Medication Management Toolkit A guide to the use of medication algorithms to guide clinical care

What Is An Algorithm ? “A step by step procedure for solving a problem…. In a finite number of steps that frequently involves repetition of an operation.” Algorithm and guidelines are often used interchangeably in the medical literature

Medication Management - Definition There appears to be no explicit definition of medication management in the SAMHSA toolkit, however, critical elements include: Utilization of a systematic plan for medication management Objectives measures of outcome are produced Documentation is thorough and clear Consumer and practitioners share in decision-making

Minimum Requirements for Reporting Medication Management Treatment plan specifies outcome for each medication Desired outcomes are tracked systematically using standardized instruments in a way to inform treatment decisions Sequencing of antipsychotic medication and changes are based on clinical guidelines

Fidelity ???? Fidelity is defined as adherence to the key elements of an evidence-based practice, as described in the controlled experimental design, and that are shown to be critical to achieving the positive results found in a controlled trail. Studies indicate that the quality of implementation strongly influences outcome.

MedMap Fidelity Scale Organizational Scale and Outpatient Chart Review Org. Scale Example: Standardized Summary of Illness and Medication History Chart Review Example: Current Comprehensive Medication Documentation

Why Use an “Algorithm” In Prescribing Psychiatric Medications ? They are frequently used with many chronic medical illnesses like diabetes, hypertension and asthma Difficulty for clinicians to keep up with new information Improvements in standard of care using an effective treatment technique Improvement in treatment outcomes and cost savings Continuity of care from hospital to community

Mental Illnesses for Which Medication Algorithms have been Developed Schizophrenia Major Depressive Disorder Bipolar Disorder / Schizoaffective Disorder

Cautions about the use of Algorithms Algorithms developed by expert consensus panels may be limited if panel member selection did not cut across a broad section of experts of differing opinions Algorithms developed through review of scientific literature and clinical trials may be more rigorous, but may be applicable to a specific population group

Cautions (continued) Accurate diagnosis of persons seeking treatment is essential if the algorithms are to be effective Algorithms must be updated frequently to reflect newly discovered treatment approaches or newly developed medications The degree of flexibility an individual practitioner has is important to consider

Kentucky Medication Algorithm Program (KyMAP) Quality Care …… Through Shared Information KyMAP is based on the Texas Medication Algorithm Project, and was designed to develop, implement and evaluate not just a set of medication algorithms, but an algorithm-driven treatment philosophy for major adult psychiatric disorders treated in the Kentucky public mental health sector.

KyMAP – Mission Statement To optimize care for those with Mental Illness through the utilization of evidence based guidelines and shared information among consumers, families and clinicians.

KyMAP - Principles A set of beliefs that guide project implementation (see handout) such as: “Patients, consumers and families not only have the right, but the responsibility, to be involved in the treatment of their mental illnesses”

Consumer Education Curriculum Information is shared about the illness Medication information is explained Symptom/side effect monitoring and coping Basic disorder and treatment information In-depth reading materials Videotapes and discussion materials Consumer-to- consumer group discussion materials Support group information

KyMAP Partners Central State Hospital Department for Mental Health & Mental Retardation Services Seven Counties Services Kentucky River Community Care KY CAN NAMI Kentucky

Current Status SAMHSA grant ends 9/30/06 Presentation of “Lessons Learned” at national EBP conference (August , 2006) Case Study as part of NIMH EBP grant Result of outcome study (satisfaction, quality of life, symptom change)

Implementation Issues Readiness for, and awareness of, the practice varies from site to site Infrastructure Needs (e.g. clinical time, training time, cost / billing issues, data collection) Insufficient buy-in at Cabinet and Department level (no mandate, policy)