Silvia Richard, Plum Michelle, Dufresne Robert
J Am Pharm Assoc (2003). 2020 Sep-Oct;60(5S):S98-S106. doi: 10.1016/j.japh.2020.05.015. Epub 2020 Jul 12.
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.
The pharmacist's practice was based in the primary care clinics of an urban Federally Qualified Community Health Center (FQCHC).
PP entered into a supervised collaborative practice agreement at the FQCHC. Primary care providers referred patients to PP for depression treatment.
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.
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.
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.
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.
本研究比较了在初级保健中纳入精神科药剂师（PP）与行为健康诊所（BHC）的处方医生治疗抑郁症的效率及增加的就医机会。
药剂师的工作基于城市联邦合格社区健康中心（FQCHC）的初级保健诊所。
PP在FQCHC签订了监督协作实践协议。初级保健提供者将患者转介给PP进行抑郁症治疗。
PP已在精神科环境中作为精神科提供者使用，但未用于初级保健。在初级保健中纳入PP可以帮助患者获得更快速、个性化的心理健康治疗。
研究人员回顾性筛查了在FQCHC接受治疗的成年人的记录，这些成年人的主要诊断为抑郁症，并被转介进行抗抑郁药物管理，其中（1）在2年期间转介给PP的患者（研究组[SG]），与（2）PP到来前一年在FQCHC的BHC接受治疗的患者（对照组[CG]）。使用连续的PHQ-9数据和直到初始评估的等待时间对两组进行比较。在2个月期间接受治疗的药剂师的患者也完成了满意度调查。
SG组和CG组分别包括107名和34名患者。SG组的平均PHQ-9评分从基线时的17.9±6.51降至随访1时的14.7±7.0（P<0.001），而CG组的PHQ-9数据极少。从治疗转介到初始药物评估的时间在SG组平均为31.3天，在CG组为104.5天（P<0.001）。SG组的39名患者表现出高度满意度，平均得分为26.8分（满分28分）。
在初级保健中纳入PP产生了积极的结果，并改善了抑郁症的治疗机会。与在BHC接受治疗的患者相比，患者的PHQ-9评分持续降低，且就诊时间仅为其三分之一。在初级保健中使用PP治疗抑郁症是可行的。
