Presentation on theme: "Role of the Pharmacist in Collaborative Care for Mental Health and Addiction Treatment in Medically Underserved Appalachia Sarah T. Melton, PharmD,BCPP,CGP."— Presentation transcript:
1Role of the Pharmacist in Collaborative Care for Mental Health and Addiction Treatment in Medically Underserved AppalachiaSarah T. Melton, PharmD,BCPP,CGPAppalachian College of Pharmacy, Oakwood, VACPNP Annual Meeting, 2009
2Central Appalachian Region: Medically Underserved Poverty rate 75% higherLower education levelsOver 25% of population is disabledMental health diagnoses for psychiatric and addiction disorders are proportionately higher in AppalachiaThe rate of increase in abuse of opiates and synthetics is Appalachia is higher, especially in coal mining areasCitizens of Southwest Virginia are 70% more likely to commit suicide than the rest of Virginia.
3Barriers to Mental Health Treatment Wait to see psychiatrist for diagnosis and medication management is 4-6 months minimumSpecific barriers to accessing treatment include:stigmatransportation availabilitylimited payment optionsprivacy issueschoice of facilitiescultural and family barriers
4C-Health, PC Compass, PCPrivate, family practice clinic with three physicians, five nurse practitioners, one physician assistant, a clinical psychologist, and 2 clinical pharmacistsMedically underserved area with a diverse patient population.20% of patients are covered by Medicaid35% are covered by Medicare35% by private insurance10% are uninsured.
5Provision of Patient-Centered Care Referral from providerPatient seen by appointmentAppointments are typically one hour in lengthAverage number of patients seen/day = 6Disorders:Depression, bipolar, anxiety, dementia, schizoaffective, ADHD, eating, seizure, sleeping, addiction, chronic pain
6Provision of Patient-Centered Care Group Medical AppointmentsOpiate dependenceChronic painTobacco cessationElectronic Medical RecordE-MD’s TopsSuiteComprehensive patient notes and documentationImmediate feedback from physicians
7Provision of Patient-Centered Care Patient/caregiver interview and assessmentMedication therapy management, including prescribingOrdering and evaluating laboratory testingReferral to the clinical psychologist for counseling or cognitive behavioral therapy (CBT)Home visitsPatient assistance program (PAP)
8Outcomes Reimbursement Improved access to healthcare Billed incident to physician visitSliding scale cash chargeImproved access to healthcareEnhanced care through optimized drug therapy managementDecreased drug-related problemsReduced costs through optimized medication regimensThrough PAP, over $100,000 of medications are ordered and delivered to patients per yearExperiential learning site (more than 35 students/year in IPPE/APPE rotations)
9ConclusionThis models demonstrates provision of an effective bridge to treatment with a psychiatrist in medically underserved, rural Appalachia.Effective interdisciplinary team collaboration between a psychiatric pharmacist, primary care physician and clinical psychologist.As a learning site for pharmacy students, the program provides real-life experiences in the provision of optimal, evidence-based, patient-centered care that addresses mental health and addiction disorders accompanied by cultural and economic challenges.Psychiatric pharmacists can be reimbursed for clinical services in the ambulatory care setting.