Mental Health and Psychiatric Pharmacy Instruction in US Colleges and Schools of Pharmacy

American Journal of Pharmaceutical Education, 2007 by Cates, Marshall E, Monk-Tutor, Mary R, Drummond, Stephanie Ogle

Objectives. To describe the extent of psychiatric pharmacy instruction in US pharmacy curricula, including course and faculty characteristics and mental health topics taught in clinical therapeutics-based courses.

Methods. An 11-item survey instrument (54% response) was developed and mailed to 91 colleges and schools of pharmacy.

Results. Over 75% of colleges and schools employed a psychiatric pharmacist; however, less than 50% of faculty teaching psychiatric pharmacy content were psychiatric pharmacy specialists as defined in the study. All colleges and schools included psychiatric topics as part of a therapeutics-based course with an average of 9.5% of course content devoted to these topics. About 25% of colleges and schools offered elective didactic courses in psychiatric pharmacy. Only 2 schools required a psychiatric pharmacy advanced pharmacy practice experience (APPE), but about 92% offered elective APPEs. The mean number of hours spent on lecture- and case-based instruction across all colleges and schools was highest for depression and lowest for personality disorders.

Conclusions. There is a need for colleges and schools of pharmacy to better identify and standardize the minimal acceptable level of didactic instruction in psychiatric pharmacy as well as the minimal level of specialty qualifications for faculty members who teach this subject.

Keywords: psychiatric pharmacy, pharmacy education, curriculum, mental health

INTRODUCTION

Approximately 26% of Americans aged 18 years and older suffer from a diagnosable mental illness.1 In addition, mental illness accounts for over 15% of the burden of disease in established market economies, such as the United States.2 Not surprisingly, psychotropic medications represent approximately 13% of the top 300 most frequently prescribed medications in the United States.3 In addition to dispensing these medications, pharmacists can play vital roles in the treatment of mentally ill patients,4 and activities such as medication counseling and monitoring of therapy have been documented to improve both satisfaction and adherence to drug therapy in this patient population.5 Clearly, an appropriate knowledge base regarding mental illnesses and psychopharmacotherapy is crucial for the new practitioner.

Faculty credentials in this specialty area of practice are also important to ensure relevant and complete instruction. Although not large in number, residencies (approximately 20) and fellowships (fewer than 10) in psychiatric pharmacy are available to those pharmacists desiring to practice pharmaceutical care and/or conduct research in mental health settings. Psychiatric pharmacy was recognized as a specialty by the Board of Pharmaceutical Specialties in 1992,6 and pharmacists have been eligible to be granted board certification in this field since 1996. There are currently 463 board-certified psychiatric pharmacists (BCPP). Ideally, academicians with these types of qualifications would teach psychiatric content in colleges and schools of pharmacy.

While the scope and nature of the teaching of a number of pharmacy topics have been documented previously, 7-18 a review of the literature revealed that no published studies have examined the status of psychiatric pharmacy education within pharmacy school curricula since the early nineties.19 The current study was undertaken to update and more thoroughly describe the extent of psychiatric pharmacy instruction provided by colleges and schools of pharmacy in the United States, including course and faculty characteristics, specific mental health topics taught in clinical therapeutics-based courses, and course time dedicated to those topics.

METHODS

A survey instrument was developed based on previous examples published in the literature,7-15 pre-tested by the authors, and approved by the Samford University Institutional Review Board. The survey instrument was divided into 3 sections. Section 1 dealt with background information, including: designation of school as public or private; total student enrollment; faculty full-time equivalents; percentage of therapeutics-based didactic course content spent on psychiatric disorders; number of psychiatric pharmacists on the faculty; plans to hire psychiatric pharmacist(s) within the next 5 years; required and elective didactic courses or APPEs in psychiatric pharmacy and the percentage of each pharmacy cohort taking these elective courses; and availability of psychiatric pharmacy practice sites for faculty members. Section 2 dealtwith course content (ie, didactic therapeuticsbased course sequence), including specific topics taught, number of contact hours of lecture-based instruction per topic, and number of contact hours of case-based instruction per topic. Section 3 dealt with instructor characteristics, including employment status of each instructor (eg, full-time or part-time); delineation of courses taught by each instructor (eg, clinical therapeutics-based course, psychiatric pharmacy didactic elective, psychiatric pharmacy APPE); and description of instructor qualifications (eg, residency, fellowship, board certification). For the purposes of this study, a psychiatric pharmacist was de- fined as one who had completed at least one of the following: a residency or fellowship in psychiatric pharmacy or board certification in psychiatric pharmacy practice (ie, BCPP). A copy of the survey instrument may be obtained from the authors.