We have NO actual or potential conflict of interest in relation to this educational activity or presentation

We have NO actual or potential conflict of interest in relation to this

educational activity or presentation.

Supplementing Student Mental Health Care with Medication

Therapy Management

Garrett Gilmer, Ph.D.Garrett Gilmer, Ph.D.

Barbara Hoffman, MSN, CNPBarbara Hoffman, MSN, CNP

Lon Muir, Pharm.D., BSPSLon Muir, Pharm.D., BSPS

Center for HealthCenter for Health

Student Health Service & Counseling CenterStudent Health Service & Counseling Center

About BGSUAbout BGSU• State-assisted university founded in State-assisted university founded in

19101910• Main campus of over 20,000 Main campus of over 20,000

studentsstudents• Small college town approximately Small college town approximately

25 miles south of Toledo, Ohio25 miles south of Toledo, Ohio• More than 200 undergraduate More than 200 undergraduate

majors and programs, 47 master's majors and programs, 47 master's degree programs and 17 doctoral degree programs and 17 doctoral degree programsdegree programs

• BGSU has once again landed in the BGSU has once again landed in the U.S. News’ “America’s Best U.S. News’ “America’s Best Colleges”Colleges”

Student Health ServiceStudent Health Service

Barbara Hoffman, MSN, CNPBarbara Hoffman, MSN, CNP


• StaffingStaffingo PhysiciansPhysicianso Certified Nurse Certified Nurse

PractitionersPractitionerso NursesNurseso Medical AssistantsMedical Assistantso Lab TechniciansLab Technicianso PharmacistsPharmacistso PsychiatristsPsychiatristso DieticianDietician


• ServicesServiceso Allergy & Allergy &

ImmunizationImmunizationo Laboratory ServicesLaboratory Serviceso Men’s HealthMen’s Healtho Women’s HealthWomen’s Healtho Full Service Full Service

PharmacyPharmacyo Nutrition ServicesNutrition Services

Student Health ServiceStudent Health ServiceDiagnosis Comparisons Diagnosis Comparisons

Student Health ServiceStudent Health ServicePsychiatric Appointments For 2010Psychiatric Appointments For 2010

Psychiatric Services are housed in the Student Health ServicePsychiatric Services are housed in the Student Health Service* Combined, Dr. Hoelzle and Dr. Schwendiman work approx. 12 hours a week * Combined, Dr. Hoelzle and Dr. Schwendiman work approx. 12 hours a week

Counseling CenterCounseling Center

Garrett Gilmer, Ph.D.Garrett Gilmer, Ph.D.

Counseling CenterStaffing

o Associate Director for Counseling Services

o Assistant Director/Training Director

o 3 full-time psychologistso 1 part-time psychologisto 1 part-time AOD counselor

o 1 part-time clinical social worker

o 1 part-time case managero 3 full-time pre-doctoral

internso 4 clinical psychology

graduate assistantso 1 masters level counseling

intern

o Individual/Group/Couples Counseling

o Alcohol and Drug Educational Counseling

o Case Managemento Consultationo Crisis interventiono Outreach

Approximately 5% of student body seen in Counseling

Center each year

Counseling CenterServices

Counseling Center National Trends

ACHA-NCHA II, 2010, p. 15









Counseling Center Most Prevalent Presenting Concerns

• Depression

20.6% primary concern; 9.9% secondary concern

• Anxiety

13.7 % primary concern; 8% secondary concern

• Romantic Relationship

12.3 % primary concern; 6.7% secondary concern

• Academic/Career Concern59.2% indicated that presenting concern was affecting their

academic performance

21.3% were considering leaving the University

Counseling Center Prevalence of Prior Treatment

• 40% of students who sought counseling services this year reported a prior history of mental health services

• 37.1 % of students who sought counseling services this year reported a history of treatment by psychotropic medication

BGSU PharmacyBGSU Pharmacy

Lon Muir, Pharm.D., BSPSLon Muir, Pharm.D., BSPS


• Serve university Serve university students, faculty, and students, faculty, and staff staff

• Services availableServices availableo Prescription servicesPrescription services

Rx’s from any providerRx’s from any provider Limited compounding Limited compounding

o Third party billingThird party billing Student Insurance planStudent Insurance plan Accept outside Accept outside

insurance plansinsurance plans


• Services cont…Services cont…o Over-the-counter productsOver-the-counter products

Wide variety of OTC products, Wide variety of OTC products, DME, Diabetic supplies and DME, Diabetic supplies and special order productsspecial order products

• BGSU Pharmacy factsBGSU Pharmacy factso ~29,000 scripts/year~29,000 scripts/yearo ~510 sq feet~510 sq feeto 2.1 FTE Pharmacist, 1.4 FTE 2.1 FTE Pharmacist, 1.4 FTE

TechnicianTechniciano Located within the Student Located within the Student

Health Service buildingHealth Service buildingo Training site for 6Training site for 6thth year year

PharmD studentsPharmD students

BGSU PharmacyBGSU Pharmacy Hours Hours

• Semester HoursSemester Hourso Monday and Tuesday 8am-7:30pmMonday and Tuesday 8am-7:30pmo Wednesday and Thursday 8am-6:30pmWednesday and Thursday 8am-6:30pmo Friday 9:30am-4:30pmFriday 9:30am-4:30pm

• Summer HoursSummer Hourso Monday- Friday 8am-4:30pmMonday- Friday 8am-4:30pm

MTMMTM• What is Medication Therapy What is Medication Therapy

Management?Management?o Service provided by pharmacists to optimize Service provided by pharmacists to optimize

therapeutic outcomes for individual patients therapeutic outcomes for individual patients o May include:May include:

Medication therapy reviewsMedication therapy reviews Pharmacotherapy consultsPharmacotherapy consults Anticoagulation managementAnticoagulation management ImmunizationsImmunizations Health and wellness programsHealth and wellness programs Many other clinical services Many other clinical services

What Makes Up an MTM?What Makes Up an MTM?

• First component- Evaluate a patient’s therapy for First component- Evaluate a patient’s therapy for safety and effectivenesssafety and effectiveness

• Second component- Meet with the patient and Second component- Meet with the patient and discuss:discuss:o Purpose of the medication Purpose of the medication o Importance of taking the medication properlyImportance of taking the medication properlyo possible side effects, drug-drug interactions, drug-possible side effects, drug-drug interactions, drug-

food interactionsfood interactionso any other support to ensure positive outcomes with any other support to ensure positive outcomes with

medication therapymedication therapy• Third component – follow up with patient & Third component – follow up with patient &

providerprovider

Difference Between MTM and Rx Difference Between MTM and Rx CounselingCounseling

• Rx Counseling Rx Counseling o Required OBRA90Required OBRA90o No reimbursement No reimbursement o Pertains to current medication being dispensedPertains to current medication being dispensed

• MTMMTMo ReimbursableReimbursableo Comprehensive disease state management/reviewComprehensive disease state management/reviewo Integration of pharmacy with existing clinical Integration of pharmacy with existing clinical

treatment team treatment team o Opportunities for collaborative practice agreements Opportunities for collaborative practice agreements

History of MTMHistory of MTM

• Asheville ProjectAsheville Projecto 1996 pharmacist began providing MTM services 1996 pharmacist began providing MTM services

to patients suffering from diabetes, asthma, to patients suffering from diabetes, asthma, hypertension, and high cholesterolhypertension, and high cholesterol

o MTM services began yielding positive results MTM services began yielding positive results including decreased A1C levels, lower total including decreased A1C levels, lower total health care costs, fewer sick days, and health care costs, fewer sick days, and increased patient satisfaction with pharmacist’s increased patient satisfaction with pharmacist’s servicesservices

o Eventually led to outcomes studies regarding Eventually led to outcomes studies regarding the services providedthe services provided

The Asheville Project: Long-Term Clinical and Economic The Asheville Project: Long-Term Clinical and Economic Outcomes of a Community Pharmacy Diabetes Care ProgramOutcomes of a Community Pharmacy Diabetes Care Program

Carole W. Cranor, Barry A. Bunting, and Dale B. Christensen Carole W. Cranor, Barry A. Bunting, and Dale B. Christensen

• Objective - Objective - Assess outcomes of diabetic pharmaceutical care services up to 5 Assess outcomes of diabetic pharmaceutical care services up to 5 years after initiation of programyears after initiation of program

• Design - Design - Quasi-experimental, longitudinal pre−post cohort studyQuasi-experimental, longitudinal pre−post cohort study• Setting - Setting - 12 community pharmacies located within Asheville, NC.12 community pharmacies located within Asheville, NC.• Patients or other Patients or other participants - participants - 136 Diabetic patients receiving benefits from 136 Diabetic patients receiving benefits from

employer’s self-insured health plans. Diabetic trained community pharmacists. employer’s self-insured health plans. Diabetic trained community pharmacists. • Intervention(s) - Intervention(s) - Patients received diabetic education from the community Patients received diabetic education from the community

pharmacists and were included in scheduled follow-ups, clinical assessments, pharmacists and were included in scheduled follow-ups, clinical assessments, goal setting, monitoring, and collaborative practice agreements with the patient’s goal setting, monitoring, and collaborative practice agreements with the patient’s physician.physician.

• Main outcome measure(s) - Main outcome measure(s) - Changes in A1c, serum lipid concentrations and Changes in A1c, serum lipid concentrations and changes in diabetic and overall medical utilization costs.changes in diabetic and overall medical utilization costs.

• Results - Results - A1c levels decreased in greater than 50% of subjects compared to A1c levels decreased in greater than 50% of subjects compared to baseline. With each subsequent follow-up the number of patients experiencing baseline. With each subsequent follow-up the number of patients experiencing optimal A1c’s increased. 50% of patients also showed improvements in lipid levels optimal A1c’s increased. 50% of patients also showed improvements in lipid levels during the follow-up time-frame. Average annual direct medicals costs decreased during the follow-up time-frame. Average annual direct medicals costs decreased $1,200 to $1,872 per year.$1,200 to $1,872 per year.

• Conclusion(s) - Conclusion(s) - Diabetic patients receiving advanced pharmaceutical care Diabetic patients receiving advanced pharmaceutical care exhibited improved A1c’s and also had decreased annual direct medical costs.exhibited improved A1c’s and also had decreased annual direct medical costs.

The Asheville Project: Long-Term Clinical, Humanistic, and Economic The Asheville Project: Long-Term Clinical, Humanistic, and Economic Outcomes of a Community-Based Medication Therapy Management Outcomes of a Community-Based Medication Therapy Management

Program for AsthmaProgram for AsthmaBarry A. Bunting and Carole W. CranorBarry A. Bunting and Carole W. Cranor

• Objective - Objective - Assess 207 adult asthmatic patients for clinical, humanistic, and economic outcomes of a Assess 207 adult asthmatic patients for clinical, humanistic, and economic outcomes of a community-based medication therapy management (MTM) programcommunity-based medication therapy management (MTM) program

• Design - Design - Quasi-experimental, longitudinal pre−post cohort studyQuasi-experimental, longitudinal pre−post cohort study• Setting -Setting -12 community pharmacies located within Asheville, NC.12 community pharmacies located within Asheville, NC.• Patients or other Patients or other participants - participants - 207 Asthmatic patients receiving benefits from employer’ self-207 Asthmatic patients receiving benefits from employer’ self-

insured health plan. 18 trained hospital and community pharmacists. insured health plan. 18 trained hospital and community pharmacists. • Intervention(s) - Intervention(s) - Patients received Asthma education from trained pharmacist and were included in Patients received Asthma education from trained pharmacist and were included in

scheduled follow-ups, monitoring, and recommendations to the patient’s physician.scheduled follow-ups, monitoring, and recommendations to the patient’s physician.• Main outcome measure(s) - Main outcome measure(s) - Changes in FEVChanges in FEV11, asthma severity, symptom frequency, degree to , asthma severity, symptom frequency, degree to

which asthma affected people’s lives, presence of an asthma action plan, asthma-related emergency which asthma affected people’s lives, presence of an asthma action plan, asthma-related emergency department/hospital events, and changes in asthma-related costs over time.department/hospital events, and changes in asthma-related costs over time.

• Results - Results - All asthma outcome measures improved and were sustained for 5 years, with significant All asthma outcome measures improved and were sustained for 5 years, with significant changes in FEVchanges in FEV11 and severity classification. The number of patients with asthma action plans and severity classification. The number of patients with asthma action plans

increased to 99% from 63%, ER visits decreased to 1.3% from 9.9%, and hospitalization decreased increased to 99% from 63%, ER visits decreased to 1.3% from 9.9%, and hospitalization decreased from 4% to 1.9%. Patients spent more on asthma medications, spent less on total asthma-related from 4% to 1.9%. Patients spent more on asthma medications, spent less on total asthma-related costs, and had less asthma related medical claims. Total annual direct and indirect costs decreased costs, and had less asthma related medical claims. Total annual direct and indirect costs decreased on average by $725/patient and $1230/patient respectively. on average by $725/patient and $1230/patient respectively.

• Conclusion(s) - Conclusion(s) - Asthmatic patients receiving education and MTM services experienced significant Asthmatic patients receiving education and MTM services experienced significant improvements in control of disease state and a significant decrease in overall asthma-related improvements in control of disease state and a significant decrease in overall asthma-related costs.

Applications of MTM ServicesApplications of MTM Services

• MTM services can be implemented for:MTM services can be implemented for:o Diabetes, asthma, hypertension, hyperlipidemia, Diabetes, asthma, hypertension, hyperlipidemia,

psychological disorders, GI issues, and other chronic psychological disorders, GI issues, and other chronic disease states.disease states.

o Patients with multiple disease states experiencing poly-Patients with multiple disease states experiencing poly-pharmacypharmacy

• MTMs can occur in almost any healthcare MTMs can occur in almost any healthcare settingsettingo Retail pharmacy, hospital, college-health, mental health Retail pharmacy, hospital, college-health, mental health

institutions, clinics, community health departments, institutions, clinics, community health departments, doctor’s offices, etc…doctor’s offices, etc…

MTM in College HealthMTM in College Health

• PrevalencePrevalenceo Not a common practice Not a common practice

Younger population with less chronic disease statesYounger population with less chronic disease stateso Documentation of established programsDocumentation of established programs

Model for Medication Therapy Management in a Model for Medication Therapy Management in a University Clinic. University Clinic. Mary Ann Kliethermes, Anne Marie Schullo-Mary Ann Kliethermes, Anne Marie Schullo-Feulner, Jessica Tilton, Shiyun Kim, and Annette Nicole PellegriFeulner, Jessica Tilton, Shiyun Kim, and Annette Nicole Pellegri

The Role of a Psychiatric Pharmacist in College The Role of a Psychiatric Pharmacist in College HealthHealth. . Caley CF, Webber D, Kurland M, Holmes P.Caley CF, Webber D, Kurland M, Holmes P.

• Applications within college healthApplications within college healtho Same as non-college health settingsSame as non-college health settings

Chronic disease states, poly-pharmacy, and patient’s Chronic disease states, poly-pharmacy, and patient’s needing additional pharmaceutical educationneeding additional pharmaceutical education

MTM for Mental HealthMTM for Mental Health

• Services could be provided to patients with Services could be provided to patients with depression, bipolar, anxiety, schizoaffective depression, bipolar, anxiety, schizoaffective disorders etc…disorders etc…o Medications used to treat these disease states:Medications used to treat these disease states:

Exhibit complex side effect profilesExhibit complex side effect profiles Require additional lab monitoringRequire additional lab monitoring Potential for multiple drug interactionsPotential for multiple drug interactions May have narrow therapeutic windowsMay have narrow therapeutic windows Adherence is extremely important Adherence is extremely important

MTM for Mental HealthMTM for Mental Health

• Benefits include:Benefits include:o Additional point of symptom monitoringAdditional point of symptom monitoring

Identifying, preventing and resolving medication-related Identifying, preventing and resolving medication-related problemsproblems

Actively monitor patients medication treatment plan, labs and Actively monitor patients medication treatment plan, labs and progressprogress

o Integration of pharmacy with existing treatment teamIntegration of pharmacy with existing treatment team Readily available to answer medication related questionsReadily available to answer medication related questions

o Student educationStudent education Disease stateDisease state Side effectsSide effects GoalsGoals Evaluate outcomesEvaluate outcomes

o Medication adherenceMedication adherence Hopefully…adherence improves with increased patient Hopefully…adherence improves with increased patient

education education

MTM MTM PlanningPlanning

DocumentationDocumentation

ReimbursementReimbursement

ImplementationImplementation

TrainingTraining

OutcomesOutcomes

StaffingStaffing

MTM TrainingMTM Training

*Any Pharmacist may provide MTM services**Any Pharmacist may provide MTM services*

• Levels of involvement:Levels of involvement:o Depends on staffing and also established relationships with providersDepends on staffing and also established relationships with providers

Basic InvolvementReviewing therapy and

educating patient

High InvolvementModifying therapy and ordering labs

MTM Training cont…MTM Training cont…

• TrainingTraining o Pharmacy SchoolingPharmacy Schooling

Skills developed during pharmacy curriculumSkills developed during pharmacy curriculum

o Continuing EducationContinuing Education Focus on mental health disease state Focus on mental health disease state

o In-servicesIn-services Provided by specialist (e.g. Rph, Nurse, Physician)Provided by specialist (e.g. Rph, Nurse, Physician) BGSU received training support from a local college of pharmacy instructorBGSU received training support from a local college of pharmacy instructor

o MTM specialty training MTM specialty training Usually provided by Schools of PharmacyUsually provided by Schools of Pharmacy Online?Online?

o Board Certified Psychiatric PharmacistBoard Certified Psychiatric Pharmacist Board of Pharmacy SpecialtiesBoard of Pharmacy Specialties

MTM ReimbursementMTM Reimbursement

• CashCasho Designate a charge and bill each patient Designate a charge and bill each patient

directlydirectly Barrier to treatment?Barrier to treatment?

• Third PartyThird Partyo Medicare Part D patientsMedicare Part D patients

The Pharmacist would perform an MTM visit and The Pharmacist would perform an MTM visit and bill accordingly using the Medicare Part D MTM bill accordingly using the Medicare Part D MTM codes 99605-99607.codes 99605-99607.

MTM Reimbursement cont…MTM Reimbursement cont…

• Third PartyThird Partyo Non-Medicare patientsNon-Medicare patients

99211-99215 office visit codes99211-99215 office visit codesPer protocol Rph would provide MTM service and a Per protocol Rph would provide MTM service and a

physician would review the form, sign and also sit with physician would review the form, sign and also sit with the patient for a moment to review the results.the patient for a moment to review the results.

99401-99404 codes99401-99404 codesCounseling Risk Factor Reduction and Behavior Counseling Risk Factor Reduction and Behavior

Change Intervention CodesChange Intervention CodesSimilar procedures to 99211-99215 billing optionSimilar procedures to 99211-99215 billing optionBetter reflect Better reflect services provided?

StaffingStaffing• Situational Situational

o Not all pharmacies/SHS clinics have the same Not all pharmacies/SHS clinics have the same staff availablestaff available

o Single pharmacist provide serviceSingle pharmacist provide serviceo Multiple pharmacists providing MTM servicesMultiple pharmacists providing MTM serviceso External per diem staffingExternal per diem staffing

• BGSU has a single pharmacist providing BGSU has a single pharmacist providing servicesservices

DocumentationDocumentation• Develop form(s) containing:Develop form(s) containing:

o Clinical informationClinical information Patient demographics, medical history, family Patient demographics, medical history, family

history, social history, current medications, history, social history, current medications, relevant lab work, patient’s goals, etc…relevant lab work, patient’s goals, etc…

EvaluationsEvaluationsMMSE, PHQ9, AIMS assessmentsMMSE, PHQ9, AIMS assessments

o Reimbursement informationReimbursement information Topics covered and length of time spent with Topics covered and length of time spent with

patient covering specific topicspatient covering specific topics

Documentation cont…Documentation cont…

ImplementationImplementation• Entire program implementationEntire program implementation• Multi-phase approachMulti-phase approach

o Phase 1- Referral basedPhase 1- Referral basedo Phase 2- Include specific inclusion criteria Phase 2- Include specific inclusion criteria

Narrow therapeutic medications, Poly-pharmacy, specific disease states, Narrow therapeutic medications, Poly-pharmacy, specific disease states, etc….etc….

• Educate providers regarding MTM servicesEducate providers regarding MTM serviceso Need support from clinical staff Need support from clinical staff

• BGSU adopted a multi-phase approach and is in Phase 1BGSU adopted a multi-phase approach and is in Phase 1

OutcomesOutcomes• Surveys for patientsSurveys for patients

o Satisfaction, increased adherence, improved symptomsSatisfaction, increased adherence, improved symptoms

• Surveys for physiciansSurveys for physicianso Satisfaction, disease state improvement Satisfaction, disease state improvement

• Chart ReviewChart Reviewo Disease state improvement, kept appointments, clinical progressDisease state improvement, kept appointments, clinical progress

• Other outcomesOther outcomeso Academic retention, cost reduction Academic retention, cost reduction

Outcomes cont…Outcomes cont…

• BGSU MTM program:BGSU MTM program:o Utilizing patient surveys and chart reviewUtilizing patient surveys and chart review

RetentionRetention Increased adherenceIncreased adherence Satisfaction Satisfaction Clinical improvement Clinical improvement

ObstaclesObstacles

• ReimbursementReimbursemento Work closely with billing department to track Work closely with billing department to track

reimbursement historyreimbursement history

• Obtaining referrals from providersObtaining referrals from providerso Continue to educate and promote MTM Continue to educate and promote MTM

servicesservices

Patient # 1Patient # 1• 19yo F, undergraduate, has previously been treated for other mental health 19yo F, undergraduate, has previously been treated for other mental health

disorders in the past disorders in the past • Diagnosis: Mood D/O NOS, social phobia, anxiety, panic D/ODiagnosis: Mood D/O NOS, social phobia, anxiety, panic D/O• PMH: Reflex sympathetic dystrophy, asthma, headaches, psychotropic PMH: Reflex sympathetic dystrophy, asthma, headaches, psychotropic

seizures seizures • Reason Referred: Counseling Center referral due to academic probation, Reason Referred: Counseling Center referral due to academic probation,

non-compliancenon-compliance• Current Medications: Current Medications:

o Abilify 30 mg dailyAbilify 30 mg dailyo Trazodone 100 mg one-two tablets at bedtimeTrazodone 100 mg one-two tablets at bedtimeo NuvaRingNuvaRingo Gabapentin 600 mg three times dailyGabapentin 600 mg three times dailyo Omeprazole 20 mg dailyOmeprazole 20 mg dailyo OTC naproxen or ibuprofen when neededOTC naproxen or ibuprofen when needed

• Utilization of other psychological services: currently sees psychiatrist (has Utilization of other psychological services: currently sees psychiatrist (has history of compliance with appointments)history of compliance with appointments)

Patient # 1 OutcomePatient # 1 Outcome

• MTM SessionMTM Sessiono Reviewed individual medicationsReviewed individual medicationso Established goals Established goals o Stressed importance of adherence to obtain Stressed importance of adherence to obtain

goalsgoalso Provided patient with daily pill reminderProvided patient with daily pill reminder

Patient # 1 OutcomePatient # 1 Outcome

• Clinical NotesClinical Noteso Most recent psychiatrist visit: Patient was Most recent psychiatrist visit: Patient was

doing very well, no troubles sleeping, doing very well, no troubles sleeping, appetite good, no further mood swings, appetite good, no further mood swings, declines side effects and anxiety. Feels like declines side effects and anxiety. Feels like she is in better control of her emotions and she is in better control of her emotions and less irritable. Currently enrolled in classes. less irritable. Currently enrolled in classes.

Patient # 2Patient # 2• 21yo F undergraduate21yo F undergraduate• Diagnosis: Depression, compulsive behaviorDiagnosis: Depression, compulsive behavior• PMH: Fibromyalgia PMH: Fibromyalgia • Reason referred: patient self referral – had multiple questions Reason referred: patient self referral – had multiple questions

regarding medications, SE, benefits, MOA, etc.regarding medications, SE, benefits, MOA, etc.• Current MedicationsCurrent Medications

o Lyrica 75 mg dailyLyrica 75 mg dailyo Lamotrigine 50 mg twice dailyLamotrigine 50 mg twice dailyo Mirtazapine 15 mg at bedtimeMirtazapine 15 mg at bedtimeo Has tried Effexor, Cymbalta, Celexa, Buspar, and Prozac but Has tried Effexor, Cymbalta, Celexa, Buspar, and Prozac but

has been noncompliant with all due to side effects has been noncompliant with all due to side effects • Utilization of other psychological services: psychologist, unhappy Utilization of other psychological services: psychologist, unhappy

with counseling services with counseling services

Patient # 2 OutcomePatient # 2 Outcome• MTM SessionMTM Session

o Established goals of learning more about medication and Established goals of learning more about medication and obtaining positive mood without side effectsobtaining positive mood without side effects

o Reviewed current therapyReviewed current therapyo Discussed Buspar vs. Lamictal Discussed Buspar vs. Lamictal o Educated on diagnosis, risks and benefits of medications and Educated on diagnosis, risks and benefits of medications and

importance of adherenceimportance of adherence• Clinical NotesClinical Notes

o Patient appeared to benefit from discussing Patient appeared to benefit from discussing medications with the pharmacist. Was very pleased medications with the pharmacist. Was very pleased with those services. Current regimen is allowing her with those services. Current regimen is allowing her symptoms to become better controlled with few side symptoms to become better controlled with few side effects effects

Patient # 2 Outcome cont…Patient # 2 Outcome cont…

• Patient FeedbackPatient Feedbacko Enjoyed talking to the pharmacist about her Enjoyed talking to the pharmacist about her

medications. Thought it was beneficial and gave medications. Thought it was beneficial and gave her a better understanding of her medication her a better understanding of her medication regimenregimen

Patient # 3Patient # 3• 26yo M, undergraduate26yo M, undergraduate• Diagnosis: Bipolar, DepressionDiagnosis: Bipolar, Depression• PMH: Ewings SarcomaPMH: Ewings Sarcoma• Reason Referred: Physician referral – patient had Reason Referred: Physician referral – patient had

questions about SE, benefits, and interactions. Also questions about SE, benefits, and interactions. Also wanted to discuss smoking cessation options with his wanted to discuss smoking cessation options with his medicationsmedications

• Medications:Medications:o Depakote ER 500 mg dailyDepakote ER 500 mg dailyo Has tried SSRI but developed side effects and stopped Has tried SSRI but developed side effects and stopped

taking it taking it • Utilization of psychological services include counseling Utilization of psychological services include counseling

services weekly and psychiatrist services weekly and psychiatrist

Patient # 3 OutcomesPatient # 3 Outcomes• MTM SessionMTM Session

o Established goals of obtaining better control of bipolar disease Established goals of obtaining better control of bipolar disease statestate

o Reviewed current therapyReviewed current therapyo Discussed safety of medications and beginning smoking Discussed safety of medications and beginning smoking

cessation productscessation productso Educated on diagnosis, risks and benefits of medications and Educated on diagnosis, risks and benefits of medications and

importance of adherenceimportance of adherenceo Recommended for PCP to monitor LFT, CBC, vision, EPS Recommended for PCP to monitor LFT, CBC, vision, EPS

• Clinical NotesClinical Noteso The patient enjoyed talking to the pharmacist about his The patient enjoyed talking to the pharmacist about his

medicationsmedicationso Monitoring parameter within normal limitsMonitoring parameter within normal limits

Patient # 3 Outcomes cont…Patient # 3 Outcomes cont…

• Patient Feedback Patient Feedback – Based on patient satisfaction survey the student Based on patient satisfaction survey the student

thought MTM was extremely valuable with an thought MTM was extremely valuable with an increase in medication compliance from 70-80% to increase in medication compliance from 70-80% to 90-100%. The patient also feels like his symptoms 90-100%. The patient also feels like his symptoms are extremely controlled and that he has achieved are extremely controlled and that he has achieved better academics since the MTM. He also would better academics since the MTM. He also would recommend MTM services to others. recommend MTM services to others.

Looking ForwardLooking Forward• BGSU Mental Health MTMBGSU Mental Health MTM

o Phase 2- Include specific inclusion criteria Phase 2- Include specific inclusion criteria Narrow therapeutic medications, Poly-pharmacy, Narrow therapeutic medications, Poly-pharmacy,

specific disease states, etc….specific disease states, etc…. Fall 2011Fall 2011

• BGSU MTM programBGSU MTM programo Offer services for other disease states Offer services for other disease states

requiring high levels of educationrequiring high levels of education Asthma and diabetesAsthma and diabetes

ReferencesReferences

American College Health Association-National College Health Assessment II: American College Health Association-National College Health Assessment II: Reference Group Executive Summary Fall 2010. Linthieum, MD: American Reference Group Executive Summary Fall 2010. Linthieum, MD: American College Health Association; 2011.College Health Association; 2011.

Bunting BA, Smith BH, Sutherland SE. The Asheville Project: clinical and economic Bunting BA, Smith BH, Sutherland SE. The Asheville Project: clinical and economic outcomes of a community-based long-term medication therapy management outcomes of a community-based long-term medication therapy management program for hypertension and dyslipidemia. J Am Pharm Assoc. 2008;48:23-31.program for hypertension and dyslipidemia. J Am Pharm Assoc. 2008;48:23-31.

Cranor CW, Bunting BA, Christensen DB. The Asheville Project: long-term clinical Cranor CW, Bunting BA, Christensen DB. The Asheville Project: long-term clinical

and economic outcomes of a community pharmacy diabetes care program. J Am and economic outcomes of a community pharmacy diabetes care program. J Am Pharm Assoc. 2003;43:173-84.Pharm Assoc. 2003;43:173-84.

Kliethermes MA, Schullo-Feulner AM, Tilton J, Kim S, Pellergri AN. Model for Kliethermes MA, Schullo-Feulner AM, Tilton J, Kim S, Pellergri AN. Model for medication therapy management in a university clinic. Am J Health Syst Pharm. medication therapy management in a university clinic. Am J Health Syst Pharm. 2008;65(9):844-56. 2008;65(9):844-56.

Caley CF, Webber D, Kurland M, Holmes P. The role of a psychiatric pharmacist in Caley CF, Webber D, Kurland M, Holmes P. The role of a psychiatric pharmacist in college health. J Am Coll Health. 2010;58(4):393-3. college health. J Am Coll Health. 2010;58(4):393-3.

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We have NO actual or potential conflict of interest in relation to this educational activity or presentation