pilot project in 2014, the Bloom Program – the first of its kind in the world – has now received ongoing support from the provincial government, and will continue to grow.

The success of the initiative is founded on partnership. In projects that came before Bloom, including More Than Meds, “we were connecting community pharmacists with people who had lived experience of mental illness. They trained together for one day, then went back to their community to train other pharmacists who then supported their community in a variety of ways,” says Dr. David Gardner, a pharmacist and co-lead of the Bloom Program.

The impact of More Than Meds was timely and aligned well with the province’s Mental Health & Addictions strategy report, which, ultimately, led to provincial funding of the patient-centred, innovative Bloom Program demonstration project. “Fast-forward three years, we have now completed the project, and it has received outspoken praise and ongoing support from the Minister of Health,” says Gardner.

To enroll in Bloom, patients have a self-disclosed diagnosis of a mental illness with or without a concurrent addictions problem along with one or more medication therapy issues. Once enrolled and following an in-depth assessment by the pharmacist, patients receive longitudinal medication therapy management. As for other persisting and chronic conditions, pharmacists in the Bloom program provide support and guidance to patients to encourage their access and use of other resources (e.g., primary care, specialized care, support organizations). An important part of getting ready to offer the Bloom Program is the requirement of pharmacists to identify and make connections with local mental health and addictions providers and support organizations.

Participating pharmacists said that this was initially challenging, very rewarding, and ultimately critical to their care of patients in the program. Familiar with local resources, programs, and organizations, pharmacists are able to offer referrals, support navigation, and on a few occasions when needed facilitate patient triage. Patient care meetings are a mix of regularly scheduled and on-demand depending on what suits the circumstances and are provided through face-to-face or telephone interactions on weekdays, evenings, and weekends. A core component of the program is collaboration – the program aims to improve communications among members of the patient’s circle of care.

“The intent is that people don’t live with unidentified, unresolved issues,” says Gardner, a professor of psychiatry and pharmacy at Dalhousie University.

Pharmacies involved in the Bloom Program, which are paid by the province to provide the service, support their communities by providing a mental health and addictions resource centre highlighting local supports and services. As well, pharmacies work with their local mental health and addictions communities to provide outreach support and education.

“The approach provides structure and support and encourages the setting of priorities in addressing medication and related health issues collaboratively among patients, pharmacists, and other members of the patient’s circle of care. In doing so, pharmacists and patients share expectations of one another and work together over weeks and months in a way that can be quite different from usual practice,” notes Gardner.

And it works. In the 27 months the demonstration project ran, 70 pharmacists and their pharmacy staff in 13 rural and 10 urban community pharmacies across Nova Scotia enrolled 221 Nova Scotians living with mental illness and addictions. According to an evaluation of the program released last year, four in five medication issues were fully resolved or improved. “Patients increased their medication and health knowledge and accessed and utilized pharmacists effectively,” says Dr. Andrea Murphy, program co-lead and an associate professor in the College of Pharmacy at Dalhousie.
They also got an important helping hand to access healthcare and other services. Almost three of every four patients surveyed reported being more aware of community resources, and 47 per cent were able to access them faster than previously.

Pharmacists also benefit significantly from the program. “A lot of community pharmacists can work in isolation,” notes Murphy. “Having the Bloom Program starts to build a community of practice. That has been really important to pharmacists.”

The success of the Bloom Program has not gone unnoticed. Federal Health Minister Jane Philpott recently travelled across Canada to learn more about innovations in mental health. The Bloom Program was on her list of must-see initiatives.

The project, which requires pharmacies to complete a nine-step application process, also points to the enhanced role pharmacists can play in the health system, says Nova Scotia Health Minister Leo Glavine. “The local pharmacy – what an ideal place to have engagement in support of those with mental health issues. It is another service well suited to re-visioning the purpose of the community pharmacy.”