J Am Pharm Assoc (2003). 2019 Jul-Aug;59(4):555-559. doi: 10.1016/j.japh.2019.03.002. Epub 2019 Apr 19.
To identify primary care providers' (PCPs') comfort level, potential barriers to management of patients with mental health disorders, and attitudes around clinical pharmacist-provided mental health medication-related support.
A 16-item cross-sectional survey was completed by PCPs in 14 patient-centered medical homes (PCMHs) at 1 academic medical center. Items assessed include PCPs' perceptions of the proportion of patients with a mental health condition, access to psychiatry services, confidence in mental health condition management, clinical pharmacist-provided mental health medication support, and demographics. Checklist, Likert-type-scale agreement statements, and an open-ended question to assess barriers to managing mental health medications were included. Descriptive statistics and qualitative content analysis were used.
Respondents (n = 85) included attending physicians (67.1%), resident physicians (24.7%), and advanced practice providers (8.2%). The average number of years in practice was 11 (SD 8.6). The majority perceived that 26% to 50% of their patients had a psychiatric illness (57.7%), referred < 10% of their patients (67.1%) to psychiatry services, and disagreed that access to psychiatric services was acceptably timely (87.0%). Participants felt confident diagnosing a patient with depression (97.6%) and starting antidepressants (94.1%) compared with antipsychotics (11.7%) or mood stabilizers (7.1%). Participants agreed that having the clinical pharmacist in clinic to provide support regarding psychiatric medications would increase their comfort level; increase in comfort level by provider type was not different (P = 0.20). Emerging barriers were lack of knowledge or training, low comfort in diagnosing severe psychiatric conditions, and access to psychiatry services.
Outside of the diagnosis and treatment of depression, PCPs indicate a lack of comfort in treating PCMH patients with mental health disorders. Pharmacists can play a key role by providing mental health medication management support to improve access and address PCMH patients' mental health needs.
确定初级保健提供者（PCP）对管理精神健康障碍患者的舒适度水平、潜在障碍以及对临床药师提供精神健康药物相关支持的态度。
在 1 家学术医疗中心的 14 个以患者为中心的医疗之家（PCMH）中，由 PCP 完成了 16 项横断面调查。评估的项目包括 PCP 对患有精神健康状况的患者比例、获得精神病服务的机会、对精神健康状况管理的信心、临床药师提供的精神健康药物支持以及人口统计学的看法。包括检查表、李克特量表同意陈述和评估管理精神健康药物障碍的开放性问题。使用描述性统计和定性内容分析。
受访者（n=85）包括主治医生（67.1%）、住院医生（24.7%）和高级执业医师（8.2%）。平均行医年限为 11 年（标准差 8.6 年）。大多数人认为他们的患者中有 26%至 50%患有精神疾病（57.7%），将<10%的患者转介给精神病服务（67.1%），并不同意获得精神病服务的时间是可以接受的（87.0%）。参与者认为，与抗精神病药物（11.7%）或情绪稳定剂（7.1%）相比，诊断患有抑郁症的患者（97.6%）和开始使用抗抑郁药（94.1%）更有信心。参与者同意让临床药师在诊所提供关于精神科药物的支持将提高他们的舒适度；不同提供者类型的舒适度增加没有差异（P=0.20）。出现的障碍是缺乏知识或培训、在诊断严重精神疾病方面舒适度低以及获得精神病服务的机会有限。
除了诊断和治疗抑郁症之外，PCP 表示在治疗 PCMH 精神健康障碍患者方面缺乏信心。药剂师可以通过提供精神健康药物管理支持来发挥关键作用，以改善获取途径并满足 PCMH 患者的精神健康需求。
