As clinical specialists, these pharmacists are in the best position to monitor psychiatric patients, who often have other medical issues and are receiving additional drug therapies.
As psychiatric diagnoses and the accompanying use of complex therapy regimens continue to mount, pharmacists are in an ideal position to help improve outcomes for patients with mental illness.
Megan Maroney“Patients with psychiatric and substance abuse disorders frequently take multiple medications, which increases risk of adverse effects, drug interactions, and poor adherence,” said Megan Maroney, PharmD, clinical assistant professor at Ernest Mario College of Pharmacy and a board-certified clinical pharmacy specialist in Psychiatry at Monmouth Medical Center (MMC), Long Branch, N.J.
Patients with mental illness are also more likely to suffer from cardiometabolic disorders and to have a shorter life expectancy as a result of these conditions. Maroney believes that psychiatric pharmacists are uniquely positioned to collaborate with other healthcare providers and educate patients about risks and benefits of treatment.
The College of Psychiatric and Neurologic Pharmacists (CPNP) has adopted a position statement on the integration of behavioral health and primary care, specifically the inclusion of pharmacists, in the medical home model (http://cpnp.org/govt/position/medical-home-model). The CPNP supports the integration of psychiatric pharmacists into primary care practices to provide comprehensive medication management (CMM) to improve quality of care and patient satisfaction.
Findings of a study published in Pharmacotherapy (December 2014) showed that patients with mental illness had numerous drug therapy problems, including adverse drug reactions, unnecessary medications, high doses, and poor adherence.
Carla Cobb, PharmD, a board-certified psychiatric pharmacist at RiverStone Health Clinic in Billings, Mont., and study author, showed that patients with mental illness benefited when pharmacists delivered CMM to help resolve therapy-related problems.
Patients at RiverStone Health, a federally qualified health center recognized as a patient-centered medical home by the National Committee for Quality Assurance, reported that CMM helped them learn more about their medications and reduced the number of therapies they were taking.
In an effort to improve the care of patients with psychiatric disorders, MMC recently started an integrated health home (IHH) for mentally ill patients. Through this program, uninsured and underinsured patients can benefit from improved access to healthcare through an enhanced case management model.
Working collaboratively with the IHH team, Maroney serves as a pharmacotherapy consultant for patients who are being discharged from the inpatient psychiatric units at MMC and entering the IHH program. She provides medication counseling and transitions-of-care services, such as medication assistance, prior authorizations, and home visits for medication reconciliation and counseling.
“My treatment recommendations are documented in the electronic health record and are available to all IHH team members,” Maroney said.
MMC and Ernest Mario College of Pharmacy have recently hired an ambulatory care psychiatric pharmacist to join the IHH team and provide CMM and medication counseling for patients. Maroney believes that psychiatric pharmacists embrace the concept of multidisciplinary team-based care and help promote patient empowerment in the recovery process.
Maroney also serves as a resource to other clinical pharmacists and provides training for pharmacy students and residents specializing in psychiatry. The psychiatric pharmacy team routinely participates in multidisciplinary rounds, manages individual patient drug regimens, and provides medication counseling in both group and individual settings.
“There is a substantial opportunity for psychiatric pharmacists to enhance the care of patients with mental illnesses,” said Maroney. Healthcare providers and patients with psychiatric disorders can benefit from pharmacists’ expertise in pharmacology, drug interactions, and optimization of medication adherence.
Owing to the prevalence of concurrent medical conditions, patients with psychiatric disorders frequently take other medications, such as mood stabilizers and antidepressant agents, increasing the risk of potential drug interactions. In addition, antidepressant treatments can interact with herbal products, such as St. John’s wort. Pharmacists should be familiar with significant drug interactions, said Maroney, and monitor medications used to treat psychiatric disorders, and should also reinforce the importance of medication adherence with patients.
Monica Shahis a writer and hospital pharmacist in New Jersey.