Project ImPACT R.Ph.s tackle depression

May 8, 2006

Asheville, N.C., the incubator for the first highly successfulcommunity pharmacist intervention project, will once again be atesting ground as the American Pharmacists Association Foundationapplies its proven concept to depression.

When asked what condition they would like to see pharmacists tackle next, employers already participating in other APhA Foundation programs for diabetes, asthma, and hyperlipidemia chose depression. It's no wonder, since more than 19 million adult Americans, or about 10% of the population, will suffer from depression at some point. Estimates of the total annual cost of depression range from $30 billion to $44 billion, with $12 billion of that in lost workdays each year. Another $11 billion is lost through lower productivity due to symptoms. And when patients are put on antidepressants, 50% to 70% do not complete even three months of therapy.

The APhA Foundation began training community pharmacists last month for the pilot sites in Asheville and in Columbus, Ohio. The North Carolina contingent includes the city of Asheville, Mission Hospitals, and the Western North Carolina Health Care Coalition. In Ohio, the Ohio University Wellness Plan will refer its staff and faculty beneficiaries to participating pharmacists. The pharmacists will collaborate with mental health caregivers, social workers, and physicians to support the best medication use in patients with depression.

Mission Hospitals, Asheville's largest employer, is already using community pharmacists for its workers with diabetes, asthma, and hyperlipidemia, said Barry Bunting, R.Ph., Mission's clinical manager of pharmacy and Asheville Project Coordinator. Despite some early skepticism, the hospital decided to give pharmacists a chance to impact appropriate prescribing and patient adherence to depression therapy. After all, antidepressants have been the hospital's No. 1 drug-spend for the past few years.

The project is "one of those rare situations in which if employers can have dollars spent more appropriately and medications taken more appropriately, people will be happier and more productive," said Bunting. "And the psychiatric professionals said having the pharmacist model offers the employer a program that doesn't have some stigma attached to it. For us, this will be an expansion of our drug program."

Successfully treating depression can have a big impact among patients who have comorbidities, such as diabetes and hypertension, said Benjamin Bluml, the APhA Foundation's VP of research. Until the depression is dealt with, it's often hard to attack a patient's other chronic health issues. "Depression can be quite debilitating," he said. "You can't get diabetes patients, for example, to focus on their glucose levels or exercise when they basically don't feel like even getting out of bed in the morning."

Working with depressive patients will not be every community pharmacist's cup of tea, said Patrick Finley, Pharm.D., board-certified psychiatric pharmacist and professor of clinical pharmacy at University of California San Francisco School of Pharmacy. He helped develop a successful pharmacist intervention depression model for Kaiser Permanente that saw 75% of patients referred to the service and started on an antidepressant complete six months of therapy. He said that in his experience, some pharmacists weren't committed to managing depressive patients, some didn't find mental illness appealing, and some didn't have the necessary interviewing skills or compassion.