{"id":1216,"date":"2013-04-01T00:00:06","date_gmt":"2013-04-01T05:00:06","guid":{"rendered":"http:\/\/rhochistj.org\/RhoChiPost\/?p=1216"},"modified":"2014-02-24T16:31:16","modified_gmt":"2014-02-24T21:31:16","slug":"increased-costs-treatment-due-dsm-v-implications-pharmacy-practice","status":"publish","type":"post","link":"https:\/\/rhochistj.org\/RhoChiPost\/increased-costs-treatment-due-dsm-v-implications-pharmacy-practice\/","title":{"rendered":"Increased Costs of Treatment due to the DSM-V: Implications for Pharmacy Practice"},"content":{"rendered":"

By: James W. Schurr and David Gao, PharmD Candidates 2014<\/span><\/p>\n

–<\/p>\n

A recent Op-ed in Newsday by Allen Frances, MD (of Duke University School of Medicine and chairman of the task force that produced the DSM-IV, the current guidelines for psychiatric disease diagnosis) criticizes the American Psychiatric Association for being \u201cextravagantly indifferent to all matters of cost\u201d in preparing the DSM-V.1 \u00a0<\/sup>This new manual, he argues, will vastly expand psychiatric diagnoses to those who do not require treatment. \u00a0He also posits that the pharmaceutical industry, and not the patients, will be the only beneficiaries of this new manual. \u00a0If there is any merit to these claims, it is imperative for pharmacists to help mitigate these increases in costs through collaborative practice. \u00a0The medical literature is replete with examples that illustrate the benefits pharmacists provide to patients through direct care models.<\/p>\n

One collaborative care model for the treatment of depression was studied by Finley et al.<\/i> and published in Pharmacotherapy<\/i> in 2003.2<\/sup> \u00a0In this study, 13 primary care providers (PCPs) referred patients who were newly diagnosed with depression and started on antidepressant therapy to clinical pharmacy services within the Health Maintenance Organization (HMO). \u00a0Clinical Pharmacy Specialists provided medication maintenance and follow-up patient care at the clinic. \u00a0In this setting, pharmacists were granted prescribing privileges for co-managing their patients in conjunction with psychiatrists. \u00a0Pharmacists performed intake interviews with patients that involved active listening for patient assessment as well as education on depression as an illness, their pharmacologic treatment, and importance of adherence to therapy. When this model was studied for impact on depression in primary care, the authors concluded that the interdisciplinary treatment model emphasizing clinical pharmacy services was associated with significant increases in treatment adherence, greater patient satisfaction, and improved resource utilization.3<\/sup><\/p>\n

\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/b>A study published in 1982 by Berchow in the American Journal of Hospital Pharmacy<\/i> examined the effects of adding a clinical consultant pharmacist to a multi-disciplinary team at an institution for the mentally disabled. \u00a0The facility was reviewed twice\u2014before and after the service was added. \u00a0Over one year, the long-term use of drugs fell from 76.1% \u2013 56.8%. \u00a0Antipsychotic drug use fell from 34.2% \u2013 16.8%. \u00a0Although a pharmacoeconomic analysis was not provided for this study, the decreases in drug use were significant (p < 0.001).4<\/sup><\/p>\n

A similar study was performed at another institution for the mentally disabled by Ellenor et al.<\/i> \u00a0This group implemented a drug assessment program for individual patients, performed a chart review, and determined the impact of a pharmacist team member on prescribing patterns over 2 years. \u00a0This non-controlled and non-randomized study revealed that pharmacist involvement reduced antipsychotic agent use by 18%, antianxiety and antidepressant use by 58%, and sedative-hypnotic use by 58%. \u00a0Net savings were projected to be $10,000 per year after subtracting a full-time pharmacist\u2019s salary.5<\/sup><\/p>\n

Lobeck et al.<\/i> performed a retrospective chart review to determine the effectiveness of pharmacy services in an outpatient mental health clinic at a Veterans Affairs (VA) hospital. \u00a0Over 3 months, pharmacist recommendation decreased clinic visits by 44%, the number of prescriptions per patient by 16%, and actual cost per prescription by 35%. \u00a0Projected annual net savings were $22,241 per year after deducting a pharmacist\u2019s salary.6<\/sup><\/p>\n

Gray et al.<\/i> determined the impact of adding clinical pharmacy services at a VA day-treatment center. \u00a0Data gathered from patient interviews, drug history records, and medical records over 3 months were analyzed according to a Likert Scale. \u00a0Although mental functioning scores dropped slightly from 55.8 to 52.7, reductions were observed in adverse effects (62 to 21) and drug use problems (61 to 3). \u00a0The yearly savings in drug costs was $27,750 and personnel cost savings was $18,750.7<\/sup><\/p>\n

Nonadherence to antipsychotics has long been associated with relapse and re-hospitalization and, consequently, an increase in cost of treatment. \u00a0In fact, hospitalization can account for up to 40% of direct costs involved with schizophrenia. \u00a0Long-acting injectable antipsychotics (LAIAs) have been suggested as a cost-saving alternative. \u00a0However, inpatient administration of LAIA has financial limitations. \u00a0In particular, second generation LAIA cost more but don\u2019t garner any additional reimbursement. \u00a0Phan and Vandenberg conducted a study evaluating the financial impact of shifting LAIA administration from an inpatient to a pharmacy-run outpatient setting. \u00a0Based on quarterly charges and costs, annual pharmacy purchase savings were projected at least $12,000 per year and unreimbursed inpatient charges avoided were projected at $25,000 per year.8<\/sup><\/p>\n

\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/sup>Pharmacy practice models for the treatment of patients with psychiatric illnesses have been developed and studied with positive humanistic, clinical, and economic outcomes. \u00a0Pharmacists specializing in psychiatric pharmacotherapy, especially those with board certification, are in a prime position to manage psychiatric patients. \u00a0If costs rise as predicted by Dr. Frances, the medical field should turn to pharmacists, the pharmacotherapy experts, to ensure that patients receive optimal and cost-effective pharmaceutical care.<\/p>\n

SOURCES:<\/p>\n

    \n
  1. Frances, Allen. New psych manual will hike health costs. Newsday<\/i>. January 1st<\/sup>, 2013. http:\/\/www.newsday.com\/opinion\/oped\/frances-new-psych-manual-will-hike-health-costs-1.4393434<\/a><\/li>\n
  2. Finley PR, Rens HR, Pont JT, et al. Impact of a collaborative care model on depression in a primary care setting: a randomized controlled trial. Pharmacotherapy. 2003;23(9):1175-85.<\/li>\n
  3. Finley PR, Rens HR, Pont JT, et al. Impact of a collaborative care model on depression in a primary care setting: a randomized controlled trial. Pharmacotherapy. 2003;23(9):1175-85.<\/li>\n
  4. Berchow RC. Effect of a consultant pharmacist on medication\u00a0use in an institution for the mentally retarded. Am J Hosp\u00a0Pharm 1982;39:1671-4.<\/li>\n
  5. Ellenor GL, Frisk AP. Pharmacist idpact on drug use in an\u00a0institution for the mentally retarded. Am J Hosp Pharm\u00a01977;34:604-8.<\/li>\n
  6. Lobeck F, Traxler WT, <\/b>Bobinet DD. The cost-effectiveness of a\u00a0clinical pharmacy service in an outpatient mental health clinic.\u00a0Hosp Commun Psychiatry 1989;40:643-4.<\/li>\n
  7. Gray DR, Namikas EA, Sax MJ, et al. Clinical pharmacists as\u00a0allied health care providers to psychiatric patients. Contemp\u00a0Pharm Pract 1979;2(3):108-16.<\/li>\n
  8. Phan SV, Vandenberg AM. Financial impact of a pharmacist-managed clinic for long-acting injectable antipsychotics. Am J Health Syst Pharm. 2012;69(12):1014-5.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

    By: James W. Schurr and David Gao, PharmD Candidates 2014 – A recent Op-ed in Newsday by Allen Frances, MD (of Duke University School of Medicine and chairman of the task force that produced the DSM-IV, the current guidelines for psychiatric disease diagnosis) criticizes the American Psychiatric Association for being \u201cextravagantly indifferent to all matters…<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4,5],"tags":[190,343,193,2249,2246,15,13,2229,2227,314,2251,20,135,315,93,14,363,968,19,2230,12,11,169,220,2239,21,1161,16,17,1061],"class_list":["post-1216","post","type-post","status-publish","format-standard","hentry","category-featured","category-news-politics","tag-account","tag-and","tag-annual","tag-antipsychotic","tag-clinic","tag-disease","tag-drug","tag-drugs","tag-ebola-virus-disease","tag-for","tag-guidelines","tag-health","tag-illness","tag-injectable","tag-january","tag-medication","tag-of","tag-one","tag-patient","tag-pharmaceutical","tag-pharmacist","tag-pharmacy","tag-relapse","tag-review","tag-salary","tag-study","tag-therapy","tag-treatment","tag-trial","tag-with"],"views":804,"_links":{"self":[{"href":"https:\/\/rhochistj.org\/RhoChiPost\/wp-json\/wp\/v2\/posts\/1216","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/rhochistj.org\/RhoChiPost\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/rhochistj.org\/RhoChiPost\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/rhochistj.org\/RhoChiPost\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/rhochistj.org\/RhoChiPost\/wp-json\/wp\/v2\/comments?post=1216"}],"version-history":[{"count":0,"href":"https:\/\/rhochistj.org\/RhoChiPost\/wp-json\/wp\/v2\/posts\/1216\/revisions"}],"wp:attachment":[{"href":"https:\/\/rhochistj.org\/RhoChiPost\/wp-json\/wp\/v2\/media?parent=1216"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/rhochistj.org\/RhoChiPost\/wp-json\/wp\/v2\/categories?post=1216"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/rhochistj.org\/RhoChiPost\/wp-json\/wp\/v2\/tags?post=1216"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}