Community pharmacists and depression: the pharmacist as intermediary between patient and physician

Abstract

Objectives - To describe community pharmacists' experiences and contributions to the management of mild to moderate depression in primary care and to explore their interactions with patients and physicians. Method - Qualitative semi-structured interview study with a purposive sample of 20 community pharmacists from a range of backgrounds in one area of England. Pharmacists were asked to describe their involvement in the management of depression from patients' self-diagnosis and self-treatment through to treatment with antidepressants. They were asked to cite examples of the questions that they were asked by patients about depression and its treatment, and about their practice in advising patients with first-time and repeat prescriptions for antidepressants. Attitudes and practice relating to compliance and concordance with antidepressants were explored. Key findings - Pharmacists were asked a wide range of questions by patients about antidepressants and depression. Often these questions posed ethical dilemmas for the pharmacists by raising topics that crossed inter-professional boundaries. Pharmacists generally saw their role as encouraging patients to take antidepressant treatment and they reported providing technical information, mainly when the first prescription was dispensed. Most pharmacists worked from a "compliance" model although this appeared to conflict sometimes with their own views about the appropriateness of antidepressant treatment. Pharmacists rarely entered into discussion with patients on their feelings about treatment or their intention to take it. Monitoring of compliance to antidepressants was largely seen as the province of the physician and pharmacists appeared to feel unable to undertake this role effectively. Nevertheless 17 of the pharmacists expressed a wish to extend their role in the management of depression. Conclusions - Pharmacists' accounts showed that patients have unmet needs in relation to the management of depression and treatment with antidepressants. Achieving concordance in the tripartite relationship between patient, GP and pharmacist poses considerable challenges. However, our findings suggest that pharmacists could play a larger role as first-line advisers on depression and its treatment if the identified barriers can be overcome.