Efficiencies and outcomes of depression treatment by a psychiatric pharmacist in a primary care clinic compared with treatment within a behavioral health clinic

Abstract

Objective: This study compared the efficiency and increased access to care by a psychiatric pharmacist (PP) incorporated into primary care versus behavioral health clinic (BHC) prescribers for depression treatment.

Setting: The pharmacist's practice was based in the primary care clinics of an urban Federally Qualified Community Health Center (FQCHC).

Practice description: PP entered into a supervised collaborative practice agreement at the FQCHC. Primary care providers referred patients to PP for depression treatment.

Practice innovation: PPs have been utilized as psychiatric providers within psychiatric settings, but not in primary care. Integrating a PP within primary care can assist patients in obtaining more rapid, individualized mental health treatment.

Evaluation: Investigators retrospectively screened the records of adults treated at a FQCHC with a primary diagnosis of depression referred for antidepressant management to (1) the PP over a 2 year period (study group [SG]), versus (2) the FQCHC's BHC over the year preceding the PP's arrival (control group [CG]). Both groups were compared using serial PHQ-9 data and wait time until initial evaluation. Pharmacist's patients treated during a 2-month period also completed a satisfaction survey.

Results: The SG and CG included 107 and 34 patients respectively. Average PHQ-9 scores decreased from 17.9 ± 6.51 at baseline to 14.7 ± 7.0 at follow-up #1 in the SG (P < 0.001), whereas there were minimal PHQ-9 data in CG. Time from treatment referral to initial medication evaluation averaged 31.3 days in the SG and 104.5 days in the CG (P < 0.001). The 39 SG patients demonstrated high satisfaction, with a mean of 26.8 out of 28 points.

Conclusion: PP incorporation into primary care produced positive outcomes and improved depression treatment access. Patients maintained reduced PHQ-9 scores and were seen in one-third the time versus those seen in the BHC. PP utilization in primary care is viable for treating depression.