Psychiatric Pharmacy in a University Student Health System

1. Psychiatric Pharmacy in a University Student Health System Charles F. Caley, Pharm.D., BCPP Associate Clinical Professor University of Connecticut

2. INTRODUCTION

3. 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.

4. College Student Mental Hlth SurveyPsychiatric Diagnosis by Student Self-Report N = 939 UMich students completed surveys NASPA Journal 2006;43(3):410–31.

5. DESCRIPTIONOF SERVICE

6. • 20,000 students at the University of Connecticut • Approximately 6,000 visits to CMHS annually • Two 0.5 FTE psychiatrists, one APRN, seven therapists

7. 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

8. (End pilot project; results presented; report to administrations submitted) (Continue psychiatric pharmacy services to present) (Inservice on mechanisms of drug intolerability given) May 2007 November 2006 September 2007 July 2007 January 2007 October 2006 (Agreement to continue service and to compensate financially is made) (Weekly APRN meetings begin) (Psychiatric pharmacist pilot project begins) Project Chronology

9. IMPACT ON PATIENT CARE

10. 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

11. 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%)

12. 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

13. Results • 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

14. Future • 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