Outcomes assessment of clinical pharmacy services in a psychiatric inpatient setting

The effects of psychiatric pharmacy services on clinical outcomes of acute care psychiatric inpatients were studied. Patients recruited at a state psychiatric facility during phase 1 (October 1996-March 1997) served as the control group and received only traditional centralized pharmaceutical services and physician-requested psychiatric pharmacotherapy consultations. Patients recruited during phase 2 (May-December 1997) received intensive psychiatric pharmacy services and served as the experimental group. Pharmaceutical services during phase 2 included attending treatment team meetings, performing baseline assessments and weekly reviews, providing pharmacotherapy recommendations, obtaining medication histories, reviewing drug administration records daily, monitoring for adverse drug reactions, conducting medication education classes, and counseling patients before discharge. Outcome variables included clinical response determined with objective rating scales, cost of care, length of stay, adverse events, rate of acceptance of recommendations, patient compliance with the first clinic visit scheduled after discharge, quality of life, and patient satisfaction. Data were analyzed for 48 patients in the control group and 45 patients in the experimental group. There were no significant differences between the two groups with respect to age, sex, duration of illness, number of hospitalizations, and number of months since the last hospitalization. Patients in the experimental group showed significant improvements in clinical response and drug-induced extrapyramidal symptoms compared with the controls and were highly satisfied with the pharmaceutical services they received. Medication costs did not differ significantly, and length of stay was about 29 days for each group. The provision of clinical pharmacy services provided to inpatients in an acute care psychiatric facility was associated with improvements in rating-scale scores for clinical response and for drug-induced extrapyramidal symptoms.