Colin Maehler, PharmD Candidate 2021
Nearly 10% of youth are prescribed psychotropic medications, with most lacking sufficient knowledge about their medictions.1 Furthermore, many adolescents report medication non-adherence, which can lead to inadequate treatment response and adverse side effects.2,3 One way to improve medication-related outcomes is through pharmacist-driven patient medication education groups (PMEGs). In adult psychiatry, pharmacist-led PMEGs are well described in literature and have demonstrated significant improvements in patient outcomes including a decrease in adverse side effects, emergency department visits, and hospital readmissions.3 In collaboration with psychiatric pharmacists, pharmacy students play an important role in the success of PMEGs on inpatient psychiatry units.
Early exposure to PMEGs on an inpatient psychiatry unit improves pharmacy students’ attitudes, stigma, and self-efficacy.4,5 While several studies describe student involvement in PMEGs, these studies are limited to adult populations. There is a lack of literature detailing pharmacy student experiences in pediatrics, particularly in child and adolescent psychiatry (CAP). As a result, a weekly Psychiatry Pharmacy Intern Shift (PPIS) was created at Children’s Hospital Colorado to (1) optimize psychotropic medication-related outcomes and (2) provide pharmacy students with early exposure to CAP.
During Psychiatry Pharmacy Intern Shifts, two pharmacy interns lead a one-hour PMEG on the inpatient adolescent psychiatry unit. Interns work with a group of adolescents, 10-18 years of age, to facilitate discussion about psychotropic medications through a game of jeopardy. Afterwards, interns document psychotropic medication interventions in the electronic health record, with support from the psychiatric pharmacist. To evaluate the impact of Psychiatry Pharmacy Intern Shifts, our study group developed a 36-question survey based of published literature utilizing the Opening Minds, Social Distance, and Self-Efficacy Scales.6-8 The survey was comprised of three domains: (1) mental health attitudes/stigma, (2) psychotropic medication knowledge, and (3) PMEG self-efficacy. Pharmacy interns took the online survey at two different time points: prior to participation in PPIS (baseline), and after working two shifts (time point 1).
At baseline, 29% of interns reported having previous experience interacting with individuals with a mental health condition. As interns participated in Psychiatry Pharmacy Intern Shifts, their interest in psychiatric pharmacy noticeably grew and their attitudes towards individuals with mental illness improved. After participation in two Psychiatry Pharmacy Intern Shifts, negative impressions towards individuals with mental illness decreased (12% vs 0%). Furthermore, discomfort in assisting an individual with a mental illness decreased by 39% (59% vs 20%). Notably, pharmacy interns were 45% more likely to recommend an individual with a severe mental illness for a job, 27% more likely to introduce this individual to a friend as a relationship partner, and 24% more likely to feel comfortable living next door to this individual.
Intern self-efficacy also improved, with pharmacy interns reporting increased comfort responding to patient medication questions, assessing understanding of psychotropic medications, and facilitating PMEGs on an inpatient psychiatry unit. Self-harm and suicidal ideation were consistently identified as the most challenging topics to discuss during PMEGs. Pharmacy interns documented a wide variety of psychotropic medication interventions in the electronic health record. The most common interventions included patient-reported adverse effects (27%), recommendations for medication dose increases (21%), and identification of drug-drug interactions (18%). The most common psychotropic medication classes assessed were antidepressants (56%), antipsychotics (16%), and anxiolytics (14%).
In conclusion, early exposure to CAP through Psychiatry Pharmacy Intern Shifts improved pharmacy intern (1) attitudes and comfort regarding mental health conditions, and (2) PMEG self-efficacy. As clinical extenders on our inpatient adolescent psychiatry unit, pharmacy interns have become valuable members of the psychiatric pharmacy team through optimization of psychotropic medication-related interventions. Participation in Psychiatry Pharmacy Intern Shifts allowed for a unique opportunity for our pharmacy interns to gain early exposure to CAP and to provide education to adolescents regarding psychotropic medication use, safety, and efficacy. We encourage other institutions to consider creating a similar experience for pharmacy interns.