A non-randomized, controlled, interventional study to investigate the effects of community pharmacists' cognitive behavioral therapy-based interventions on medication adherence and relevant indicators in patients with depression.

BACKGROUND: The prevalence of depression is increasing in Japan. Pharmacists play an important role in helping patients use medicines effectively. Several studies had investigated the impact of community pharmacists on patient adherence to antidepressant therapy, and their results indicated that further study was warranted. METHODS: This study was conducted from June 2019 to May 2020 using a cluster non-randomized, open-label, parallel-group design. Four community pharmacy stores in Osaka and Hyogo Prefectures, Japan, participated in the study, and enrolled patients with unipolar depression. In the intervention group (IG), patients received cognitive behavioral therapy (CBT)-based medication support, and their medication adherence and adverse drug reactions were monitored by telephone. In the control group (CG), the pharmacists engaged in routine interactions with the study participants. Before participating in this study, the intervention-group pharmacists attended a 5-hour training session on CBT-based medication support. The primary outcome of this study was medication adherence, assessed using the Drug Attitude Inventory (DAI)-10. Secondary outcomes included the changes from baseline at 6 months in the following variables: the Patient Health Questionnaire (PHQ)-9 total score, the EQ-5D-5 L (Euro-QOL 5 dimensions 5 levels) score, patient satisfaction, and the Pharmacists' Confidence Scale about Medication Consultation for Depressive Patients (PCMCD) score. RESULTS: Four pharmacies (two in IG and two in CG) completed the intervention period. Results were obtained from 19 patients in the IG and 12 patients in the CG. In the IG, the mean DAI-10 score increased from 4.941 at baseline to 6.105, the mean PHQ-9 score decreased from 9.263 to 8.625, and the mean patient satisfaction score increased from 39.947 to 42.211. In the CG, the mean DAI-10 score decreased from 6.333 to 4.167, the mean PHQ-9 score increased from 9.333 to 12.923, and the mean patient satisfaction score decreased from 38.929 to 38.167. CONCLUSION: CBT-based medication support provided by community pharmacists may improve patient medication adherence to antidepressant therapy and symptoms. Such support can be expected to facilitate better treatment of depressed patients and may also allow the duration of treatment to be shortened. TRIAL REGISTRATION: UMIN000037954, Date of first registration: 17/06/2019.

Validation of a Reorganized Training Program Using a Cognitive Behavioral Therapy Approach to Enable Community Pharmacists to Provide Empathic Patient Counseling.

To enable community pharmacists to provide empathic patient counseling, we developed and validated a training program based on the cognitive behavioral therapy approach (CBT-A) in our previous study. The major focus points of the re-structured training program were "inclusion of basic communication skills", "exemplifying correspondence involving CBT-A using pre-recorded video(VTR)", and "approach methods for cases where counter-evidence is unavailable". The training program lasted for 4 h per day, for a total of 8 h. We also performed role-play scenarios on information gathering and medication guidance for simulated patients before and after training, and evaluated patient satisfaction with counseling, patient counseling alliance scores, and the degrees of the psychological distance between patients and pharmacists. Participants had high satisfaction with the discussion and role-play aspects of the training, as in our previous study. Participants also showed high satisfaction with "exemplifying correspondence involving CBT-A using VTR". Counseling time was significantly longer when using CBT-A compared to ordinary information gathering and medication guidance, but patient satisfaction and patient counseling alliance scores were both higher, and the psychological distance between patient and pharmacist was lower. Accordingly, if patients cannot solve their own problems, even when pharmacists provide polite responses and expertise, patients can be guided in their problem solving using CBT-A. It suggested that using CBT-A could solve the problem of patients with anxiety due to problems that cannot be solved only via drug-centered approach.

Development and Validation of a Training Program Using a Cognitive Behavioral Therapy Approach with the Purpose of Enabling Community Pharmacists to Provide Empathic Patient Counseling.

To enable community pharmacists to provide empathic patient counseling, we developed and validated a training program based on cognitive reframing, which is one of the cognitive behavioral therapies. We divided 24 community pharmacists into two groups, providing training to the intervention group. The duration of the training program was two hours per session, with a total of eight hours. We conducted a survey of the intervention group to evaluate their training experience. In addition, we performed two role-play scenarios on patient counseling using simulated patients, evaluating the patient counseling alliance scores and the degrees of the psychological distance between the patients and pharmacists. The degree of satisfaction correlated with four training items, including "explanation by comics". When pharmacists felt that the cognitive behavioral therapy approach was successful, no significant differences were found in the patient counseling alliance grades. However, the psychological distance between the patients and pharmacists was smaller. We were able to infer that a cognitive behavioral therapy approach could decrease the psychological distance between patients and pharmacists, thereby enabling empathic patient counseling.