People with severe and persistent mental illness (SPMI) such as schizophrenia and bipolar disorder have higher risks for obesity, diabetes, heart disease, and other conditions. They may have difficulty staying on needed psychiatric medications because of side effects or uncertainty about needing to continue treatment.

Kaiser Permanente in Northern California created an innovative program that adds a psychiatric clinical pharmacist to the patient’s care team. New research has found that this program, called SPMI Population Care, is effective with the following:

• Participants filled their mental health medication prescriptions more regularly.
• They were also screened for blood sugar levels more often than other similar patients who had the usual care without visits with a pharmacist.

In SPMI Population Care, a trained pharmacist has a telehealth appointment with the patient and collaborates with the patient’s mental and physical health care team.

“The clinical pharmacists are providing important additional support, while the psychiatrist is leader of the team,” explained co-lead author Lisa Fazzolari, DO, a psychiatrist at Kaiser Permanente and regional medical director of the SPMI program.

This program started in 2021 and is now in 11 Northern California service areas.

The program’s clinical pharmacists are board-certified or board-eligible in psychiatric pharmacy. They have completed a 2-year specialized postgraduate program or equivalent clinical experience.

To increase the supply of these highly in-demand practitioners, Kaiser Permanente established an in-house postgraduate training program, run by Leah Arnbrecht, PharmD, psychiatric residency program director.

“This program has resulted in increased satisfaction among our pharmacists who gain valuable new skills and career opportunities,” said study co-author and program Regional Director Macy Shia, PharmD. “We believe similar training programs could be beneficial for other health care systems.”

Pharmacists are ‘well integrated into the care team’

Program participants overall did not have an increase in psychiatric emergency department visits or hospitalizations. This suggests that shifting some routine tasks from psychiatrists to trained pharmacists is beneficial and safe, said co-lead author Esti Iturralde, PhD, a research scientist with the Kaiser Permanente Division of Research.

“The feedback we’ve received from both patients and clinicians is that pharmacists are well-integrated with the care team,” Iturralde said. “This collaboration allows psychiatrists to focus on stabilizing patients while pharmacists check in with patients to make adjustments that support treatment success and overall health goals.”

The study compared 968 program enrollees at 6 Northern California locations with 8,339 similar patients with SPMI who are not enrolled in the program. The research examined several health outcomes for the year before and after the program began.

More than 75% of participants attended an initial virtual intake meeting and at least one follow-up visit, suggesting that people with SPMI were open to receiving support through telehealth, possibly on their smartphones or other devices.

“Offering a connection through telehealth may overcome challenges to attending appointments. A phone or video visit provides a convenient way to stay in touch with the care team,” said Dr. Fazzolari. “These may be patients who wouldn’t otherwise be seen in person and are now getting important health screenings.”

The researchers are expanding their evaluation of the program.

They will look at additional health outcomes, preventive care, and psychiatric status, and other aspects.

Iturralde added: “There’s a definite need to study these types of specialized clinical pharmacists and if they should be more integrated into health systems.”

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