Pharmacists help people with severe mental illness overcome health barriers

Pharmacists help people with severe mental illness overcome health barriers

Innovative Kaiser Permanente plan promotes behaviors that protect health in people with schizophrenia and bipolar disorder, study finds

Telemedicine visits with specially trained pharmacists can improve medication adherence and medication compliance among patients with severe mental illness enrolled in an innovative Kaiser Permanente Northern California (KPNC) program, according to a study published in the Journal of Clinical Psychiatry Diabetes screening.

Iturralde Estibaliz
Dr. Esti Ituralde

Analysis found that patients with severe and persistent mental illness (SPMI) who participated in a collaborative care program were prescribed psychotropic medications more frequently and had their blood sugar levels screened more frequently than those with SPMI who received usual care and did not require pharmacist visits. .

Project participants did not see any increase in psychiatric emergency department visits or hospitalizations, said Dr. Esti Iturralde, co-lead author of the project and a research scientist at Kaiser Permanente. It is beneficial and safe to transfer some routine tasks from the psychiatrist to a trained pharmacist. Research.

SPMI program pharmacists work closely with patients’ psychiatrists in a collaborative care model. “Clinical pharmacists are providing important additional support, and psychiatrists are leaders of the team,” explains co-lead author Lisa Fazzolari, DO, a psychiatrist at The Permanente Medical Group and regional medical director of the SPMI program. . The collaborative care team also includes other clinicians such as primary care physicians, and pharmacists serve as care navigators and follow patients through regular video and phone appointments.

“The feedback we’ve received from patients and clinicians is that pharmacists are integrated with the care team,” Iturralde said. “This collaboration allows the psychiatrist to focus on stabilizing the patient’s condition while the pharmacist communicates with the patient and makes adjustments to support treatment success and overall health goals.”

Greater risk of chronic disease

People with SPMI (those with conditions such as schizophrenia and bipolar disorder) may have difficulty continuing to take required psychotropic medications due to side effects or uncertainty about the need to continue treatment. Many patients are also at higher risk for health problems such as obesity, diabetes and heart disease, in part because of side effects from the medications they take. Adding a psychiatric clinical pharmacist to their care team is designed to help manage mental and physical health.

lisa fazzolari
Lisa Fazzollari, DO

The study compared 968 program participants at six KPNC demonstration sites with 8,339 similar SPMI patients, examining multiple health outcomes one year before and after the collaborative care program began in 2021.

On average, patients’ adherence to psychotropic medications improved during the study period in both groups, but those who participated in the collaborative care group improved more, with 60% of patients in the usual care group reaching optimal thresholds by the end of the study. , while 50% of patients in the usual care group reached the optimal threshold. The collaborative care group was also more likely to receive blood glucose screening (74% vs. 64% at the end of the study).

More than 75% of collaborative care participants attended an initial induction meeting and at least one follow-up visit, indicating that SPMI patients are willing to receive support via telehealth, possibly on a smartphone or other device.

“Providing contact via telehealth may overcome the challenges of scheduling an appointment, providing a convenient way to stay connected with a care team via phone or video visit,” Fazzollari said. “These patients may not be seen in person but are now receiving important health checks.”

Building clinical pharmacy expertise

Macy Shia Head Shot
Messia, Pharm.D.

Clinical pharmacists in this program are board certified or board eligible in Psychiatric Pharmacy and have completed 2 years of professional graduate coursework or equivalent clinical experience. To maintain access to these much-needed practitioners, KPNC established an in-house graduate training program, said study co-author and program regional director Macy Shia, Pharm.D.

Professional training provides motivation for the care team and pharmacists, Shea said. She said: “A staff survey found that senior practitioners who attended a specialized training program had increased confidence and felt more fulfilled and satisfied in tackling a variety of challenges.”

The program is unique to KPNC and is described in more detail in a 2022 paper in NEJM Catalyst, a publication of the New England Journal of Medicine, and in a previous Research Spotlight story.

Iturralde said researchers are continuing to expand their evaluation of the program, which is now in 11 KPNC service areas. They will focus on additional health outcomes, preventive care, psychiatric conditions and program costs. Estimating the cost of implementing the program will be important for other health systems to consider adopting the model, she said.

“There is a real need to look at these types of specialist clinical pharmacists and whether they should be more integrated into the health system,” Ituralde added.

The research was funded by the Permanente Medical Group Delivery Science and Applied Research Programme.

Additional co-authors include Natalie E. Slama, MPH, Stacy E. Alexeeff, PhD, and Stacy A. Sterling, MSW, DrPH, of the Department of Research; and Sameer Awsare, MD, and Maria T. Koshy, MD, of The Permanente Medical Group.


About Kaiser Permanente Research

Kaiser Permanente Research conducts, publishes and disseminates epidemiological and health services research to improve the health and health care of Kaiser Permanente members and society at large. It aims to understand the determinants of disease and well-being and to improve the quality and cost-effectiveness of health care. Currently, DOR’s more than 600 employees are conducting more than 450 epidemiological and health services research projects. For more information, visit or follow us @KPDOR.

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