Mental health pharmacists as interim prescribers

Abstract

Introduction: Turnover leading to fluctuations in prescriber availability presents many challenges, most notably in access to and continuity of care. In 2015, the Veterans Affairs Eastern Colorado Healthcare System (VA ECHCS) experienced a period of significant mental health prescriber turnover leading to patient utilization of psychiatric emergency services (PES) for nonemergent medication management. The resulting increase in volume placed excessive stress on PES prescribers. Mental health pharmacists have opportunities to provide interim medication management while patients are between prescribers.

Methods: This study was a retrospective, cohort study of patients unassigned to an outpatient mental health prescriber due to prescriber turnover, receiving care at VA ECHCS between October 1, 2015, and February 28, 2016. The primary outcome was the number of pharmacist interventions performed. Secondary outcomes characterize the interventions performed and describe the change in the mean monthly volume of patients presenting to PES.

Results: In this veteran population, 152 interventions were performed in 81 unique patients. The most common intervention was prescription renewals (80%). Interventions most commonly involved antidepressants (28%), antipsychotics (10%), and mood stabilizers (10%). Before initiation of the clinic, Denver VA PES experienced a mean of 300 monthly visits. After clinic implementation, PES visits decreased significantly to a mean of 237 visits per month (P = .041).

Discussion: The pharmacist interim prescriber clinic was associated with a significant decrease in mean number of patients seen per month in PES. The success of the clinic also contributed to interest by the mental health service to expand clinical pharmacy services.

Keywords: PES; interim; intervention; mental health; pharmacist; pharmacy; prescriber; psychiatric emergency service; psychotropic medications; turnover.

FIGURE 1

Percentage of interventions; note groups are listed by medication class and specification of a pharmacological class or individual drug was based on perceived importance of the distinction (antianxiety = non-benzodiazepine and non-antidepressants such as buspirone, gabapentin, and hydroxyzine; EPS = extrapyramidal symptoms; EtOH = ethanol; other sleep aids = amitriptyline, ramelteon, and trazodone)

FIGURE 2

Total number of patients encountered by psychiatric emergency services