People living with severe mental health conditions such as schizophrenia and bipolar disorder often rely on medication to stave off difficult symptoms, including suicidal thoughts and psychosis. But side effects and other barriers can make sticking with a drug regimen challenging.
“Schizophrenia and bipolar disorder often develop earlier in life, and younger patients can struggle with the idea of going on lifelong medication,” said Esti Iturralde, PhD, a research scientist with the Kaiser Permanente Division of Research.
In addition, some psychiatric medications increase the risk of obesity, diabetes, and heart disease.
“It’s a double-edged sword, because when patients achieve psychiatric stability on their medications, they may then have to contend with more physical health problems over time,” Iturralde added. “They have to balance these 2 forces that are sometimes opposed to one another.”
Helping patients find balance
Choosing drugs and dosages and adjusting them over time is essential in caring for patients with mental health conditions. An innovative telehealth program at Kaiser Permanente in Northern California gives patients with serious mental health conditions direct access to psychiatric clinical pharmacists.
Psychiatrists continue to oversee the care of their patients and partner with the clinical pharmacists, who join the collaborative care team and act as care navigators. They establish ongoing relationships with patients through regular video and telephone appointments.
“Our clinical pharmacists help manage their medications, monitor their labs and blood pressure, and connect them with preventive health and other support services,” said psychiatrist Lisa Fazzolari, DO.
The program is currently in operation at 8 locations in Northern California, with plans to eventually serve as many as 27,000 patients. To help train more psychiatric clinical pharmacists, who have 2 years of additional training specifically in the field of psychiatry, Kaiser Permanente established an in-house postgraduate training program in Northern California.
“We believe this collaborative care model will greatly benefit our patients with this unique set of needs,” said psychiatrist Don Mordecai, MD, Kaiser Permanente’s national leader for mental health and wellness.
Measuring results for optimal care
To assess how well the telehealth program is working, Dr. Fazzolari and Iturralde are leading research to compare the results for a group of 968 patients to a group of similar patients not enrolled in the program. They published an in-depth description of the program in NEJM Catalyst, a publication of the New England Journal of Medicine (a subscription is required to read the entire paper).
They are hopeful that patients in the study, who are at high risk and could benefit from extra help, will find value in the video visits with the clinical pharmacists.
“On average, people with serious mental illness tend to live 20 years less than the general population,” said national pharmacy leader Sameer Awsare, MD, who is also hopeful about the outcomes of the study. “This collaboration between our psychiatrists and pharmacists will decrease disparities and allow our patients to live longer and healthier lives.”
Learn more about Kaiser Permanente’s mental health care.