The Role of Clinical Pharmacists in Outpatient Psychiatric Clinics

1. The Role of Clinical Pharmacists in Outpatient Psychiatric Clinics Mary A. Gutierrez, Pharm.D., BCPP Associate Professor of Clinical Pharmacy University of Southern California School of Pharmacy Clinical Pharmacist Medication Follow-up & Education Clinic Veterans Affairs Dual Diagnosis Treatment ProgramVA Medical Center, Brentwood, CaliforniaNAMI Annual National Convention 2007

2. Dual Diagnosis Treatment Program (DDTP)Medication Follow-up and Education Clinic USC School of Pharmacy faculty (BCPP) with students running 3x/week Medication Follow-up & Education Clinic (one on one basis) Weekly education groups for 40-50 DDTP patients  open forum for any questions regarding their medications (benefits vs. risks) and symptoms

3. Medications Follow-up  Unidentified Problems Current medications’ efficacy  “better, but…” Side effects  don’t ask, don’t tell…noncompliance No renewal of Rx after no refills left  missed meds Rx for twice a day  daytime sedation or insomnia Doses started too highintolerable ADRsstop meds Drug interactions  incr’d ADRs or decr’d efficacy

4. Lab Results Follow-up  Unidentified Problems Metabolic syndrome  atypical antipsychotics Macrocytic anemia  chronic alcoholic consumption Electrolytes changes  antihypertensiveseffects Increased symptoms  positive urine drug tests Hepatitis  hepatitis screenings Increased ADRs  impaired renal or hepatic function

5. Patient Education  Improved Clinical Outcomes Progress notes “good baseline, renew meds” for years …but still have symptoms  education on treatment options & how to report their symptoms Sexual side effects “It must be my medications!” …stopped all medications  education regarding sexual dysfunction, R/O other possible etiologies Years of “hand me down” diagnoses from resident to resident in teaching hospitals  education on history of symptoms & R/Os for diagnoses

6. Patient Ed Tools  Improved Clinical Outcomes Provide index cards with patients’ current meds, dosing schedule, and indications  better understanding of medications use  less chances of missing renewal of Rx  easier to assess potential drug interactions for any new Rx from multiple prescribers  avoid duplicate meds for same indication  avoid dispensing errors by staff Patient education information from NAMI, NIMH, etc.

7. “Outcomes of Pharmacists’ Interventions in Psychiatric Outpatients” Gutierrez M, Holloman L, Lee E. Study designed to assess the impact of clinical pharmacists interventions in improving patient outcomes by optimizing drug therapy (N = 11) Results showed that 7 patients with recommendations implemented showed significant improvement in their medical/ psychiatric conditions. Two patients with recommendations not accepted  symptoms worsened (1 hospitalized) Received one of the Top Ten Awards for the 2000 National Hospital Pharmacy Quality Award

8. “Outcomes of Pharmacists’ Interventions in Psychiatric Outpatients” Recommendations Most common (29%) – d/c unnecessary meds! 26% – increase doses of medications (subtherapeutic) 18% – change meds d/t lack of efficacy or high ADRs 11% – change dosing schedules to minimize ADRs 8% – decrease doses (minimum effective doses) 8% – add new meds for untreated conditions