Implementation of a collaborative practice agreement for depression and anxiety in the primary care setting

Background

There is a lack of appropriate access to mental health care in the United States, particularly in the underserved community. Data show that individuals living below the poverty level are 2.5 times more likely to develop depression and similar trends have been reported for anxiety. However, socioeconomic status and these conditions are not mutually exclusive and occur throughout the general population. To expand patient access, a collaborative practice agreement (CPA) for major depressive disorder (MDD) and generalized anxiety disorder (GAD) was developed and implemented within a network of primary care clinics.

Objectives

This study aimed to (1) describe the development of a pharmacist-led CPA for MDD and GAD within an outpatient primary care clinic and (2) describe the growth of the depression and anxiety CPA service after implementation.

Methods

This intervention was completed at a network of 7 primary care clinics associated with a large academic medical center in Columbus, Ohio. A CPA for MDD and GAD was created and implemented in November 2021. An electronic health record–generated report was used to identify patients for which a referral to pharmacy for MDD or GAD was placed between November 1, 2021, and March 1, 2023. A retrospective chart review was used to collect information to describe the growth of the service. Data were analyzed using descriptive statistics.

Results

A total of 308 patients were appropriately referred to the pharmacist-led service for MDD and GAD between November 1, 2021, and March 1, 2023. Of the patients who established care with the pharmacist, 35% (54 of 155) experienced improvement in symptoms and 29% (45 of 155) achieved remission.

Conclusion

The implementation of a pharmacist-led CPA for MDD and GAD in a primary care setting improved patient access to pharmacotherapy management for depression and anxiety.