OCTOBER 2019 - Researcher Philippe Vincent and pharmacists at 30 community pharmacies hope to smooth the path to recovery for patients with depression through a ground-breaking research study funded in part by the Canadian Foundation for Pharmacy’s (CFP’s) Innovation Fund.
The research is unique in that it combines pharmacist coaching with a smartphone app. The app will also differentiate itself within the virtual sea of mental health apps in that it will be built around the PHQ-9 and GAD-7 self-assessment questionnaires, two standardised, validated tools to assess depression and anxiety, respectively. Participating pharmacists will be able to access a patient’s results using a secure, online dashboard.
The study’s primary objective is to shorten the time to recovery by helping patients achieve treatment response as quickly as possible and by supporting adherence.
“Our project seeks to bring patients who suffer in silence and pharmacists together into a meaningful relationship. The self-rating scales and smartphone app are mediators of a safe space for private, sometimes emotional conversations and goal-setting,” says Vincent, Associate Professor of Clinical Pharmacy at University of Montreal and a researcher with the university-affiliated Institute universitaire en sante mentale de Montreal (a psychiatric hospital).
A secondary goal is to prove the value of pharmacists’ interventions. “If we can show that the time pharmacists put into monitoring and coaching is directly proportional to the remission of patients, so people can go back to meaningful occupations and live fuller lives, then insurance, government and other stakeholders will understand that the pharmacists’ time is worth something,” says Vincent.
As well, the stage is already set for possible adoption of the research model into regular pharmacy practice, and possibly on a national scale. All 30 participating pharmacies are part of the Pharmaprix banner, a division of Shoppers Drug Mart and Loblaw companies. Pharmaprix is co-funding the project with CFP.
Inspiration for the project came in part from the positive experiences of his pharmacy students, who use the PHQ-9 tool as part of practical training. “Many patients become emotional. They are so grateful that someone is taking the time to do this, and impressed that pharmacists are able to do it. My students see that they are making a real difference,” says Vincent.
The study is a randomized, unblinded, multicenter intervention trial that will follow patients over six months. The 30 participating pharmacies will each enrol 10 patients who have been diagnosed with a new episode of major depression, broken down as follows:
Pharmacists in the coaching group will receive training based on best practices in clinical psychiatry. They will call their participating patients every week during the dose-finding period and conduct a 5-minute semi-structured interview that seeks to create rapport, agree on treatment goals and agree on tasks. Pharmacists will also ask about side effects, which will be addressed as required through separate interventions that will be documented in the dashboard.
Throughout the six months of the study, the app will send notifications to patients every two weeks to remind them to complete the PHQ-9 and GAD-7 questionnaires. The app will also prompt patients to complete the PHQ-2 questionnaire every day for the first 15 days, every two days for the next 15 days, and every three days thereafter. “In a pharmacy setting where everything is so busy, you need to have useful, fast and complete information. This model enables systematic monitoring and a communication bridge between patients and pharmacists,” says Vincent.
Design and testing of the mobile app has already begun, and the estimated project completion date, including data analysis, is mid 2021.