Psychiatric Pharmacy in a University Student Health System Charles F. Caley, Pharm.D., BCPP Associate Clinical Professor University of Connecticut

I NTRODUCTION

Mental Illness on Campus u American College Health Survey  Top 10 health problems during academic year Depression17.8% Anxiety12.4% SAD8.1%  Top 10 health impediments to academic performance Depr/SAD/Anx15.7% N = 94,806 completed surveysJ Am College Health 2007;55(4):195–206.

N = 939 UMich students completed surveysNASPA Journal 2006;43(3):410–31. College Student Mental Hlth Survey Psychiatric Diagnosis by Student Self-Report

D ESCRIPTION OF S ERVICE

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 u Consultation w/ patient record review / pt interview / written note in chart u Consultation w/ record review and discussion with APRN u Education  Direct to patient  Weekly APRN meetings  Staff inservices  Drug information questions

Project Chronology October 2006 November 2006 January 2007 (Weekly APRN meetings begin) (Inservice on mechanisms of drug intolerability given) (Psychiatric pharmacist pilot project begins) May 2007 (End pilot project; results presented; report to administrations submitted) July 2007 (Agreement to continue service and to compensate financially is made) September 2007 (Continue psychiatric pharmacy services to present)

I MPACT ON P ATIENT C ARE

Results u 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 u Consultations by type of recommendation  Change dose8 (30%)  Change medication7 (26%)  Start new medication6 (22%)  Patient education6 (22%)  No changes to tx plan2 (7%)  Recommend adj. psychotherapy1 (4%)

Staff Education u Weekly APRN Meetings  Clinical pharmacology  Pk drug–drug interactions  Psychotropic adverse effect profiles  Pharmacotherapeutic selection process u SHS Inservices  Mechanisms of drug intolerance  Drug interactions btwn common Rxs and common OTCs  Serotonin syndrome review and update

u 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 u Clinical outcomes beyond implementation Results

u To maintain service funding  Explore additional avenues for billing / funding u Obtain outcome data  Symptom severity change  CMHS service use  Academic performance  Patient satisfaction u Campus outreach u Present project results at annual ACHA in June Future