Closing the Care Gap for People with Severe and Persistent Mental Illness: Collaborative Care, Telehealth, and Clinical Pharmacy

Iturralde, Esti; Fazzolari, Lisa; Shia, Macy; Slama, Natalie; Leang, Jessica; Awsare, Sameer; Nguyen, Lily

doi:10.1056/cat.21.0417

Cited by 7 publications

(7 citation statements)

References 32 publications

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“…For instance, in a randomized controlled effectiveness study in patients with chronic mental disorders and cardiovascular disease risk, a Life Goals Collaborative Care model had better physical health‐related quality of life than usual care 34 . Similar results have been reported in other studies 35 . The high prevalence of almost all physical conditions, including cardiovascular and endocrine disorders, in our OOABD group is also a reminder of the importance of primary, secondary, and tertiary prevention in younger patients with BD 36 …”

Section: Discussionsupporting

confidence: 80%

“…34 Similar results have been reported in other studies. 35 The high prevalence of almost all physical conditions, including cardiovascular and endocrine disorders, in our OOABD group is also a reminder of the importance of primary, secondary, and tertiary prevention in younger patients with BD. 36 Our OOABD group had an average age of onset of 45 years, significantly later than the OABD and younger adult cohort.…”

Section: Physical Comorbiditymentioning

confidence: 96%

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Sociodemographic and clinical characteristics of people with oldest older age bipolar disorder in a global sample: Results from the global aging and geriatric experiments in bipolar disorder project

Chen,

Sajatovic,

Briggs

et al. 2024

Int J Geriat Psychiatry

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ObjectsStudies of older age bipolar disorder (OABD) have mostly focused on “younger old” individuals. Little is known about the oldest OABD (OOABD) individuals aged ≥70 years old. The Global Aging and Geriatric Experiments in Bipolar Disorder (GAGE‐BD) project provides an opportunity to evaluate the OOABD group to understand their characteristics compared to younger groups.MethodsWe conducted cross‐sectional analyses of the GAGE‐BD database, an integrated, harmonized dataset from 19 international studies. We compared the sociodemographic and clinical characteristics of those aged <50 (YABD, n = 184), 50–69 (OABD, n = 881), and ≥70 (OOABD, n = 304). To standardize the comparisons between age categories and all characteristics, we used multinomial logistic regression models with age category as the dependent variable, with each characteristic as the independent variable, and clustering of standard errors to account for the correlation between observations from each of the studies.ResultsOOABD and OABD had lower severity of manic symptoms (Mean YMRS = 3.3, 3.8 respectively) than YABD (YMRS = 7.6), and lower depressive symptoms (% of absent = 65.4%, and 59.5% respectively) than YABD (18.3%). OOABD and OABD had higher physical burden than YABD, especially in the cardiovascular domain (prevalence = 65% in OOABD, 41% in OABD and 17% in YABD); OOABD had the highest prevalence (56%) in the musculoskeletal domain (significantly differed from 39% in OABD and 31% in YABD which didn't differ from each other). Overall, OOABD had significant cumulative physical burden in numbers of domains (mean = 4) compared to both OABD (mean = 2) and YABD (mean = 1). OOABD had the lowest rates of suicidal thoughts (10%), which significantly differed from YABD (26%) though didn't differ from OABD (21%). Functional status was higher in both OOABD (GAF = 63) and OABD (GAF = 64), though only OABD had significantly higher function than YABD (GAF = 59).ConclusionsOOABD have unique features, suggesting that (1) OOABD individuals may be easier to manage psychiatrically, but require more attention to comorbid physical conditions; (2) OOABD is a survivor cohort associated with resilience despite high medical burden, warranting both qualitative and quantitative methods to better understand how to advance clinical care and ways to age successfully with BD.

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Section: Discussionsupporting

confidence: 80%

Section: Physical Comorbiditymentioning

confidence: 96%

Sociodemographic and clinical characteristics of people with oldest older age bipolar disorder in a global sample: Results from the global aging and geriatric experiments in bipolar disorder project

Chen,

Sajatovic,

Briggs

et al. 2024

Int J Geriat Psychiatry

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“…In addition, high rates of care coordination activities, including referrals to other providers, obtaining and sending medical records, and collaborating with external providers on the patient's care team, were documented in this study. The combination of these activities, along with the high rate of telehealth delivery, is more representative of a collaborative care program described by Iturralde et al 14 Such a model may represent a unique opportunity for a psychiatric pharmacist to take on a care manager role as described in the Psychiatric Collaborative Care Model (CoCM) under the Center for Medicare and Medicaid Services Behavioral Health Integration reimbursement initiative 15 . While the CoCM model is most commonly employed in the primary care setting, similar models can be employed in other non‐psychiatry specialty settings.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of a psychiatric pharmacist consultation service in a multispecialty outpatient clinic

Hui,

Chibli,

Catanzano

2024

J Am Coll Clin Pharm

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BackgroundIntegrated care programs provide both medical and mental health care in clinical settings. Psychiatric pharmacists play a key role in optimizing patient care when integrated into a healthcare team. This project describes the implementation and trends of a psychiatric pharmacist consultation service in a multispecialty outpatient through an integrated behavioral healthcare model.MethodsThis is a retrospective study analyzing a psychiatric pharmacist consultation service at an academic multispecialty outpatient clinic. Eligible patients were aged ≥17 years and seen by the psychiatric pharmacist between June 1, 2019 and June 30, 2022. Patient demographics, reasons for referral, and pharmacist interventions were collected. Patient outcomes on depression, anxiety, and diabetes were also explored. Descriptive statistics were used to quantify information.ResultsA total of 572 encounters were identified. Of those, 285 (49.8%) represented unique patients. Over the 36‐month period, an average of 16 consults were conducted per month. Anxiety and depressive disorders, pain syndromes, and adult attention‐deficit/hyperactivity disorder were the most common diagnoses listed as reasons for consultation. An average of five recommendations or interventions were provided by the psychiatric pharmacist at each initial consultation. Anxiety and depression symptom scores, as well as hemoglobin A1c (HbA1c) values, were lower following pharmacist consultation.ConclusionPsychiatric pharmacists can serve a unique role at multispecialty clinics by providing consultation for patients with psychiatric conditions, chronic pain, medical conditions, and polypharmacy. This study demonstrates the successful utilization of such a service and suggests a psychiatric pharmacist's expertise contributes to improved depression, anxiety, and glycemic outcomes. The multispecialty outpatient setting represents an opportunity to further explore growth for psychiatric pharmacists and the impact these services have on patient outcomes.

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“…Recent implementation of psychiatric pharmacist services within Kaiser reflects the successful implementation of psychiatric pharmacists within a private, nonprofit, value based healthcare system. 13 We challenge you by paraphrasing the closing remarks from Mar-…”

Section: Khartabil Et Al Provide a Narrative Review Of Studies Lookin...mentioning

confidence: 99%

“…Psychiatric pharmacist payment by insurance companies and the government is a major challenge to the expansion of the specialty, and the rapid utilization of psychiatric pharmacists in the VA is reflective of what is possible within a value based healthcare system. Recent implementation of psychiatric pharmacist services within Kaiser reflects the successful implementation of psychiatric pharmacists within a private, nonprofit, value based healthcare system 13 …”

mentioning

confidence: 99%

Acknowledging progress and current challenges

Crismon,

Rush

2024

J Am Coll Clin Pharm

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Closing the Care Gap for People with Severe and Persistent Mental Illness: Collaborative Care, Telehealth, and Clinical Pharmacy

Cited by 7 publications

References 32 publications

Sociodemographic and clinical characteristics of people with oldest older age bipolar disorder in a global sample: Results from the global aging and geriatric experiments in bipolar disorder project

Sociodemographic and clinical characteristics of people with oldest older age bipolar disorder in a global sample: Results from the global aging and geriatric experiments in bipolar disorder project

Evaluation of a psychiatric pharmacist consultation service in a multispecialty outpatient clinic

Acknowledging progress and current challenges

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