title: Cost-avoidance and qualitative analysis of clinical pharmacy interventions by psychiatric pharmacy residents at state psychiatric facilities.
abstract: OBJECTIVE
  The cost avoidance and quality of clinical interventions made by postgraduate year 2 (PGY2) psychiatric pharmacy residents are analyzed.
  
  
  METHODS
  A retrospective database review of clinical interventions made by PGY2 psychiatric pharmacy residents in two state psychiatric facilities from July 1, 2007 through June 30, 2014, was conducted using a clinical intervention documentation software system. Cost avoidance was calculated by multiplying the mean cost of an adverse drug reaction (ADR) by the probability of an ADR occurring had the intervention not occurred. Sensitivity analyses were performed to identify a conservative estimate of cost avoidance and an upper limit estimate of cost avoidance. The significance of an intervention was determined based on the potential of the intervention type to impact patient care.
  
  
  RESULTS
  A total of 2,329 clinical interventions were documented by 10 residents during the seven-year study period, with a mean of 233 interventions made per resident. Interventions were largely accepted (70.1%), were of moderate significance (61.9%), were associated with management of psychiatric conditions (48.7%), and primarily involved medication adjustments (13.7%), particularly for antipsychotics (24.6%). The estimated overall cost avoidance associated with PGY2 psychiatric pharmacy resident interventions was $406,944 over the study period, with a mean cost avoidance of $40,694 per resident.
  
  
  CONCLUSIONS
  A detailed qualitative analysis revealed that PGY2 psychiatric pharmacy residents' interventions were largely accepted, focused on medication adjustments for psychiatric conditions, and were of moderate significance at two state psychiatric facilities. Antipsychotics were associated with the greatest cost avoidance and total number of interventions.
authors.affiliation: Kristen N. Gardner, Pharm.D., is Clinical Pharmacy Specialist-Behavioral Health, Kaiser Permanente Colorado, Denver; at the time of writing she was Postgraduate Year 2 Psychiatric Pharmacy Resident, Western Missouri Psychiatric Pharmacy Residency Program, Center for Behavioral Medicine, Kansas City, MO. Lauren A. Diefenderfer, Pharm.D., BCPP, is Clinical Pharmacist, Center for Behavioral Medicine. Leigh Anne Nelson, Pharm.D., BCPP, is Associate Professor, University of Missouri-Kansas City (UMKC) School of Pharmacy, Kansas City. Courtney Iuppa, Pharm.D., BCPP, is Clinical Manager; and Ellie Elliott, Pharm.D., BCPP, is Director of Pharmacy, Center for Behavioral Medicine. Kalee Kleinhesselink, Pharm.D., is Clinical Manager; and Debbie Sass, B.S.Pharm., BCPP, is Clinical Pharmacist, Northwest Missouri Psychiatric Rehabilitation Center, St. Joseph. Roger W. Sommi, Pharm.D., BCPP, FCCP, is Associate Dean, UMKC School of Pharmacy at MU, Columbia, and Vice Chair, Division of Pharmacy Practice and Administration, Professor of Pharmacy Practice and Psychiatry, UMKC School of Pharmacy.
authors.forename: Kristen N
authors.initials: KN
authors.lastname: Gardner
authors.affiliation: Kristen N. Gardner, Pharm.D., is Clinical Pharmacy Specialist-Behavioral Health, Kaiser Permanente Colorado, Denver; at the time of writing she was Postgraduate Year 2 Psychiatric Pharmacy Resident, Western Missouri Psychiatric Pharmacy Residency Program, Center for Behavioral Medicine, Kansas City, MO. Lauren A. Diefenderfer, Pharm.D., BCPP, is Clinical Pharmacist, Center for Behavioral Medicine. Leigh Anne Nelson, Pharm.D., BCPP, is Associate Professor, University of Missouri-Kansas City (UMKC) School of Pharmacy, Kansas City. Courtney Iuppa, Pharm.D., BCPP, is Clinical Manager; and Ellie Elliott, Pharm.D., BCPP, is Director of Pharmacy, Center for Behavioral Medicine. Kalee Kleinhesselink, Pharm.D., is Clinical Manager; and Debbie Sass, B.S.Pharm., BCPP, is Clinical Pharmacist, Northwest Missouri Psychiatric Rehabilitation Center, St. Joseph. Roger W. Sommi, Pharm.D., BCPP, FCCP, is Associate Dean, UMKC School of Pharmacy at MU, Columbia, and Vice Chair, Division of Pharmacy Practice and Administration, Professor of Pharmacy Practice and Psychiatry, UMKC School of Pharmacy. lauren.diefenderfer@dmh.mo.gov.
authors.forename: Lauren A
authors.initials: LA
authors.lastname: Diefenderfer
authors.affiliation: Kristen N. Gardner, Pharm.D., is Clinical Pharmacy Specialist-Behavioral Health, Kaiser Permanente Colorado, Denver; at the time of writing she was Postgraduate Year 2 Psychiatric Pharmacy Resident, Western Missouri Psychiatric Pharmacy Residency Program, Center for Behavioral Medicine, Kansas City, MO. Lauren A. Diefenderfer, Pharm.D., BCPP, is Clinical Pharmacist, Center for Behavioral Medicine. Leigh Anne Nelson, Pharm.D., BCPP, is Associate Professor, University of Missouri-Kansas City (UMKC) School of Pharmacy, Kansas City. Courtney Iuppa, Pharm.D., BCPP, is Clinical Manager; and Ellie Elliott, Pharm.D., BCPP, is Director of Pharmacy, Center for Behavioral Medicine. Kalee Kleinhesselink, Pharm.D., is Clinical Manager; and Debbie Sass, B.S.Pharm., BCPP, is Clinical Pharmacist, Northwest Missouri Psychiatric Rehabilitation Center, St. Joseph. Roger W. Sommi, Pharm.D., BCPP, FCCP, is Associate Dean, UMKC School of Pharmacy at MU, Columbia, and Vice Chair, Division of Pharmacy Practice and Administration, Professor of Pharmacy Practice and Psychiatry, UMKC School of Pharmacy.
authors.forename: Leigh Anne
authors.initials: LA
authors.lastname: Nelson
authors.affiliation: Kristen N. Gardner, Pharm.D., is Clinical Pharmacy Specialist-Behavioral Health, Kaiser Permanente Colorado, Denver; at the time of writing she was Postgraduate Year 2 Psychiatric Pharmacy Resident, Western Missouri Psychiatric Pharmacy Residency Program, Center for Behavioral Medicine, Kansas City, MO. Lauren A. Diefenderfer, Pharm.D., BCPP, is Clinical Pharmacist, Center for Behavioral Medicine. Leigh Anne Nelson, Pharm.D., BCPP, is Associate Professor, University of Missouri-Kansas City (UMKC) School of Pharmacy, Kansas City. Courtney Iuppa, Pharm.D., BCPP, is Clinical Manager; and Ellie Elliott, Pharm.D., BCPP, is Director of Pharmacy, Center for Behavioral Medicine. Kalee Kleinhesselink, Pharm.D., is Clinical Manager; and Debbie Sass, B.S.Pharm., BCPP, is Clinical Pharmacist, Northwest Missouri Psychiatric Rehabilitation Center, St. Joseph. Roger W. Sommi, Pharm.D., BCPP, FCCP, is Associate Dean, UMKC School of Pharmacy at MU, Columbia, and Vice Chair, Division of Pharmacy Practice and Administration, Professor of Pharmacy Practice and Psychiatry, UMKC School of Pharmacy.
authors.forename: Courtney
authors.initials: C
authors.lastname: Iuppa
authors.affiliation: Kristen N. Gardner, Pharm.D., is Clinical Pharmacy Specialist-Behavioral Health, Kaiser Permanente Colorado, Denver; at the time of writing she was Postgraduate Year 2 Psychiatric Pharmacy Resident, Western Missouri Psychiatric Pharmacy Residency Program, Center for Behavioral Medicine, Kansas City, MO. Lauren A. Diefenderfer, Pharm.D., BCPP, is Clinical Pharmacist, Center for Behavioral Medicine. Leigh Anne Nelson, Pharm.D., BCPP, is Associate Professor, University of Missouri-Kansas City (UMKC) School of Pharmacy, Kansas City. Courtney Iuppa, Pharm.D., BCPP, is Clinical Manager; and Ellie Elliott, Pharm.D., BCPP, is Director of Pharmacy, Center for Behavioral Medicine. Kalee Kleinhesselink, Pharm.D., is Clinical Manager; and Debbie Sass, B.S.Pharm., BCPP, is Clinical Pharmacist, Northwest Missouri Psychiatric Rehabilitation Center, St. Joseph. Roger W. Sommi, Pharm.D., BCPP, FCCP, is Associate Dean, UMKC School of Pharmacy at MU, Columbia, and Vice Chair, Division of Pharmacy Practice and Administration, Professor of Pharmacy Practice and Psychiatry, UMKC School of Pharmacy.
authors.forename: Ellie
authors.initials: E
authors.lastname: Elliott
authors.affiliation: Kristen N. Gardner, Pharm.D., is Clinical Pharmacy Specialist-Behavioral Health, Kaiser Permanente Colorado, Denver; at the time of writing she was Postgraduate Year 2 Psychiatric Pharmacy Resident, Western Missouri Psychiatric Pharmacy Residency Program, Center for Behavioral Medicine, Kansas City, MO. Lauren A. Diefenderfer, Pharm.D., BCPP, is Clinical Pharmacist, Center for Behavioral Medicine. Leigh Anne Nelson, Pharm.D., BCPP, is Associate Professor, University of Missouri-Kansas City (UMKC) School of Pharmacy, Kansas City. Courtney Iuppa, Pharm.D., BCPP, is Clinical Manager; and Ellie Elliott, Pharm.D., BCPP, is Director of Pharmacy, Center for Behavioral Medicine. Kalee Kleinhesselink, Pharm.D., is Clinical Manager; and Debbie Sass, B.S.Pharm., BCPP, is Clinical Pharmacist, Northwest Missouri Psychiatric Rehabilitation Center, St. Joseph. Roger W. Sommi, Pharm.D., BCPP, FCCP, is Associate Dean, UMKC School of Pharmacy at MU, Columbia, and Vice Chair, Division of Pharmacy Practice and Administration, Professor of Pharmacy Practice and Psychiatry, UMKC School of Pharmacy.
authors.forename: Kalee
authors.initials: K
authors.lastname: Kleinhesselink
authors.affiliation: Kristen N. Gardner, Pharm.D., is Clinical Pharmacy Specialist-Behavioral Health, Kaiser Permanente Colorado, Denver; at the time of writing she was Postgraduate Year 2 Psychiatric Pharmacy Resident, Western Missouri Psychiatric Pharmacy Residency Program, Center for Behavioral Medicine, Kansas City, MO. Lauren A. Diefenderfer, Pharm.D., BCPP, is Clinical Pharmacist, Center for Behavioral Medicine. Leigh Anne Nelson, Pharm.D., BCPP, is Associate Professor, University of Missouri-Kansas City (UMKC) School of Pharmacy, Kansas City. Courtney Iuppa, Pharm.D., BCPP, is Clinical Manager; and Ellie Elliott, Pharm.D., BCPP, is Director of Pharmacy, Center for Behavioral Medicine. Kalee Kleinhesselink, Pharm.D., is Clinical Manager; and Debbie Sass, B.S.Pharm., BCPP, is Clinical Pharmacist, Northwest Missouri Psychiatric Rehabilitation Center, St. Joseph. Roger W. Sommi, Pharm.D., BCPP, FCCP, is Associate Dean, UMKC School of Pharmacy at MU, Columbia, and Vice Chair, Division of Pharmacy Practice and Administration, Professor of Pharmacy Practice and Psychiatry, UMKC School of Pharmacy.
authors.forename: Debbie
authors.initials: D
authors.lastname: Sass
authors.affiliation: Kristen N. Gardner, Pharm.D., is Clinical Pharmacy Specialist-Behavioral Health, Kaiser Permanente Colorado, Denver; at the time of writing she was Postgraduate Year 2 Psychiatric Pharmacy Resident, Western Missouri Psychiatric Pharmacy Residency Program, Center for Behavioral Medicine, Kansas City, MO. Lauren A. Diefenderfer, Pharm.D., BCPP, is Clinical Pharmacist, Center for Behavioral Medicine. Leigh Anne Nelson, Pharm.D., BCPP, is Associate Professor, University of Missouri-Kansas City (UMKC) School of Pharmacy, Kansas City. Courtney Iuppa, Pharm.D., BCPP, is Clinical Manager; and Ellie Elliott, Pharm.D., BCPP, is Director of Pharmacy, Center for Behavioral Medicine. Kalee Kleinhesselink, Pharm.D., is Clinical Manager; and Debbie Sass, B.S.Pharm., BCPP, is Clinical Pharmacist, Northwest Missouri Psychiatric Rehabilitation Center, St. Joseph. Roger W. Sommi, Pharm.D., BCPP, FCCP, is Associate Dean, UMKC School of Pharmacy at MU, Columbia, and Vice Chair, Division of Pharmacy Practice and Administration, Professor of Pharmacy Practice and Psychiatry, UMKC School of Pharmacy.
authors.forename: Roger W
authors.initials: RW
authors.lastname: Sommi
mesh_terms: D017046:Cost Savings / Q000191:economics*; D006778:Hospitals, Psychiatric / Q000191:economics* / Q000592:standards; D006801:Humans; D010595:Pharmacists / Q000191:economics* / Q000592:standards; D064172:Pharmacy Residencies / Q000191:economics* / Q000592:standards; D010607:Pharmacy Service, Hospital / Q000191:economics* / Q000592:standards; D011787:Quality of Health Care / Q000191:economics* / Q000592:standards; D012189:Retrospective Studies