Responding to people in danger: a community pharmacy response service for domestic abuse and suicidal ideation, a development and feasibility study.

Abstract

Background: Domestic abuse and suicidal ideation are highly prevalent and often co-occur. These issues are distressing and put people in danger from themselves or others. Numerous practical and psycho-social barriers inhibit help-seeking. Community pharmacies are accessible healthcare environments that deliver various public health functions. However, no studies have yet developed and tested a robust intervention for responding to domestic abuse and suicidal ideation in community pharmacy.

Objectives: To co-develop a domestic abuse and suicidal ideation response service in community pharmacy; and to test whether the co-developed intervention and a future trial to evaluate it would be feasible and acceptable in community pharmacies.

Design and methods: Service scope and resources were co-developed with 36 people (lay and professional) who participated in focus groups, interviews and/or workshops. A randomised feasibility trial tested the deliverability and feasibility of consenting clients and collecting study data, including data for a future economic evaluation. A nested process evaluation, comprising staff focus groups, customer interviews and a wider public survey, assessed the fidelity, acceptability and accessibility. A final feasibility workshop reviewed all feasibility objectives.

Setting, participants and interventions: The service was tested for 6 months in eight intervention pharmacies in Lincolnshire. Four more pharmacies acted as controls, providing usual care. In intervention pharmacies, trained staff provided triage assessment and structured signposting to those identified at risk of domestic abuse and/or suicidal ideation.

Main outcome measures: Data were collected on the number and type of relevant patient contacts from intervention and control pharmacies. Staff training was evaluated using the Continuing Professional Development-Reaction questionnaire, with before-and-after data analysed via paired t-tests. Feasibility objectives were assessed in a multistakeholder workshop. Qualitative process evaluation data were thematically analysed.

Results: Co-development participants considered community pharmacies to be an ideal service setting. Their recommendations for safety, equity, empowerment and discretion were incorporated into service design. Following training, staff showed statistically significant improvements in their perceived ability and confidence in responding to people in need of help for suicidal ideation and/or domestic abuse. The public and pharmacy customers showed positive support and acceptability. During the intervention period, 24 patients needing support were identified in the intervention pharmacies compared to two in the control pharmacies. Stakeholder workshop findings confirmed community pharmacy as an appropriate setting for a staff-initiated intervention and the dual focus on domestic abuse and suicidal ideation. The findings do not support a client-initiated service at this stage due to challenges related to marketing and ensuring sufficient staffing capacity to deliver a safe, high-quality service.

Limitations: Limited participant diversity and significant gaps in data collection from clients due to complexities of gaining consent in a pharmacy setting for this type of intervention.

Conclusions: A co-developed, staff-initiated response service for suicidal ideation and/or domestic abuse in community pharmacy was found to be feasible to deliver and acceptable to patients and staff.

Future work: An implementation study to scale-up service roll-out, evaluate it in diverse settings and streamline operational processes across more organisations is required. Further work is needed to determine how to collect outcome and cost-effectiveness data from people receiving a rapid intervention and/or in distress.

Funding details: This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme as award number NIHR133132.