Changes in PHQ-9 score after clinical pharmacy practitioner intervention in primary care mental health integration...

The Lt. Col. Luke Weathers, Jr. Veterans Affairs Medical Center (Memphis VAMC) expanded clinical pharmacy mental health services to Primary Care Mental Health Integration (PCMHI) in July 2023. This expansion provides an opportunity for further evaluation of the specialized Clinical Pharmacy Practitioners' (CPP) impact on providing patient-centered healthcare and improving mental health outcomes. This study aimed to assess the impact of adding a CPP in PCMHI.

A retrospective chart review of computerized medical records from the Memphis VAMC was conducted from August 1, 2023, to August 1, 2024, in patients seen by the PCMHI CPP who had pre- and post-intervention PHQ-9 scores. The primary objective of this study was to assess changes in PHQ-9 scores. Secondary objectives were to analyze pharmacotherapy agents used, concomitant psychotherapy usage, changes in other measurement-based care (Generalized Anxiety Disorder-7 item scale [GAD-7] and Posttraumatic Stress Disorder Checklist for the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition [PCL-5]), reported side effects and adherence, and disposition after treatment. Descriptive statistics were used to analyze demographic data and outcomes.

A total of 376 patients were screened, and 199 patients enrolled. PHQ-9 scores improved in 78.4% of patients, with a median score improvement of 5 points (interquartile range [IQR] 1-10). In patients with documented pre- and post-CPP intervention GAD-7 (n = 173) and/or PCL-5 (n = 8) scores, the median score improvement was 5 points (IQR 1-10) and 19 points (IQR 8.75-28.5), respectively.

PHQ-9, GAD-7, and PCL-5 scores improved after incorporating a CPP in the PCMHI clinic. These findings suggest patients benefit from CPP expertise in assessing the efficacy of mental health pharmacotherapy and improving mental health symptomology.