The impact of a pharmacist intervention on 6-month outcomes in depressed primary care patients.
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.
Adler
David A
DA
Department of Medicine, The Health Institute, Division of Clinical Care Research, (T-NEMC), Boston, MA, USA. dadler@tufts-nemc.org
Bungay
Kathleen M
KM
Wilson
Ira B
IB
Pei
Yu
Y
Supran
Stacey
S
Peckham
Emily
E
Cynn
Diane J
DJ
Rogers
William H
WH
D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use*; D001900:Boston; D003376:Counseling; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000188:drug therapy*; D003955:Diagnostic Tests, Routine; D019263:Dysthymic Disorder / Q000175:diagnosis / Q000188:drug therapy*; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010348:Patient Care Team; D010349:Patient Compliance / Q000706:statistics & numerical data*; D010595:Pharmacists; D011320:Primary Health Care / Q000379:methods*; D011569:Psychiatric Status Rating Scales; D012017:Referral and Consultation; D012720:Severity of Illness Index
D000928:Antidepressive Agents