The impact of a pharmacist intervention on 6-month outcomes in depressed primary care patients

Adler, David A; Bungay, Kathleen M; Wilson, Ira B; Pei, Yu; Supran, Stacey; Peckham, Emily; Cynn, Diane J; Rogers, William H

doi:10.1016/j.genhosppsych.2003.08.005

« Previous Next »General Hospital Psychiatry
Volume 26, Issue 3 , Pages 199-209, May 2004

The impact of a pharmacist intervention on 6-month outcomes in depressed primary care patients☆

David A Adler, M.D.
- Department of Medicine, The Health Institute, Division of Clinical Care Research, (T-NEMC), Boston, MA, USA
- Tufts University School of Medicine, Boston, MA, USA
- Department of Psychiatry, Tufts-New England Medical Center (T-NEMC), Boston, MA, USA
- Corresponding author. Tel.: +1-617-636-8755; fax: +1-617-636-8351.
Kathleen M Bungay, Pharm.D.
- Department of Medicine, The Health Institute, Division of Clinical Care Research, (T-NEMC), Boston, MA, USA
- Tufts University School of Medicine, Boston, MA, USA
Ira B Wilson, M.D., M.Sc.
- Department of Medicine, The Health Institute, Division of Clinical Care Research, (T-NEMC), Boston, MA, USA
- Tufts University School of Medicine, Boston, MA, USA
Yu Pei, M.P.A.
- Department of Medicine, The Health Institute, Division of Clinical Care Research, (T-NEMC), Boston, MA, USA
Stacey Supran, M.Sc.
- Department of Medicine, The Health Institute, Division of Clinical Care Research, (T-NEMC), Boston, MA, USA
Emily Peckham, B.S.
- Department of Medicine, The Health Institute, Division of Clinical Care Research, (T-NEMC), Boston, MA, USA
Diane J Cynn, B.A.
- Department of Medicine, The Health Institute, Division of Clinical Care Research, (T-NEMC), Boston, MA, USA
William H Rogers, Ph.D.
- Department of Medicine, The Health Institute, Division of Clinical Care Research, (T-NEMC), Boston, MA, USA

Received 31 January 2003; accepted 12 August 2003.

Abstract

The object of the study was to evaluate outcomes of a randomized clinical trial (RCT) of a pharmacist intervention for depressed patients in primary care (PC). We report antidepressant (AD) use and depression severity outcomes at 6-months. The RCT was conducted between 1998 and 2000 in 9 eastern Massachusetts PC practices. We studied 533 patients with major depression and/or dysthymia as determined by a screening test done at the time of a routine PC office visit. The majority of participants had recurrent depressive episodes (63.5% with ≥4 lifetime episodes), and 49.5% were taking AD medications at enrollment. Consultation in person and by telephone was performed by a clinical pharmacist who assisted the primary care practitioner (PCP) and patient in medication choice, dose, and regimen, in accordance with AHCPR depression guidelines. Six-month AD use rates for intervention patients exceeded controls (57.5% vs. 46.2%, P = .03). Furthermore, the intervention was effective in improving AD use rates for patients not on ADs at enrollment (32.3% vs. 10.9%, P = .001). The pharmacist intervention proved equally effective in subgroups traditionally considered difficult to treat: those with chronic depression and dysthymia. Patients taking ADs had better modified Beck Depression Inventory (mBDI) outcomes than patients not taking ADs, (−6.3 points change, vs. −2.8, P = .01) but the outcome differences between intervention and control patients were not statistically significant (17.7 BDI points vs. 19.4 BDI points, P = .16). Pharmacists significantly improved rates of AD use in PC patients, especially for those not on ADs at enrollment, but outcome differences were too small to be statistically significant. Difficult-to-treat subgroups may benefit from pharmacists' care.

Keywords: Depression, Primary care, Clinical pharmacist, Antidepressant medication, Outcomes