Study on the feasibility of pharmacist intervention on management of antidepressant treatment in late life depression under MDT: a mixed methods study

Abstract

Abstract OBJECTIVE: To evaluate the effect of pharmacist intervention on antidepressant treatment in late life depression under multidisciplinary team (MDT). Method: Patients with late life depression were selected from psychological department of The Afliated Wuxi Mental Health Center of Jiangnan University from Jan. 2021 to Mar. 2022, and randomly divided into observation group and control group, with 90 cases in each group. After 3 months of follow-up, the control group was given antidepressants and routine intervention, while the observation group was treated with pharmacist intervention under MDT and the same antidepressants. The Hamilton Depression scale (HAMD), medication appropriateness index (MAI), potential inappropriate medication (PIM), adherence, quality of life and satisfaction, the incidence of adverse drug events (ADEs), number of medication regimen optimization and clinician adoption rate were observed in two groups before and after intervention. Results: At admission, there were no statistically difference in HAMD score, total MAI scores, PIM number, adherence and quality of life between two groups (P>0.05). After intervention, HAMD scores of both groups were significantly reduced, while MMAS-8, GQOLI-74 and GWB scores were elevated. Moreover, the differences of scores before and after interventions, both the reduction in HAMD score and the increase in MMAS-8, GQOLI-74 and GWB scores, were more significant in the observation group than in the control group. Interestingly, the total MAI score and PIM number were increased in the control group after intervention, but decreased in the observation group. With the prolongation of the treatment, the number of patients with mild to moderate depression and general to high medication adherence in two groups was increased gradually, while patients with major depression and low medication adherence were decreased gradually. Meanwhile, the observation group also showed more significant difference than the control group. Low adherence patients increased substantially at 90 days treatment in control group. There was no significant difference in the incidence of ADEs between two groups (P>0.05). The quality of life in the observation group was significantly higher than control group (P<0.05). Pharmacists put forward 164 optimization suggestions of drug regimen for the observation group, among which 109 suggestions were adopted and implemented by clinicians, with an implementation rate of 66.46%. Clinicians have a high adoption rate of pharmaceutical recommendations based on therapeutic drug monitoring (TDM), individualized genetic testing and medication methods. Conclusion: Pharmacist intervention can improve the management of antidepressant treatment in late life depression by using HAMD, MAI, PIM and MMAS-8 as main evaluation indicators under MDT.