Herbert Christina, Winkler Holly
Patient Aligned Care Team/Primary Care Mental Health Integration Clinical Pharmacy Specialist, Pharmacy Department, South Texas Veterans Health Care System, San Antonio, Texas; Pharmacotherapy Division, College of Pharmacy, The University of Texas at Austin, Austin, Texas; Pharmacotherapy Education & Research Center, School of Medicine, UT Health San Antonio, San Antonio, Texas,
Primary Care Mental Health Integration Clinical Pharmacy Specialist, Pharmacy Department, South Texas Veterans Health Care System, San Antonio, Texas; Pharmacotherapy Division, College of Pharmacy, The University of Texas at Austin, Austin, Texas.
Ment Health Clin. 2018 Apr 26;8(3):105-109. doi: 10.9740/mhc.2018.05.105. eCollection 2018 May.
The demand for mental health (MH) services has increased as more veterans seek MH care. At the South Texas Veterans Health Care System, Primary Care Mental Health Integration (PCMHI) was developed to manage patients with uncomplicated MH conditions, including depression, anxiety, or posttraumatic stress disorder (PTSD), within an interdisciplinary primary care (PC) team that includes clinical pharmacy specialists (CPSs). Pharmacists have improved outcomes and access to care for many chronic medical conditions, but limited data demonstrate the impact of MH pharmacists within PC.
This project evaluated the impact of a PCMHI CPS clinic on managing patients with recent antidepressant initiation and CPS clinic intake from September 2015 through December 2016, including follow-up through January 2017. Markers used to evaluate effectiveness of the service included the Patient Health Questionnaire-9 scores, antidepressant medication possession ratio, number of emergency department visits for MH-related concerns, patient engagement in concurrent psychotherapy, and referrals to specialty MH providers.
A total of 196 unique patients had intake with the PCMHI CPS in the time specified; 172 of these patients were included in analyses. There were 155 patients maintained in PC. Average Patient Health Questionnaire-9 scores decreased from 14.5 to 8.5, with 63 patients (46%) achieving response and 42 patients (31%) achieving remission. The average antidepressant medication possession ratio was 0.93 for all included patients.
A PCMHI CPS successfully manages and maintains patients with uncomplicated MH conditions in PC through evidence-based pharmacotherapy, as evidenced by symptom improvement, medication adherence, and low rate of specialty MH referrals.
随着越来越多的退伍军人寻求心理健康护理，对心理健康（MH）服务的需求有所增加。在南德克萨斯退伍军人医疗保健系统中，开展了初级保健心理健康整合（PCMHI）项目，以便在包括临床药学专家（CPS）在内的跨学科初级保健（PC）团队中管理患有不复杂MH疾病的患者，这些疾病包括抑郁症、焦虑症或创伤后应激障碍（PTSD）。药剂师已经改善了许多慢性疾病的治疗效果并增加了患者获得护理的机会，但仅有有限的数据表明MH药剂师在初级保健中的作用。
本项目评估了2015年9月至2016年12月期间PCMHI CPS诊所对近期开始使用抗抑郁药的患者的管理情况以及CPS诊所的接诊情况，随访至2017年1月。用于评估该服务有效性的指标包括患者健康问卷-9得分、抗抑郁药物持有率、因MH相关问题前往急诊科就诊的次数、患者接受同步心理治疗的情况以及转介至MH专科提供者的情况。
在指定时间内，共有196名不同患者在PCMHI CPS处就诊；其中172名患者纳入分析。有155名患者在初级保健中持续接受治疗。患者健康问卷-9平均得分从14.5降至8.5，63名患者（46%）症状得到缓解，42名患者（31%）症状完全缓解。所有纳入患者的抗抑郁药物平均持有率为0.93。
PCMHI CPS通过循证药物治疗成功地在初级保健中管理和维持患有不复杂MH疾病的患者，症状改善、药物依从性以及转介至MH专科的低比率都证明了这一点。
