Pharmacists: Essential Partners in Shared Decision-Making for Schizophrenia and Schizoaffective Disorder

Pharmacists: Essential Partners in Shared Decision-Making for Schizophrenia and Schizoaffective Disorder
Tim Isdahl, PharmD, Minnesota Community Care

Background: Schizophrenia and schizoaffective disorder are diagnoses that require significant understanding and collaboration between patients and their care team for optimal treatment. Medications used to treat schizophrenia and schizoaffective disorder often require frequent monitoring of drug levels, and have side effect risks including metabolic syndrome, akathisia, and tardive dyskinesia.

The American Society of Health System Pharmacists (ASHP) recently published a Therapeutic Position Statement on schizophrenia and schizoaffective disorder to serve as a resource for pharmacists participating in shared decision-making processes with patients. Shared decision-making, a clinical approach that emphasizes empowering patients to participate in their own care, is designed to give autonomy back to patients. Past research has found that shared decision-making typically leads to better outcomes than coercive treatments in mental health care.

Discussion: Early recognition and treatment of schizophrenia and schizoaffective disorder have been found to slow neurodegeneration and decrease all-cause mortality. Past research by Ringen et al. has noted that people living with schizophrenia have a life expectancy that is 20 to 25 years shorter than those without this diagnosis. This shortened life expectancy, along with studies demonstrating that over half of persons with schizophrenia are non-adherent to prescribed treatment at some point, demonstrates a space for pharmacists to step in to help patients receive optimal treatment. Shared decision-making, which involves open and honest discussions about potential treatment options and probable outcomes, can help increase patient buy-in and respect patients’ views about their own ideal care. Pharmacists are able to support this process in the ambulatory setting by providing comprehensive medication management and working under collaborative practice agreements with providers.

Practice Impact: The pharmacist’s role in patient care is no longer confined to traditional retail and hospital settings. Pharmacists are increasingly a frontline resource and provider for patients with mental illnesses, whether they are leading medication education classes in inpatient psychiatric units or seeing patients independently in an ambulatory care setting. This position statement and the guidelines contained within will allow pharmacists to practice at the top of their licenses and provide information to patients to allow for informed consent in treatment.

 

References:

  1. Ringen, PA, Engh, JA, Birkenaes, AB, Dieset, I, Andreassen, OA. Increased mortality in schizophrenia due to cardiovascular disease – a non-systematic review of epidemiology, possible causes, and interventions. Frontiers in Psychiatry. 2014;5. https://doi.org/10.3389/fpsyt.2014.00137
  2. Dopheide, JA. Pharmacists: Essential partners in shared decision-making for schizophrenia and schizoaffective disorder. American Journal of Health-System Pharmacy: AJHP: Official Journal of the American Society of Health-System Pharmacists.2020;77(24): 2023–2024. https://doi.org/10.1093/ajhp/zxaa372