Medication Management Toolkit

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Medication Management Toolkit

• A guide to the use of medication algorithms to
  guide clinical care

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What Is An Algorithm ?

• A step by step procedure for solving a problem.
  In a finite number of steps that frequently
  involves repetition of an operation.
• Algorithm and guidelines are often used
  interchangeably in the medical literature

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Medication Management - Definition

• There appears to be no explicit definition of
  medication management in the SAMHSA toolkit,
  however, critical elements include
• Utilization of a systematic plan for medication
  management
• Objectives measures of outcome are produced
• Documentation is thorough and clear
• Consumer and practitioners share in
  decision-making

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Minimum Requirements for Reporting Medication
Management

• Treatment plan specifies outcome for each
  medication
• Desired outcomes are tracked systematically using
  standardized instruments in a way to inform
  treatment decisions
• Sequencing of antipsychotic medication and
  changes are based on clinical guidelines

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Fidelity ????

• Fidelity is defined as adherence to the key
  elements of an evidence-based practice, as
  described in the controlled experimental design,
  and that are shown to be critical to achieving
  the positive results found in a controlled trail.
  Studies indicate that the quality of
  implementation strongly influences outcome.

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MedMap Fidelity Scale

• Organizational Scale and Outpatient Chart Review
• Org. Scale Example
• Standardized Summary of Illness and Medication
  History
• Chart Review Example
• Current Comprehensive Medication Documentation

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Why Use an Algorithm In Prescribing Psychiatric
Medications ?

• They are frequently used with many chronic
  medical illnesses like diabetes, hypertension and
  asthma
• Difficulty for clinicians to keep up with new
  information
• Improvements in standard of care using an
  effective treatment technique
• Improvement in treatment outcomes and cost
  savings
• Continuity of care from hospital to community

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Mental Illnesses for Which Medication Algorithms
have been Developed

• Schizophrenia
• Major Depressive Disorder
• Bipolar Disorder / Schizoaffective Disorder

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Cautions about the use of Algorithms

• Algorithms developed by expert consensus panels
  may be limited if panel member selection did not
  cut across a broad section of experts of
  differing opinions
• Algorithms developed through review of scientific
  literature and clinical trials may be more
  rigorous, but may be applicable to a specific
  population group

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Cautions (continued)

• Accurate diagnosis of persons seeking treatment
  is essential if the algorithms are to be
  effective
• Algorithms must be updated frequently to reflect
  newly discovered treatment approaches or newly
  developed medications
• The degree of flexibility an individual
  practitioner has is important to consider

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Kentucky Medication Algorithm Program (KyMAP)

• Quality Care Through Shared Information
• KyMAP is based on the Texas Medication Algorithm
  Project, and was designed to develop, implement
  and evaluate not just a set of medication
  algorithms, but an algorithm-driven treatment
  philosophy for major adult psychiatric disorders
  treated in the Kentucky public mental health
  sector.

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KyMAP Mission Statement

• To optimize care for those with Mental Illness
  through the utilization of evidence based
  guidelines and shared information among
  consumers, families and clinicians.

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KyMAP - Principles

• A set of beliefs that guide project
  implementation (see handout) such as
• Patients, consumers and families not only have
  the right, but the responsibility, to be involved
  in the treatment of their mental illnesses

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Consumer Education Curriculum

• Information is shared about the illness
• Medication information is explained
• Symptom/side effect monitoring and coping
• Basic disorder and treatment information

• In-depth reading materials
• Videotapes and discussion materials
• Consumer-to-consumer group discussion materials
• Support group information

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KyMAP Partners

• Central State Hospital
• Department for Mental Health Mental Retardation
  Services
• Seven Counties Services
• Kentucky River Community Care
• KY CAN
• NAMI Kentucky

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Current Status

• SAMHSA grant ends 9/30/06
• Presentation of Lessons Learned at national EBP
  conference (August 28-30, 2006)
• Case Study as part of NIMH EBP grant
• Result of outcome study (satisfaction, quality of
  life, symptom change)

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Implementation Issues

• Readiness for, and awareness of, the practice
  varies from site to site
• Infrastructure Needs (e.g. clinical time,
  training time, cost / billing issues, data
  collection)
• Insufficient buy-in at Cabinet and Department
  level (no mandate, policy)