Medication Management Toolkit

A guide to the use of medication algorithms to

guide clinical care

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

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 managementObjectives measures of outcome are producedDocumentation is thorough and clearConsumer and practitioners share in decision-making

Minimum Requirements for Reporting Medication Management

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

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.

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

Why Use an “Algorithm” In Prescribing Psychiatric Medications ?

They are frequently used with many chronic medical illnesses like diabetes, hypertension and asthmaDifficulty for clinicians to keep up with new informationImprovements in standard of care using an effective treatment techniqueImprovement in treatment outcomes and cost savingsContinuity of care from hospital to community

Mental Illnesses for Which Medication Algorithms have been Developed

Schizophrenia

Major Depressive Disorder

Bipolar Disorder / Schizoaffective Disorder

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

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

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.

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.

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”

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

KyMAP Partners

Central State Hospital

Department for Mental Health & Mental Retardation Services

Seven Counties Services

Kentucky River Community Care

KY CAN

NAMI Kentucky

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)

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)