Archana Jhawar, Clinical Pharmacist
University of Illinois at Chicago College of Pharmacy
At the AAPP 2024 Annual Meeting, Dr. Chelsea Di Polito, PharmD, BCPP presented “The Good, the Bad, and the Unknown of Psychotropic Stewardship Implementation: A Focus on Antipsychotics”. Dr. Di Polito is the Assistant Director of the Peer Review for Mental Health Drugs Program through the University of Maryland School of Pharmacy and works in the Peer-to-Peer program with Medicaid to reduce unnecessary antipsychotic prescribing to children and adolescents. She was a member of the Psychotropic Stewardship Taskforce and a co-author of AAPP’s paper on psychotropic stewardship.
Dr. Di Polito compared antimicrobial stewardship (AMS) and psychotropic stewardship programs (PSPs). AMS is a well-known healthcare program, and most providers know the imperative role pharmacists play in ensuring safe antibiotic usage to reduce rates of resistance. Conversely, PSP is a relatively new concept with sparse data despite pharmacists participating in these activities for years.
The first papers outlining PSPs were published in 2018 and had a pharmacist at the center. AAPP published a 2023 article identifying psychiatric pharmacists and prescribers as co-leaders and included social workers, psychiatric nurses, and the patient to complete the team. The article suggests starting with easily identified areas such as high-risk medications or known problematic areas within the practice setting. The teams should focus on a maximum of one or two targeted areas. There are likely straightforward interventions regardless of practice setting and several opportunities center around antipsychotics. Here are a few examples.
When starting a new service there can be numerous barriers hindering its implementation. For example, limited time is a struggle for many BCPPs. Selecting only one or two areas of impact will create a small target to show proof of concept and allow future growth. Identify champions early on who will support the program and provide them with as much background research, planning information, and updates as required to obtain leadership buy-in. Pending the barrier, there are possible solutions.
An important part of planning includes identifying how to measure the effectiveness of the PSPs. Using data to drive outcomes will help justify the team, show patient benefit, and continue to foster leadership buy-in. It also provides the opportunity to reassess and modify the programs to better achieve desired goals. Here are examples of possible data points.
A natural next step is writing a manuscript for publication. Randomized controlled trials are likely not feasible in most settings, but comparing the clinic or unit with the PSP to a similar one without the PSP is likely a more achievable design. If that’s not possible, reviewing the same unit or clinic prior to and post-implementation also provides valuable information. With an increase in publications about the implementation and successes of stewardship, it can foster more programs and grow to become a regulatory standard, following the trajectory of AMS.
Healthcare systems expanding AMS resulted in an increased need for board-certified infectious disease pharmacists, and a similar cycle can be applied to mental health. As BCPPs expand PSPs, this will likely become the standard of care in healthcare systems. As prevalence and access to PSPs grows, there will be an increased need for BCPPs, which will result in more BCPPs available to develop stewardship. This session and AAPP's publication supports psychiatric pharmacists taking the lead on expanding stewardship to advance our profession and patient care.
