Austin Campbell, PharmD, BCPP
Clinical Pharmacy Specialist – Psychiatry
University of Missouri Health Care
As the health care environment continues to adapt and grow, more and more services are being provided through outpatient clinics. This drastic shift in delivery has created a multitude of opportunities for pharmacists to demonstrate their value in primary care settings. At a session entitled “Collaborations to Improve Care: Psychiatric and Ambulatory Care Pharmacists,” Dr. Steven Chen, Pharm.D., FASHP, FNAP, Associate Professor at the USC School of Pharmacy and the Hygeia Centennial Chair in Clinical Pharmacy, presented compelling information regarding the need for expanded roles by pharmacists.
With the majority of mental health disorders being treated by primary care, there is a growing need for specialist involvement.1, 2 Mental health disorders have been associated with an increase in chronic disease development leading to greater utilization of services and, ultimately, inflated costs.3 During his session, Dr. Chen presented statistics on the lack of available services for patients suffering from mental illness, as well as the numerous barriers (i.e., stigma) individuals face when seeking treatment.4,5 He went on to further illustrate the higher rates of potentially harmful adverse drug reactions (ADRs) experienced by patients prescribed psychotropic medications in primary care.6 Dr. Chen speculates a limited expertise in psychiatry and psychopharmacology is largely to blame. All of these factors taken together highlight large gaps in the provision of health care, gaps which Dr. Chen believes should be filled by pharmacy practitioners.
The integration of clinical pharmacy services into outpatient clinics could be one solution to the many fundamental barriers, such as access to health care. The unique skillset and knowledge base offered by clinical pharmacists has routinely demonstrated significant improvements in patient care across multiple settings.7-10 As a leader in ambulatory care pharmacy, Dr. Chen shared the details of one of his most successful collaborations. He is the Co-Investigator and clinical manager of a $12 million CMMI grant that partners USC with AltaMed Health Services. The goal of this grant was to assess the impact of 10 clinical pharmacy teams, each consisting of a clinical pharmacist, a pharmacy resident, and a clinical pharmacy technician, compared to usual medical care. The program evaluated the following outcome measures: healthcare quality, safety, total cost, patient and provider satisfaction, and patient access. In addition to MD referrals, Dr. Chen’s group utilized numerous electronic health record-embedded triggers to identify high risk patients that would qualify for comprehensive medication management (CMM) services. To date, more than 6,000 patients have been enrolled. The pharmacist-led teams have demonstrated and sustained significant reductions in blood pressure, hemoglobin A1c, hospitalizations, and emergency room visits versus the control group. Additionally, patient and provider satisfaction with the program has been extraordinarily high. After 2 years in operation, more than 93% of patients have rated the service as a 9 or 10. Additionally, greater than 90% of physicians surveyed supported having the teams at the clinic and “strongly agree” that the pharmacy teams were respectful, knowledgeable, and had a positive impact on patient care.
To round out this session, Dr. Chen drew upon his wealth of experience with inter-professional collaborations to present ten “Practice Integration and Sustainment Keys.” They were as follows:
Current deficits in psychiatric services have resulted in the majority of patients with mental health disorders seeking treatment in primary care clinics. The relative lack of expertise in managing psychotropic medications within this setting presents psychiatric pharmacists with a unique opportunity. By emulating the successes of our colleagues in ambulatory care pharmacy, psychiatric pharmacists can work to integrate themselves into outpatient clinics.