ObjectiveThe American Association of Psychiatric Pharmacists (AAPP) sought to develop a consensus-based set of outcomes and measures to standardize psychiatric pharmacy practice and research. The measures in this Core Outcome Set for Psychiatric Pharmacists (COS-PP) are designed to study the impact of psychiatric pharmacists caring for individuals living with psychiatric disorders.MethodsThe COS-PP was developed using guidelines from the Core Outcome Measures in Effectiveness Trials (COMET) initiative. A committee systematically reviewed a catalog of 194 articles and 40 posters that referenced psychiatric disorders, patient-level outcomes, and pharmacist interventions. From these initial 234 resources, 554 combinations of outcomes and measures were identified. Additional papers, guidelines, and feedback from experts increased the number to 592 combined outcomes and measures. The principal investigator consolidated the list to 46 potential outcomes. AAPP members were invited to complete a survey rating the 46 potential outcomes on five key factors: comprehensive, attributable to pharmacy, feasible, scientifically sound, and usable. These survey results were provided to the 18 Board-Certified Psychiatric Pharmacists participating in a summit examining the potential outcomes and measures gleaned from literature review. Through discussion and refinement, consensus was achieved on the final COS-PP.ResultsThe final COS-PP included 21 outcomes, 14 of which included at least 1 measure (84 total measures). The outcomes were grouped according to the quadruple health care aims: better care, reduced healthcare costs, improved patient experience, and improved clinician well-being.ConclusionsCOS-PP will help define psychiatric pharmacists' support of the interdisciplinary team in addressing the quadruple health care aims. Using standardized outcomes across practice sites will allow aggregation of data on the impact of psychiatric pharmacists on patient care.

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.

Reporting interventions thoroughly and consistently in the literature allows for study reproducibility or implementation of the intervention into practice. Although there is currently no standard for describing Board-Certified Psychiatric Pharmacist (BCPP) interventions in the published literature, there are multiple checklists or guides that have been developed for reporting clinical interventions, including the template for intervention description and replication and the pharmacist patient care intervention reporting (PaCIR) checklist, that seek to improve the quality of reporting interventions in the literature. The purpose of this paper is to describe a proposed guide for reporting BCPP interventions in the literature by expanding the PaCIR checklist. Authors use a logic model developed by the American Association of Psychiatric Pharmacists to ensure all elements of the process are addressed in the expanded guide.

Journal Article Corrected proof The mental health workforce needs pharmacists Get access Julie A Dopheide, PharmD, BCPP, FASHP, Julie A Dopheide, PharmD, BCPP, FASHP University of Southern California Mann School of Pharmacy and Pharmaceutical Sciences, Los Angeles, CA, USA Address correspondence to Dr. Dopheide (dopheide@usc.edu). Search for other works by this author on: Oxford Academic Google Scholar Ijeoma E Onyema, PharmD, BCPP, Ijeoma E Onyema, PharmD, BCPP Northwestern Memorial Hospital, Chicago, IL, USA Search for other works by this author on: Oxford Academic Google Scholar Tyler Casey, PharmD, BCPP, Tyler Casey, PharmD, BCPP Kaiser Permanente – Northwest, Portland, OR, USA Search for other works by this author on: Oxford Academic Google Scholar Heather Goodwin, PharmD, BCPP, MS, Heather Goodwin, PharmD, BCPP, MS Yale New Haven Hospital, New Haven, CT, USA Search for other works by this author on: Oxford Academic Google Scholar Tera D Moore, PharmD, BCACP, Tera D Moore, PharmD, BCACP Clinical Pharmacy Practice Office, Department of Veterans Affairs, Aurora, CO, USA Search for other works by this author on: Oxford Academic Google Scholar Gregory H Payne, MBA, CAE Gregory H Payne, MBA, CAE American Association of Psychiatric Pharmacists, Lincoln, NE, USA Search for other works by this author on: Oxford Academic Google Scholar American Journal of Health-System Pharmacy, zxad213, https://doi.org/10.1093/ajhp/zxad213 Published: 02 September 2023 Article history Published: 02 September 2023 Corrected and typeset: 26 September 2023

INTRODUCTION:Mental health (MH) clinical pharmacy specialists (CPS) are increasingly functioning as integral providers in MH care teams. MH providers may delegate many medication management tasks to the CPS. As there is a shortage of primary care and specialist MH providers, CPS are increasingly being utilized in MH care clinics. We assess provider and CPS perceptions of the contributions of CPS to MH clinical teams in the Veterans Health Administration.METHODS:We examined the roles and functions of CPS in MH clinics through surveys (n = 374) and semistructured interviews (n = 16) with MH CPS and other members of MH clinical teams (psychiatrists, nurse practitioners, registered nurses, social workers) to gain insight into how CPS were integrated in these settings. We assessed perceptions of CPS contributions to MH teams, interactions between CPS and other providers, and challenges of integrating CPS into MH clinical teams.RESULTS:Contributions of CPS in MH were received positively by clinical team members. Clinical pharmacy specialists providing comprehensive medication management were especially valuable in the management of clozapine. The knowledge and training of CPS reassured providers who frequently referred to them with questions about medication and medication therapy management. MH CPS were also perceived to be received well by patients.DISCUSSION:The integration of MH CPS into MH teams was well received by team members and patients alike. The MH CPS have become important members of the MH team and are widely viewed as being able to improve access, quality, and workflow.

Introduction The American Association of Psychiatric Pharmacists (AAPP) used multiple modalities to develop and refine 28 attribute statements to describe a best practice model for outpatient psychiatric pharmacists. Before addressing implementation, assessment, and field testing, it was necessary to finalize and confirm the statements and their supporting narratives among stakeholders. The objective of this project was to confirm the attribute statements and supporting justifications for a best practice model for outpatient psychiatric pharmacists providing direct patient care. Methods The 4 phases that resulted in the 28 attribute statements and supporting narratives have been described and published elsewhere. As part of phase 5, the confirmation survey was distributed to pharmacists and resident members of AAPP in November 2021 for 3 weeks. Results The survey respondents (n = 74; 6.1%) were licensed pharmacists for an average of 15.6 years (SD = 12.0) and had been practicing as psychiatric pharmacists for an average of 11.3 years (SD = 10.4). Slightly more than half (54.2%) of the respondents reported practicing in the outpatient setting and three-fourths (74.3%) were Board Certified Psychiatric Pharmacists. For each of the 28 statements, more than 90% of respondents either agreed or agreed with minimal reservations. Discussion Given the high degree of agreement on the proposed practice model statements, they will be used as the basis for the outpatient psychiatric pharmacist best practice model. Next steps in developing this model include establishing implementation guidance, determining appropriate metrics for evaluation of these statements in practice, and establishing appropriate field-testing methods.

Comprehensive medication management (CMM) is defined as the standard of care that ensures each patient's medications are individually assessed to determine that each medication is appropriate for the patient, effective for the medical condition, safe given any comorbidities and other medications being taken, and able to be taken by the patient as intended. The practice management component of CMM can be defined as “the structural and system level supports within a practice related to practice management and operations that enable the efficiency, effectiveness, and sustainability of CMM services.” To date, there has been no consistent process in the Veterans Health Administration (VHA) to evaluate CMM practice management standardization. This article will describe the VHA effort in development, implementation, and outcomes of a CMM practice optimization tool modified from an existing tool. A modified version of practice management assessment tool was developed to integrate and align with VHA clinical pharmacy practice and policy. The VHA CMM Practice Optimization and Evaluation Tool (POET) was developed to access CMM practice management in multiple practice areas and was deployed for assessment in all VHA facilities. From May 2021 to March 2022, 352 practice area evaluations were completed at 152 VHA facilities using POET. Total submission practice area detail was gathered from 245 Patient Aligned Care Team (primary care), 32 outpatient mental health, 29 acute care, 11 pain, 11 specialty ambulatory care, 8 geriatric community living centers (eg, long‐term care) or hospice, 6 home‐based primary care, 4 critical care, 4 emergency department, and 2 residential rehabilitation and treatment programs. This work evaluating the five essential core practice management domains of CMM using a standardized evaluation process revealed that the VHA could adapt a tool that yields immeasurable information for standardization of CMM provided by a clinical pharmacist.

The “Increasing Access to Care for Rural Veterans by leveraging Clinical Pharmacy Specialist (CPS) Providers,” known as the CPS Rural Veteran Access Initiative (CRVA), focused on providing access to comprehensive medication management (CMM) for rural Veterans in the areas of primary care, mental health, and pain management. Clinical pharmacy boot camps trained CPS to accomplish this goal.

Introduction Despite the high prevalence of those with mental illnesses, there is a critical shortage of psychiatric providers in the United States. Psychiatric pharmacists are valuable members of the health care team who meet patient care needs, especially those practicing with prescriptive authority (PA). Methods A cross-sectional electronic survey was administered to Board Certified Psychiatric Pharmacists (BCPPs) and non-BCPP members of the College of Psychiatric and Neurologic Pharmacists. The objective of this study was to compare demographic and practice characteristics between respondents with and without PA. Results Of the 334 respondents, 155 (46.4%) reported having PA. Those with PA, including those with Veterans Affairs (VA) affiliated PA, had fewer mean number of years of licensure than those without PA (P = .008 and P = .007, respectively). The majority with PA practiced in outpatient settings (53.5%). Respondents with PA (including those with VA-affiliated PA) were more likely to have their positions funded by practice sites (P < .001). The most common referral source for medication management for those with PA were physicians although pharmacists also provided referrals in both VA and non-VA settings. Pharmacists with PA were more likely to track practice outcomes versus those without PA (P < .001). Discussion The current study confirms the variability in PA among psychiatric pharmacists. Demographics of the respondents reflect changes in residency accreditation and increased numbers of psychiatric residencies within VA facilities. Psychiatric pharmacists with PA reported treating psychiatric and medical conditions, creating added value. Psychiatric pharmacists should be empowered to track outcomes and help meet the critical shortage of psychiatric providers.

PURPOSE Access to care is a critical issue facing healthcare and affects patients living in rural and underserved areas more significantly. This led the Department of Veterans Affairs (VA) to launch a project that leveraged the expertise of the clinical pharmacy specialist (CPS) provider, embedding 180 CPS providers into primary care, mental health, and pain management across the nation. METHODS This multidimensional project resulted in hiring 111 CPS providers in primary care, 40 CPS providers in mental health, and 35 CPS providers in pain management to serve rural veterans' needs. From October 2017 to March 2020, CPS providers provided direct patient care to 213,477 veterans within 606,987 visits. This was an average of 43,000 additional visits each quarter to support comprehensive medication management services, demonstrating an additional 219,823 visits in fiscal year 2018 and 232,030 visits in fiscal year 2019. Over the course of the project, the team provided mentorship to 164 CPS providers, performed consultative visits at 27 VA facilities, and trained 180 CPS providers in educational boot camps. CONCLUSION VA funding of rural health initiatives adding CPS providers to primary care, mental health, and pain teams has resulted in positive measures of comprehensive medication management, interdisciplinary team satisfaction, facility leadership acceptance, and multiple positive outcomes.

INTRODUCTION:A comprehensive review of psychiatric pharmacy practice has never been performed in the United States. As psychiatric pharmacists become more involved in mental illness treatment, determining the current state of practice is important to help advance the specialty. The Professional Affairs Committee of the College of Psychiatric and Neurologic Pharmacists (CPNP) was charged with performing this review to define current psychiatric pharmacy practice.METHODS:An electronic survey was sent to all pharmacist members of CPNP and all nonmember Board Certified Psychiatric Pharmacists (BCPPs) in the United States in late summer 2019. The survey consisted of 36 questions across multiple domains to obtain information about respondents' education and training background, practice setting and type, and information about prescriptive authority and other areas. An initial e-mail invitation was sent along with 2 reminder e-mails over the subsequent 2 weeks.RESULTS:A total of 334 of 1015 pharmacists completed the survey (32.9%). Responders completed a postgraduate residency 77.8% of the time, and 88.3% were BCPP. Practice settings were split evenly between inpatient and outpatient practices or a combination of the 2. Among respondents, 46.5% reported having prescriptive authority as part of their practice, and 41.3% reported treating nonpsychiatric as well as psychiatric illnesses. Prescriptive authority was more likely in outpatient practices and in those treating nonpsychiatric illnesses.DISCUSSION:The current practice of psychiatric pharmacy is incredibly varied in terms of practice setting, activities performed, and services provided. Further exploration is needed to help determine the optimal role of psychiatric pharmacists.

INTRODUCTION:Psychiatric and neurologic illnesses are highly prevalent and are often suboptimally treated. A 2015 review highlighted the value of psychiatric pharmacists in improving medication-related outcomes. There is a need to describe areas of expansion and strengthened evidence regarding pharmacist practice and patient care impact in psychiatric and neurologic settings since 2015.METHODS:A systematic search of literature published from January 2014 to June 2019 was conducted. Publications describing patient-level outcome results associated with pharmacist provision of care in a psychiatric/neurologic setting and/or in relation to central nervous system (CNS) medications were included.RESULTS:A total of 64 publications were included. There was significant heterogeneity of published study methods and data, prohibiting meta-analysis. Pharmacists practicing across a wide variety of health care settings with focus on CNS medication management significantly improved patient-level outcomes, such as medication adherence, disease control, and avoidance of hospitalization. The most common practice approach associated with significant improvement in patient-level outcomes was incorporation of psychiatric pharmacist input into the interprofessional health care team.DISCUSSION:Pharmacists who focus on psychiatric and neurologic disease improve outcomes for patients with these conditions. This is important in the current health care environment as most patients with psychiatric or neurologic conditions continue to have unmet needs. Additional studies designed to measure pharmacists' impact on patient-level outcomes are encouraged to strengthen these findings.

BACKGROUND:To highlight the role and impact of the mental health (MH) clinical pharmacist provider in outpatient MH through successful practice integration into team-based care.OBJECTIVE:The MH clinical pharmacy specialist (CPS) provider serves in many key roles to improve patient-centered care and medication outcomes by supporting the needs of the MH team, patients, and caregivers in areas of comprehensive medication management. MH CPS providers are integrated as MH providers in general and specialty MH clinics, behavioral health clinics embedded in primary care, residential rehabilitation facilities, specialty MH programs, and in inpatient MH units to improve access, quality, and safety.PRACTICE DESCRIPTION:There is a shortage of psychiatrists across the United States, which affects the ability to provide MH care to patients.PRACTICE INNOVATION:There is a need to transform the MH team to include clinicians focused on providing services to the growing population with MH conditions; hence, the expertise of the MH CPS is an asset to increase access to comprehensive medication management services.EVALUATION:The MH CPS provider serves patients with a variety of MH conditions, managing medication-related adverse events, performing ongoing and acute medication monitoring, and collaborating with other health care providers for management of new diagnoses.RESULTS:The MH CPS provider improves access to care, clinical outcomes, and safety when deployed as direct patient care providers on Veterans Affairs (VA) interprofessional care teams. VA MH clinical pharmacy practice continues to demonstrate what the MH CPS provider, practicing at the top of their license, can achieve as a core member in MH team-based care.CONCLUSION:These foundational concepts can be applied to further expand MH clinical pharmacy practice into non-VA settings through the use collaborative practice agreements and integration into interprofessional care teams, providing access to patients in need of MH care.

Developing a standardized practice model and a consistent process for the provision of clinical pharmacy services has been described by some as the “Achilles heel of the clinical pharmacy discipline.” The foundation of a standardized practice model and therefore a consistent care process requires evaluation of the competencies of the providers practicing in the model. The credentialing and privileging process is intended to verify that the health care professional has obtained the requisite qualifications to practice within a certain setting and exhibits the clinical acumen to provide care to patients. The process of credentialing and privileging along with the professional practice evaluation (PPE) process varies across the country. The Clinical Pharmacy Practice Office within the Veterans Health Administration has defined a system‐wide process and solidified the elements essential to clinical pharmacist scope of practice, as well as ensuring the robustness of the pharmacist PPE process within the Department of Veterans Affairs (VA). While specific to the VA, this framework may be considered by other health care systems in creating a process for pharmacist providers.