Assessment of an integrated psychiatric pharmacy practice within a rural internal medicine clinic

Abstract

<h2>Abstract</h2><h3>Background</h3> One-fifth of all adults in the United States have a mental health disorder. More than 60% of rural Americans live in a mental health provider shortage area. However, psychiatric pharmacist integration has not been widely used to full capacity at many rural, private institutions. <h3>Objective</h3> To assess the impact of psychiatric pharmacist integration into an outpatient, rural primary care office. <h3>Practice description</h3> A rural health institution that provides both inpatient and outpatient care. <h3>Practice innovation</h3> A psychiatric pharmacist was integrated within the outpatient internal medicine clinic. On referral from the primary care provider, the pharmacist, in consultation with the primary care provider, can make pharmacotherapy and monitoring recommendation and determine time to follow-up. <h3>Evaluation methods</h3> Single-center, retrospective cohort study from July 1, 2018, to May 23, 2022, with 3 main components: (1) patient outcomes using a within-subject comparison; (2) potential revenue from billable services and pharmacist interventions from all encounters September 12, 2019, to May 23, 2022; and (3) provider satisfaction using an adapted, anonymous survey. Descriptive statistics or percentages were used for both primary and secondary end points. A McNemar test was performed for repeated measures of nominal data, and a Wilcoxon matched-pairs signed rank test was used to analyze continuous data. A <i>P</i> value of < 0.05 was considered statistically significant. <h3>Results</h3> A statistically significant increase in guideline-driven treatments was seen after psychiatric pharmacist integration. A statistically significant improvement in Patient Health Questionnaire-9 scores was also seen after pharmacist integration in contrast to standard of care. Provider time and health care utilization also showed positive results after pharmacist integration. A total of $29,600 is estimated to have been billable for pharmacist services, and clinic staff perceptions of pharmacist integration proved positive. <h3>Conclusion</h3> Psychiatric pharmacist integration showed a statistically significant positive impact on patient care in a rural internal medicine outpatient clinic.