Academic journal article Current Psychiatry

Opportunities to Partner with Clinical Pharmacists in Ambulatory Psychiatry: Clinical Pharmacists Can Play a Vital Role in Ambulatory Psychiatry, This Model Reveals

Academic journal article Current Psychiatry

Opportunities to Partner with Clinical Pharmacists in Ambulatory Psychiatry: Clinical Pharmacists Can Play a Vital Role in Ambulatory Psychiatry, This Model Reveals

Article excerpt

In this article, we highlight key steps that were needed to integrate clinical pharmacy specialists at an academic ambulatory psychiatric and addiction treatment center that serves pediatric and adult populations. Academic stakeholders identified addition of pharmacy services as a strategic goal in an effort to maximize services offered by the center and increase patient access to care while aligning with the standards set out by the patient-centered medical home (PCMH) model.

We outline the role of clinical pharmacists in the care of adult patients in ambulatory psychiatry, illustrate opportunities to enhance patient care, point out possible challenges with implementation, and propose future initiatives to optimize the practitioner-pharmacist partnership.

Background: Role of ambulatory pharmacists in psychiatry

Clinical pharmacists' role in the psychiatric ambulatory care setting generally is associated with positive outcomes. One study looking at a collaborative care model that utilized clinical pharmacist follow-up in managing major depressive disorder found that patients who received pharmacist intervention in the collaborative care model had, on average, a significantly higher adherence rate and patient satisfaction score than the "usual care" group. (1) Within this study, patients in both groups experienced global clinical improvement with no significant difference; however, pharmacist interventions had a positive impact on several aspects of the care model, suggesting that pharmacists can be used effectively in ambulatory psychiatry.

Furthermore, a systematic study evaluating pharmacists' impact on clinical and functional mental health outcomes identified 8 relevant studies conducted in the outpatient setting. (2) Although interventions varied widely, most studies focused on pharmacists' providing a combination of drug monitoring, treatment recommendations, and patient education. Outcomes were largely positive, including an overall reduction in number and dosage of psychiatric drugs, inferred cost savings, and significant improvements in the safe and efficacious use of antidepressant and antipsychotic medications.

These preliminary positive results require replication in larger, randomized cohorts. Additionally, the role of the pharmacist as medication manager in the collaborative care model requires further study. Results so far, however, indicate that pharmacists can have a positive impact on the care of ambulatory psychiatry patients. Nevertheless, there is still considerable need for ongoing exploration in this field.

Pre-implementation

The need for pharmacy services. Various initiatives and existing practices within our health care system have underscored the need for a psychiatric pharmacist in the outpatient setting (Table 1).

Table 1

System initiatives, opportunities for involving the pharmacist in psychiatry care

Highlighting quality, including optimizing metabolic monitoring for patients treated with an atypical antipsychotic, as well as other best-practice issues

Optimizing transition of care to primary care providers and other specialists Providing additional support and resources for psychiatry patients and for non-psychiatric providers

Fostering team-based care

Integrating care

Showcasing successful use of pharmacists in the patient-centered medical home model

Involving pharmacists in education of psychiatry residents

Note: This list is not exhaustive: it was thought that these initiatives in particular would most likely benefit from Involvement of a pharmacist

Clinical Point

Results so far indicate that pharmacists can have a positive impact on the care of ambulatory psychiatry patients

Clinical Point

Collaborative care models appear to offer the best hope for managing demand for medical services

A board-certified psychiatric pharmacist (BCPP) possesses specialized knowledge about treating patients affected by psychiatric illnesses. …

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