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People living with severe mental disorders such as schizophrenia and bipolar disorder often rely on medication to prevent severe symptoms, including suicidal thoughts and psychosis. But side effects and other barriers can make it difficult to adhere to a treatment regimen.

“Schizophrenia and bipolar disorder often develop at an earlier age, and younger patients may have difficulty with the idea of ​​lifelong medication,” he said. Esty IturraldeCandidate of Medical Sciences, Researcher Kaiser Permanente Research Department.

In addition, some psychiatric drugs 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 have to contend with new health problems over time,” Iturralde added. “They have to balance these two forces that sometimes oppose each other.”

Help patients find balance

The choice of drugs and dosages, and their adjustment over time, are important in the care of patients with mental illness. The innovative telehealth program at Kaiser Permanente in Northern California provides patients with serious mental illness with direct access to clinical psychiatrist pharmacists.

Psychiatrists continue to oversee the care of their patients and collaborate with clinical pharmacists who join the collaborative care team and act as care navigators. They establish an ongoing relationship with patients through regular video and telephone meetings.

“Our clinical pharmacists help manage their medications, monitor their lab tests and blood pressure, and connect them to preventive health and other support services,” the psychiatrist said. Lisa FazzolariDO.

The program currently operates in 8 locations in Northern California and is expected to serve up to 27,000 patients eventually. To help train more clinical psychiatrist pharmacists with two years of additional training specifically in psychiatry, Kaiser Permanente has established an in-house graduate program in Northern California.

“We believe this collaborative care model will greatly benefit our patients with such a unique set of needs,” said psychiatrist Don Mordecai, MD, Kaiser Permanente’s national leader in mental health and wellness.

Measuring results for optimal care

To evaluate how well the telemedicine program is working, Dr. Fazzolari and Iturralde are conducting a study that compares the results for a group of 968 patients with a group of similar patients not enrolled in the program. They published detailed description of the program in NEJM Catalyst, a publication of the New England Journal of Medicine (subscription required to read entire article).

They hope that study patients who are at high risk and who may benefit from additional care will find value in video visits to clinical pharmacists.

“On average, people with serious mental illness tend to live 20 years less than the general population,” said the national pharmacy chief. Sameer Avsare, MD, who is also looking forward to the results of the study. “This collaboration between our psychiatrists and pharmacists will reduce disparities and enable our patients to live longer and healthier lives.”

Learn more about Kaiser Permanente mental health care.

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