Due to a previous lack of published evidence surrounding the role of a pharmacist in medication management within an ADHD clinic, the primary objective of this study was to integrate clinical pharmacists into a college health centre and measure the growth of an ADHD clinic. Additionally, the authors aimed to evaluate adherence to policies and procedures at initial visits before and after the integration of pharmacists.
The study was a retrospective evaluation of data collected from pharmacists partnering with counselling and psychological services at the University of North Carolina. During the initial appointment, the pharmacist independently assessed the patient for the initiation of ADHD treatment and for comorbid psychiatric disorders, then a collaborative treatment decision was made with the psychiatrist. Follow-up appointments were scheduled every 2–4 weeks until the individual with ADHD was on a stable and effective dose, after which follow-up appointments were every 1–3 months. The follow-up appointments also provided treatment for other comorbid psychiatric disorders that may be present. Data were extracted from the electronic health record for individuals aged ≥18 years with an ADHD diagnosis who completed a visit for a medication evaluation or medication follow-up from 1 July 2016 to 30 July 2019. A focus group was held to gather information on the pharmacists’ perceptions on the current operations of the ADHD clinic.
Prior to pharmacist integration into the counselling and psychological services, the treatment of ADHD was provided by various psychiatrists and psychiatric nurse practitioners. Over the three-year period of the study, pharmacist presence within the ADHD clinic increased from 0 full-time equivalent to 0.2 full-time equivalent. In total, 443 visits to the ADHD clinic were included in the analysis; over the study period the total number of appointments increased by 1003% (from 26 to 287 visits). The mean age of individuals with ADHD who attended the clinic was 24 years, 56% (n=247) were female and 53% (n=234) had ≥1 comorbid psychiatric condition. The majority of ADHD medications prescribed were from the amfetamine class (84%, n=370), followed by 11% (n=49) from the methylphenidate class and 3% (n=13) were non-stimulants.
The pharmacist-run appointments were more adherent to monitoring blood pressure (77%, n=293/381) compared with the psychiatrist-run appointments (11%, n=7/62; p < 0.001). Additionally, heart rate monitoring was performed more in pharmacist-run appointments (75%, n=285/381) compared with psychiatrist-run appointments (6%, n=4/62; p < 0.001). Compliance with clinic policy requiring patient signature on a stimulant medication contract was higher for the pharmacy-run appointments (75%, n=283/378) than psychiatrist-run appointments (64%, 39/61; p = 0.019). Substance use was assessed at 53% (n=21/40) of initial pharmacist-run appointments and mood was assessed at 95% of appointments (n=38/40); however, there were only two initial psychiatrist-run appointments and substance use was not assessed at either.
The focus group revealed that pharmacists in the counselling and psychological services felt that their recommendations for medication therapy were highly valued. The pharmacists believed that the individuals with ADHD who attended the clinics were either “satisfied” or “very satisfied” with pharmacist-run appointments. Positive feedback was received from individuals with ADHD who attended the pharmacist-run clinics, regarding appointment availability, ability for more frequent follow-ups and thorough patient education.
There were limitations to this study. First, there were a lack of initial visits from the 2016–2017 fiscal year, which may have been due to how the visits were recorded in the electronic record; or individuals could have been seen by another provider and were referred to the ADHD clinic. Second, patient satisfaction was not measured during the first three years of pharmacist integration. Third, the increase in initial appointments and follow-ups may not have been solely due to pharmacist involvement. Fourth, there were more follow-up visits than initial visits as each new patient (initial visit) needed to have a follow-up appointment at least every three months. Finally, when the ADHD clinic started, there was not a well-organised template that directed the provider or pharmacist to ask certain questions or take vital signs.
To conclude, the authors stated that in this study by providing pharmacist-run appointments, in collaboration with psychiatrists, for individuals with ADHD, the number of available appointments increased and the quality of care and adherence to monitoring improved. Therefore, the authors suggested that pharmacists could be used to assist psychiatrists or physicians in a college health setting to provide medication management of ADHD and comorbid conditions.
Read more about pharmacist-run ADHD clinics in a college setting here
Pohl L, El-Kurdi R, Selinger R, et al. Implementation of a community-based pharmacist-run attention deficit hyperactivity disorder clinic in a college health center. J Am Pharm Assoc 2021; Epub ahead of print.