Int J Pharm Pract 2002:10:253-65
Department of Medicines Management, Keele University, Keele, Staffs, England ST5 5BG
M. Landers, BPharm (Qld), MRPharmS, MSc research student and community pharmacist
A. Blenkinsopp, PhD, FRPharmS, professor of the practice of pharmacy
K. Pollock, MA, PhD, concordance research fellow
J. Grime, BSc, MMedSci, concordance research fellow
Correspondence: Professor Blenkinsopp a.blenkinsopp@keele.ac.uk
Original Papers
Community pharmacists and depression: the pharmacist as intermediary between patient and physician
M. Landers, A. Blenkinsopp, K. Pollock and J. Grime
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.