Training Pharmacists to Implement Depression Screening Services

Abstract

Background: Depression is the leading cause of disability in persons over 15 years old. It is estimated that over 7% of people have depression but only 40-50% of those actually receive treatment. Inadequate treatment has sweeping negative effects, including school dropout, decreased work productivity, and suicide. Rural areas are affected to a greater degree due to the increase of the “mental health care gap”: the phenomenon of increasing mental health conditions that are not being kept up with by the number of mental health providers. Pharmacists offer a solution here by being more accessible to rural patients than other mental healthcare providers. Studies have demonstrated the feasibility and patient acceptance of pharmacists offering depression screening services in urban pharmacies; however, the rate of implementation of such services is low. Thus, this project seeks to inform an effective depression screening training program for rural community pharmacies, thus improving implementation of depression screening services in underserved areas by incorporating current practices, strategies to address barriers, and preferred implementation strategies. Hypothesis 1: Knowledge, intention, confidence, attitude, subjective norms, and perceived behavior control of a depression screening service will be improved from pre-training to immediately post-training in pharmacists after participating in a depression screening training webinar. Hypothesis 2: Knowledge, confidence, attitude, subjective norms, and perceived behavior control of a depression screening service will continue to be increased from pre- to 3-months post the depression screening training webinar. Hypothesis 3: Implementation of depression screening services will increase from pre- to 3-months post after the depression screening training webinar. Methods: A survey was developed and pre-tested with a stakeholder panel to identify current community pharmacist depression screening practices, unique barriers/facilitators, stigma towards patients with mental health, and preferred implementation strategies that rural pharmacists may encounter when implementing a depression screening service. This survey was sent to rural pharmacists in Alabama and Mississippi identified with the Hayes directory and RUCA codes 4-10. Subsequently, a live webinar training program was developed using data from the initial survey and a second stakeholder panel to fill in knowledge gaps, address barriers, improve confidence and beliefs, and disseminate preferred implementation strategies to implementing a depression screening service in rural pharmacies. This webinar was delivered to rural and urban pharmacists in Alabama and Mississippi who were identified using the Hayes directory and a continuing education office listserv. Knowledge, intention, confidence, and beliefs were assessed pre, post, and three months post the webinar. Results: Eighty-five rural pharmacists completed the survey for a response rate of 14%. Rural pharmacists reported they have several barriers towards implementing a depression screening service: primarily low confidence, lack of time, and lack of knowledge for themselves and their staff. The training webinar significantly increased pharmacist confidence, knowledge, and beliefs pre-post and maintained the increase 3-months post webinar for every variable except subjective norms. Intention to implement and implementation behaviors did not significantly increase. Barriers towards implementation were primarily lack of time and lack of staff. Conclusion: While the interventional educational webinar increased pharmacists’ knowledge, confidence, and attitudes towards depression screening services, intention to implement as well as actual implementation of these services remained low to non-existent. Further research should be undertaken to gain a better understanding of systematic barriers pharmacists face when implementing depression screening services so that potential solutions may be found.