|
In Depression Care, Patient Interaction Makes Pharmacy Visits Uplifting
Truth be told, pharmacists haven't been thought to assume an active role in the treatment process: the doctor decides on the correct prescription and the pharmacist merely fills it. Yet taking the pharmacist for granted--as the mere purveyor of the doctor's orders--means ignoring a reserve of potential when it comes to caring for depression. According to a 2003 Dutch study, when local pharmacists play an active role in antidepressive care, patients' antidepressant use becomes more regular. And in antidepressive care, where a patient's resistance to taking medication is a common problem of especial risk, this is worth noting.
The study was a randomized controlled trial with a 3 month follow up; there were 79 patients in the control group; 69 patients in the "intervention group"; and 19 participating pharmacists. Alongside a 25-minute video explaining the background of depression and the effects of the medication they were about to take, pharmacists also provided the intervention group with 3 "coaches" at the pharmacy. During the follow up, patients from the intervention group reported a markedly improved drug attitude and awareness of the treatment process.
The Dutch study is corroborated by a Massachusetts study conducted between 1998 and 2000, its findings published in 2004. In this study, the pharmacist worked with the primary care practioner and the patient to choose the drug, its dosage, and regimen. As a result of this consultation, six-month antidepressant use rate showed the intervention group using prescribed antidepressants by 57.5% as compared to the control group's 46.2% use rate. Like the Dutch study, the Massachusetts study clearly endorses an enlarged role for pharmacists in the treatment of depression.
Jeffrey Hauptman, a New York pharmacist, felt the Dutch study went beyond antidepressive care to show what the patient-pharmacist relationship could--and ought--be in many cases. After all, no matter what the condition, a pharmacist can listen, lend a shoulder to cry on and give expert advice without an appointment. According to Mr. Hauptman, a pharmacist's counseling is also valuable because "most people don't ask questions or are too intimidated during the prescription process and most doctors don't have the time or inclination to provide the necessary counseling."
As the Massachusetts study showed, after diagnosis patients spent much more time (in person or by telephone) with the pharmacist than the doctor. Considering the current uncertainty surrounding antidepressant use and the remaining stigma of depression, a pharmacist's words of assurance and what to expect could go a long way in stabilizing a depressive patient's life. Indeed, the Massachusetts study found that when the pharmacists were with the intervention group patients, they spent half their time discussing antidepressants and the importance of adherence and 85% of their time just in "general support" of the patient. Mr. Hauptman himself called patient noncompliance "a big problem."
By emphasizing the trust and support within the patient-pharmacist relationship, the recommendation of a greater role for the pharmacist shows a growing concern that physicians be able to communicate the nature and treatment of depression to their patients, that antidepressive care be clear and educative. As one study writes, "good physician communication is associated with positive patient outcomes [but] it dose not figure in current depression treatment guidelines."
But even more importantly, the recommendation of an enlarged role for the pharmacist shows an understanding of optimal antidepressive care as a "collaborative" effort and not an isolated therapy starting and ending with only the doctor or only the psychiatrist. By involving pharmacists in the collaborative effort of antidepressive care, patients can get the sustained attention they need--necessary attention that doesn't start and stop with a doctor's check up.
|
