Transcript Psychiatric Emergencies and Delirium

Role of the Pharmacist in
Collaborative Care
for Mental Health and Addiction
Treatment in Medically Underserved
Appalachia
Sarah T. Melton, PharmD,BCPP,CGP
Appalachian College of Pharmacy, Oakwood, VA
CPNP Annual Meeting, 2009
Central Appalachian Region:
Medically Underserved
• Poverty rate 75% higher
• Lower education levels
• Over 25% of population is
disabled
• Mental health diagnoses for
psychiatric and addiction
disorders are proportionately
higher in Appalachia
• The rate of increase in abuse of
opiates and synthetics is
Appalachia is higher, especially
in coal mining areas
• Citizens of Southwest Virginia
are 70% more likely to commit
suicide than the rest of Virginia.
Barriers to Mental Health Treatment
• Wait to see psychiatrist for diagnosis and
medication management is 4-6 months minimum
• Specific barriers to accessing treatment include:
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stigma
transportation availability
limited payment options
privacy issues
choice of facilities
cultural and family barriers
C-Health, PC
Compass, PC
• Private, family practice clinic with three physicians, five
nurse practitioners, one physician assistant, a clinical
psychologist, and 2 clinical pharmacists
• Medically underserved area with a diverse patient
population.
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20% of patients are covered by Medicaid
35% are covered by Medicare
35% by private insurance
10% are uninsured.
Provision of Patient-Centered Care
• Referral from provider
• Patient seen by appointment
• Appointments are typically one hour in
length
• Average number of patients seen/day = 6
• Disorders:
– Depression, bipolar, anxiety, dementia,
schizoaffective, ADHD, eating, seizure,
sleeping, addiction, chronic pain
Provision of Patient-Centered Care
• Group Medical Appointments
– Opiate dependence
– Chronic pain
– Tobacco cessation
• Electronic Medical Record
– E-MD’s TopsSuite
– Comprehensive patient notes and documentation
– Immediate feedback from physicians
Provision of Patient-Centered Care
• Patient/caregiver interview and assessment
• Medication therapy management, including
prescribing
• Ordering and evaluating laboratory testing
• Referral to the clinical psychologist for
counseling or cognitive behavioral therapy
(CBT)
• Home visits
• Patient assistance program (PAP)
Outcomes
• Reimbursement
– Billed incident to physician visit
– Sliding scale cash charge
• Improved access to healthcare
• Enhanced care through optimized drug therapy
management
– Decreased drug-related problems
– Reduced costs through optimized medication regimens
• Through PAP, over $100,000 of medications are ordered
and delivered to patients per year
• Experiential learning site (more than 35 students/year in
IPPE/APPE rotations)
Conclusion
• This models demonstrates provision of an effective
bridge to treatment with a psychiatrist in medically
underserved, rural Appalachia.
• Effective interdisciplinary team collaboration between a
psychiatric pharmacist, primary care physician and
clinical psychologist.
• As a learning site for pharmacy students, the program
provides real-life experiences in the provision of
optimal, evidence-based, patient-centered care that
addresses mental health and addiction disorders
accompanied by cultural and economic challenges.
• Psychiatric pharmacists can be reimbursed for clinical
services in the ambulatory care setting.