Role of Clinical Pharmacist in Psychiatry Alam Sher, PharmD, MBA MHC Cl. Pharmacist, Togus VAMC, Augusta, Maine Adj. Assoc. Prof. Pharmacy Practice, MCPHS, Boston, Mass Cl. Assoc. Prof. Family Med. (Psychiatry), UNE Col Of Osteopath Medicine HEC Visiting Scholar, Islamia Uni of Bahawalpur, Pakistan President, NA Sher Foundation for Health, Education & Humanities www.sherfoundation.org - Wikipedia Article: Nasreen & Alam Sher Foundation
Role of Clinical Pharmacist in Psychiatry. Alam Sher, PharmD, MBA MHC Cl. Pharmacist, Togus VAMC, Augusta, Maine Adj. Assoc. Prof. Pharmacy Practice, MCPHS, Boston, Mass Cl. Assoc. Prof. Family Med. (Psychiatry), UNE Col Of Osteopath Medicine - PowerPoint PPT Presentation
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Role of Clinical Pharmacist in Psychiatry
Alam Sher, PharmD, MBA
MHC Cl. Pharmacist, Togus VAMC, Augusta, MaineAdj. Assoc. Prof. Pharmacy Practice, MCPHS, Boston, Mass
Cl. Assoc. Prof. Family Med. (Psychiatry), UNE Col Of Osteopath Medicine
HEC Visiting Scholar, Islamia Uni of Bahawalpur, PakistanPresident, NA Sher Foundation for Health, Education & Humanitieswww.sherfoundation.org - Wikipedia Article: Nasreen & Alam Sher
Foundation
Road Map• Definitions
• Psychiatry / Mental Health• Psychiatric Pharmacist• History of Psychiatric Pharmacy
• Is there a need for it?• What Does a Psychiatric Pharmacist Do?• Psychiatric Pharmacist Skills
• Assessment and Interview Skills• Comprehensive Medication History
• Literature Review• Other Notable References• Q/A
Psychiatry or Mental Health
Psychiatry is devoted to the study and treatment of mental disorders. These mental disorders include various affective, behavioral, cognitive and perceptual abnormalities.
The term was first coined by the German physician Johann Christian Reil in 1808, and literally means the 'medical treatment of the mind' (psych-: mind; from Ancient Greek psykhē: soul; -iatry: medical treatment; from Gk. iātrikos: medical, iāsthai: to heal).
Wikipedia - 2011
The Psychiatric Pharmacist
PharmD with relevant clinical experience in Psychiatry
Additional residency and fellowship in psychiatric medication use
Board certified in psychiatric pharmacyMost work in academics, MH facilities, VAIncreasing interest in the Patient-Centered
Medical Home (PCMH)
C. Cobb and J. McKee of The Col. of Psychiatric and Neurologic Pharmacists (CPNP) - 2011
Brief History of Psychiatric Pharmacy Practice
For over 40 years, some pharmacists have specialized in psychiatric pharmacy
In 1992, the Board of Pharmacy Specialty recognized psychiatric pharmacy as a specialty of pharmacy
As of 2011, there are 627 board-certified pharmacists (BCPP)
In 1998, the College of Psychiatric and Neurologic Pharmacists (CPNP) was founded
The University of Texas Medical Branch at Galveston (UTMB) - CPNP - 2011
Psychiatric Pharmacist Skills
Interview techniquesComfort with patients with mental illnesses and
their familiesMeasurement-based careEvidence-based treatment guidelinesAccess to affordable medicationsPatient medication educationTeam-based careReferral to therapy, support
C. Cobb and J. McKee of The Col. of Psychiatric and Neurologic Pharmacists (CPNP) - 2011
Assessment
Indication for useEfficacySafety – adverse effects, drug
interactionsAdherence Comprehensive Medication
Management
Comprehensive Medication Management DefinedMeet with the patient and family or NOK, if
needed, to help them identify their medication-related goals
Review all medicationsRx, OTC, supplementsCaffeine, tobacco, alcohol, illicit drugsFrom all providersAs they actually take themObtain pertinent vital signs, labs especially UDS, TSH,
Vit. B12, Folate, and Vit. D3
C. Cobb and J. McKee of The Col. of Psychiatric and Neurologic Pharmacists (CPNP) - 2011
Comprehensive Medication Management
Focus on medication useGoal to prevent or identify and resolve
medication-related problemsReferred to as Medication Therapy
Management (MTM) by Medicare Part DSee Patient-Centered Primary Care
Collaborative (PCPCC )Document developed by the Medication Management task force
ReimbursementVaries by statePharmacy schoolsMedicare Part DEmployersMedicaid in some statesNew payment structures???
Medication Management Services: Resource-Based Relative Value Scale
Source: Minnesota Department of Human Services, MHCP Provider Manual, Medication Management Therapy Services, - HIPAA– Compliant MTMS CPT Codes, Revised 1/5/2010. Accessed 11/11
Value
Return on investment varies, average 5:1Improves patient outcomesImproves access to careDecreases resource utilization, admissionsImproves patient satisfactionMay increase drug spend
C. Cobb and J. McKee of The Col. of Psychiatric and Neurologic Pharmacists (CPNP) - 2011
Bond et alIntervention: Drug monitoringPt population: SchizophreniaStudy design: Retrospective chart reviewStudy duration: 1 yearN = 25Results: ↓ in hospital readmissions (42 vs
3), ↓ in AEs reported (38 vs 4), 39% ↓ in fluphenazine dosage requirements, 42% ↓ in anticholinergic use
AE = Adverse EffectBond et al. J Clin Psychiatry 1979;40:501-3.
Brianne Fairchild – BECVAMC, Pa
Gray et alIntervention: Treatment
recommendations b/f clinic visit & education to pts
Pt population: VariousStudy design: Retrospective chart reviewStudy duration: 3 monthsN = 19Results: ↓ in AEs reported (61 vs 20), ↓
of 1.32 meds/pt/month, improvement in pt’s drug knowledge score (53% vs 77%)
Gray et al. Contemp Pharm Pract 1979;2:108-16.Brianne Fairchild –
BECVAMC, Pa
Lobeck et alIntervention: Drug monitoring & weekly
intervention & 2662 visits after)Results: 66% of recommendations were
implemented, very favorable provider response to survey (4.41 on a 1-5 scale), saved $22,241
Lobeck et al. Hosp Commun Psychiatry 1989;40:643-4.Brianne Fairchild –
BECVAMC, Pa
Lee et al600 VA pharmacist recommendations
reviewed
92% were accepted by providers
Improved clinical outcomes in >30%
Avoided harm in 90%
Total cost avoidance = $420,155
Lee et al. Am J Health-Syst Pharm 2002;59:2070-7. Brianne Fairchild – BECVAMC, Pa
ACCP Task ForceEvidence of economic benefit of clinical
pharmacy services: 1996-2000
No. of studies = 59 (12 were VA)
100% demonstrated positive findings
Benefit:cost ratio range = 1.74:1 – 17.0:1 (median = 4.68:1)
Schumock et al. Pharmacotherapy 2003;23:113-32.Brianne Fairchild – BECVAMC,
Pa
Other Notable Publications JH Colman, III, RL Evans and SA Rosenbluth. “Extended clinical roles for the
pharmacist in psychiatric care”; AJHP, 30:1143-1146 (Dec) 1973 KK Roe, JA Doheide, and MZ Wincor. “Developing a Partnership With NAMI
and Psychiatric Pharmacists”; Schizophrenia Bulletin, 28 (3), 2002 N Sanghera, PO chan, ZF Khaki, Claire Planner, KKC Lee, NE Cranswick, and
ICK Wong. “Interventions of hospital Pharmacists in Improving Drug Therapy in Children”; Drug Society 29(11): 1031-1047, 2006
P Tait, and D Hall. “Pharmacy Involvement on a Psychiatric Unit at St. Paul’s Hospital”; The Canadian Journal of Hospital Phramacy, Vol XXXI, Nov-Dec, 1978
GL Ellenor, and BR Dishman. “Pharmaceutical Care Role Model in Psychiatry-Pharmcist Prescribing”; Hosp Pharm, 30(5):371-373, 377-378, 1995
MH Jenkins, and CA Bond. “The Impact of Clinical Pharmacists on Psychiatric Patients”; Pharmacotherapy, 16(4): 708-714, 1996
WA Morton, AR Mendenhall, PG Windsor, B Lydiard. “Clinical Psychopharmacy Cosultations: Acceptance of Recommendations on an Adult Inpatient Psychiatric Unit”; Hosp Pharm, 30(9), 786-790, 1995
CA O’Reilly, JS Bell, and TF Chen. “Pharmacists’ beliefs about Treatment and Outcomes of Mental Disorders: “A Mental Health Literacy Survey”; Aust N Z J Psychiatry 44: 1089-1096, 2010
JE Duga, AA Cardoni, and PG Pierpaoll. “Pharmacists Should Serve on Psychiatric Patients’ Units”; Hospitals, J.A.H.A., 49, Sept 16, 1975
SummaryPharmacist interventions improve:
Better Patient CarePrescribing patterns
↓ the dosage & absolute number of psychotropic drugs
↓ the potential AE burden of the psychotropic agents administered
Access to prescribersCost-EffectivePatient and medication safety
28
For every $1 invested in clinical pharmacy services, more than $4 in benefit is
expected.
.
Schumock et al. Pharmacotherapy 2003;23:113-32.Brianne Fairchild – BECVAMC,