1. The Role of Clinical Pharmacists in Outpatient Psychiatric Clinics Mary A. Gutierrez, Pharm.D., BCPP Associate Professor of Clinical Pharmacy University of Southern California School of Pharmacy Clinical Pharmacist Medication Follow-up & Education Clinic Veterans Affairs Dual Diagnosis Treatment Program VA Medical Center, Brentwood, California NAMI Annual National Convention 2007

2. Dual Diagnosis Treatment Program (DDTP) Medication Follow-up and Education Clinic  USC School of Pharmacy faculty (BCPP) with students running 3x/week Medication Follow-up & Education Clinic (one on one basis)  Weekly education groups for 40-50 DDTP patients  open forum for any questions regarding their medications (benefits vs. risks) and symptoms

3. Medications Follow-up  Unidentified Problems  Current medications’ efficacy  “better, but…”  Side effects  don’t ask, don’t tell…noncompliance  No renewal of Rx after no refills left  missed meds  Rx for twice a day  daytime sedation or insomnia  Doses started too high  intolerable ADRs  stop meds  Drug interactions  incr’d ADRs or decr’d efficacy

4. Lab Results Follow-up  Unidentified Problems  Metabolic syndrome  atypical antipsychotics  Macrocytic anemia  chronic alcoholic consumption  Electrolytes changes  antihypertensives effects  Increased symptoms  positive urine drug tests  Hepatitis  hepatitis screenings  Increased ADRs  impaired renal or hepatic function

5. Patient Education  Improved Clinical Outcomes  Progress notes “good baseline, renew meds” for years …but still have symptoms  education on treatment options & how to report their symptoms  Sexual side effects “It must be my medications!” …stopped all medications  education regarding sexual dysfunction, R/O other possible etiologies  Years of “hand me down” diagnoses from resident to resident in teaching hospitals  education on history of symptoms & R/Os for diagnoses

6. Patient Ed Tools  Improved Clinical Outcomes  Provide index cards with patients’ current meds, dosing schedule, and indications  better understanding of medications use  less chances of missing renewal of Rx  easier to assess potential drug interactions for any new Rx from multiple prescribers  avoid duplicate meds for same indication  avoid dispensing errors by staff  Patient education information from NAMI, NIMH, etc.

7. “Outcomes of Pharmacists’ Interventions in Psychiatric Outpatients” Gutierrez M, Holloman L, Lee E.  Study designed to assess the impact of clinical pharmacists interventions in improving patient outcomes by optimizing drug therapy (N = 11)  Results showed that 7 patients with recommendations implemented showed significant improvement in their medical/ psychiatric conditions. Two patients with recommendations not accepted  symptoms worsened (1 hospitalized)  Received one of the Top Ten Awards for the 2000 National Hospital Pharmacy Quality Award

8. “Outcomes of Pharmacists’ Interventions in Psychiatric Outpatients” Recommendations  Most common (29%) – d/c unnecessary meds!  26% – increase doses of medications (subtherapeutic)  18% – change meds d/t lack of efficacy or high ADRs  11% – change dosing schedules to minimize ADRs  8% – decrease doses (minimum effective doses)  8% – add new meds for untreated conditions