Pharmacy and behavioral health: How can we collaborate in primary care?

Developing working knowledge of integrated care models can guide pharmacists in operationalizing comprehensive medication management (CMM) alongside behavioral health services for holistic primary care integration. Over the last decade forces from both within and outside the pharmacy profession have culminated in trends toward an oversupply of pharmacists in the United States. In response, advocates of the profession have called for the materialization of long-awaited advancements in innovative, team-based, medication management roles. Although pharmacists are uniquely qualified to provide CMM services, the widespread integration to primary care teams has lagged behind that of other professions, such as behavioral health. Through the application of evidence-based integrated care models, behavioral health clinicians have become regular and routine contributors to primary care teams. To thrive in primary care roles, pharmacists must be able to navigate established teams practicing within existing integrated care models. Understanding how primary care physicians interact with other specialties, such as behavioral health, and the implications this has for pharmacy will play a role in meaningful adaptation of CMM services.

Gastric bypass surgery is associated with reduced inflammation and less depression: a preliminary investigation.

BACKGROUND: Prior studies have documented elevated symptoms of depression among patients undergoing gastric bypass surgery, in addition to significant elevations of inflammatory markers including C-reactive protein (CRP) and interleukin-6 (IL-6). No prior study has examined the relationship of changes in depression with change in inflammation among patients undergoing gastric bypass surgery. This pilot study was designed to examine the relationship of inflammation and depression among gastric bypass patients in a 12-month longitudinal study. METHODS: 13 Caucasian women (mean age 46.9 +/- 5.7 years) who were scheduled to undergo a Roux-en-Y gastric bypass (RYGBP) were recruited prior to surgery for measurement of body mass and blood markers of inflammation, as well as self-report measures of depression, quality of life, and disordered eating. 12 months later, subjects completed the same battery of physiological and psychological measures. Data were analyzed with paired t-tests and Pearson correlations. RESULTS: In addition to significant reductions in BMI (P < .001), participants experienced significant reductions in CRP (P < .001), IL-6 (P = .002), and depressive symptoms (P = .025). Reductions also were observed in binge eating (P = .005). Decreased depression during the 12-month follow-up was highly correlated with reduced CRP (r = .98, P < .001). CONCLUSIONS: Results from this pilot study indicate that RYGBP is associated with significant reductions in inflammatory markers of cardiovascular disease risk (e.g., CRP, IL-6) and depressive symptoms, in addition to reductions in weight. Results suggested that reductions in depression were associated with the observed decreases in inflammation.

Effects of a brief coping skills training intervention on nociceptive flexion reflex threshold in patients having osteoarthritic knee pain: a preliminary laboratory study of sex differences.

Studies have documented the efficacy of coping skills training (CST) for managing pain, distress, and disability in persons with arthritis. However, no laboratory studies have examined the effects of CST on descending modulation of nociception. This study used the nociceptive flexion reflex (NFR) to document pain and nociceptive responding among 62 men and women with osteoarthritis of the knee (mean age=63.3+/-7.5 years). Before and after a 45-minute CST session, participants completed laboratory assessments of NFR threshold and questionnaires evaluating pain and state anxiety. Results indicated significantly increased NFR thresholds and decreased pain ratings following CST for men and women. A significant time by sex interaction was observed for state anxiety, with women reporting greater decreases in anxiety following CST than men. This is the first study to demonstrate effects of a CST protocol on a measure of descending inhibition of nociception among patients with osteoarthritic knee pain.