Depression service pilot gets approval from first patients
Against the background of a challenging couple of years for capacity and workforce, 74 pharmacies have so far gone live in the NMS pilot service looking at extending the service to depression. Thirty are currently active in seeing patients.
Speaking at the Pharmacy Show on Monday, NHS England national pharmacy integration lead Hammaad Patel said 193 confirmed patients had entered the service by the end of September. Of these, at least 147 had received an intervention, 91 completed the follow-up stage and 15 had taken up the offer of an additional, later, follow-up. Numbers will increase with the pilot ongoing.
“At each stage, patients are being escalated back to the prescriber where there is a medicines-related issue” Mr Patel said. “Reported adherence increases at each stage.” He said that 60 per cent of patients report using the medicine as prescribed with no issues at the intervention stage, while 21 per cent are using the medicine but with some outstanding concerns or potential side effects. Of those receiving the second, later, follow up, these numbers had changed to 80 per cent and 7 per cent respectively.
Consultation times were a particular concern for community pharmacists before commencing the pilot service, he said. “The majority of consultations in the engagement, intervention, follow up or additional follow up stages, were less than 10 minutes, and the maximum time was 25 minutes.” Further work is planned on how different demographic profiles move across the pathway, drop-out rates, and whether prescribing rates change across the course of the pilot.
Early qualitative analysis shows generally positive views from service users in improving knowledge of what to do with medicines prescribed for them, although there are concerns about whether pharmacists had the time to provide the service. “Patients like the idea of having an extra person in a community pharmacy checking up on them, taking the time to address ideas and expectations they might have about a medicine and supporting them in their initial journey.” Mr Patel said. “The practical information on managing side effects was useful.“
Pharmacists feel there is a lot more they can do to support patients newly prescribed antidepressants, and there is more to say about side-effects and their impact on medicines taking. “They feel the service offers tangible benefits to patients, and preconceived ideas about the time to provide the service was easily overcome,” Mr Patel said. While some pharmacists reported conversation veering outside the bounds of the NMS, none felt out of their depth.
While the core of the NMS service is retained in the pilot, given the specific characteristics of the medicines for depression, the timing of the intervention and follow up stages have been tweaked and there is the option of an additional follow up at around 140 days.
The main routes into the service are the same, but the pilot builds in opportunities for increased referrals from hospitals via the Discharge Medicine Service (DMS), and greater signposting by third sector organisations, which are particularly important in a therapy area like depression. With increasing awareness of the NMS through charities, Mr Patel said more people will use the service..
The pilot which includes the SSRIs, as well as mirtazapine and dulotexine, involves clusters of pharmacies (of mixed contractor types) to provide opportunities for collaborative working and peer support. Areas were chosen based on factors such as deprivation and rurality, those with high antidepressant prescribing and those furthest ahead with mental health transformation.