(B-052) Intervention Mapping-based Development of a Pharmacist-led Intervention to discontinue Chronic Antidepressant Use

Background: In significant numbers of patients the in principle finite treatment of depression with an antidepressant (AD) results in chronic AD use. Discontinuation, however, is a complex and often long-term process since patients not only have to be made aware of their chronic AD use and its consequences but it also requires drawing up patient-tailored AD discontinuation schedules. Although a multidisciplinary guideline is available, it remains challenging for many HCPs to perform an AD discontinuation intervention. This study describes the systematic development of a pharmacist-led intervention to improve AD discontinuation care.

Objectives: To develop an intervention including a systematic workflow for pharmacists, in collaboration with general GPs and psychiatrists, to support patients to discontinue chronic AD use.

Methods: Intervention development was guided by the Intervention Mapping approach. First, a scoping review was performed to assess the determinants of the challenges, i.e. the needs of patients, pharmacists, GPs/psychiatrists and associated nurse-practitioners. Second, intervention objectives were discussed within an expert group. Step three concluded the design of program content tools and step four the design of practical tools.

Results: Major barriers to starting an intervention for AD discontinuation largely consist of poorly defined responsibilities between the different HCPs with regard to the identification, invitation and support of patients. They can be addressed by providing tools that can facilitate HCPs in performing the intervention and developing a model collaboration protocol.
The systematic workflow for pharmacists relates to the invitation and support of patients with chronic AD use. For their identification, a protocol for a systematic search in the pharmacy information system was developed. For inviting patients a standardized letter and a protocol for subsequent telephone conversations were developed. Patient support materials include: a topic list for the intake and follow-up consultations, a relapse prevention plan, conversation techniques and a set of basic AD discontinuation schedules. To support the implementation, promotion materials including a flyer and a poster as well as training were designed.
The HCP collaboration protocol describes shared patient counselling, responsibilities, the allocation of tasks, communication and support activities in case of withdrawal symptoms or relapse.

Conclusions: A pharmacist-led intervention was developed to initiate and complete the process of AD discontinuation. Performing the intervention is facilitated by a number of pharmacy support tools and a protocol for HCP collaboration. The next step is to test the feasibility of the intervention in daily practice.