The field of psychiatric pharmacy has continuously advanced for the past few decades with origins dating back to the 1960s and 1970s.1 Historically, psychiatric pharmacists practiced in traditional settings such as private or academic hospitals, Veteran's Affairs hospitals, mental health clinics, pharmaceutical industry, and academia. However, psychiatric pharmacists' training and expertise in neuropsychiatric medications make them ideally suited to work in a wide variety of clinical settings. Their pharmacotherapy knowledge regarding both medical and psychiatric medications allows them to proficiently serve in capacities unique among healthcare professionals. At present, there are over 1500 members of the College of
A board-certified psychiatric pharmacist is an ideal clinician to manage medication needs for patients being treated for chronic hepatitis C virus infection. Underlying psychiatric symptoms should be managed before initiating medications such as interferons-therapeutic biologicals associated with causing psychiatric adverse events, including suicide. The role of a psychiatric pharmacist in a hepatitis C liver clinic highlights the value of a psychiatric pharmacist providing direct patient care and improving the quality of healthcare services in a subspecialty practice model.
Community Care of North Carolina (CCNC) is a state-wide public/private partnership, primarily serving North Carolina (NC) Medicaid recipients, which focuses on the Primary Care Medical Home model of care. The CCNC Behavioral Health Pharmacy Coordinator has a leadership role for the direction and management of Behavioral Health Initiative (BHI) pharmacy projects, while other CCNC clinical pharmacists work in a variety of settings and help to implement and support those BHI projects. CCNC clinical pharmacists also perform medication management in all settings, help to implement the NC Medicaid Preferred Drug List (PDL), support the care managers, and are involved with the transitional care (TC) process. Transitional care medication management focuses on the identification of medication list discrepancies after discharge from an acute care facility. Patients receiving TC were 20% less likely to return to the hospital in the coming year. We observed the same trend even when looking specifically at those patients who were discharged from a psychiatric unit (Wilcoxon-Gehan statistic = 21.22, p<.0001). It is the goal of the CCNC behavioral health team to provide practicing pharmacists (those directly supported by CCNC and those collaborating with CCNC) with the tools to continue serving populations with behavioral health issues.
With the rapid growth of medication information and increased demands on healthcare practitioners, efficiently finding answers to clinical questions is of great importance. Working for a medical information services and publishing company is a unique pharmacy practice setting that aims to help improve global healthcare outcomes by efficiently delivering answers to clinical questions during a healthcare practitioner's normal work-flow. This practice setting is well-suited for pharmacists with strong interests in medical writing, research, evidence-based medicine, and informatics.
Typical services for psychiatric pharmacists include inpatient psychiatry units and outpatient psychiatry clinics. An increasingly common portal of entry to psychiatric hospitals, however, is the emergency department (ED). We describe a new clinical pharmacy service for psychiatric patients in the ED at our institution.
Transitions of care in services within and between organizations are a potential source of medication-related problems. These include errors in medication reconciliation, which can lead to patient misunderstanding regarding their medication regimen. Health systems have increasingly focused on improving transitions of care to enhance patient outcomes and decrease the risk of adverse events and/or hospital readmissions. The clinical pharmacy team of the Virginia Garcia Memorial Health Center (VGMHC) collaborated with the pharmacy department and discharge planners of a local community hospital. The goal of this collaboration was to streamline the transition of care between the two organizations for new referrals of uninsured, complex patients that were recently hospitalized and needing to establish care with a primary care provider at a federally qualified health center. This article will further describe the process of collaboration between a local community hospital and a federally qualified health center targeting a specific population for transitions of care.
Treatment of mental illnesses has slowly shifted to primary care settings over the past decade. As more patients are identified as needing treatment for a mental illness, the availability of behavioral health (BH) practitioners has become more strained, leading to this shift towards primary care treatment. With more patients receiving psychiatric health care from their primary care providers (PCP), a need for dedicated BH practitioners within the primary care setting was developed. This article describes a novel program where a clinical psychiatric pharmacist is utilized as the primary psychiatric provider within an integrated BH program of a busy primary care clinic in a major metropolitan area. Working under a collaborative practice agreement to prescribe, the pharmacist acts as the initial BH contact for the clinic, as well as a liaison between primary care and BH. Patients referred to the pharmacist from primary care are then evaluated and appropriate medication prescribed for their illness. Most patients are followed prospectively by the pharmacist, with more complex patients (i.e., those not appropriate for primary care-based BH treatment) referred to the BH clinic for follow-up care. The pharmacist serves on the intake committee for the BH clinic, and facilitates patient referrals to their clinicians. Preliminary analysis of the program's effectiveness shows positive results. Within the first two months of the program, 28 patients were referred to the pharmacist (including five referred by BH clinic therapists through primary care). Most patients were referred for depression or anxiety, with attention deficit hyperactivity disorder, substance abuse, bipolar disorder, and psychosis also being treated. As such, antidepressants and anxiolytics were the most common agents prescribed, but most every class of psychotherapeutic agents was utilized. Patient wait times to meet with the pharmacist were generally less than a week, with exceptions being found for patients already being prescribed a psychotherapeutic agent by their PCP and being referred to the pharmacist for follow-up care, or for patients being referred by their existing therapist. Initial reviews of the program by patients, primary care staff, and BH staff have been positive, especially in regards to patient access to specialized BH services.
Mental health is intrinsically linked to general medical health. People with severe and persistent mental illnesses (SPMIs) have been reported to have higher rates of infectious diseases, type 2 diabetes, respiratory illnesses, and cardiovascular disease. They also have 1.5 to 2 times the prevalence of dyslipidemia, hypertension, and obesity than the general population. Healthcare Homes (HCHs) are an integrated treatment approach allowing for psychiatric and medical conditions to be addressed collaboratively. The HCH model promotes open communication among healthcare providers, wellness education, and preventative care. Physicians and nurses are mandatory providers within the HCH. Pharmacists are not routine members of this new approach to care. This article will describe an example of how psychiatric pharmacy services have been incorporated into a HCH. It also calls for advocacy within the specialty of psychiatric pharmacy in an effort to encourage state and government policy changes that mandate the addition of pharmacists into the HCH model of care.
Introduction
This study analyzed patient satisfaction survey responses in which patients evaluated their experience with the pharmacy staff in an acute psychiatric unit.
Methods
Thirty-one patients rated pharmacy services upon discharge by completing a 13-item survey.
Results
Overall patient satisfaction was found to be high with a 77.4–100% satisfaction rating reported on every survey item.
Discussion
Results indicated that the pharmacy staff should focus their efforts on improving communication with patients by selecting a quiet meeting location and by making themselves more accessible to patients in order to better serve their needs.
Background: Post-Traumatic Stress Disorder (PTSD) is a syndrome that can emerge after exposure to a traumatic event. In the veteran population, the strongest predictor of developing PTSD is frequency and intensity of direct combat exposure. The 2010 Veterans Affairs (VA)/Department of Defense (DoD) guidelines for the treatment of PTSD published in 2010 recommend psychotherapy techniques and/or pharmacotherapy (selective serotonin reuptake inhibitor or venlafaxine) as initial management.
Objective: This study aimed to determine whether Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) veterans received treatment for PTSD in concordance with VA/DoD guidelines.
Methods: A retrospective chart review was conducted for 400 patients at the South Texas Veterans Health Care System (STVHCS) with OEF/OIF service who had a PTSD-related encounter between September 1, 2011 and August 31, 2012. The primary outcome was the percentage of OEF/OIF veterans with PTSD who received treatment in concordance with VA/DoD guidelines. Secondary outcomes included length of time veterans waited to see mental health (MH) providers, and comparison of outcomes between patients who received evidence-based treatment to those that did not.
Results: Two-hundred and seventy-nine patients met the inclusion criteria and the majority of patients (n = 183, 65.5%) received treatment consistent with the VA/DoD Guidelines. The overall median wait time to see a MH provider was 10 +/−26.64 days, and did not differ significantly between groups. Patients whose treatment did not follow guideline recommendations had statistically more psychiatric emergency department (ED) visits (10 vs. 17, p=0.0026).
Conclusions: The majority of patients at the STVHCS received treatment for PTSD in concordance with the VA/DoD guidelines, and 67.7% of patients saw MH providers within 14 days. Patients who did not receive guideline-supported treatment had more frequent ED visits, but the reason for this is unknown and may be due to a number of factors not accounted for in this review. The number of ED visits may be reduced by fully utilizing the processes in place that work to improve veteran access to MH care and the provision of guideline-based treatment. Prospective studies are needed to clearly elucidate the factors that may impact whether or not patients receive recommended treatment.