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