Telehealth

Clarissa Chan, PharmD

Pharmacist-led telehealth collaborative care has the potential to enhance treatment adherence and preventive screening for individuals with psychosis or bipolar disorder, according to findings from a January 2024 study published in the Journal of Clinical Psychiatry.

“People with [severe and persistent mental illness] can struggle to stay on their medications over the long term, increasing their risk for psychiatric decompensation,” said Esti Iturralde, PhD, co-first study author. “[Patients] also face high long-term risk for diabetes and heart disease, so keeping up with glycemic and lipid screening is important.”

Iturralde and colleagues examined the impact of a telehealth collaborative care program at Kaiser Permanente Northern California that is managed by psychiatric pharmacists who treat adults with severe and persistent mental illness (SPMI). The retrospective cohort study compared program enrollees to similar patients receiving usual care using EHR data. Results showed that the program is associated with improved psychotropic medication adherence and glycemic screening, but unexpectedly led to a decrease in annual psychiatrist visits. Emergency department use remained unchanged.

“Offering a connection through telehealth may overcome challenges to attending appointments, providing convenient ways to stay in touch with the care team by phone or video,” said Lisa Fazzolari, DO, author of the study. “These may be patients who wouldn’t otherwise be seen in-person and are now getting important health screenings.”

The program, called SPMI Population Care, is a team-based approach, with telehealth pharmacist visits serving as an innovative add-on to the existing team, according to Fazzolari, a psychiatrist with the Permanente Medical Group.

Improved health care quality

The study provided encouraging evidence that integrating psychiatric pharmacist visits for patients adds value and improves the quality of their care, added Fazzolari.

“On average, patients in both groups improved in their psychotropic medication adherence during the study, but those enrolled in the collaborative care group improved more with 60% versus 50% in the usual care group meeting an optimal threshold at study’s end,” she said.

Compared to a control group receiving usual care without interaction from a pharmacist, the collaborative care group was also more likely to receive glycemic screening—64% versus 74%, respectively—at study end, noted Fazzolari.

The research highlights the significant role specially trained psychiatric pharmacists can play in improving health outcomes for patients with SPMI, according to Macy Shia, PharmD, program regional director, who was also part of the study.

Considerations for pharmacists

Jill Nofziger, PharmD, who was not involved in the study, noted that gaining the support of providers early on with a program like this is key.

“Quickly establishing rapport to achieve patient buy-in with the program will help accelerate the program’s success and growth,” added Nofziger, who is regional ambulatory care pharmacy supervisor at Northern California Regional Clinical Pharmacy Operations.

Technology challenges may arise, too, and providing resources to triage these issues for both pharmacists and patients will help maintain workflow efficiency and reduce user frustration, Nofziger added.

“Time and resources dedicated to continued monitoring of long-term outcomes are also needed to assess the program’s lasting effects,” said Nofziger.

Also, consistent follow-up through a population-based model helps to build trust with patients and the mental health care team, noted Leah Arnbrecht, PharmD, a PGY2 psychiatric pharmacy residency program director and ambulatory care pharmacy supervisor within the Kaiser Permanente Healthcare system, who was not involved with the study.

Study implications

“This study showed that pharmacists with specialized training in psychopharmacology can improve adherence to psychiatric medications and improve rates of disease prevention screening as the care continuity navigators for patients with SPMI,” said Stacey Raffe, PharmD, regional clinical pharmacy director at Northern California Regional Clinical Pharmacy Operations, who was not part of the study.

“The significance for pharmacy practice includes expanding care models where pharmacists are at the center and responsible not only for the delivery of safe and effective pharmacotherapy, but coordination among the larger care delivery team,” she said.

Researchers of the study are continuing to expand their evaluation of the program, which is now in 11 Kaiser Permanente Northern California service areas. They are looking at additional health outcomes, preventive care, psychiatric status, and program costs. ■