0
Experience
Development of a pharmacist–psychiatrist collaborative medication therapy management clinic
Kimberly B. Tallian; Jan D. Hirsch; Grace M. Kuo; Cathy A. Chang; Todd Gilmer; Mindl Messinger; Pauline Chan; Charles E. Daniels; Kelly C. Lee
J Am Pharm Assoc (2003) 2012;52:e252-e258. doi:10.1331/JAPhA.2012.11215

Abstract

Objective  To describe a needs assessment, practice description, practice innovation and reimbursement of a psychiatric pharmacist medication therapy management (MTM) clinic with related challenges and opportunities.

Setting  An MTM clinic established in collaboration with the Outpatient Psychiatric Services (OPS) at the University of California San Diego (UCSD), under contract with the San Diego County Health and Human Services Agency Adult and Older Adult Mental Health Services (A/OAMHS).

Practice description  Two board-certified psychiatric pharmacists provided direct patient care using a collaborative practice protocol 3 days per week. Clinical services included pharmacotherapy management, laboratory monitoring, medication counseling, and psychosocial referrals to other providers.

Practice innovation  Payment to UCSD OPS for clinical services was based on a contract between the San Diego County A/OAMHS and the clinic. Two pharmacists co-managed mental health patients and billed for medication management based on face-to-face contact time (medication minutes) and documentation time with each patient.

Main outcome measures  Number of patients comanaged, dropout rates, visit duration, and billed minutes.

Results  From May 2009 to December 2010, two pharmacists comanaged 68 patients, mean (± SD) age 48.6 ± 11.6 years,  diagnosed with major depressive, schizophrenic, schizoaffective, and/or bipolar disorder. A total of 56 (82.3%) patients were clinically stable and remained on the pharmacist caseload, but 12 (17.6%) patients were lost to follow-up (10 lost contact, 1 moved, 1 expired). On average, patients had 7.7 patient visits , for 491 total visits (with an average of 26 minutes per visit) that were billed at a rate of $4.82 per minute for medication minutes, translating to $84,542.80.

Conclusion  With provider education and appropriate physician champions, pharmacists are able to work collaboratively with psychiatrists in a mental health clinic.

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References

Kessler RC, Chiu WT, Demler O, et al .  Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication.  Arch Gen Psychiatry .  2005; 62: 617– 27. [PubMed]
 
American Psychiatric Association.  Task Force on DSM-IV. Diagnostic and statistical manual of mental disorders: DSM-IV-TR. 4th ed.  Washington, DC:  American Psychiatric Association;  2000.
 
Substance Abuse and Mental Health Services Administration.   Prevalence of serious mental illness among U.S. adults by age, sex, and race. Accessed at www.nimh.nih.gov/statistics/SMI_AASR.shtml,  November 13, 2012.
 
Brown S, Inskip H, Barraclough B.  Causes of the excess mortality of schizophrenia.  Br J Psychiatry .  2000; 177: 212– 7. [PubMed]
 
American Diabetes Association, American Psychiatric Association, American Association of Clinical Endocrinologists, North American Association for the Study of Obesity.   Consensus development conference on antipsychotic drugs and obesity and diabetes.  Diabetes Care.  2004; 27: 596– 601. [PubMed]
 
APhA Foundation.  Medication therapy management in pharmacy practice: core elements of an MTM service model (version 2.0).  J Am Pharm Assoc.  2008; 48: 341 –53.
 
Vanina Y, Podolskaya A, Sedky K, et al.  Body weight changes associated with psychopharmacology.  Psychiatr Serv.  2002; 53: 842– 7. [PubMed]
 
Cranor CW, Bunting BA, Christensen DB.  The Asheville Project: long-term clinical and economic outcomes of a community pharmacy diabetes care program.  J Am Pharm Assoc.  2003; 43: 173– 84.
 
Cranor CW, Christensen DB.  The Asheville Project: short-term outcomes of a community pharmacy diabetes care program.  J Am Pharm Assoc.  2003; 43: 149– 59.
 
Finley PR, Crismon ML, Rush AJ.  Evaluating the impact of pharmacists in mental health: a systematic review.  Pharmacotherapy.  2003; 23: 1634– 44. [PubMed]
 
Caballero J, Souffrant G, Heffernan E.  Development and outcomes of a psychiatric pharmacy clinic for indigent patients.  Am J Health Syst Pharm.  2008; 65: 229– 33. [PubMed]
 
Bagchi AD, Esposito D, Verdier JM.  Prescription drug use and expenditures among dually eligible beneficiaries.  Health Care Financ Rev.  2007; 28: 43– 56. [PubMed]
 
   Medco Report.    America's state of mind. Accessed at  apps.who.int/medicinedocs/documents/s19032en/s19032en.pdf,     January 10, 2012.
 
Chung B, Dopheide JA, Gregerson P.  Psychiatric pharmacist and primary care collaboration at a skid-row safety-net clinic.  J Natl Med Assoc.  2011; 103: 567– 74. [PubMed]
 
Jenkins MH, Bond CA.  The impact of clinical pharmacists on psychiatric patients.  Pharmacotherapy.  1996; 16: 708– 14. [PubMed]
 
Poisal JA, Truffer C, Smith S, et al.  Health spending projections through 2016: modest changes obscure part D's impact.  Health Aff (Millwood).  2007; 26: w242– 53. [PubMed]
 
Shin C, Pham Q, Chang D, et al .  Medication therapy management in mental health. In:  UCSD Skaggs School of Pharmacy and Pharmaceutical Sciences Research Symposium .  La Jolla, CA; 2009.
 
Messinger M, Chang C, Lee KC, Hirsch JD.  Evaluation of primary care integration with mental health care within a county-supported outpatient psychiatric clinic.  Pharmacotherapy.  2009; 29: 1723.
 
Chang C, Messinger M, Hirsch JD, Lee KC.  Evaluation of antipsychotic polypharmacy within county-supported outpatient psychiatric clinic.  Phamacotherapy.  2009; 29: 1273.
 
2011 Lawbook for Pharmacy.  Scope of Practice, Number 4052. Accessed at www.pharmacy.ca.gov/laws_regs/lawbook.pdf ,  November 13, 2012.
 
Guy W.    ECDEU Assessment Manual for Psychopharmacology (DHEW publication no. ADM 76–338).  Rockville, MD:  U.S. Department of Health, Education, and Welfare;  1976 : 218– 22.
 
Guy W.  US Dept Health, Education and Welfare publication (ADM). In:  Assessment Manual for Psychopharmacology.  Rockville, MD:  National Institute of Mental Health;  1976: 76– 338.
 
Hogan TP, Awad AG, Eastwood R.  A self-report scale predictive of drug compliance in schizophrenics: reliability and discriminative validity.  Psychol Med.  1983; 13: 177– 83. [PubMed]
 
Fisher DG, Pilon D, Hershberger SL , et al.  Psychometric properties of an assessment for mental health recovery programs.  Community Ment Health J.  2009; 45: 246– 50. [PubMed]
 
 San Diego pharmacist median salary. Accessed at http://swz.salary.com/SalaryWizard/Pharmacist-Salary-Details-San-Diego-CA.aspx,  January 11, 2012.
 
Lobeck F, Traxler WT, Bobinet DD.  The cost-effectiveness of a clinical pharmacy service in an outpatient mental health clinic.  Hosp Community Psychiatry.  1989; 40: 643– 5. [PubMed]
 
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