Sub-threshold depression in people with long-term conditions - is the community pharmacy a setting to offer a psychosocial intervention? A qualitative study.

Conference:

SAPC ASM 2018 - London

Talk Code:

5D.4

Presenter:

Carolyn Chew-Graham

Twitter:

@CizCG

Co-authors:

Charlotte Kitchen, Liz Littlewoood, Samantha Gascoyne, David Ekers

Author institutions:

Keele University, University of York

Problem

Approximately 30% of the UK population have long-term health conditions (LTCs). People with LTCs are 2-3 times more likely to experience depressive symptoms which can worsen individual health outcomes and quality of life, and increase healthcare utilisation and costs. For many people with milder depression (sub-threshold depression) their symptoms will often go undetected and/or untreated alongside their LTCs. The study aims to explore whether community pharmacies represent a suitable public health setting in which to offer psychological support to people with LTCs and co-morbid sub-threshold depression.

Approach

As part of a feasibility study, in preparation for a pilot randomised controlled trial (RCT), we recruited 24 people with LTCs and sub-threshold depression via community pharmacies and one GP practice. Seventeen community pharmacy staff (not Pharmacists), across eight community pharmacies, were trained to deliver an Enhanced Support Intervention (ESI) designed to reduce depressive symptoms and prevent progression to major depression. The ESI included Behavioural Activation, supported by a self-help workbook, and was delivered over 4-6 sessions either face-to-face or over the telephone, across a 4-month period. We invited intervention participants and trained pharmacy staff (who we called ESI facilitators) to participate in one-to-one interviews to explore their experiences of the study, the training and delivering the intervention. A focus group with pharmacy staff was conducted to explore the impact of the study on the routine work of the community pharmacies.

Findings

Pharmacy staff and intervention participants viewed community pharmacies as places where mental health problems could be supported using a non-stigmatising approach. ESI facilitators suggested modifications to the training. The intervention made sense to both ESI facilitators and intervention participants. The intervention manual was well received by the ESI facilitators, and the participant self-help workbook was acceptable to participants. Pharmacy staff reported that flexibility in the study protocol and additional resources would be required to support the study recruitment procedures in a future trial, and to enable the ESI to be incorporated into routine community pharmacy practice.

Consequences

Community pharmacies were viewed as an appropriate setting in which to deliver preventative brief psychological support to people with LTCs at risk of depression. Learning from the feasibility study has been incorporated into adapting the ESI facilitator training and training manual, the self-help workbook and recruitment procedures for the pilot RCT.

Submitted by:

Carolyn A. Chew-Graham

Funding acknowledgement:

Funding NIHR Programme for Applied Research Grant Reference number: 14/186/11 The views and opinions expressed in this report are those of the authors and do not necessarily reflect those of the NIHR, the NHS or the Department of Health. The NIHR and Department of Health had no role in study design, the collection, analysis and interpretation of data, or the writing of the abstract.