Randomized Trial of Pharmacist Interventions to Improve
Randomized Trial of Pharmacist Interventions to Improve
Purpose: The impact of pharmacist interventions on the care and outcomes of patients with depression in a primary care setting was evaluated.
Methods: Patients diagnosed with a new episode of depression and started on antidepressant medications were randomized to enhanced care (EC) or usual care (UC) for one year. EC consisted of a pharmacist collaborating with primary care providers to facilitate patient education, the initiation and adjustment of antidepressant dosages, the monitoring of patient adherence to the regimen, the management of adverse reactions, and the prevention of relapse. The patients in the UC group served as controls. Outcomes were measured by the Hopkins Symptom Checklist, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria for major depression, health-related quality of life, medication adherence, patient satisfaction, and use of depression-related health care services. An intent-to-treat analysis was used.
Results: Seventy-four patients were randomized to EC or UC. At baseline, the EC group included more patients diagnosed with major depression than did the UC group (p = 0.04). All analyses were adjusted for this difference. In both groups, mean scores significantly improved from baseline for symptoms of depression and quality of life at three months and were maintained for one year. There were no statistically significant differences between treatment groups in depression symptoms, quality of life, medication adherence, provider visits, or patient satisfaction.
Conclusion: Frequent telephone contacts and interventions by pharmacists and UC in a primary care setting resulted in similar rates of adherence to antidepressant regimens and improvements in the outcomes of depression at one year.
More than half of all patients with depression receive their care exclusively from primary care providers (PCPs). The pharmacologic management of depression in primary care has been reported as inadequate with suboptimal clinical outcomes. Depression is frequently treated for an inadequate length of time or with insufficient antidepressant dosages. Patients often discontinue medication because of adverse effects, lack of benefit, or cost. Interventions to improve the quality of care and use of medication have been favorable with the utilization of various nonphysician providers in collaborative care delivery models.
The pharmacist's role in the management of depression is evolving. In other chronic diseases, such as hypertension, hyperlipidemia, diabetes, and asthma, pharmacists have had a positive impact on the quality of patient care and outcomes of the disease. In mental health, pharmacists have the potential to improve the quality of care and outcomes by enhancing compliance, adjustment of medications, and monitoring and managing adverse effects. Pharmacists can also facilitate the use of patient assistance programs if cost is a barrier to treatment.
The purpose of this study was to evaluate the impact of an additional pharmacist's interventions in collaborative care to improve the care of and outcomes for patients with depression at a large university family practice clinic. The goal of this study was to test the effectiveness of pharmacist-delivered multifaceted interventions in collaboration with PCPs and a staff psychiatrist (enhanced care [EC]) versus usual care (UC) in improving quality of care and outcomes to patients diagnosed with a new episode of depression.
Purpose: The impact of pharmacist interventions on the care and outcomes of patients with depression in a primary care setting was evaluated.
Methods: Patients diagnosed with a new episode of depression and started on antidepressant medications were randomized to enhanced care (EC) or usual care (UC) for one year. EC consisted of a pharmacist collaborating with primary care providers to facilitate patient education, the initiation and adjustment of antidepressant dosages, the monitoring of patient adherence to the regimen, the management of adverse reactions, and the prevention of relapse. The patients in the UC group served as controls. Outcomes were measured by the Hopkins Symptom Checklist, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria for major depression, health-related quality of life, medication adherence, patient satisfaction, and use of depression-related health care services. An intent-to-treat analysis was used.
Results: Seventy-four patients were randomized to EC or UC. At baseline, the EC group included more patients diagnosed with major depression than did the UC group (p = 0.04). All analyses were adjusted for this difference. In both groups, mean scores significantly improved from baseline for symptoms of depression and quality of life at three months and were maintained for one year. There were no statistically significant differences between treatment groups in depression symptoms, quality of life, medication adherence, provider visits, or patient satisfaction.
Conclusion: Frequent telephone contacts and interventions by pharmacists and UC in a primary care setting resulted in similar rates of adherence to antidepressant regimens and improvements in the outcomes of depression at one year.
More than half of all patients with depression receive their care exclusively from primary care providers (PCPs). The pharmacologic management of depression in primary care has been reported as inadequate with suboptimal clinical outcomes. Depression is frequently treated for an inadequate length of time or with insufficient antidepressant dosages. Patients often discontinue medication because of adverse effects, lack of benefit, or cost. Interventions to improve the quality of care and use of medication have been favorable with the utilization of various nonphysician providers in collaborative care delivery models.
The pharmacist's role in the management of depression is evolving. In other chronic diseases, such as hypertension, hyperlipidemia, diabetes, and asthma, pharmacists have had a positive impact on the quality of patient care and outcomes of the disease. In mental health, pharmacists have the potential to improve the quality of care and outcomes by enhancing compliance, adjustment of medications, and monitoring and managing adverse effects. Pharmacists can also facilitate the use of patient assistance programs if cost is a barrier to treatment.
The purpose of this study was to evaluate the impact of an additional pharmacist's interventions in collaborative care to improve the care of and outcomes for patients with depression at a large university family practice clinic. The goal of this study was to test the effectiveness of pharmacist-delivered multifaceted interventions in collaboration with PCPs and a staff psychiatrist (enhanced care [EC]) versus usual care (UC) in improving quality of care and outcomes to patients diagnosed with a new episode of depression.