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Community pharmacists as behavioral health extenders: an effectiveness-implementation hybrid type II feasibility
Melanie Livet1, Amber Watson2, Shweta Pathak3
1National Implementation Research Network, Frank Porter Graham Child Development Institute, and Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. melanie.livet@unc.edu.
Background:
Availability of mental health services is often limited, with many patients suffering from depression or anxiety either unidentified or unable to access care. Community pharmacists may be well-positioned to serve as behavioral healthcare extenders by offering timely screening, referrals, education, and medication management. However, evidence supporting feasibility and effectiveness of behavioral health (BH) care interventions in community pharmacy settings remains anecdotal. The purpose of this article is to summarize the findings from a feasibility evaluation of a BH intervention in 7 U.S. community pharmacies.
Methods:
The BH intervention, delivered over 6-11 months, consisted of a screening and referral program and a 6-session education and medication management program. Participating pharmacies benefited from a multi-faceted implementation strategy (e.g., coaching, toolkits). An effectiveness-implementation hybrid Type II design was used to assess effectiveness of the intervention, while evaluating its implementation. Implementation outcomes involved program adoption rates, levels of program acceptability, appropriateness, and feasibility, intent to sustain, and fidelity rates. Intervention outcomes included: patient referral rates, perceived benefits, and changes in patient knowledge, clinical symptoms, and medication adherence. The data were collected using multiple methods (e.g., surveys, interviews, administrative data) and analyzed accordingly.
Results:
Results indicated a 100% adoption rate by the pharmacies with intent to continue past the project period; significant increases in program acceptability, appropriateness, and feasibility; and high levels of program fidelity. All 206 patients were appropriately referred as needed, with patients enrolled in the 6-session program reporting statistically significant changes in knowledge, clinical symptoms, and a nonadherence to medications.
Conclusions:
These findings lend support to the role that community pharmacists can play in bridging the mental health care gap and improving population health.
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