Gregory H. Payne

Introduction: Federal and state policymakers, accreditation organizations, and mental health agencies developed standards for evidence-based use of psychotropic medications among youth in foster care. Despite these efforts, foster youth are vulnerable to psychotropic polypharmacy, high dosing, and low rates of monitoring. This manuscript aimed to (1) analyze state-specific psychotropic oversight programs, and (2) examine specific state approaches and outcomes. Methods: State guidelines, including all 50 United States and Washington, DC, were identified via Google search and a Center for Health Care Strategies, Inc., 2018 technical assistance tool. For each state, authors documented whether guidelines were specific to foster care and whether they included thresholds related to polypharmacy, metabolic monitoring, age-based prescribing, maximum dosages, and any distinctive characteristics. Results: Most states (61%) have published a foster care psychotropic guideline; 9 states (18%) do not have a one, and the authors were unable to locate guidelines for the remaining 11 states (22%). More than one-third of foster care youth (38%) live in states with no psychotropic monitoring requirements. Sixty-three percent (n = 32) of states require a prior authorization (PA) or drug utilization review (DUR) for youth prescribed more than 1 psychotropic. Forty-seven states have age-based prescribing support in place, with PA (n = 28) and DUR (n = 9) being the most common oversight processes. Conclusions: States have a wide range of age restrictions, approaches to PA and DUR, and prioritization of monitoring. Some states lack guidelines entirely. Variability in state psychotropic oversight programs, reporting methods, and data collection contributes to barriers to successful optimization of psychotropic prescribing among youth in foster care.

Polypharmacy, gaps in transitions of care, and inconsistent medication monitoring contribute to inappropriate psychotropic prescribing among youth in foster care. Additionally, foster care psychotropic prescribing regulations are complex and insufficient. Acknowledging these concerns, pharmacists have been identified as essential advocates for youth in foster care given their expertise in medication therapy management, medication reconciliation, patient/caregiver education, and interprofessional collaboration. Specifically, inclusion of board-certified psychiatric pharmacists (BCPPs) on the foster care team could allow for the implementation of best practices, including psychotropic stewardship, collaborative telemedicine services, telemedicine teaching initiatives, comprehensive medication management, and procurement of accurate medical and medication histories, amongst others. It is critical that child welfare administrators, health system administrators, and the foster care team consider inclusion of a BCPP to better support prescribing practices of psychotropic medications among youth in foster care.

Introduction: Pharmacists managing psychotropic medications improve clinical and patient-level outcomes across a variety of healthcare settings and diagnoses. The Systematic Literature Review (SLR) Committee of the American Association of Psychiatric Pharmacists published the original paper, known as SLR1, in 2024. This paper served as a comprehensive database, cataloguing the impact of psychiatric pharmacists. The purpose of this paper was to expand the database from SLR1. Methods: A second systematic literature review (SLR2) from January 1, 1961, to December 31, 2024, was conducted using PubMed and search terms based on a previous paper (SLR1). The inclusion criteria required pharmacist intervention focused on psychiatric diagnoses and/or psychotropic medications, as well as evaluation of patient-level outcomes. Exclusion criteria were met if there was no pharmacist intervention, no psychiatric disorder treatment, no clinical outcomes, no original research, no access to full text, and/or no English-language version available. Results: A total of 5883 articles were identified for possible inclusion, with only 466 remaining after screening by title and Another 374 were excluded on the first full-text review. The remaining articles underwent a second full-text review, resulting in 52 articles meeting the inclusion criteria. SLR1 and SLR2 combine for 246 included articles. Discussion: Publication of articles displaying the impact of psychiatric pharmacists has slowed over the past two years, but the overall outcomes were positive, as was also seen in SLR1. The cumulative results of SLR1 and SLR2 support the need for standardization of outcomes and stronger study designs to fully demonstrate the benefit of psychiatric pharmacists.

Introduction: Board-Certified Psychiatric Pharmacists (BCPPs) are highly trained mental health providers. The workload of clinical pharmacists has been inconsistently reported in the literature. The goals of this study were to quantify the typical and ideal workloads of BCPPs and characterize their practice settings and clinical activities. Methods: This was a cross-sectional survey study of BCPP members of the American Association of Psychiatric Pharmacists. The survey included demographic, practice-related, and burnout questions. The primary outcome was the self-reported typical and ideal workloads of BCPPs in inpatient, outpatient, and transition-of-care settings. Secondary outcomes included practice settings and types of activities. Results: Of 571 invitees, 173 respondents were included in the analysis. The mean typical number of patients per day for inpatient and outpatient BCPPs were 35.6 (±22.8) and 9.29 (±10.9), respectively. The mean ideal number of patients per day for inpatient and outpatient BCPPs were 23.6 (±10.4) and 9.96 (±10.6), respectively. Inpatient pharmacists reported spending 15.4 (±12.2) hours on direct patient care and consults during a typical workweek compared with outpatient pharmacists (25.4 ± 15.1, p ≤ .001). A greater number of outpatient pharmacists reported that electronic health record documentation contributed to a significant portion of their workflow compared with inpatient pharmacists (96.2% versus 71.9%, respectively, p ≤ .001). Discussion: This was the first study to quantify BCPPs self-reported typical and ideal workload in different practice settings. Future research is needed to identify the factors that determine ideal workloads for BCPPs at specific practice sites.

Introduction: Burnout is an occupational phenomenon resulting from chronic workplace stress that is unsuccessfully managed. Data related to burnout among clinical pharmacists are limited. This study aimed to measure burnout among Board-Certified Psychiatric Pharmacists (BCPPs) and evaluate the correlation between practice characteristics and demographics. Methods: This was a cross-sectional survey study of BCPPs. The survey included demographic, practice-related, and burnout questions. The primary outcome was burnout scores using the Maslach Burnout Inventory Human Services Survey for Medical Personnel (MBI-HSS [MP]). Secondary outcomes assessed the practice and demographic factors that may have affected burnout levels. Correlation and regression statistics between MBI-HSS (MP) and practice and demographic variables were performed. Results: Of 571 invitees, 225 participated in the study, and 173 respondents were included. Burnout subscale scores were not significantly different based on age, race, gender, marital, or caregiver status; however, a sense of belonging positively influenced all subscale scores. Regular mentorship and engaging in a hobby were correlated with significantly lower emotional exhaustion scores (20.2 vs 24.8, P = 0.028, and 22.7 vs 28.4, P = 0.010). Burnout subscale scores were comparable between practice settings. However, personal accomplishment subscale scores were significantly lower for pharmacists in the inpatient versus outpatient setting (37.1 vs 38.9, P = 0.036). Conclusion: BCPPs are at risk for burnout. Race, gender, and patient volume were not associated with burnout. Factors including mentorship, engaging in hobbies, and a sense of belonging were identified as potential modifiers of burnout in BCPPs.

Reporting interventions thoroughly and consistently in the literature allows for study reproducibility or implementation of the intervention into practice. Although there is currently no standard for describing Board-Certified Psychiatric Pharmacist (BCPP) interventions in the published literature, there are multiple checklists or guides that have been developed for reporting clinical interventions, including the template for intervention description and replication and the pharmacist patient care intervention reporting (PaCIR) checklist, that seek to improve the quality of reporting interventions in the literature. The purpose of this paper is to describe a proposed guide for reporting BCPP interventions in the literature by expanding the PaCIR checklist. Authors use a logic model developed by the American Association of Psychiatric Pharmacists to ensure all elements of the process are addressed in the expanded guide.

Deaths related to opioid overdoses continue to climb, and there remains a need for innovative strategies to address this ongoing crisis. Harm reduction (HR), a nonjudgmental philosophy aimed at reducing consequences associated with drug use and other potentially unsafe behavior, has emerged as a compassionate and effective approach. Harm reduction further emphasizes overdose prevention and fosters a shift in perspective that recognizes substance use disorder as a disease and not a moral failing. The tenets of HR collectively advocate for the well-being of individuals who use substances and support any positive change as defined by the individual. Given the high rate of morbidity and mortality associated with substance misuse and barriers or ambivalence to receiving treatment, awareness of and advocacy for HR practice is essential. This manuscript aims to describe evidence-based HR interventions, provide a foundation for the implementation of services, and further promote the importance of providing humanistic care without judgment. As valued members of the multidisciplinary treatment team, Board-Certified Psychiatric Pharmacists should implement and engage in HR services in the settings where people with substance use disorders receive care.

Introduction: Pharmacists focusing on psychotropic medication management and practicing across a wide variety of healthcare settings have significantly improved patient-level outcomes. The Systematic Literature Review Committee of the American Association of Psychiatric Pharmacists was tasked with compiling a comprehensive database of primary literature highlighting the impact of psychiatric pharmacists on patient-level outcomes. Methods: A systematic search of literature published from January 1, 1961, to December 31, 2022, was conducted using PubMed and search terms based on a prior American Association of Psychiatric Pharmacists literature review. Publications describing patient-level outcome results associated with pharmacist provision of care in psychiatric/neurologic settings and/or in relation to psychotropic medications were included. The search excluded articles for which there was no pharmacist intervention, no psychiatric disorder treatment, no clinical outcomes, no original research, no access to full text, and/or no English-language version. Results: A total of 4270 articles were reviewed via PubMed, with 4072 articles excluded based on title, abstract, and/or full text in the initial pass and 208 articles selected for inclusion. A secondary full-text review excluded 11 additional articles, and 5 excluded articles were ultimately included based on a secondary review, for a final total of 202 articles meeting the inclusion criteria. A comprehensive database of these articles was compiled, including details on their study designs and outcomes. Discussion: The articles included in the final database had a wide range of heterogeneity. While the overall impact of psychiatric pharmacists was positive, the study variability highlights the need for future publications to have more consistent, standardized outcomes with stronger study designs.

In the context of ongoing workforce shortages, rising symptom severity, and increased rates of psychotropic prescribing, the 2021 declaration of a national emergency in child and adolescent psychiatry (CAP) has highlighted the need for innovative strategies to address access to quality care. As valued members of the interdisciplinary team, Board‐Certified Psychiatric Pharmacists (BCPPs) in CAP are well‐positioned to address these needs as they are integrated across various settings (e.g., ambulatory clinics, and psychiatric hospitals) and have expertise in psychiatric and neurodevelopmental disorders. As educators and advocates for evidence‐based psychotropic medication management, BCPPs in CAP decrease polypharmacy, increase medication adherence and knowledge, and enhance patient outcomes. Given the need for interdisciplinary collaboration among BCPPs, CAP, and primary care providers, it is crucial for pharmacy administrators to respond and recognize the necessity of integrating pharmacy services into CAP and integrating BCPPs into pharmacy departments.