Pharmacists are Untapped Resource in Treatment of Mental Illness
“The best medication at the best dose can never be effective if the patient does not take it.”
According to a recent study published in the Journal of Clinical Psychopharmacology, less than half the patients prescribed medication to be taken for an extended period of time to treat persistent mental health problems like schizophrenia and bipolar disorder remain adherent. Mean rates of treatment adherence are approximately 42 percent in schizophrenia and 41 percent in bipolar disorder.
In human terms, the outcomes can be devastating – hospitalization, ancillary health problems and inability to maintain social connections resulting in loss of job and broken relationships, with increased chance of relapse. And, the economic impact is staggering. A 2005 study published in Patient Related Outcome Measures estimated that rehospitalization costs in the U.S. attributable to antipsychotic nonadherence were approximately $1.5 billion per year.
Non-adherence may be as simple as forgetting to take a pill, or it can be a deliberate decision to stop taking medication because the patient feels better and doesn’t feel the need to continue. Denial of illness, financial burden, unpleasant side-effects and limited access to treatment facilities also contribute to the problem.
Pharmacists are often the first to see the red-flags of non-adherence – missed or late refills.
And pharmacists can also play a critical role in addressing the problem by working together with prescribers to administer long-acting injectable antipsychotics (LAIAs). LAIAs are effective in treating schizophrenia and other severe psychotic disorders because they assure stable blood levels that lead to a lower risk of relapse. In addition, adherence is more transparent –patients either come in for scheduled injections or they don’t.
Over the past several decades, pharmacists are playing a more active role in patient care, notably in the administration of vaccines. This success has the potential to be translated into administration of LAIAs.
But administering LAIAs is not like giving a flu shot. It requires a long-term commitment to building a relationship with referring prescribers and patients. Pharmacists must be trained to administer the intra-muscular injections, report to the physician in charge about the patient’s ongoing condition, comply with all record-keeping required by Medicaid, and create a dedicated, private space.
To prepare pharmacists in Connecticut to enter this new area of care, University of Connecticut’s School of Pharmacy, the State Division of Drug Control and Genoa, a QoL Healthcare Company conducted a training seminar on administration of LAIAs in May (http://today.uconn.edu/school-stories/community-pharmacists-role-improving-outcomes-patients-mental-illness/). The problem in Connecticut is acute, with hospitalizations for mental illnesses resulting in some 32,000 discharges in 2013, and 260,000 inpatient days with 8 million emergency department admissions between 2009 and 2013. State law in Connecticut provides pharmacists the opportunity to administer LAIA through a collaborative practice agreement with physicians.
Currently, there are eight Genoa pharmacists in Connecticut who are trained to administer LAIAs. These pharmacists practice in the communities of Manchester, East Hartford, Norwich and New London. The pilot phase of this initiative is intended to help pharmacists learn important details of incorporating this service into their existing workflows. To date, a small handful of injections have been administered and in each case, the pharmacists have been called in to fill a service gap when injection nurses have been unintentionally unavailable. The long-range goal of this initiative is to increase the number of trained Connecticut pharmacists, including all Genoa sites, as well as traditional community pharmacies.
Pharmacists can fill a gap by helping patients obtain access to appropriate treatment. With almost 275,000 pharmacists employed in the United States, they are an untapped source of care. With most Americans living within five miles of a pharmacy, they can also address the barrier of access for many patients.
By counseling patients about the benefits of LAIAs, pharmacists can play an integral role in supporting client choice. In regions where patients receive LAIA injections directly from a pharmacist, patients receive these LAIs in the same place where people routinely receive injections like vaccinations, further minimizing the stigma attached to entering a clinic or physician’s office.
Pharmacists are already on the front-lines as educators who work daily with individuals experiencing a breadth of physical and psychiatric conditions. A 2012 survey by the College of Psychiatric and Neurologic Pharmacists Foundation and National Alliance on Mental Illness found that 91 percent of people who take mental health medication are very comfortable going to community pharmacies to fill their medications.
Pharmacists can play a critical role addressing non-adherence and helping individuals with mental health issues like schizophrenia and bi-polar disorder receive the high-quality care that will lead them into recovery and full lives as active members of their communities.