Williams Andrew M, Dopheide Julie A
University of Southern California School of Pharmacy, Los Angeles (both authors); and University of Southern California Keck School of Medicine, Los Angeles (Dr Dopheide).
Prim Care Companion CNS Disord. 2014 Nov 6;16(6). doi: 10.4088/PCC.14m01680. eCollection 2014.
Studies have demonstrated the benefits of incorporating comprehensive medication management into primary care, but no study describes the types of nonpsychiatric medication-related interventions provided by a psychiatric pharmacist while providing comprehensive medication management.
A chart review of Center for Community Health patients enrolled in the University of Southern California Psychiatric Pharmacy Clinic, Los Angeles, between July 1, 2013, and January 10, 2014, was conducted. Progress notes were reviewed to collect medication recommendations and interventions. The number and types of interventions were compared between groups based on substance abuse history, comorbid medical conditions, number of psychiatric diagnoses, and number of medications. An anonymous survey was distributed to primary care providers (PCPs) regarding perceptions and attitudes toward a postgraduate year 2 psychiatric pharmacy resident's interventions pertaining to nonpsychiatric medications.
177 nonpsychiatric medication interventions were documented. Fifty interventions required PCP approval, and 45% of those were accepted. Having a diagnosis of diabetes (P < .0001), hypertension (P < .0001), gastroesophageal reflux disease (P < .0001), ≥ 9 medications (P < .0001), or ≥ 5 medical diagnoses (P < .0001) were all associated with an increased mean number of interventions. Of the PCPs, 66% viewed the psychiatric pharmacist as a resource for addressing medical interventions by providing drug information. The PCPs were agreeable to having a psychiatric pharmacist provide drug information and monitor the patient but reported mixed opinions on whether a psychiatric pharmacist should comanage nonpsychiatric conditions.
Psychiatric pharmacists can successfully collaborate with PCPs in primary care clinics to provide comprehensive medication management that optimizes pharmacotherapy for patients with medical and psychiatric conditions. Continued efforts are needed to promote interdisciplinary approaches to provide comprehensive medication management services for patients with both psychiatric and medical disorders.
研究已证明将综合药物管理纳入初级保健的益处，但尚无研究描述精神科药剂师在提供综合药物管理时所提供的非精神科药物相关干预措施的类型。
对2013年7月1日至2014年1月10日期间在洛杉矶南加州大学精神科药房诊所登记的社区健康中心患者进行病历审查。审查病程记录以收集药物推荐和干预措施。根据药物滥用史、合并内科疾病、精神科诊断数量和药物数量，比较各亚组之间干预措施的数量和类型。向初级保健提供者（PCP）发放了一份匿名调查问卷，询问他们对一名第二年精神科药房住院医师在非精神科药物方面的干预措施的看法和态度。
记录了177项非精神科药物干预措施。50项干预措施需要PCP批准，其中45%获得批准。患有糖尿病（P <.0001）、高血压（P <.0001）、胃食管反流病（P <.0001）、≥9种药物（P <.0001）或≥5种内科诊断（P <.0001）均与平均干预措施数量增加相关。在PCP中，66%认为精神科药剂师是通过提供药物信息来处理医疗干预措施的资源。PCP们同意让精神科药剂师提供药物信息并监测患者，但对于精神科药剂师是否应共同管理非精神科疾病，他们的意见不一。
精神科药剂师可以在初级保健诊所与PCP成功合作，提供综合药物管理，优化患有内科和精神科疾病患者的药物治疗。需要持续努力以促进跨学科方法，为患有精神科和内科疾病的患者提供综合药物管理服务。
