Prison Pharmacy
Ariel L. Clark, PharmD
Mental health and psychiatric conditions affect millions every year. Within the prison system, inmates’ mental health conditions are compounded by limited providers, lack of access, and complexity of care. Coupled with bureaucratic and political hardships as well as the COVID-19 pandemic, which was a catalyst for increased mental health crises, providing care for incarcerated patients continues to pose a challenge.
Researchers of a study published May 4, 2023, in JAPhA investigated how pharmacists could fill gaps in care with a new inpatient psychiatric pharmacist service. The study found that integration of a pharmacist in the Federal Correction Center (FCC) at Butner Medical Center in North Carolina inpatient psychiatric program improved inmate treatment acceptance and drug monitoring, and reduced overall cost related to the treatment of psychiatric conditions.
At the FCC at Butner Medical Center in North Carolina, over 60% of inmates have a mental health condition—more than double the prevalence for those who are not incarcerated.
Drawing on the successful collaboration within primary care for patients with chronic conditions like diabetes, this investigation of the Butner FCC pharmacist service relies on CPAs to manage treatment for patients with conditions such as schizophrenia, bipolar disorder, ADHD, and more.
Pharmacist impact on treatment
The study investigated FCC Butner’s nearly 4,000 psychiatry visits for 241 inmates in the center between January 2020 and March 2023. The inpatient pharmacist directly provided 576 of the visits and services for 892 additional visits. Over the course of the study, the pharmacist followed 125 patients directly and interventions included medication reviews, adjustments, and extensive education provided directly to patients.
At the start of the new program, 25 inmates admitted to the psychiatric center were not taking any medications for their condition. In these cases, the inpatient pharmacist held and directed antipsychotic psychoeducation meetings with those who were interested to discuss patient questions and dispel misconceptions about treatment with antipsychotics.
Inmates were encouraged to submit questions prior to the meetings, and they were able to not only get their questions answered, but were also able to hear directly from inmates who started treatment successfully. At the conclusion of the study, 15 of those who originally refused treatment accepted and began medication therapy for their conditions.
Pharmacist impact on monitoring
Many antipsychotic medications require monitoring due to their narrow therapeutic index. Clozapine, for example, causes severe neutropenia and requires monitoring for the duration of its use. Many other medications require monitoring for weight gain, increased cholesterol, and involuntary movements, among others.
As a result of the FDA REMS program, providers monitored clozapine in 100% of patients who receive it at FCC Butner. But a review for metabolic and movement changes were lacking in 19% and 100% of cases, respectively. The study found that when the psychiatric pharmacist came onboard, they were able to improve monitoring according to national and Bureau of Prisons guidelines in 100% of cases.
Takeaways
Several previous studies have shown that using pharmacists in collaboration with prescribers can decrease costs. This study found similar results and estimated that putting in place an inpatient psychiatric pharmacist resulted in over $100K in cost savings.
Care for patients who are incarcerated with concomitant psychiatric and mental health conditions is limited in the same ways that it is for the general population. This study showed that the use of a pharmacist to close this gap in care can improve adoption of treatment, patient monitoring and outcomes, and can decrease cost for inmate care.
More studies that emulate this investigation are needed to see the full extent of improvement in outcomes and other measures as a result of pharmacist interventions within the Bureau of Prisons. ■
Correct Rx: Based on the practice of clinical pharmacy
Correct Rx, a 20-year-old provider of correctional and clinical pharmacy services, received a Pinnacle Award this year from the APhA Foundation. Clinical pharmacists with CorrectRx work directly with health care providers and patients in a unique clinical pharmacy delivery model.
They provide services to over 200,000 incarcerated individuals in over 400 correctional and juvenile facilities. Correct Rx is based in Maryland, but pharmacists are licensed in 49 states and currently deliver correctional pharmacy services in 35 states and Washington, D.C.