An HMO psychopharmacology service

A pilot HMO psychopharmacology service is described. The program utilized a consultant psychopharmacologist (14 hours per week on-site) and two master's degreed nurse-clinicians who spent four and eight hours per week treating psychopharmacology patients. The psychopharmacologist evaluated all patients, initiated drug therapy, and referred selected patients to the nurse-clinicians for follow-up. The latter functioned as independent clinicians, making treatment decisions and writing prescriptions (which were countersigned by the psychopharmacologist or other staff psychiatrists). Support services (e.g., emergency triage) were provided by the mental health department. At the end of one year, the service was managing a caseload of 184 patients, 64 of whom were being followed by the two nurse-clinicians). Patient acceptance was good, and the service was supported by other mental health and medical personnel, who viewed it in pragmatic terms of increasing access to care. Issues related to the implementation of such a service in HMO settings are discussed.