Mental Health Team - Prescription Pathway Link

Each member of the mental health team may play different but important roles in the process by which patients receive, fill, and refill their prescriptions. Prescription pathway, is a kind of timeline that begins when a person first experiences symptoms of mental illness (Acute Stage). After making contact with a particular facility (e.g., emergency department or psychiatric inpatient unit), the patient receives treatment from prescriber (usually a psychiatrist). Later in the prescription pathway, because mental illness is usually a long-term condition, patients enter the Chronic Stage as they experience relapses, require medication changes, or need to enter different types of facilities (i.e., long-term care). Thus, as patients enter the Chronic Stage, the prescription pathway cycles back to the facility or institutional part of the time line, but under different circumstances and under different influences. Treatment decisions are influenced at different points in the prescription pathway by many people and
policies, depending on the circumstances and facility. These include different members of the mental health care team, managed care organizations, and the patient and family. It is important to be aware of how these different environments and factors influence treatment decisions all along the prescription pathway: They can act not only act as positive influences, but in some cases may pose barriers to the patient receiving the best medication available, or any medication at all.

Other key points about the prescription pathway include:

• although the first prescription may be written by a patient’s primary care physician, in many cases the patient goes directly or by referral to a psychiatrist for the first prescription; in some states, other team members (e.g., nurse practitioners, or PAs) may also have prescribing privileges
• the physician’s initial prescription may be influenced at various points in the process by other team members, managed care, or pharmacists
• the prescription pathway and its potential influences are applicable each time a patient renews a prescription or requires a different medication, whether at the acute or chronic stage of the illness

With regard to the promotion of medications to different members of the prescription pathway, the following points should be kept in mind:

Psychiatrists are usually the primary decision makers regarding medication choice, weighing a medication’s benefits against its potential side effects for each specific patient.

Pharmacists can influence medication selection and formulary decisions, as well as provide information to physicians, patients, and caregivers to ensure adherence.

Only about 15% of new prescriptions come from PCPs. However, PCPs often become involved by refilling prescriptions, answering patient questions, and providing education to patients and their families. They may also provide input to the psychiatrist regarding problems the patient may be having with the medication.

• Psychiatric nurses administer medications, report on efficacy and safety, and are well-trained for examining patients for side effects. In busy community mental health clinics and nursing homes, nurses may even drive the use of certain medications.
• Other team members do not make the initial choice of medication, but may suggest choices, answer patient questions, and provide education to patients and their families.