WASHINGTON -- Physicians who are grappling with their depressed patients' nonadherence to medications can get a helping hand from an unexpected source: pharmacists.
A program in which a pharmacist intervention was added to standard primary care treatment for depression showed that these specialists were uniquely able to address "the remarkably broad and continuing needs" of depressed patients, who so often are unable to care well for themselves. Preliminary data from a clinical trial of the intervention were presented at an international conference sponsored by the National Institute of Mental Health.
"We really want to get this information out to primary care providers. Clinical pharmacists can intervene with these patients to ensure they are making safe, efficacious, and adequate use of antidepressants," Kathleen Bungay, Pharm.D., said in an interview at the conference.
The study involved five pharmacists who proactively worked with 258 depressed patients being treated by internists at nine sites in the Boston area. The patients were predominantly white women and had a mean age of 43 years; most were employed full time. They were diagnosed as having a major depressive episode (41%) dtysthymia (24%), or both (35%).
The pharmacists attempted to contact the patients nine times, at 2-week intervals for the first few months and at 3-month intervals thereafter, for the duration of the 18-month intervention. Interim results were available for the first 6 months of the trial, so the full effect of the intervention on actual medication use hasn't yet been analyzed, said Dr. Bungay of Tufts-New England Medical Center, Boston.
At the first contact, the pharmacists conducted a detailed medical and medication history assessed whether the current medication regimen was optimal, and evaluated the patient's willingness to accept depression treatment.
Guided by the patient's needs, the pharmacists then used in-person, telephone, or e-mail contact to offer general support in navigating the health care system, motivation to start or continue antidepressant therapy, patient education specific to depression, and support concerning other medications or health conditions. They also kept the primary care physicians informed of the patients' progress.
The pharmacists identified 28 actions they performed to meet the needs of these patients, whose disorder often impaired their ability to access help, perform self-care, and sometimes even to summon the energy for personal interactions. …