Is the community pharmacy an appropriate place to deliver a psychological intervention for adults with comorbid sub-threshold depression and long-term conditions? A feasibility study and pilot randomised controlled trial (CHEMIST)

Conference:

SAPC ASM 2020 - cancelled due to pandemic

Talk Code:

P.7

Presenter:

Liz Littlewood

Co-authors:

Samantha Gascoyne(1), Carolyn Chew-Graham(2), Claire Sloan(1), Charlotte Kitchen(1), Elizabeth Coleman(1), Della Bailey(1), Suzanne Crosland(1), Caroline Pearson(1), Simon Gilbody(1,3), David Ekers(1,4) on behalf of the CHEMIST team.

Author institutions:

(1) Department of Health Sciences, University of York; (2) School of Primary, Community and Social Care, Keele University; (3) Hull York Medical School, University of York; (4) Tees, Esk & Wear Valleys NHS Foundation Trust

Problem

Approximately 30% of the UK population have a long-term condition (LTC). Depression is two to three times more likely in people with LTCs resulting in poorer health outcomes, reduced quality of life, and increased healthcare costs. Sub-threshold depression, a risk factor for major depression, is prevalent in people with LTCs, but many people remain untreated due to demand on services. The community pharmacy may be an alternative setting to offer psychological support for people with comorbid sub-threshold depression and LTCs.

Approach

A feasibility study and pilot randomised controlled trial (RCT) evaluated the feasibility of pharmacy staff delivering an Enhanced Support Intervention (ESI) for people with comorbid sub-threshold depression and LTCs. The ESI focussed on Behavioural Activation and involved up to six sessions delivered by trained pharmacy staff (ESI facilitators). Participants were identified via pharmacies or GP practice database searches. Participants (aged ≥18, with sub-threshold depression and at least one LTC) were all offered the ESI in the feasibility study. In the pilot RCT, participants were randomised to either the ESI or usual care. Main outcomes included recruitment and retention rates, ESI engagement and depression severity (Patient Health Questionnaire) at four months (primary outcome). Semi-structured interviews were conducted with participants, pharmacy staff (including ESI facilitators) and GPs.

Findings

Feasibility study: Twenty-four participants were recruited and 17 ESI facilitators were trained. Seventeen participants (71%) commenced the ESI; all completed two or more sessions and ten completed all six sessions. Retention at four months was 83%. Depressive symptoms decreased slightly at four months. Interview data suggested the ESI was acceptable to participants and ESI facilitators, and that the community pharmacy was an appropriate place to offer a psychological intervention. Learning generated led to refinements to study materials/ processes for the pilot RCT. Pilot RCT: Forty-four participants were recruited (out of a target of 100); 24 randomised to the ESI and 20 to usual care. An additional 18 ESI facilitators were trained. Eighteen participants (75%) commenced the ESI with 16 participants completing at least two sessions and nine completing all six sessions. Retention at four months was 93%. Depressive symptoms reduced slightly at four months, with a slightly larger reduction in the usual care group, although the sample size is too small to draw any conclusions. Interview data reported good acceptability of the ESI and identified barriers associated with implementation of recruitment and study processes within routine pharmacy practice.

Consequences

Community pharmacy represents a new setting for mental health research. This is the first study to demonstrate that pharmacy staff can be trained to deliver a depression prevention intervention. Despite good retention rates and ESI engagement, recruitment was a challenge and this has implications for conducting a definitive RCT. Further research is needed to address recruitment barriers.

Submitted by:

Liz Littlewood

Funding acknowledgement:

This work presents independent research funded by the National Institute for Health Research (NIHR) Public Health Research programme [14/186/11]. The views expressed in this work are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.