Integrating a mental health clinical pharmacy specialist into the Homeless Patient Aligned Care Teams.

INTRODUCTION: To address the complex needs of the homeless veteran population, the US Department of Veterans Affairs created the Homeless Patient Aligned Care Team (H-PACT) model. The South Texas Veterans Health Care System has an established H-PACT model, however it does not include a clinical pharmacy specialist in mental health (MH). METHODS: An H-PACT MH pharmacy resident clinic was created and managed by a postgraduate year-2 psychiatric pharmacy resident. Improvements in access to MH care, Veterans Health Administration performance metrics, and estimated cost savings associated with resident interventions were reviewed to evaluate clinic utility. RESULTS: Over the 6-month clinic time frame, there were a total of 40 patient encounters in which 21 veterans had MH medication evaluation on at least 1 occasion. The average wait time for Veterans previously followed by the H-PACT psychiatrist was approximately 8 weeks. The H-PACT MH pharmacy resident clinic enabled veterans to be evaluated every 4 to 6 weeks. Interventions made by the resident included identification of medication administration errors, medication adjustments, adherence education, reduction in polypharmacy, and referral to other services. Estimated cost savings from clinic interventions totaled $33 613.67. DISCUSSION: The H-PACT MH pharmacy resident clinic allowed for an improvement in wait time for psychiatric pharmacotherapy follow-up for homeless veterans, with interventions that were associated with significant estimated cost savings.

A review of medical marijuana for the treatment of posttraumatic stress disorder: Real symptom re-leaf or just high hopes?

INTRODUCTION: The incidence of posttraumatic stress disorder (PTSD) is common within the population and even more so among veterans. Current medication treatment is limited primarily to antidepressants. Such medicines have shown to produce low remission rates and may require 9 patients to be treated for 1 to have a response. Aside from the Veterans Affairs/Department of Defense guidelines, other guidelines do not recommend pharmacotherapy as a first-line option, particularly in the veteran population. Marijuana has been evaluated as an alternative and novel treatment option with 16 states legalizing its use for PTSD. METHODS: A systematic search was conducted to evaluate the evidence for the use of marijuana for PTSD. Studies for the review were included based on a literature search from Ovid MEDLINE and Google Scholar. RESULTS: Five studies were identified that evaluated the use of marijuana for PTSD. One trial was conducted in Israel and actively used marijuana. Three studies did not use marijuana in the treatment arm but instead evaluated the effects postuse. A retrospective chart review from New Mexico relied on patients to recall their change in PTSD symptoms when using marijuana. Three studies concluded there might be a benefit, but two discouraged its use. Although the two negative studies show a statistical difference in worse PTSD outcomes, clinical significance is unclear. DISCUSSION: Conflicting data exist for the use of marijuana for PTSD; however, current evidence is limited to anecdotal experiences, case reports, and observational studies, making it difficult to make clinical recommendations.

Psychiatric pharmacists' perception on the use of pharmacogenomic testing in the mental health population.

AIM: Pharmacogenomics could play a role in improving patient care, reducing adverse drug reactions and overall healthcare costs. However, whether it is utilized may be determined by how it is perceived by healthcare professionals, including pharmacists. METHODS: A cross-sectional web-based survey evaluated psychiatric pharmacists' use, knowledge and perception of the effectiveness of such testing. RESULTS: Among participants, 80% worked at sites not offering pharmacogenomic testing, mostly due to a lack of funding. About 36% of pharmacists considered themselves more knowledgeable and 47% considered themselves less knowledgeable about pharmacogenomic testing; however, most agreed on the potential usefulness of testing. CONCLUSION: Among psychiatric pharmacists, the use of pharmacogenomics appears underappreciated due to factors such as lack of availability and understanding of testing. Original submitted 26 November 2014; Revision submitted 13 February 2015.