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

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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 Calgary 
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
    • 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 
Resources:
1. MAP-AP Study
  1. MAP-AP Study Protocol
  2. MAP-AP Overview Summary Flowsheet
  3. MAP-AP Overview Video (video-pending)
  4. AHS Calgary Zone Addictions & Mental Health Options brochure
  5. Screening Tool for Participant Recruitment
  6. End of Study Form
 2. Consent forms
  1. Patient Formal Informed Consent Form 
  2. Notification Letter for Physicians 
3. Pre/Post test resources
  1. Presentation Videos Playlist (Videos)
    • Major Depressive Disorder
    • Generalized Anxiety Disorder
    • Switching Medications
    • Managing Adverse effects
  2. Presentations
  3. Presentation topic summaries
4. Other Resources
  1.  MAP-AP Participant Questionnaire
  2. MAP-AP Case report form paper-copy
  3. Generalized Anxiety Disorder 7 Question Monitoring tool (GAD-7) 
  4. Patient Health Questionnaire 9 Question Monitoring tool (PHQ-9)