MAP-AP Study – Mental Health Assessment and Prescribing by Alberta Pharmacists 

Purpose:

MAP-AP tracks and quantifies the impact of community pharmacists (practicing at the
full scope within Alberta) on the management of patients with newly diagnosed Major Depressive Disorder (MDD)
and/or Generalized Anxiety Disorder (GAD), compared to usual care

Setting: 

Community Pharmacies in Alberta

Participants: 

Adult patients with new diagnosis and prescribed medication for the management of
Major Depressive Disorder (MDD) and/or Generalized Anxiety Disorder (GAD)

Study Design: 

Multi-centre randomized controlled trial

This study will last approximately 18 months, with each participant is enrolled for
6 months

Control Group (Standard Care)

• Receives standard care from both physician and pharmacist 

• Pharmacist provides brochure from Alberta Health Services Access Mental
  Health 

• Completes the PHQ-9 and/or GAD-7 questionnaire at enrollment (month 0) and
  prior to their 6 month in-person appointment at the end of study involvement 

Intervention (Pharmacist Full Scope Interventions) 

• Same as Control group but may receive additional pharmacist involvement,
  which may involve: 

  • Pharmacist-initiated clinical assessment

  • Identification of adverse drug effects, drug interactions, or severe
    deterioration (i.e. suicide attempt)

  • Pharmacist-initiated drug dose adjustments, discontinuation of
    medication, or prescribing adjunctive therapy

  • Pharmacist-initiated collaboration with prescribing physicians
    regarding medication therapy

  • Medication counselling and educational support

  • Pharmacist-initiated interim follow-up interviews with patients over
    the telephone/telehealth and/or in person

  • Discussion with the prescribing physician to facilitate patient
    referral to non-pharmacotherapy management resources (e.g. psychologist) 

• Completes the PHQ-9 and/or GAD-7 questionnaire at enrollment (month 0),
  month 1, month 3, and prior to their 6 month in-person appointment at the end of study
  involvement 

Outcomes

• Primary Outcome is the mean score difference in PHQ-9 and GAD-7
  scores from baseline to end of study participation between the intervention and control groups
  

• Secondary Outcomes:

• • Difference in proportion of participants achieving clinically
    significant treatment response for PHQ-9 and /or GAD-7 between groups at the end of study
    period 

  • Difference in proportion of participants achieving remission for
    PHQ-9 and /or GAD-7 between groups at the end of study period 

  • Difference in proportion in self-reported safety concerns during the
    study period between groups

Rationale:

• Stigma still presents as a major barrier to accessing care for mental health
  disorders

• Bloom Program piloted in Nova Scotia revealed positive patient benefits when
  community pharmacists are able to practice to their full scope for patients with mental health
  conditions–highlighting greater collaborative practice and comprehensive support for patients 
  

• Alberta pharmacists operate with the most expansive scope of practice in
  Canada, including additional prescribing authority (APA) and lab monitoring–which places community
  pharmacists in a unique position to expand their involvement in the management of patients with MDD and
  GAD

Research Team

Primary Investigators 

• Dr. Yazid Al Hamarneh, BSc (Pharm), PhD, CDM, Department of Medicine
  

  •  yazid.alhamarneh@ualberta.ca (780) 492-9608

• Dr. Matt Chow, BSc Pharm, BSc Biology, PharmD, Alberta Health
  Services

  • mchow1@ualberta.ca 
    (587) 999-0778

Resources:

1. MAP-AP Study	MAP-AP Study Protocol MAP-AP Overview Summary Flowsheet MAP-AP Overview Video (video) Alberta Health Services Zone Map Alberta North Zone – Important Contact Information Alberta Edmonton Zone – Important Contact Information Alberta Central Zone – Important Contact Information Alberta Calgary Zone – Important Contact Information Alberta South Zone – Important Contact Information Screening Tool for Participant Recruitment End of Study Form
2. Consent forms	Patient Formal Informed Consent Form  Notification Letter for Physicians
3. Pre/Post test resources	Presentation Videos Playlist (Videos) Major Depressive Disorder Generalized Anxiety Disorder Switching Medications Managing Adverse effects Presentations Major Depressive Disorder Generalized Anxiety Disorder Switching Medications  Managing Adverse effects Presentation topic summaries Major Depressive Disorder Generalized Anxiety Disorder  Switching Medications Managing Adverse effects
4. Other Resources	MAP-AP Participant Questionnaire MAP-AP Case report form paper-copy Generalized Anxiety Disorder 7 Question Monitoring tool (GAD-7)  MDCalc Online Resource Patient Health Questionnaire 9 Question Monitoring tool (PHQ-9) MDCalc Online Resource MAP-AP Standard Operating Procedures Playlist (Videos) MAP-AP Study–Standard Operating Procedures MAP-AP Study–Redcap walkthrough SwitchRX