Table 1.
Synthesis of four studies conducted to assess patients’ and community pharmacists’ needs regarding antidepressant (AD) treatment (Step 1 of the Intervention Mapping protocol).
| Perspective | Health Care Leaders | Patients Taking ADs | Community Pharmacists (I) | Community Pharmacists (II) |
|---|---|---|---|---|
| Study Objective | To explore the perspectives of leaders in pharmacy and mental health on the current and potential contributions of community pharmacists for patients on ADs [41]. | To explore patients’ experiences with community pharmacy services for ADs and avenues for improvement [40]. | To describe community pharmacists’ perceptions of their practices around patients with a prescription for ADs [42]. | To identify factors from the theory of planned behavior associated with community pharmacists’ intention to perform systematic AD monitoring * [43]. |
| Population | Leaders in health care, pharmaceutical services, physician and pharmacist education, and patient and healthcare professional associations. | Patients diagnosed with major depression who were prescribed ADs. | Community pharmacists in 5 regions of the province of Quebec. | Community pharmacists in the province of Quebec. |
| Design | Qualitative descriptive exploratory study. | Qualitative descriptive exploratory study. | Qualitative descriptive exploratory study. | Cross-sectional population-based study. |
| Methods | 21 interviews with leaders | Individual interviews with 14 patients. | 6 focus groups with 43 pharmacists | Questionnaire completed by 1609 community pharmacists. |
| Key Results | Pharmacists were perceived as accessible drug experts whose particular strengths are the following: (1) thorough knowledge of drugs; (2) commitment to ensure safety and tolerability; (3) commitment to inform and support patients. Leaders perceived the need for enhanced pharmacist monitoring of AD adherence and efficacy. Leaders stated that health care teams could also benefit from pharmacists’ expertise. |
Patients reported that pharmacists concentrate their involvement at initiation and the first refill and that pharmacists’ contributions mainly consisted of providing information and reassurance. Patients’ expectations were that pharmacists: (1) extend their involvement by providing information throughout the length of treatment; (2) enhance the confidentiality of discussions in pharmacy. |
Major aspects of current pharmacist practice around ADs: (1) convincing patients to initiate ADs; (2) dealing with side effects in the first weeks of treatment; (3) intervening mainly when patients have questions for the remainder of treatment. Challenges were mainly organizational (e.g., lack of time and remuneration). Recommendations to improve practice: (1) clear guidelines for monitoring patients; (2) better training for pharmacy technicians; (3) providing educational tools to the patient; (4) improving pharmacy software to facilitate monitoring. |
Systematic AD monitoring has not been widely adopted by pharmacists, and pharmacists’ intention to perform systematic AD monitoring is moderate. Psychosocial factors associated with the intention to perform systematic AD monitoring include attitude, perception of control, subjective norms, and professional identity. |
* Systematic ADs monitoring was defined as performing four consultations with each patient treated for depression during the first year of AD treatment to address side effects, treatment efficacy, and adherence.