1. Role of the Pharmacist in Collaborative Care for Mental Health and Addiction Treatment in Medically Underserved Appalachia
Sarah T. Melton, PharmD,BCPP,CGP
Appalachian College of Pharmacy, Oakwood, VA
CPNP Annual Meeting, 2009

2. Central Appalachian Region: Medically Underserved
Poverty rate 75% higher
Lower education levels
Over 25% of population is disabled
Mental health diagnoses for psychiatric and addiction disorders are proportionately higher in Appalachia
The rate of increase in abuse of opiates and synthetics is Appalachia is higher, especially in coal mining areas
Citizens of Southwest Virginia are 70% more likely to commit suicide than the rest of Virginia.

3. Barriers to Mental Health Treatment
Wait to see psychiatrist for diagnosis and medication management is 4-6 months minimum
Specific barriers to accessing treatment include:
stigma
transportation availability
limited payment options
privacy issues
choice of facilities
cultural and family barriers

4. C-Health, PC Compass, PC
Private, family practice clinic with three physicians, five nurse practitioners, one physician assistant, a clinical psychologist, and 2 clinical pharmacists
Medically underserved area with a diverse patient population.
20% of patients are covered by Medicaid
35% are covered by Medicare
35% by private insurance
10% are uninsured.

5. Provision of Patient-Centered Care
Referral from provider
Patient seen by appointment
Appointments are typically one hour in length
Average number of patients seen/day = 6
Disorders:
Depression, bipolar, anxiety, dementia, schizoaffective, ADHD, eating, seizure, sleeping, addiction, chronic pain

6. Provision of Patient-Centered Care
Group Medical Appointments
Opiate dependence
Chronic pain
Tobacco cessation
Electronic Medical Record
E-MD’s TopsSuite
Comprehensive patient notes and documentation
Immediate feedback from physicians

7. Provision of Patient-Centered Care
Patient/caregiver interview and assessment
Medication therapy management, including prescribing
Ordering and evaluating laboratory testing
Referral to the clinical psychologist for counseling or cognitive behavioral therapy (CBT)
Home visits
Patient assistance program (PAP)

8. Outcomes Reimbursement Improved access to healthcare
Billed incident to physician visit
Sliding scale cash charge
Improved access to healthcare
Enhanced care through optimized drug therapy management
Decreased drug-related problems
Reduced costs through optimized medication regimens
Through PAP, over $100,000 of medications are ordered and delivered to patients per year
Experiential learning site (more than 35 students/year in IPPE/APPE rotations)

9. Conclusion
This 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.