Learning the “Science of the Art of Prescribing”: From Evidence-based Algorithms to Individualized Medicine in Psychiatric Care

King, Ian P.; Shapiro, Yakov

doi:10.1097/pra.0000000000000651

Cited by 4 publications

(5 citation statements)

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“…"Despite many legitimate challenges… teaching an integrated approach incorporating objective, subjective, and relational factors in psychopharmacology provision and utilizing evidence-based principles of individualized care should be prioritized in both residency training and clinical psychopharmacology provision. " 15 It will not be easy, but we believe both are worth it, and necessary, to improve the quality of psychiatric care for patients and their significant others. It may even save money in the long run, not only for patients, their families, or their caretakers, but to the entire psychiatric delivery system of care.…”

Section: Discussionmentioning

confidence: 99%

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Raising the Quality of Psychopharmacology Clinical Psychiatric Practice

Glick

Balon

DeBattista

2022

J Clin Psychopharmacol

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A s the science underlying psychopharmacology practice has become roughly that of the science underlying other medical illnesses, the level of quality clinical care competence in practice has become more difficult for clinicians to achieve. This report aims to suggest ways to improve teaching to raise the quality level by describing the core tasks for prescribing quality clinical psychopharmacology. We describe the reasons why the quality is low and why the most common clinical practices are not being done, and most importantly, we delineate the necessary core elements for ongoing follow-up visits. We detail clinical psychopharmacology "pearls" that underlie global, integrative, long-term practice. As academic psychiatrists, who do clinical psychopharmacology practice and reach out to clinical psychopharmacology practitioners in the community, we are often asked to recommend a "good, competent psychopharmacologist." It is our impression that, over the decades since the field changed, despite the advances in translational neuroscience and introduction of many new and effective medications for most psychiatric disorders, the level of quality clinical psychopharmacology treatment in some areas of psychiatry has not sufficiently kept up with these changes and/or improved to an optimum competence level. We now know that most of the disorders that we treat are genetic in origin and chronic, for example, bipolar and major depressive disorder, schizophrenia, and even anxiety disorders such as generalized anxiety disorder. Individualized psychiatric care is especially difficult now as psychiatric patients are being treated over their lifetime.Ironically, as the science and the data underlying psychopharmacological treatments have become roughly equal to the science underlying the rest of medical illnesses, the level of clinical competence in practice seems to us as consultants to have become more and more difficult for practitioners to achieve. At worst, the quality/level of care of psychopharmacology clinical practice may be very low, even unacceptable in many settings, especially in primary care, where psychopharmacology training is limited and there are few, if any, psychopharmacology curriculums used.This article attempts to fill that gap and raise the level of clinical psychopharmacology practice to competence by describing what we consider the crucial, core tasks for practicing good clinical psychopharmacology in both inpatient and outpatient settings. By competence, we mean prescriber knowledge and expertise to get treatment done in a manner that we all recognize as reasonably effective. Somewhat parenthetically, the care should have the following elements: "safe, effective, patient-centered, efficient, equitable, and timely." 1,2 There have been articles on teaching psychopharmacology over the last 2 decades and an entire issue in Academic Psychiatry dedicated to the teaching issues in 2005. [3][4][5][6] They go into detail on what needs to be done to teach. However, there have been very few articles in the litera...

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Section: Discussionmentioning

confidence: 99%

“…“Despite many legitimate challenges… teaching an integrated approach incorporating objective, subjective, and relational factors in psychopharmacology provision and utilizing evidence-based principles of individualized care should be prioritized in both residency training and clinical psychopharmacology provision.” 15 …”

Section: Discussionmentioning

confidence: 99%

Raising the Quality of Psychopharmacology Clinical Psychiatric Practice

Glick

Balon

DeBattista

2022

J Clin Psychopharmacol

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Section: Introductionmentioning

confidence: 99%

“…To better prescribe the right medication for the right patient at the right time, prescribers should consider patients' genetic and clinical factors, reports of symptoms, and their experiences with treatment. 3 The Clinical Pharmacogenomics Implementation Consortium (CPIC), an international consortium that systematically curates and translates evidence on pharmacogenetics into recommendations of how to use pharmacogenetic test results has developed guidelines for three pharmacogenes, CYP2D6, CYP2B6, and CYP2C19, that are associated with metabolism of selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs). 4 In addition, the US Food and Drug Administration (FDA) has updated package inserts to include information about pharmacogenes for several…”

Section: Introductionmentioning

confidence: 99%

“…Testing for genes known to impact drug metabolism and activation, known as pharmacogenetic testing, can indicate how individuals may respond to a medication with respect to medication efficacy and risk of side effects. To better prescribe the right medication for the right patient at the right time, prescribers should consider patients' genetic and clinical factors, reports of symptoms, and their experiences with treatment 3 …”

Section: Introductionmentioning

confidence: 99%

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Pharmacogenetic testing in primary care could bolster depression treatment: A value proposition

Sperber,

Roberts,

Gonzales

et al. 2024

Clinical Translational Sci

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Pharmacogenetic testing could reduce the time to identify a safe and effective medication for depression; however, it is underutilized in practice. Major depression constitutes the most common mental disorder in the US, and while antidepressant therapy can help, the current trial –and error approach can require patients to endure multiple medication trials before finding one that is effective. Tailoring the fit of pharmacogenetic testing with prescribers' needs across a variety of settings could help to establish a generalizable value proposition to improve likelihood of adoption. We conducted a study to explore the value proposition for health systems using pharmacogenetic testing for mental health medications through prescribers' real‐world experiences using implementation science concepts and systematic interviews with prescribers and administrators from four health care systems. To identify a value proposition, we organized the themes according to the Triple Aim framework, a leading framework for health care policy which asserts that high‐value care should focus on three key metrics: (1) better health care quality and (2) population‐level outcomes with (3) reduced per capita costs. Primary care providers whom we interviewed said that they value pharmacogenetic testing because it would provide more information about medications that they can prescribe, expanding their ability to identify medications that best‐fit patients and reducing their reliance on referrals to specialists; they said that this capacity would help meet patients' needs for access to mental health care through primary care. At the same time, prescribers expressed differing views about how pharmacogenetic testing can help with quality of care and whether their views about out‐of‐pocket cost would prevent them from offering it. Thus, implementation should focus on integrating pharmacogenetic testing into primary care and using strategies to support prescribers' interactions with patients.

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