Implementation of depression management by ambulatory care pharmacists in the primary care setting.

BACKGROUND: In the United States, depression is one of the most common mental health disorders. Ambulatory care pharmacists play a critical role in assisting with medication and dosage selection, identifying and managing drug interactions and adverse effects, and increasing medication adherence. Existing data on depression management by ambulatory care pharmacists trained in primary care is limited and outdated. OBJECTIVES: This study provides insight into current practices for depression management by primary care pharmacy specialists within an academic health center and how pharmacist interventions may impact functional outcomes of depression. METHODS: This single-center, retrospective study analyzed 27 patients with a primary care physician within the health system who were seen by an ambulatory care pharmacist for depression. Subjects were excluded if they were under 18 years old, pregnant, or had a diagnosis of bipolar disorder, schizophrenia, schizoaffective disorder, or dementia. The primary outcome was characterization of pharmacist interventions for treatment of depression. Secondary outcomes included change in depressive symptoms, as measured by the patient health questionnaire (PHQ), characterization of adverse effects correlated with medications for depression, and utilization of pharmacogenomics testing and results. RESULTS: Of 27 patients seen by a pharmacist for depression management, 38 total interventions were made, with an average of 1.77 interventions per patient. The most common intervention was new medication initiation (32%). Average PHQ-9 scores dropped from 14.9 to 7.3 twelve weeks following the initial pharmacist visit. Only 6 patients reported adverse effects to a current antidepressant during their visit with the pharmacist, and only 2 of these cases warranted a change in therapy. Ten patients obtained pharmacogenomic testing with pharmacist facilitation. CONCLUSION: Pharmacists in the primary care setting are positioned to be an additional resource for depression management and can offer a wide variety of interventions to improve patient health.

Impact of pharmacist intervention to improve medication access for patients with diabetes.

BACKGROUND: Despite newer guideline-recommended antidiabetic agents demonstrating a reduction of disease burden and improved health outcomes, high drug cost and restrictive insurance coverage limit public access. To address this issue, many manufacturers offer free medication through manufacturer patient assistance programs. OBJECTIVES: This study aimed to determine the impact of pharmacist intervention using manufacturer patient assistance programs in individuals who are uninsured or enrolled in Medicare Part D prescription drug plan and to evaluate the impact of pharmacist utilization in meeting diabetic quality measures set forth by accountable care organizations (ACOs). METHODS: This single-center, retrospective cohort study evaluated 171 participants enrolled into a manufacturer patient assistance program owing to pharmacist intervention compared with 171 participants receiving usual care. The primary outcome was the change in glycosylated hemoglobin (A1c) between groups. Secondary outcomes included the impact of pharmacist management on change in weight, change in blood pressure, and the number of participants meeting ACO quality measures. RESULTS: The average change in A1c in the intervention group was -2.5% compared with an average A1c reduction of -1.3% in the control group (95% CI -2.11 to -1.67, P < 0.001). The average change in weight of the intervention group was -4.01 kg, whereas the control group had an average weight reduction of -1.4 kg from baseline (95% CI -3.95 to -1.61, P < 0.05). The body mass index (BMI) of the intervention group was a value of 1.4 kg/m2 lower whereas the BMI of the control group was 0.6 kg/m2 lower than at baseline (95% CI -1.38 to -0.61, P < 0.05). CONCLUSION: Participants who were enrolled in a manufacturer patient assistance program by a pharmacist and were followed for diabetes care management experienced greater A1c lowering and weight loss than participants receiving usual care.