Impact of pharmacist intervention on psychiatric conditions in - - PowerPoint PPT Presentation

Impact of pharmacist intervention on psychiatric conditions in pregnancy

Emily Walsh, Pharm.D., PGY2 Ambulatory Care Pharmacy Resident

• St. Louis College of Pharmacy/SSM Health St. Mary’s

Project mentors: Alicia Forinash, Pharm.D., FCCP, BCPS, BCACP; Abigail Yancey, Pharm.D., FCCP, BCPS; Katherine Mathews, MD, MPH, MBA

Background

Fetal outcomes

• Preterm birth
• Low birth weight
• Decreased growth
• Spontaneous abortion
• Decreased developmental scores
• Cardiovascular defects
• Perstistent pulmonary hypertension
• Increased neonatal cortisol and

catecholamine levels Maternal outcomes

• Stress
• Prolonged labor
• Forced delivery
• Impaired bonding
• Decreased social support
• Increased use of tobacco, alcohol and

illicit substances

• Suicide
• Poor adherence to postpartum care

Objective

To measure the impact of clinical pharmacy services in the management

• f psychiatric conditions in pregnancy

Inclusion criteria

• Seen in SSM Health St. Mary’s

Maternal Fetal Care Center (MFCC)

• Pregnant women 18 years of age or
• lder or postpartum
• <35 weeks gestational age unless

postpartum

• Suspected diagnosis of depression,

anxiety and/or bipolar disorder

• English or Spanish speaking

Exclusion criteria

• Declined participation
• Did not complete study follow up
• Previous visits with clinical

pharmacy team for assessment of depression, anxiety or bipolar disorder during this pregnancy

• Women and Infant Substance Help

(WISH) Center patient

Identify patients Past medical history Medication list Provider referral Visit with pharmacy team Informed consent Standard visit EPDS Telephone call (1 week) Medication pickup Adverse drug reactions Answer questions Follow up with pharmacy team (at least 3 weeks) Standard visit EPDS Satisfaction survey

EPDS: Edinburgh Postnatal Depression Scale

Descriptive Paired t-test Descriptive

Descriptive

10 patients currently enrolled 6 patients completed follow-up

n (%)* Age - mean 29.8 Ethnicity African American/Black Caucasian 5 (83.3) 1 (16.7) Level of care High risk Low risk 3 (50) 3 (50) Gestational age – mean 1st trimester 2nd trimester 3rd trimester 17 weeks, 2 days 3 (50) 2 (33.3) 1 (16.7) Gravidity – mean Primiparous Multiparous 4 1 (16.7) 5 (83.3)

*unless otherwise noted

Comorbidities n (%)* # comorbidities - mean 4.8 Obesity 4 (66.7) History of poor pregnancy outcome^ 3 (50) Nausea/vomiting 3 (50) HTN 2 (33.3) Asthma 2 (33.3) Other (all n = 1): DM/GDM, HIV, fibromyalgia, migraine, chronic pain, anemia, brain cyst

*unless otherwise noted ^Poor pregnancy outcome: c-section, preterm delivery, polyhydramnios DM: diabetes, GDM: gestational diabetes, HTN: hypertension, PPD: postpartum depression, ADHD: attention deficit hyperactivity disorder

Psychiatric diagnosis n (%)* # psych diagnoses - mean 2.5 Depression/PPD 4 (66.7) Anxiety 3 (50) Bipolar 3 (50) Trauma 2 (25) Other (all n = 1): PTSD, ADHD, schizoaffective disorder, borderline personality, antisocial personality

1antidepressants: SSRI, SNRI 2mood stabilizer: lamotrigine

n (%) Stop/taper inappropriate medications

• Start new medications

Psychiatric medication Acute PG issues, prenatal vitamin Asthma, smoking cessation Aspirin 14 (18.7) 3 7 3 1 Medications in list but no longer active 26 (34.7) Medications not listed in list but currently taking 1 (1.3) Other Vaccinations Labs Patient education* Refer to specialist 15 (20.0) 3 (4.0) 12 (16.0) 4 (4.0) TOTAL 75

n (%) Stop/taper inappropriate medications

• Start new medications

1 (3.2) Medications in list but no longer active

• Medications not listed in list but currently

taking 1 (3.2) Other Vaccinations Labs Patient education Refer to specialist 14 (45.2)

• 12 (38.7)

3 (9.7) TOTAL 31

Psych – n (%) Non-psych – n (%) Stop/taper inappropriate medications

• Start new medications

4 (3.8) 11 (10.4) Medications in list but no longer active

• 26 (24.5)

Medications not listed in list but currently taking

• 2 (1.9)

Other Vaccinations Labs Patient education Refer to specialist

• 2 (1.9)

12 (11.3) 2 (1.9) 29 (27.4) 1 (0.9) 12 (11.3) 5 (4.7) TOTAL (n = 106) 20 (18.9) 86 (81.1)

2 4 6 8 10 12 14

EPDS score (mean) Change in EPDS from baseline to follow up Initial Follow-up 13.1 10.7 p = 0.34 *EPDS >10 is considered uncontrolled

Controlled 67% Uncontrolled 33%

Assessment of mood by MD/NP/Pharm.D Initial visit (n = 6)

Controlled 67% Uncontrolled 33%

Assessment of mood by MD/NP/Pharm.D Follow-up visit (n = 6)

Controlled 33% Uncontrolled 67%

Assessment of EPDS Initial visit (n = 6)

Controlled 50% Uncontrolled 50%

Assessment of EPDS Follow-up visit (n = 6)

Of patients that were uncontrolled at baseline, 50% (n = 2) experienced a clinically significant change at follow-up

1 2 3 4 5 6 Patient reported mood (mean)

Change in patient reported mood from baseline to follow-up Initial Follow-up 4.8 3.8 *Scale of 1 to 10 with 1 being the best

Many recommendations were made by the pharmacy team to provide comprehensive care to patients Trend towards improved EPDS scores and control of

• bstetrics patients with psychiatric conditions

Patients were satisfied by the care provided by the pharmacy team

Strengths

• Contribute to the body of

evidence related to pharmacist management

• f psychiatric conditions

and obstetrics patients

• Quantify impact of current

standard of care at MFCC Limitations

• Lower than anticipated

study enrollment due to COVID-19

• Lack of comparator group
• Poor follow-up

Continue enrollment Provide recommendations and education to the healthcare team on how to best care for patients with mood disorders

Impact of pharmacist intervention on psychiatric conditions in pregnancy

Emily Walsh, Pharm.D., PGY2 Ambulatory Care Pharmacy Resident

• St. Louis College of Pharmacy/SSM Health St. Mary’s

Project mentors: Alicia Forinash, Pharm.D., FCCP, BCPS, BCACP; Abigail Yancey, Pharm.D., FCCP, BCPS; Katherine Mathews, MD, MPH, MBA