Finley PR, Rens HR, Pont JT, Gess SL, Louie C, Bull SA, Bero LA; Academy for Health Services Research and Health Policy. Meeting.
Abstr Acad Health Serv Res Health Policy Meet. 2000; 17: UNKNOWN.
Presented by: Patrick R. Finley, Pharm.D. BCPP, Associate Clinical Professor, University of California at San Francisco, 521 Parnassus Avenue, Room C-152, San Francisco, CA 94143-0622. Tel: 415-502-8041; FAX 415-476-6632; e-mail: pfinley@itsa.ucsf.edu
Research Objective: This controlled investigation was conducted to assess the outcomes of depressed patients managed by clinical pharmacists in an integrated practice model at a staff model HMO. Clinical pharmacists provided case management services (under the auspices of psychiatric mentors) featuring medication monitoring, patient counseling, extensive treatment follow-up and improved provider access.Study Design: Thirteen (13) primary care providers were designated to refer depressed patients to this protocol immediately after initiating antidepressant medications. Clinical pharmacists began the treatment protocol with a brief intake interview and coordinated extensive treatment follow-up comprised of scheduled clinic visits and telephone contacts. The control group consisted of depressed patients treated by 17 other providers from the same facility who delivered the traditional level of care. The control group was identified as depressed patients receiving an initial prescription for antidepressant medications from automated HMO records. The principal outcome variables were medication adherence, patient satisfaction and change in total resource utilization (comparison of utilization 12 months pre/post intervention). Medication adherence was assessed objectively through refill records and subjectively through the patient satisfaction survey. The surveys were mailed to both groups of subjects six months after the index prescription was received. Clinical outcomes and functional outcomes were measured in the intervention group as well.Patient Population: Depressed primary care patients enrolled in a closed staff model HMO.Principal Findings: A total of 91 patients were referred to the protocol during the 10 month recruitment phase and 129 patients were identified in the control group during the same time frame. Statistical comparison of demographic variables revealed no significant differences in sex, age, medical comorbidity (Chronic Disease Score) or provider prescribing practices. An intent-to-treat analysis of medication possession ratios (MPR) demonstrated that adherence was significantly higher in the intervention group (MPR = 0.81 vs 0.66; p=0.0005) and more patients had a prescription filled between months 3 and 6 (76% vs 51%; p=0.001). The intervention group expressed greater satisfaction with the personal nature of care, follow-up services, provider accessibility, and overall impression of the HMO than controls (chi square analysis of paired data; p < 0.05, all measures). More intervention patients also indicated they had completed six months of antidepressant (76% vs 49%; p=0.008). Comparison of resource utilization data is ongoing.Conclusions: Results from this controlled investigation suggest that case management of depression by clinical pharmacists can have a very favorable impact on medication adherence and patient satisfaction among depressed adults enrolled in a staff model HMO. This practice model may prove to be a valuable alternative to traditional methods of managing depression in the primary care setting.Implications: A variety of deficiencies have been identified with the contemporary management of depression in primary care. Through close medication monitoring and thorough patient follow-up, clinical pharmacists (or other similarly trained health professionals) may improve patient outcomes and satisfaction with health services. Primary Funding Source: Garfield Memorial Fund, Kaiser Permanente Division of Research
Publication Types:
Keywords:
- Adult
- Antidepressive Agents
- Case Management
- Cognitive Therapy
- Counseling
- Data Collection
- Depression
- Depressive Disorder
- Health Maintenance Organizations
- Humans
- Patient Satisfaction
- Pharmacists
- Primary Health Care
- Telephone
- economics
- hsrmtgs
Other ID:
UI: 102272098
From Meeting Abstracts