Project ImPACT: Depression
Patient enrollment began in July 2006 and continued at each site dependent on employer-specific enrollment timetables. Data was collected for this evaluation up until December 31, 2007.
Upon enrollment into the program, participants:
- Scheduled an intake interview with participating pharmacists to assess their current mental status, ongoing stressors, past psychiatric history, social and family histories, and medical history (including allergies and comorbid conditions).
- Completed a validated, self-rated depression scale (the nine-item Patient Health Questionnaire [PHQ-9] instrument) at baseline.
- Worked closely with pharmacists to achieve consensus on treatment goals and subsequently formulated a treatment plan primarily consisting of medication recommendations, patient education, and lifestyle changes.
All participating patients met with a pharmacist on a regular, long-term basis - as frequently as once a month - with the option to withdraw at any time. Pharmacist–patient encounters were face to face, scheduled, and conducted in a private area, with access to the Internet for documenting and tracking of patient care interventions.
Pharmacists partnered with the patient and members of the health care team to identify the best ways to empower that patient to become more adherent to prescribed medications and to make lifestyle modifications that would improve control of depressive symptoms. At each visit:
- Treatment goals were revisited;
- Medication therapy management was performed;
- Treatment adherence was evaluated by patient self-report;
- Participants completed a follow-up PHQ-9 assessment; and
- Pharmacists devliered tailored education to meet specific patient needs and placed strong emphasis on anticipated benefits and risks of treatment, as well as lifestyle changes needed to reduce stress and improve overall health (e.g., exercise, yoga, dietary modifications).
Following these visits, pharmacists communicated with physicians via faxes that summarized the patient–pharmacist encounter. These included patient comments, PHQ-9 scores, and suggestions for therapy changes when indicated, with the prescriber having ultimate decision-making authority in the process. If urgent needs were identified, the pharmacist would call the office to collaborate on an action plan.