Patient and prescriber perceptions of depression screening within a community pharmacy setting

Patient Perspectives on Portal-Based Anxiety and Depression Screening in HIV Care: A Qualitative Study Using the Consolidated Framework for Implementation Research

Electronic patient portals represent a promising means of integrating mental health assessments into HIV care where anxiety and depression are highly prevalent. Patient attitudes toward portal-based mental health screening within HIV clinics have not been well described. The aim of this formative qualitative study is to characterize the patient-perceived facilitators and barriers to portal-based anxiety and depression screening within HIV care in order to inform implementation strategies for mental health screening. Twelve adult HIV clinic patients participated in semi-structured interviews that were audio recorded and transcribed. The transcripts were coded using constructs from the Consolidated Framework for Implementation Research and analyzed thematically to identify the barriers to and facilitators of portal-based anxiety and depression screening. Facilitators included an absence of alternative screening methods, an approachable design, perceived adaptability, high compatibility with HIV care, the potential for linkage to treatment, an increased self-awareness of mental health conditions, the ability to bundle screening with clinic visits, and communicating an action plan for results. The barriers included difficulty navigating the patient portal system, a lack of technical support, stigmatization from the healthcare system, care team response times, and the novelty of using patient portals for communication. The patients in the HIV clinic viewed the use of a portal-based anxiety and depression screening tool as highly compatible with routine HIV care. Technical difficulties, follow-up concerns, and a fear of stigmatization were commonly perceived as barriers to portal use. The results of this study can be used to inform implementation strategies when designing or incorporating portal-based mental health screening into other HIV care settings.

Pregnancy-related risk factors and receipt of postpartum care among Texas Medicaid pregnant enrollees: Opportunities for pharmacist services

BACKGROUND

The United States (US) experiences the highest rate of maternal mortality of similar countries. Postpartum care (PPC) focused on chronic disease management is potentially lifesaving, especially among pregnancies complicated by risk factors such as diabetes, hypertension, and mental health conditions (MHCs), which are conditions in which pharmacists can have an impact.

OBJECTIVE

To evaluate the prevalence of maternal mortality risk factors and their relationships with receipt of PPC among Texas Medicaid enrollees.

METHODS

A retrospective study included women with a delivery between 3/25/2014-11/1/2019 who were continuously enrolled in Texas Medicaid during the study period from 84 days pre-delivery to 60 days post-delivery. PPC was defined as ≥1 visit associated with postpartum follow-up services. Maternal mortality risk factors (diabetes, hypertension, and MHCs) during and after pregnancy were identified using diagnoses and medication utilization. Age, race/ethnicity, cesarean delivery, and preterm birth served as covariates. Multivariable logistic regression was used to address the study objective.

RESULTS

The sample (N = 617,010) was 26.5±5.7 years, primarily (52.8%) Hispanic, and 33.0% had cesarean deliveries and 9.3% had preterm births. Risk factor prevalence included: diabetes (14.0%), hypertension (14.3%), and MHCs during (6.3%) and after (9.1%) pregnancy. A majority (77.9%) had a PPC visit within 60 days of delivery. The odds of receiving PPC were 1.2 times higher for patients with diabetes (OR = 1.183; 95% CI = 1.161-1.206; P < 0.0001), 1.1 times higher for patients with hypertension (OR = 1.109; 95% CI= 1.089-1.130; P < 0.0001), and 1.1 times higher for patients with MHCs (OR=1.138; 95% CI = 1.108-1.170; P < 0.0001) than patients without, respectively.

CONCLUSION

Over three-quarters of Texas Medicaid pregnant enrollees received PPC within 60 days of delivery and risk factors were prevalent and predictive of receipt of PPC. Pharmacists can have a positive impact on maternal health by addressing hypertension, diabetes, and MHC risk factors.

Global Advancement in Pharmacy Services for Mental Health: A Review for Evidence-Based Practices

The symptoms of psychiatric infirmities have variability, and selected drug regimens for mental illness are comparatively complex and individualized; therefore, pharmacy services vary with respect to patients, diseases, healthcare settings, community structures, and countries. Clinical pharmacy services for mental health (MH) are continuously being upgraded. A structured search of the literature was performed in the Cochrane, PubMed (Medline), PsycINFO, Google scholar, Scopus, Science Direct, and Springer Links databases. The title and abstract of each retrieved article were evaluated for relevance. To remove uncertainty and ambiguity, the full-text articles were retrieved and examined for relevance. The articles were further assessed on the basis of inclusion and exclusion criteria. Narrative synthesis was performed, creating new categories and relevant subcategories and further subsections. The articles and the results were assessed for quality and bias. Pharmacists have a range of expertise in psychiatric care. The services can be classified as conventional, extended, and advanced pharmacy services. Conventional services include the quality use of medicines in healthcare settings and medication support services in communities that ensure medication adherence. Pharmacists perform extended roles in collaborative medication therapy management, multidisciplinary community mental health teams, collaborative care, patient education, home medication review, hospital-to-home transit, and screening services. In the USA, the role of pharmacists was advanced by prescribing as collaborative and interim prescribers. Australia launched an accredited program for psychiatric first-aid pharmacists. Pharmacists can provide mental care to rural populations using health technology. The role of pharmacists in MH is appreciated either independently or as a team member. Patients and healthcare providers rank the services of pharmacists in MH highly. Still, there is a margin for improvement in the training of pharmacists. Pharmacists cannot provide sufficient time to their patients. Public awareness about the role of pharmacists in MH needs more attention. Moreover, the training of psychiatric pharmacists should be standardized around the world.

Patients' opinions on participation in patient-centered outcomes research in community pharmacies: A qualitative study

BACKGROUND

Patient-centered outcomes research (PCOR) often brings patient voices, thoughts, and opinions into the research process, allowing patients to have a say in the research process from project inception to dissemination of results. Community pharmacy teams are well-situated to engage patients in their own health and in research, given their trusting relationships with patients and access in communities.

OBJECTIVE

To gather patients' opinions on participation in PCOR at their local community pharmacy.

METHODS

Four regional focus groups representing western, central, northeastern, and southeastern Pennsylvania were conducted. A single community pharmacy in each region recruited patients to participate in each focus group. A focus group discussion guide was developed and reviewed by a Stakeholder Advisory Board that consisted patients, pharmacists, and researchers. Questions focused on patients' relationships with their pharmacy and pharmacist, perceptions of research occurring at their local pharmacy, and patient engagement methods. Focus group sessions were audio-recorded, transcribed verbatim, and independently coded by 2 investigators. Coding discrepancies were reconciled through discussion, and a qualitative inductive thematic analysis was conducted by the research team.

RESULTS

A total of 44 patients participated in one of 4 focus groups. Patients provided insights into what would make them more likely to participate in PCOR at their local community pharmacy. Four themes emerged from the discussions: (1) Understanding the impact to one's health or community affects participation; (2) Patients prefer to schedule research activities at times outside of prescription pick-up or drop-off; (3) Trusted relationships can be leveraged for recruitment; and (4) Face-to-face engagement is preferred for participant recruitment.

CONCLUSION

Patients want to engage in research in a way that is respectful of their time and matters to them. Strong patient-pharmacist relationships are essential for patient engagement in and acceptance of PCOR opportunities in community pharmacies. Community pharmacies may be rich locations to engage patients in PCOR.

Strategies for implementing the Appointment-Based Model at a rural independent chain of community pharmacies

BACKGROUND

The Appointment-Based Model (ABM) is a care model that helps community pharmacists streamline their medication dispensing workflow while simultaneously integrating patient care into the medication preparation process through medication synchronization. Implementation of the ABM has varied across community pharmacies. Further studies that identify tailored implementation approaches are needed to support broad adoption of the ABM in practice.

OBJECTIVES

(1) To determine facilitators and barriers to ongoing adoption and implementation of the ABM at a small chain of rural independent pharmacies where adoption has stalled and (2) to identify implementation strategies to support further adoption of the ABM at these pharmacies METHODS: This project was an exploratory, mid-implementation study. Semistructured interviews were conducted with pharmacy staff who participated in the ongoing implementation and use of the ABM at the pharmacies. Interviews elicited stakeholder-centered perspectives on (1) experiences with the ABM to date, (2) processes and roles for the ABM, and (3) opinions on how implementation of the ABM could be improved at the pharmacies. Rapid qualitative assessment methodology was used for analysis to identify facilitators and barriers and to select implementation strategies.

RESULTS

Thirty-one pharmacy personnel were interviewed: pharmacists (n = 10), pharmacy technicians (n = 7), and fill clerks (n = 14). The research team identified 6 facilitators and 4 barriers to the implementation of the ABM at the pharmacies. Five implementation strategies were selected based on the facilitators and barriers: (1) capture and share local knowledge across pharmacy sites, (2) conduct educational outreach visits, (3) conduct ongoing training, (4) prepare patients to be active participants in the ABM, and (5) organize clinician implementation team meetings.

CONCLUSIONS

Development of a stakeholder-driven implementation approach may support further implementation and adoption of the ABM in practice.

Implementation of a depression screening as part of a holistic adherence assessment in a large community pharmacy chain

BACKGROUND

Medication nonadherence is associated with increased morbidity and mortality, higher rates of hospital admissions, and increased health care costs. Nearly half of patients do not take their medications as prescribed leading to poor outcomes. Patients with chronic conditions, especially those with depression, demonstrate lower adherence to their medications. Community pharmacists routinely address demographic and sociocultural barriers and are equipped to screen for and assist with behavioral barriers to medication adherence.

OBJECTIVES

The purpose of this study was to assess the feasibility and impact of conducting a depression screening as part of a holistic adherence assessment. The primary objective of this project was to evaluate the impact of a holistic adherence assessment on medication adherence. The secondary objectives evaluated patients' barriers to adherence, Patient Health Questionnaires 2 and 9 (PHQ-2 and 9) results, and pharmacist interventions.

PRACTICE DESCRIPTION

Pharmacists conducted a holistic adherence assessment and performed a depression screening for patients who were nonadherent or at risk of becoming nonadherent to their chronic medications.

PRACTICE INNOVATION

A pharmacist-led holistic adherence assessment implemented in 2 pharmacies of a large community pharmacy chain between January and May 2020.

EVALUATION METHODS

The impact on medication adherence was evaluated by assessing if patients received the next fill of their chronic medication on time after the holistic adherence assessment.

RESULTS

During the study period, 69 patients completed the holistic adherence assessment and were screened for depression. A total of 12 patients (17.4%) screened positive on the PHQ-2, and 6 patients (8.7%) screened positive on the PHQ-9. After the intervention, 42 patients (60.9%) received the next fill of their targeted chronic medication on time, and 27 patients (39.1%) were late to pick up their next fill.

CONCLUSION

The results illustrated that community pharmacists can incorporate a depression screening into a holistic adherence assessment effectively to screen for behavioral barriers that may affect medication adherence.