Complexity of patients with mental healthcare needs cared for by mental health clinical pharmacist practitioners in Veterans Affairs.

PURPOSE: The complexity of patients with mental healthcare needs cared for by clinical pharmacists is not well delineated. We evaluated the complexity of patients with schizophrenia, bipolar disorder, and major depressive disorder (MDD) in Veterans Affairs (VA) cared for by mental health clinical pharmacist practitioners (MH CPPs). METHODS: Patients at 42 VA sites with schizophrenia, bipolar disorder, or MDD in 2016 through 2019 were classified by MH CPP visits into those with 2 or more visits ("ongoing MH CPP care"), those with 1 visit ("consultative MH CPP care"), and those with no visits ("no MH CPP care"). Patient complexity for each condition was defined by medication regimen and service utilization. RESULTS: For schizophrenia, more patients in ongoing MH CPP care were complex than those with no MH CPP care, based on all measures examined: the number of primary medications (15.3% vs 8.1%), inpatient (13.7% vs 9.1%) and outpatient (42.6% vs 29.7%) utilization, and receipt of long-acting injectable antipsychotics (36.7% vs 25.8%) and clozapine (20.5% vs 9.5%). For bipolar disorder, more patients receiving ongoing or consultative MH CPP care were complex than those with no MH CPP care based on the number of primary medications (27.9% vs 30.5% vs 17.7%) and overlapping mood stabilizers (10.1% vs 11.6% vs 6.2%). For MDD, more patients receiving ongoing or consultative MH CPP care were complex based on the number of primary medications (36.8% vs 35.5% vs 29.2%) and augmentation of antidepressants (56.1% vs 54.4% vs 47.0%) than patients without MH CPP care. All comparisons were significant (P < 0.01). CONCLUSION: MH CPPs provide care for complex patients with schizophrenia, bipolar disorder, and MDD in VA.

Implementation of a pharmacy consult to reduce co-prescribing of opioids and benzodiazepines in a Veteran population.

BACKGROUND: The dangers of co-administration of opioid pain relievers (OPRs) and benzodiazepines (BZDs) are well documented. The combination of OPRs and BZDs make up the majority of medications involved in prescription drug-related overdose and are often used concomitantly. This pattern is consistent among the veteran population where mental health illness and substance abuse are prominent. The Veterans Health Administration implemented the Opioid Safety Initiative (OSI) aimed at improving patient safety surrounding OPRs. In alignment with OSI, the study facility implemented a prior authorization pharmacy consult in an effort to reduce OPR and BZD co-prescribing and optimize patient safety. The purpose of this article is to report the frequency of co-prescribing before and after implementation of the consult. Secondary aims include reporting the emergency room visits and hospitalizations, prescribers' actions in the setting of disapproved consults, patient characteristics associated with co-prescribing, and frequency of co-prescribing without a consult. METHODS: This was a single-center, retrospective chart review study. Microsoft Structured Query Language server database and Veterans Health Information Systems and Technology Architecture were used to extract data and identify study patients. The Computerized Patient Record System was used to collect patient data. Microsoft Access and Excel were utilized to organize, query, and analyze the extracted data. RESULTS: There was a 34.6% reduction in patients on chronic OPR therapy co-prescribed a BZD, and the total number of overdose-related events decreased after implementation of the consult. In the event of disapproved consults, pharmacists' evidence-based recommendations were implemented 63% of the time. Patients for whom co-prescribing consults were placed were more likely to have mental health diagnoses. CONCLUSIONS: Following implementation of a pharmacy consult, there was a reduction in co-prescribing and overdose-related events at the study facility.