Through patient education and screening processes, pharmacists can identify and support underserved patients with mental illness
CHAINS & BUSINESS
Among the most trusted and most accessible healthcare professionals, pharmacists improve patient outcomes for many chronic disease states without increasing costs. The 2011 Report to the U.S. Surgeon General from the Office of the Chief Pharmacist states that “pharmacy practice models can rapidly relieve some of the projected burdenâ¨of access to quality care, reduce health disparities, and improve overall health care delivery.”1
Even though community pharmacists are moving from behind the counter to provide more clinical services than ever before, the extra attention may not have reached patients with mental illness yet.
A 2012 survey conducted by the National Alliance for Mental Illness (NAMI) and the College of Psychiatric and Neurologic Pharmacists (CPNP) found that 35% of respondents did not think their pharmacists were interested in their mental health conditions, even though 53% felt they had a strong relationship with their pharmacists.2 In addition, a 2010 survey showed that most of the community pharmacists surveyed were more likely to provide services to asthmatic patients than to those with mental illness.3
It has become commonplace for pharmacists to teach wellness classes, offer health screenings, and provide MTM services for a variety of disease states. Though such initiatives are not so widespread in the case of mental illness, some pharmacists across the nation are taking aim at this situation in several different ways.
One approach is through patient education. In a fashion similar to teaching healthy eating habits to a diabetic patient, cognitive behavioral therapy (CBT) teaches patients with mood disorders how to improve their moods by breaking the cycle of negative thought patterns. CBT has been shown to treat residual depressive symptoms effectively when used as an adjunct to pharmacotherapy, yet many patients cannot afford the cost of sessions.4
To increase access to care, Barney’s Pharmacy, an independent pharmacy in Augusta, Ga., offers a free CBT-based wellness class called “Healthy Minds.” The class was created and taught by a pharmacist using CBT reference books. Participants learn techniques such as thought-stopping and recognition of negative thought patterns.
Barry Bryant, RPh, President of Barney’s Pharmacy, feels that pharmacists should do more to serve mentally ill patients. “Most mental health patients are not understood and don’t understand their illness,” said Bryant. “They take their medications, start to feel better, then stop taking their medications. They relapse, and the cycle repeats. No one is reaching out to help these patients in the community setting. We want to show them how it’s done.”
Wellness classes target patients with a diagnosis, but almost one-third of symptomatic patients never seek medical care.5 Because of this, the American Pharmacists Association Foundation strongly encourages community pharmacists to offer point-of-care screening for major depressive disorder (MDD). 6 Validated, easy-to-use screening tools such as the Patient Health Questionnaire (PHQ) produce reliable results and are widely accepted by the medical community.
Pharmacists at a large grocery chain in Ohio used the PHQ to screen over 3,000 patients; positive scores were referred to a primary care provider. At follow-up, 60% of the referrals resulted in a therapeutic initiation or modification.7 Just as they act as a referral source for hypertensive or diabetic patients, pharmacists are well positioned to serve as a link between patients and mental health care.
Meeting the needs of all
With one in five Americans taking some type of medication for a mental health condition, the business model for clinical services targeting mental health is also growing. Depressed employees use more than $4,000 per year in medical services compared with less than $1,000 per year for employees without depression. Pharmacists who attract patients with mental health issues through dynamic clinical programs also realize the benefit of increased prescription counts.
Pharmacy practices such as Barney’s and others are paving the way throughout the nation to increased use of innovative services in the area of mental health. With simple diagnostic tools and groundbreaking clinical programs, pharmacies are addressing mental health issues in ways that improve both patient outcomes and pharmacy bottom lines.
Government-mandated decreases in mental health funding and the current shortage of primary care providers will only make it more difficult for patients to find quality mental health care. It is more important than ever for community pharmacists to accept the call to serve the nation’s mentally ill population.
1. Giberson S, Yoder S, and Lee MP. Improving patient and health system outcomes through advanced pharmacy practice: A report to the U.S. Surgeon General. Office of the Chief Pharmacist. U.S. Public Health Service. December 2011.
2. Caley CF and Stimmel GL. Characterizing the relationship between patients with mental health conditions and community pharmacists: Results from a 2012 survey. CPNP Foundation and NAMI. December 2012. NAMI website.
3. Rickles NM, Dube GL, McCarter A, et al. Relationship between attitudes toward mental illness and provision of pharmacy services. J Am Pharm Assoc. 2010;50 (6):704–713.
4 Rush, J. STAR*D: What have we learned? Am J Psychiatry 2007; 64(2); 201.
5 González HM, Vega WA, Williams DR, et al. Depression care in the United States: too little for too few. Arch Gen Psychiatry. 2010;67(1):37–46.
6 American Pharmacists Association Foundation. "White paper on expanding the role of the community pharmacist in managing depression." APhA website. Accessed April 18, 2013.
7 Rosser S, Frede S, Conrad WF, and Heaton PC. Development, implementation and evaluation of a pharmacist-conducted screening program for depression. J Am Pharm Assoc. 2013;53:22–29.