Psychiatric Pharmacy in a University Student Health System
Charles F. Caley, Pharm.D., BCPP
Associate Clinical Professor
University of Connecticut
INTRODUCTION
Mental Illness on Campus
American College Health Survey Top 10 health problems during academic year
• Depression 17.8%• Anxiety 12.4%• SAD 8.1%
Top 10 health impediments to academic performance• Depr/SAD/Anx 15.7%
N = 94,806 completed surveys J Am College Health 2007;55(4):195–206.
N = 939 UMich students completed surveys NASPA Journal 2006;43(3):410–31.
College Student Mental Hlth SurveyPsychiatric Diagnosis by Student Self-Report
0
2
4
6
8
10
12
14
16
Depr Eating Anx ADHD PTSD SocAnx OCD SA Bipolar Psychosis
%
DESCRIPTION OF SERVICE
• 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
Consultation w/ patient record review / pt interview / written note in chart
Consultation w/ record review and discussion with APRN
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)
IMPACT ON PATIENT CARE
Results 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 Consultations by type of recommendation
Change dose 8 (30%) Change medication 7 (26%) Start new medication 6 (22%) Patient education 6 (22%) No changes to tx plan 2 (7%) Recommend adj. psychotherapy 1 (4%)
Staff Education
Weekly APRN Meetings Clinical pharmacology Pk drug–drug interactions Psychotropic adverse effect profiles Pharmacotherapeutic selection process
SHS Inservices Mechanisms of drug intolerance Drug interactions btwn common Rxs and
common OTCs Serotonin syndrome review and update
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 Clinical outcomes beyond implementation
Results
To maintain service funding Explore additional avenues for billing / funding
Obtain outcome data Symptom severity change CMHS service use Academic performance Patient satisfaction
Campus outreach Present project results at annual ACHA in June
Future