Safer Samples with Pharmacist Care: An Innovative Program for Enhancing Medication Experience in Patients with Mental Health Conditions

Objectives:

Patients with mental illness often have multiple medical co-morbidities. They experience higher rates of adverse drug reactions compared to patients with no mental health diagnosis, and are at higher risk of experiencing toxicity from medications other than those required for their psychiatric diagnosis. Adverse effects are the leading cause of medication discontinuation in this population. Traditional medication sampling practices contradict essential elements of safe and effective medication use.  As such, many facilities have implemented policies prohibiting their use.  Yet, using medication samples is attractive for patients with mental health conditions as prescribers try to determine effective and well-tolerated medication regimens and alleviate the cost of multiple medications which may go partially unused.

Methods:

The Safer Samples program partners Pharmacy Services and the Mental Health Program at Women’s College Hospital, Toronto, Ontario, Canada.  Rather than providing the sample directly to the patient, prescribers provide patients with a voucher for a medication sample, which is then prepared by our outpatient pharmacy.  Vouchers are redeemable for up to 28 days of medication at no cost to the patient.  A best possible medication history (BPMH) is also conducted through a face-to-face visit between the patient and pharmacist.

Results:

On receipt of the voucher, the pharmacist reviews it (as they would any other prescription) for drug-therapy problems, appropriate labeling, and accurate dispensing.  The BPMH and recommendations for optimizing pharmacotherapy are then shared with the prescriber.  For eligible patients, there is a fee for the medication consultation that is paid by the provincial government.

Conclusion:

A mixed methods evaluation of the program is ongoing and will explore: physician’s beliefs around medication samples; characteristics of patients receiving medication samples; the number and types of drug-therapy problems and recommendations identified; and workflow factors including time for inventory management, dispensing and patient medication reviews.