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HIMAP: Psychopharmacologic Evidence Based Practice

HIMAP: Psychopharmacologic Evidence Based Practice. Iqbal “Ike” Ahmed, M.D. Landmark Schizophrenia PORT Study: Care for Schizophrenia Lags Behind Science. Schizophrenia PORT Actual Treatment Recommendations Treatment Rates (%) Antipsychotic medication for new or relapsed symptoms 1 89.2

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HIMAP: Psychopharmacologic Evidence Based Practice

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  1. HIMAP: Psychopharmacologic Evidence Based Practice Iqbal “Ike” Ahmed, M.D.

  2. Landmark Schizophrenia PORT Study: Care for Schizophrenia Lags Behind Science Schizophrenia PORT ActualTreatment Recommendations Treatment Rates (%) Antipsychotic medication for new orrelapsed symptoms1 89.2 Appropriate dose of antipsychoticmedication for new or relapsed symptoms1 62.4 Antipsychotic medication on an ongoing basis2 92.3 Appropriate dose of ongoing antipsychotic medication 29.1 Antiparkinsonian medication for side effects 46.1 Long-lasting injections of antipsychotic medication 35.0 PORT=patient outcome research team.1Data from inpatients studied.2Data for this box and all remaining categories are from outpatients studied.

  3. Landmark Schizophrenia PORT Study: Care for Schizophrenia Lags Behind Science (cont’d) Schizophrenia PORT ActualTreatment Recommendations Treatment Rates (%) Medication for depression 45.7 Medication for anxiety 41.3 Additional medication for schizophrenia symptoms 14.4 Psychotherapy 45.0 Family education and support 9.6 Vocational rehabilitation 22.5 Assertive community treatment3 10.1 3Data indicate number of outpatients receiving these services.

  4. CONCEPTS • Recovery is an outcome • Disease management is an approach • Medication algorithms are tools

  5. Elements of Effective Psychopharmacologic Practice • Systematic evidence based approach to medication selection and use • Measurement of treatment response and side-effects • Enhancement of patient adherence to taking prescribed medications

  6. Algorithm “A step by step procedure for solving a problem or accomplishing some end.” Webster’s Dictionary

  7. Clinical Reasons for Algorithms • Facilitate clinical decision-making • Improve quality of care • Make treatment plans consistent across sites and physicians • Tailor treatment to individuals • Provide adequate clinical documentation • Define where new medications fit for optimal outcomes

  8. Administrative Reasonsfor Algorithms • Accountability for scarce resources • Uniform expectations for providers • Improve cost efficiency • Predictable costs • Define where new medications are cost- effective • Define costs related to specific treatments or outcomes

  9. Algorithm Philosophy • Most efficacious/safest treatments first • Simplest interventions first • Subsequent interventions tend toward increased complexity and increased risk • Multiple options for physicians when appropriate • Patient preference

  10. Medication Algorithms • Three disorder groups • Major depressive disorders • Schizophrenia • Bipolar disorders • Strategies (identifying the what) • Tactics (identifying the how) • Specific guidelines • Planned revisions

  11. HI M A P Texas Medication Algorithm Project

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