Comparison of pharmacist- and provider-managed lithium in an inpatient medical center: A 6-month review

Johnson, Kayla C.; Smith, Sydney T.; Pouliot, Jonathon D.; Miller, Lindsey

doi:10.1016/j.japh.2021.06.014

Cited by 4 publications

(5 citation statements)

References 10 publications

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“…One publication reported descriptions of comparison between pharmacist and provider managed lithium in an inpatient medical center. A retrospective chart review study, including 67 patients by Johnson and colleagues, compared outcomes when lithium was managed by pharmacists versus the provider 33 . The authors found statistically significant differences in favor of the pharmacist‐managed cohort for the primary outcome.…”

Section: Resultsmentioning

confidence: 99%

“…This study showed the positive impact pharmacists can make on preventing medication safety events in this inpatient setting. Overall pharmacists can have a more active role in the tapering and monitoring of mental health medications 33 …”

Section: Discussionmentioning

confidence: 99%

“…A retrospective chart review study, including 67 patients by Johnson and colleagues, compared outcomes when lithium was managed by pharmacists versus the provider. 33 The authors found statistically significant differences in favor of the pharmacist-managed cohort for the primary outcome. This included the collection of lithium levels within 24 h of patient admission (100% pharmacist managed versus 89.1% provider managed, P = 0.012); pregnancy test completion during admission when indicated (90.5% vs. 41.7%, P < 0.001); identification of serious DDI (47.8% vs. 27%, P = 0.014), and patient education on deliverance of pharmacy provided lithium (71.6% vs. 34.9%, P < 0.001).…”

Section: Appropriate Prescribingmentioning

confidence: 94%

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The impact of pharmacists on medication safety in mental health: A narrative review

Khartabil,

Haghparast,

Al‐Chokachi

et al. 2023

J Am Coll Clin Pharm

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BackgroundPharmacists' role in providing favorable patient outcomes has been established in previous literature. However, the impact of pharmacists in treating patients with mental illness needs further investigation. Patients diagnosed with mental illnesses face multiple challenges that affect their quality and longevity of life compared to the general population with similar age groups. Previous studies confirmed that drug related problems (DRPs) play a major role in these patients due to several factors, such as medication errors and drug interactions. The purpose of this review is to investigate the impact of pharmacist‐led initiatives in safe medication use for mental health populations.MethodsThis narrative review examines the extent and nature of the literature on pharmacist‐led interventions related to medication safety with mental health conditions. The PubMed, Embase, PsycINFO, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases were searched from January 2000 until September 2023. A manual search of relevant citations was also conducted. The inclusion criteria included full‐text studies written in English and published within the above date range. Studies exploring pharmacist‐led interventions in any practice setting for patients with mental illnesses were included. Pharmacist‐led interventions as part of an interdisciplinary team were excluded.ResultsA total of 13 studies were included, collectively involving 4488 patients and 51 pharmacists. The most described interventions included DRPs, medication adherence, and appropriate prescribing. Pharmacist‐led interventions were presented in various aspects, including medication therapy management, long‐acting antipsychotic medication administration, and DRPs resolution through clinical interventions as transition of care.ConclusionThe variation in healthcare settings and regulatory environments influenced the effectiveness of pharmacist‐led interventions. Pharmacists can depict DRP, prevent rehospitalizations, and assess any serious drug interactions that prevent harm and consequently have cost saving outcomes. This review highlights the need for more research, to quantify the impact of pharmacists in improving medication safety for mental health patients.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Appropriate Prescribingmentioning

confidence: 94%

See 1 more Smart Citation

The impact of pharmacists on medication safety in mental health: A narrative review

Khartabil,

Haghparast,

Al‐Chokachi

et al. 2023

J Am Coll Clin Pharm

View full text Add to dashboard Cite

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“…Non-pharmacist managed TDM of lithium. Smith [22] PDDBS 2023, 6, 1; a0000355 No challenges in TDM of lithium found. Due to its narrow therapeutic range, lithium levels need to be carefully monitored to avoid toxicity.…”

Section: Challenges In Tdm Of Lithium Challenges In Usage Of Lithium ...mentioning

confidence: 99%

Challenges of Therapeutic Drug Monitoring and Usage of Lithium in Managing Psychiatric Disorders: A Review

Leo¹,

Mathews²,

Ikhsan³

et al. 2023

Prog Drug Discov Biomed Sci

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Lithium is referred by all key guidelines as a first-line treatment for bipolar disorder (BD) maintenance therapy. Therapeutic drug monitoring (TDM) is necessary while using lithium as lithium treatment. The concern arose when there is one article discussed about the declining of usage of lithium in certain countries such as US and Canada. However, the prescription rates of lithium in United Kingdom and Scandinavia do not show a downward trend. The aim of this study was to determine the challenges of TDM and usage of lithium in managing psychiatric disorders. A total of 32 articles have mentioned the challenges in TDM and usage of lithium. Descriptive statistics was done to identify the challenges in TDM and usage of lithium in psychiatric disorders. There is a total of 25 and 27 challenges found in TDM and usage of lithium in psychiatric disorders respectively. The most stated challenges in TDM of lithium were drug-drug and drug-disease interactions (16.07%), poor compliance (14.28%) and different therapeutic levels or dose suggested by different authors or guidelines (14.28%). The most stated challenges in usage of lithium in psychiatric disorders were potential toxicity (16.85%), side effects of lithium (16.85%), narrow therapeutic range (15.73%) and needs frequent monitoring (15.73%). However, the usage of lithium in certain countries remains still high may be due to the benefits of lithium to psychiatric patients in reducing risk of manic relapse and depressive relapse. Although there are 52 challenges found in the TDM and usage of lithium, there is no definite article or statement stating that the usage of lithium is declining. Future multi-national study is needed to study the extend challenges in TDM and usage of lithium in developed countries as compared to developing countries.

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“…Furthermore, several studies in both in-and outpatient settings showed that the involvement of clinical pharmacists in the physicians' medication policy and monitoring practices resulted in a reduction of potentially inappropriate medication and inadequate blood-test monitoring, and may thus be of added value in a shared care agreement [17][18][19][20][21][22][23][24][25][26]. Apart from clinical pharmacists, incorporating community pharmacist-support in these agreements is also needed to improve monitoring practices of lithium in an outpatient setting [27].…”

Section: Introductionmentioning

confidence: 99%

Lithium surveillance by community pharmacists and physicians in ambulatory patients: a retrospective cohort study

Brouwer

Risselada²,

Wit

et al. 2022

Int J Clin Pharm

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Background Shared care agreements between clinical pharmacists and physicians can improve suboptimal lithium monitoring in in- and outpatient settings. However, it is unknown whether incorporating community pharmacists in such agreements can also improve lithium monitoring in an outpatient setting. Aim To assess the necessity for a shared care agreement for lithium monitoring in our region by investigating: intervention rates by community pharmacists and whether those are sufficient; lithium monitoring by physicians in ambulatory patients; the extent of laboratory parameter exchange to community pharmacists. Method Patient files of lithium users were surveyed in a retrospective cohort study among 21 community pharmacies in the Northern Netherlands. Outcome was the intervention rate by community pharmacists and whether those were deemed sufficient by an expert panel. Additionally, we investigated both the percentages of patients monitored according to current guidelines and of laboratory parameters exchanged to community pharmacists. Results 129 patients were included. Interventions were performed in 64.4% (n = 29), 20.8% (n = 5), and 25.0% (n = 1) of initiations, discontinuations, and dosage alterations of drugs interacting with lithium, respectively. The expert panel deemed 40.0% (n = 14) of these interventions as “insufficient”. Physicians monitored 40.3% (n = 52) of the patients according to current guidelines for lithium serum levels and kidney functions combined. Approximately half of the requested laboratory parameters were available to the community pharmacist. Conclusion Intervention rates by community pharmacists and lithium monitoring by physicians can be improved. Therefore, a shared care agreement between community pharmacists, clinical pharmacists, and physicians is needed to improve lithium monitoring in ambulatory patients.

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Comparison of pharmacist- and provider-managed lithium in an inpatient medical center: A 6-month review

Cited by 4 publications

References 10 publications

The impact of pharmacists on medication safety in mental health: A narrative review

The impact of pharmacists on medication safety in mental health: A narrative review

Challenges of Therapeutic Drug Monitoring and Usage of Lithium in Managing Psychiatric Disorders: A Review

Lithium surveillance by community pharmacists and physicians in ambulatory patients: a retrospective cohort study

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