Assessing a Pharmacist Provided Mental Health Screening Service in a Rural Community to Address Anxiety and Depression

Objectives: The current state of the mental health crisis has been a topic of discussion around the nation, with those in rural communities being at a particularly higher risk. These risks are due to social determinants of health (SDOH) as well as geographical limitations in which communities reside in health professional shortage areas. Community pharmacists are uniquely positioned to screen patients for mental health disorders as well as provide education and patient monitoring following medication changes by prescribers and therapeutic lifestyle recommendations to improve patient outcomes. The objective of this study is to describe the implementation of a mental health service and determine and measure the impact that community pharmacist interventions can have on the mental health and wellbeing of patients who take mental health medications.

Methods: This retrospective evaluation of a pilot study describes a behavioral health service and documents quantifiable outcomes that were provided by administering appropriate screening tests. The pilot program allowed for the pharmacist to utilize state specific provider status protocols to conduct and receive payment for clinical services without the need for a collaborative practice agreement. Eligible patients were 18 years of age or older, taking one or more mental health medications and covered by the specific Medicaid health plan that was participating in the pilot program at enrolled pharmacies. Participating pharmacies were those that had a significant patient population participating with that plan, as well as credentialed and trained pharmacists. Pharmacists performed telehealth visits WEEKLY with eligible patients where they confirmed their mental health diagnosis and medications. This provided the information needed to administer the appropriate GAD7 or PHQ9 test. The pharmacists then made recommendations to the patients or their prescribers and created a plan with the patient for implementation based on their score. Follow- up calls were scheduled anywhere from 4 to 24 weeks to re-administer the appropriate test to identify changes in mental health scores.

Results: There were 61 patients who participated in the services across four pharmacies. Out of those patients, 24 patients with diagnosed anxiety performed GAD7 tests, and 37 patients with diagnosed depression performed PHQ9 tests. Mean GAD7 scores, which range from 0 (minimal anxiety) to 21 (severe anxiety) were 8.1 at initial appointment and 6.4 at follow-up. (This showed a 20% reduction in gad7 scores. Mean PHQ9 scores, which range from 1 (minimal depression) to 27 (severe depression) were 11.2 at initial appointment and 10.0 at follow-up. This showed a 10% reduction in PHQ scores. This data trends toward the service potentially showing a significant impact. Of the patients with anxiety, three had confirmed medication changes compared to 5 medication changes amongst those with depression. Additionally, 56.8% of patients showed a reduction in phq9 scores and one third showed a reduction in gad7 scores.

Conclusions: though this implementation project had significant limitations in detecting clinically significant changes in questionnaire scores the study supports the creation of additional mental health services in the community pharmacy setting to reinforce and encourage follow up provider visits in areas where there are mental health provider shortages and may possibly improve patient outcomes.

Authors:

T’Bony M. Jewell, PharmD, MBA¹, Andrea Kowalski, PharmD², Rebecca Lahrman, PharmD, MS, BCACP³

¹Ohio Northern University

²Shrivers Pharmacy

³Ohio State University College of Pharmacy