Pharmacists Improve Quality of Depression Care at Patient, Community Levels

Health is influenced by many factors, Shari N. Allen, PharmD, BCPP, said in a session at the AAPP Conference 2024. Genetics, behaviors, environments, and poor medical care can all increase the risk of depression. However, social factors can also play a significant role in patients’ likelihood to develop depression and the subsequent care they receive.

“Social determinants of health are the non-medical variables that affect your health. They are the physical, the social, and the economic conditions that affect your health. They are where we live, they are where we grow up, where we worship, and where we play,” Allen said in the session.

Image credit: zinkevych | stock.adobe.com

There are 5 domains of social determinants of health (SDOH): economic stability, neighborhood and environment, education access and quality, social and community context, and health care quality and access, according to Allen. SDOH can worsen mental health disorders and vice versa, Allen indicated. She added that a trickle-down effect could be experienced depending where patients grew up, and it could be carried on into adulthood.

“The reason why you should be thinking about or considering [SDOH] in your care models is because it affects depression, but then depression can also affect the [SDOH],” Allen said.

Allen went on to talk about the Healthy People 203o initiatives, which are a set of objectives and goals aimed at improving the national health by the year 2030. One goal is to increase the proportion of primary care visits during which adolescents and adults are screened for depression. The goal is to reach 13.5%, whereas the baseline was 8.5% and the current data suggests it has increased to 9.1%, according to Allen in the session.

“Most of our patients are not going to see a mental health provider initially. Sixty percent of patients see their primary care provider, and their mental health is being managed by the primary care provider,” Allen said.

She added that approximately 79% of psychiatric medications are prescribed by non-mental health providers.

Additionally, barriers to access still exist, including the stigma around depression, lack of transportation for patients, long wait times, lack of access to providers, lack of coverage or inadequate coverage, lack of childcare, and patients’ lack of awareness regarding resources.

Other objectives of the Healthy People 203o initiative are reducing the suicide rate and suicide attempts in adolescents, reducing anxiety and depression among caregivers for patients with disabilities, and increasing the number of women who are screened for postpartum depression. Another objective that Allen highlighted was increasing education for those who are providing mental health care.

“In medical school, less than 5% of the medical school curriculum is focused on psychiatric care,” Allen said. Further, Allen added that less than 5% of the total curriculum is focused on psychiatric care.

In the Combining Medications to Enhance Depression Outcomes study, investigators assessed socioeconomic factors and direct effects on treatment. They found that lack of college education, being non-white, and being unemployed resulted in slower or less improvements with depression outcomes in 12 weeks of treatment, according to Allen.

Other data showed that lower socioeconomic status increased risk of depression and outcomes of treatment, according to Allen. Lower socioeconomic status may be associated with decreased efficacy and lower remission rates of depression, she said. For employment, the results were similar, suggesting that employment status might contribute to outcomes of depression treatment.

Additionally, education had similar trends affecting depression symptoms and treatment outcomes. High school education and higher were associated with positive outcomes, Allen said. However, she said, all these factors have also been shown in some studies to not have effects on treatment, so the outcomes can vary.

Allen said that pharmacists can play a role in SDOH and depression care, although there is limited guidance and direction for pharmacists. Furthermore, she indicated that there could be barriers to the inclusion of pharmacists in the recommendations.

“As psychiatric pharmacists, we can be making recommendations that are helpful to the patient. We can help to minimize patient [medication] lists, [and] we can consolidate their medications,” Allen said.

Psychiatric pharmacists can also help impact economic stability, including food insecurity and patients’ inability to afford prescription medications. Allen said that pharmacists can refer patients to food banks and other resources that are available. Furthermore, pharmacists can help patients navigate savings and prescription discount programs. Psychiatric pharmacists can also help in the community and social context to impact public health, beyond a single patient.

Each specialty and role for pharmacists (oncology, specialty, etc.) can have important impacts for patients with regards to depression. For instance, community pharmacists can screen for depression, help with optimal medication use, and help navigate insurance. Clinical pharmacists can refer patients to an appropriate specialist, and psychiatric pharmacists can address prior authorization issues as well as improve access to care.

At the patient level, pharmacists can educate patients at both pickup and discharge, and can also further their educations in culture, backgrounds, and beliefs to provide better quality of care for patients. At the practice level, pharmacists can provide screening, point-of-care testing, help with smoking cessation, and refer to appropriate providers. At the community level, pharmacists can also partner with community groups, address the needs of their specific community, and engage in political advocacy.

“As a pharmacist, we can play a large role in other areas aside from just the medication, and then we can help engage patients,” Allen concluded in the session.

Reference

Allen SN. Social Determinants of Health in the Treatment of Depression. American Association of Psychiatric Pharmacists Conference 2024; Orlando, Florida; April 7-10, 2024.