Clozapine Prescribing in Resource-Limited Areas Andrew J. McLean, - - PowerPoint PPT Presentation

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Clozapine Prescribing in Resource-Limited Areas Andrew J. McLean, - - PowerPoint PPT Presentation

Clozapine Prescribing in Resource-Limited Areas Andrew J. McLean, MD, MPH Medical Director, ND Department of Human Services Chair, Department of Psychiatry and Behavioral Science UND School of Medicine and Health Sciences 2624 9th Avenue S


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Clozapine Prescribing in Resource-Limited Areas

Andrew J. McLean, MD, MPH Medical Director, ND Department of Human Services Chair, Department of Psychiatry and Behavioral Science UND School of Medicine and Health Sciences 2624 9th Avenue S Fargo, ND 58103-2350 Phone: 701-298-4520 Fax: 701-298-4400 ajmclean@nd.gov

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Clozapine for Treating Schizophrenia: A Comparison of the States (TAC-2015)

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North Dakota Frontier Counties

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CMHCs

= 6 patients at NDSH = 19 patients at LSTC

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Outpatient Prescribers:

Medical Nursing

  • MD, DO (16)

most Board Certified

  • PA (1) with psychiatric

certification

  • APRNs (4)

DNP, NP, CNS some with psychiatric certification In ND, APRNs are independent practitioners with no physician collaborative agreement

  • requirements. In DHS, we can

set privileges, however.

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How have we managed?

Each CMHC has a medical director Most CMHCs have multiple prescribers Good intra/inter-professional collaboration. Willingness to ask for help.

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What’s new?

  • Clozapine Clinic/Consultative Model
  • Telepsychiatry
  • Psychiatry Residency
  • Jointly funded State/University position for supervision.
  • Plan to establish a system wide “medical/clinical staff”
  • Statewide Health Information Network
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Clozapine Clinic

  • Dedicated:
  • Nurse
  • Psychiatric Supervisor
  • Psychiatric Pharm D.
  • Psychiatric Resident
  • *Social Worker/Case

Manager…

  • LAIA
  • Consultation
  • Initiation and referral back
  • Ongoing Care
  • Re: Integrated care, we do

not yet have a psychiatric medical home, nor a lab within our center. We do have telepharmacy, where all of our nurses are also certified pharmacy assistants

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Telepsychiatry

  • All CMHCs have the same:
  • EHR
  • Electronic prescribing system
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Psychiatry Residency

  • 1/3 of our state’s current practicing psychiatrists

trained in our residency program

  • 2 additional slots per year were added to the

residency program, with emphasis on rural and tele- psychiatry

  • In addition, elective and scheduled rotation

through the clozapine clinic

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Case Examples

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Q+A