Transcript Psychiatric Pharmacy in a University Student Health System

Psychiatric Pharmacy in a
University Student Health System
Charles F. Caley, Pharm.D., BCPP
Associate Clinical Professor
University of Connecticut
INTRODUCTION
Mental Illness on Campus

American College Health Survey
 Top 10 health problems during academic year
• Depression
17.8%
• Anxiety
12.4%
• SAD
8.1%
 Top 10 health impediments to academic performance
• Depr/SAD/Anx 15.7%
N = 94,806 completed surveys
J Am College Health 2007;55(4):195–206.
College Student Mental Hlth Survey
Psychiatric Diagnosis by Student Self-Report
16
14
12
10
8
%
6
4
2
0
Depr
Eating
Anx
ADHD
N = 939 UMich students completed surveys
PTSD
SocAnx
OCD
SA
Bipolar
Psychosis
NASPA Journal 2006;43(3):410–31.
DESCRIPTION OF SERVICE
• 20,000 students at the University of Connecticut
• Approximately 6,000 visits to CMHS annually
• Two 0.5 FTE psychiatrists, one APRN, seven therapists
Psychiatric Pharmacist Services



Consultation w/ patient record review / pt interview /
written note in chart
Consultation w/ record review and discussion with
APRN
Education
 Direct to patient
 Weekly APRN meetings
 Staff inservices
 Drug information questions
Project Chronology
(Inservice on mechanisms
of drug intolerability given)
(Weekly APRN
meetings begin)
(Continue psychiatric
pharmacy services to
present)
May
2007
November
2006
October
2006
(End pilot project; results
presented; report to
administrations submitted)
January
2007
(Psychiatric
pharmacist pilot
project begins)
September
2007
July
2007
(Agreement to
continue service and
to compensate
financially is made)
IMPACT ON PATIENT CARE
Results

27 patients consulted on to date
 18–42 yrs ( mean = 24)
 Predominantly female
 Presenting w/ depression &/or anxiety spectrum
 Typically not responding or not tolerating current tx
 Most receive “full consult”
 Recommendations implemented in 88% of cases
Results

Consultations by type of recommendation
 Change dose
8 (30%)
 Change medication
7 (26%)
 Start new medication
6 (22%)
 Patient education
6 (22%)
 No changes to tx plan
2 (7%)
 Recommend adj. psychotherapy
1 (4%)
Staff Education


Weekly APRN Meetings
 Clinical pharmacology
 Pk drug–drug interactions
 Psychotropic adverse effect profiles
 Pharmacotherapeutic selection process
SHS Inservices
 Mechanisms of drug intolerance
 Drug interactions btwn common Rxs and
common OTCs
 Serotonin syndrome review and update
Results

Clinical credibility firmly established
 Patients willing to:
• Accept / implement tx recommendations
• Be taught about their meds and illnesses
 Patients gave positve feedback to APRNs
 APRNS, psychiatrists, therapists, CMHS director,
SHS director
• High rate of implementing recommendations

Clinical outcomes beyond implementation
Future




To maintain service funding
 Explore additional avenues for billing / funding
Obtain outcome data
 Symptom severity change
 CMHS service use
 Academic performance
 Patient satisfaction
Campus outreach
Present project results at annual ACHA in June