Pharmacist-led depression screening and intervention in an underserved, rural, and multi-ethnic diabetic population.

OBJECTIVES: To test the feasibility of implementation and integration of community pharmacist-led depression screening for patients with diabetes in an underserved rural area and to assess the response rate of prescribers to pharmacist-led depression screening and treatment recommendation.

SETTING: Independent community pharmacy-run diabetes education center.

PRACTICE DESCRIPTION: Clinical community pharmacy site on Maryland's Eastern Shore.

PRACTICE INNOVATION: All patients with uncontrolled diabetes (A1C >7%) 18 years of age and older attending one or both diabetes self-management classes and diabetic counseling completed the Patient Health Questionnaire 9 (PHQ-9). Those with moderate to severe cognitive impairment or preexisting mental illness except for anxiety or untreated/undertreated depression were excluded from the results. A copy of the screening was faxed to the referring provider with an accompanying letter. Positive screening reports included a suggestion for further evaluation and possible pharmacologic treatment.

EVALUATION: Data collected (PHQ-9 scores, provider response rate, and A1C) were analyzed with the use of appropriate evaluation tools.

RESULTS: Of the 57 patients who took the screening, 11 (19.3%) were positive and 46 (80.7%) negative for possible depression. Responses were received from providers on 3 of the 11 patients who screened positive, and no providers initiated depression treatment. The site plans to continue data collection following this residency's completion to assess clinical impact.

CONCLUSION: This model may be replicated at many community pharmacies to integrate a depression screening. Based on prescribers' response rate, faxing alone is not recommended as the primary communication with the provider, and an alternate method should be assessed to effectively recommend pharmacologic therapy for patients with positive depression screenings.