Last Updated: 2022-02-07
Psychiatric pharmacists have engaged in team-based care for 50 years, and the research is overwhelmingly positive about their contribution to access, outcomes and cost. More broadly, evidence shows that clinical pharmacists providing Comprehensive Medication Management (CMM) also improve provider satisfaction, improve patient satisfaction, improve medication safety, and save lives.1 The impact of psychiatric pharmacists is no secret. In 2011, the Office of the Chief Pharmacist reported to the US Surgeon General that “medication management services demonstrated an ROI of as high as 12:1 and an average of 3:1 to 5:1.”2 In 2017, the National Council Medical Director Institute identified BCPPs as a group that could help address the projected psychiatric provider shortage.3 Additionally, evidence below includes data from the US Department of Veterans Affairs (VA), a landmark study funded by the Centers for Disease Control and Prevention (CDC), and work by the Primary Care Collaborative (PCPCC), which includes executive members AARP, the American Cancer Society, the American Psychiatric Association Foundation, the American Psychological Association, and many more.
The current lack of Medicare Part B coverage has limited the capacity for large-scale primary research into the impact of psychiatric pharmacists on access, clinical outcomes, and cost for patients living with mental illness, including substance use disorders. However, three veins of research confirm the benefits of integrating psychiatric pharmacists into the mental health treatment team. First, there is a growing body of work specifically related to the impact of clinical pharmacists on mental health care. Second, there are significant research projects affirming the positive impact of CMM provided by a pharmacist, which is the primary service provided by psychiatric pharmacists. Finally, the unique nature of the VA has allowed them to leverage the potential of clinical pharmacist practitioners (CPPs) in ways that validate the impact of psychiatric pharmacists when integrated into the primary care and mental health care teams. For each vein of research, key articles are identified along with additional references for further exploration. Ultimately, each perspective supports expanding the use of CMM by psychiatric pharmacists, and we simply wait for the collective will to make a change.
The Impact of Clinical Pharmacists on Mental Health Care
Psychiatric Services (by APA) published a paper outlining the current role of BCPPs on the mental health treatment team.5 While that addressed areas of emphasis, further peer-reviewed research delineated current activities and practice settings of BCPPs, including prescriptive authority.6-7 Finally, a systematic literature review8-9 confirms the positive impact of psychiatric pharmacists in diverse settings. This is reinforced by 190+ PubMed original research references related to pharmacists’ impact on mental health care (publication as a literature review is projected for late 2022).10 As summarized in another upcoming paper:11
Psychiatric pharmacy specializes in treating patients living with mental health and substance use disorders…. Psychiatric pharmacists have extensive training and expertise in medication treatment and the psychosocial factors inherent within these conditions. They are responsible for evidence-based, patient-centered assessments, medication management, and comprehensive care plan development. Psychiatric pharmacists work collaboratively with medical and mental health interprofessional teams to improve patients' short- and long-term outcomes. They partner with and educate patients, families, and providers, and they advocate for the appropriate use of medications.
The Impact of CMM by Pharmacists
Psychiatric pharmacists provide CMM to patients living with mental illness, but many patients live with comorbid medical conditions and are treated by primary care. Although this makes identifying the outcomes of treatment by a specialized pharmacist more complicated, it provides more opportunities to verify that having a pharmacist provide the CMM service positively impacts access, outcomes, and cost. The Primary Care Collaborative provides the source definition and the primary guide for integrating CMM into practice,13-14 which is reiterated in peer-reviewed literature.15 The model has been tested multiple times, including via a $12m CDC grant in southern California.16 CMM was developed to improve on Medication Therapy Management (MTM). In collaboration with the rest of the health care team, CMM puts the patient at the center of the process rather than the medications.17 Although Medicare Part D covers some MTM services, CMM needs to be addressed under Part B as a medically necessary service. Literature confirms that CMM addresses the quadruple aim of health care,18 and Get the Medications Right (GTMRx) tracks additional CMM-related research.19- 20
The Impact of Psychiatric Pharmacists at the VA
Ultimately, the VA provides an ideal test case for validating the impact of psychiatric pharmacists. Because of their unique regulatory structure, they have been able to utilize clinical pharmacists in ways that other health systems cannot until Medicare changes its payment policies. They clearly explain how clinical pharmacists are integrated into the care team.21 Then, they explain the benefits to the VA specifically in the areas of mental health,22 substance use disorders,23 and opioid safety.24 Finally, they provide bibliographies to further support the practices that are already creating positive outcomes.25-26
The 10,000-Foot View of Psychiatric Pharmacists
While the above sections focus on scholarly references, the data has also been distilled and presented in more consumable documents:
- An introduction to psychiatric pharmacists (2pg)
- Profiles of psychiatric pharmacists and their practice settings (2pg each)
- Combating the Opioid Crisis Through Medication-Assisted Treatment (MAT)
- Reducing the Gap of the Psychiatric Shortage
- Optimizing Inpatient Care, Reducing the Length of Stay
- Providing Expertise in Mental Health Medications
- Ensuring Patient Safety
- Telehealth for Rural Veterans
- Veteran Suicide Prevention
- Issue briefs (2pg each)
- Psychiatric Pharmacists Add Value To The Interprofessional Patient Care Team
- Access to Mental Health Care Matters
- CPNP Urges CMS To Pay For Comprehensive Medication Management (CMM) Provided By Psychiatric Pharmacists
- Addressing the Treatment Gap for Opioid and Substance Use Disorders
- Enact Telehealth Reform
- Protect 340B Drug Pricing Program
- Chen SW. Indian Health Service [Internet]. Improving Healthcare Quality and Safety While Reducing Costs Through Clinical Pharmacy Service Integration. [cited 2022 Feb 7]. Available from: https://www.ihs.gov/california/tasks/sites/default/assets/File/GPRA/C3_%20Clinical%20Pharmacy%20Consultation%20(Chen)_508_rev.pdf.
- Giberson S, Yoder S, Lee MP. Improving patient and health system outcomes through advanced pharmacy practice. A report to the U.S. Surgeon General. December 2011. [cited 2022 Feb 7]. Available from: https://www.accp.com/docs/positions/misc/improving_patient_and_health_system_outcomes.pdf.
- Medical Director Institute. The National Council for Mental Wellbeing [Internet]. [updated 2018 Mar 1; cited 2022 Feb 7]. Available from: https://www.thenationalcouncil.org/wp-content/uploads/2017/03/Psychiatric-Shortage_National-Council-.pdf?daf=375ateTbd56.
- Eaves S, Gonzalvo J, Hamm JA, Williams G, Ott C. The evolving role of the pharmacist for individuals with serious mental illness. J Am Pharm Assoc (2003). 2020;60(5):S11- S14. DOI: 10.1016/j.japh.2020.04.017. PubMed PMID: 32522521.
- Goldstone LW, DiPaula BA, Werremeyer A, Botts S, Hepburn B, Liu HY, Duckworth K, Young AS, Kelly DL. The Role of Board Certified Psychiatric Pharmacists in Expanding Access to Care and Improving Patient Outcomes. Psychiatr Serv. 2021 May 4. DOI: 10.1176/appi.ps.202000066. PMID: 33940946.
- Silvia RJ, Lee KC, Bostwick JR, Cobb CD, Goldstone LW, Moore TD, et al. Assessment of the current practice of psychiatric pharmacists in the United States. Ment Health Clin [Internet]. 2020;10(6):346-53. DOI: 10.9740/mhc.2020.11.346.
- Lee KC, Silvia RJ, Cobb CD, Moore TD, Payne GH. Survey of prescriptive authority among psychiatric pharmacists in the United States. Ment Health Clin [Internet]. 2021;11(2):64-9. DOI: 10.9740/mhc.2021.03.064.
- Werremeyer A, Bostwick J, Cobb C, Moore TD, Park SH, Price C, et al. Impact of pharmacists on outcomes for patients with psychiatric or neurologic disorders. Ment Health Clin [Internet]. 2020;10(6):358-80. DOI: 10.9740/mhc.2020.11.358.
- Goldstone LW, DiPaula BA, Caballero J, Park SH, Price C, Slater MZ. Improving medication-related outcomes for patients with psychiatric and neurologic disorders: value of psychiatric pharmacists as part of the health care team. Ment Health Clin [Internet]. 2015;5(1):1-28. DOI: 10.9740/mhc.2015.01.001.
- College of Psychiatric and Neurologic Pharmacists [Internet]. [updated 2022 Jan 20, cited 2022 Feb 7]. Available from: https://cpnp.org/psychpharm/research/bibliography.
- Dopheide JA, Werremeyer A, Haight RJ, Gutierrez CA, Williams AM. Positioning Psychiatric Pharmacists to Improve Mental Health Care. Forthcoming 2022.
- Pestka DL, Frail CK, Sorge LA, Funk KA, Janke KK, Roth McClurg MT, et al. Development of the comprehensive medication management practice management assessment tool: A resource to assess and prioritize areas for practice improvement. J Am Coll Clin Pharm. 3rd ed. 2019;3(2):448- 454. DOI: 10.1002/jac5.1182.
- Patient-Centered Primary Care Collaborative (PCPCC) [Internet]. The Patient-Centered Medical Home: Integrating Comprehensive Medication Management to Optimize Patient Outcomes. 2nd ed. [updated 2012 Jun; cited 2022 Feb 7]. Available from: https://www.pcpcc.org/sites/default/files/media/medmanagement.pdf.
- American College of Clinical Pharmacy [Internet]. The Patient Care Process for Delivering Comprehensive Medication Management (CMM): Optimizing Medication Use in Patient-Centered, Team-Based Care Settings. [cited 2022 Feb 7]. Available from: https://www.accp.com/docs/positions/misc/CMM_Care_Process.pdf.
- McFarland MS, Finks SW, Smith L, Buck ML, Ourth H, Brummel A. Medication Optimization: Integration of Comprehensive Medication Management into Practice. American Health & Drug Benefits [Internet]. 2021;14(3):111-114. Available from: https://www.ahdbonline.com/issues/2021/september-2021-vol-14-no-3/3174-medication-optimization-integration-of-comprehensive-medication-management-into-practice.
- Butler A, Dehner M, Gates RJ, Shane P, Chu M, DeMartini L, et al. Comprehensive Medication Management programs: 2015 status in Southern California. Res Soc Adm Pharm. 2017;13(1):63-87. DOI: 10.1016/j.sapharm.2016.02.003. PubMed PMID: 27234647. Available from: https://calrightmeds.org/wp-content/uploads/2019/04/CMMWhitePaperCDPH2015Dec23FINALrev.pdf.
- Buck ML, McFarland MS. GTMRx Institute [Internet]. [created 2021 Jan 13, cited 2022 Feb 7]. Available from: https://gtmr.org/blog-cmm-vs-mtm-patient-focused-process-vs-medication-focused-activity/.
- McFarland MS, Buck ML, Crannage E, Armistead LT, Ourth H, Finks SW, et al. Assessing the Impact of Comprehensive Medication Management on Achievement of the Quadruple Aim. Am J Medicine. 2021;134(4):456- 461. DOI: 10.1016/j.amjmed.2020.12.008. PubMed PMID: 33472055.
- GTMRx Institute [Internet]. The Outcomes of Implementing and Integrating Comprehensive Medication Management in Team-Based Care: A Review of the Evidence on Quality, Access and Costs, December 2021. [created 2021 Dec, cited 2022 Feb 7]. Available from: https://gtmr.org/resources/the-outcomes-of-implementing-and-integrating-cmm-in-team-based-care-a-review-of-the-evidence-on-quality-access-and-costs/.
- Optimizing Medications for Better Health [Internet]. CMM Evidence and Research. [cited 2022 Feb 7]. Available from: https://www.optimizingmeds.org/comprehensive-medication-management/cmm-evidence-and-research/.
- Department of Veterans Affairs Pharmacy Benefits Management (PBM) Services [Internet]. Clinical Pharmacist Practitioner (CPP) to Improve Access to and Quality of Care. [updated 2021 Aug, cited 2022 Feb 7]. Available from: https://www.pbm.va.gov/PBM/CPPO/Documents/ExternalFactSheet_OptimizingtheCPPToImproveAccess_508.pdf.
- Department of Veterans Affairs Pharmacy Benefits Management (PBM) Services [Internet]. Clinical Pharmacist Practitioner (CPP) Role in Mental Health. [updated 2021 Jun, cited 2022 Feb 7]. Available from: https://www.pbm.va.gov/PBM/CPPO/Documents/ExternalFactSheet_CPPRoleinMentalHealth_508.pdf.
- Department of Veterans Affairs Pharmacy Benefits Management (PBM) Services [Internet]. Clinical Pharmacist Practitioner (CPP) Role in Substance Use Disorders (SUD). [updated 2020 Jun, cited 2022 Feb 7]. Available from: https://www.pbm.va.gov/PBM/CPPO/Documents/ExternalFactSheet_CPPRoleinSubstanceUseDisorders_508.pdf.
- Department of Veterans Affairs Pharmacy Benefits Management (PBM) Services [Internet]. Clinical Pharmacist Practitioner (CPP) Role in Opioid Safety. [updated 2021 Jun, cited 2022 Feb 7]. Available from: https://www.pbm.va.gov/PBM/CPPO/Documents/ExternalFactSheet_CPPRoleinOpioidSafety_508.pdf.
- Department of Veterans Affairs Pharmacy Benefits Management (PBM) Services [Internet]. Evidence Bibliography: Clinical Pharmacy Practice in Mental Health. [updated 2021 Jun, cited 2022 Feb 7]. Available from: https://www.pbm.va.gov/PBM/CPPO/Documents/EvidenceBibliography_ClinicalPharmacyPracticeinMentalHealth_508.pdf.
- Department of Veterans Affairs Pharmacy Benefits Management (PBM) Services [Internet]. Evidence Bibliography: Clinical Pharmacy Practice in Substance Use Disorder. [updated 2021 Jun, cited 2022 Feb 7]. Available from: https://www.pbm.va.gov/PBM/CPPO/Documents/EvidenceBibliography_ClinicalPharmacyPracticeinSubstanceUseDisorder_508.pdf.