Mental health support for the most vulnerable

Starting a new mental health medication isn’t always easy. You need to remember when to take it. You may deal with side effects. Improvement may be slow.

So, you might give up. And your condition can worsen.

But then, your pharmacist calls. She asks how you’ve been. You tell her what’s wrong. She guides you through managing your side effects and explains that it may take a month or two to feel better. She signs you up for free same-day prescription delivery. You are encouraged to call back at any time with concerns.

Luckily, your store is part of the Chicago Health Equity Incubator program. Launched in August 2020, the pilot program was designed to remove adherence barriers, provide education to empower and support patients, and reduce health disparities in communities by opening direct lines of communication between pharmacists and patients.

Making mental health support a priority

Since launch, the program has expanded to 18 stores on the South and West Sides of Chicago. As of July 2022, the Health Equity pilot was further expanded and launched in select Walgreens pharmacies across Texas, Arizona, Nevada and New Mexico, for a total of nearly 50 pharmacies offering proactive mental health support to patients.
 
The incubator moved from its first phase, where outreach concentrated on prescription management for patients living with diabetes and asthma, to its second phase in July 2022, when a mental health wellness check for patients new to mental health prescription therapy was added to the program. The pharmacies involved are situated in underserved areas where mental health disparities may be worse due to institutional racism, health insurance access and coverage, inadequate care and treatment and cultural acceptance, among other social determinants of health.
 
“Throughout COVID-19, certain chronic conditions have affected underserved populations disproportionately, and that's no different with mental health,” says Giang Tran, behavioral health program manager, health equity strategy at Walgreens. “But conversations around mental health often don’t happen in underserved communities. They have less access to resources available to them to make healthcare a priority. As a licensed professional therapist myself, I can attest to how difficult it can be to navigate the mental health system.”

Through Walgreens mental health wellness check initiative, pharmacists outreach to patients who have been prescribed select mental health medications. The initial outreach is made shortly after the patient begins their prescription with additional outreach and follow up after a specific timeframe in which the medication should have begun to take effect.

“The ability to educate our pharmacists and have that foundational trust and knowledge of mental health is so important and valuable to our patients who can receive accurate and correct resources and guidance,” says Tran.

The impact so far

Danielle Cameau, pharmacy manager on the West Side of Chicago, has found that these wellness checks open the door to access and adherence issues that can be solved with advice from a pharmacist.

“This is when we can probe and see what barriers are keeping them from successfully taking their medications,” says Cameau, in reference to the 45-day mental health consults. “I had a patient who was skipping doses and told me they would double up the next day. So that’s when it comes to the deep dive, and I ask why they skip doses, and they say it’s forgetfulness or side effects like an upset stomach. So, I can remind them of the correct dosing schedule and remind them to take it in the morning with breakfast or set an alarm or to take it with other medications. And then we begin to find solutions to some of these issues.”

Between July and December 2022, more than 1,200 wellness checks were made 45 days post pick-up across Chicago-area pharmacies, many of which were with women and patients who are beneficiaries of Medicare Part D and Medicaid. Of the patients who received a 45-day outreach call, they were more likely to refill their medication when due and did so within fewer days than patients who did not receive an outreach call. The proportion of patients in the initiative who refilled their medications within seven days of the outreach call rose by 8.7%.

Patients who received a call were also more likely to pick up their mental health medication sooner, within approximately five days of the call, a significant increase over patients who did not receive a wellness check.
 

Breaking down barriers and planning for the future

Another benefit of the mental health wellness checks is that they allow pharmacists to identify non-medical barriers to medication access and adherence.  Free same-day delivery is an offering through the broader Chicago Health Equity Incubator program that pharmacists can leverage if the wellness check reveals that patients would be unable to pick up medications and those medications are eligible for delivery.

“The major barrier in getting patients their medication is transportation,” remarks Cameau. “We have a large elderly population, and they don’t always have a family member or neighbor who can get their meds for them. They love this delivery service because it’s one less thing they have to worry about—because money for the bus or a taxi can be a big factor. This service is a blessing for a lot of people.”

As the mental health wellness check program for new-to-therapy patients continues to grow across additional states, the goal is to continue analyzing data to explore how patient outcomes can improve and what other conditions may be included. Expansion planning to include additional pharmacies in this initiative is in progress, with specific focus on pharmacies supported by Walgreens microfulfillment centers, where pharmacists’ have more time freed up to focus on proactive patient outreach. Cameau, for one, looks forward to the initiative’s expansion, as she has observed only positive reactions from patients since opening up more lines of communication.

“A lot of people are shocked when we call,” she says. “And then it lets them know that we care. It’s not that they just get their medication and then we forget about them. I've noticed some patients will be on a medication but not fully understand why they're taking it or what they're taking. And that's when I can educate them. Because once a patient is knowledgeable about their medications, they are empowered to continue taking their medications. It prevents rehospitalizations, it builds rapport and addresses barriers. Everyone has been very receptive, and I’m happy for it.”