Clozapine Prescribing in Resource-Limited Areas Andrew J. McLean, MD, MPH Medical Director, ND Department of Human Services Chair, Department of Psychiatry and Behavioral Science UND School of Medicine and Health Sciences 2624 9th Avenue S Fargo, ND 58103-2350 Phone: 701-298-4520 Fax: 701-298-4400 ajmclean@nd.gov
Clozapine for Treating Schizophrenia: A Comparison of the States (TAC-2015)
North Dakota Frontier Counties
CMHCs = 6 patients at NDSH = 19 patients at LSTC
Outpatient Prescribers: Medical Nursing APRNs (4) • MD, DO (16) • most Board Certified DNP, NP, CNS some with psychiatric certification • PA (1) with psychiatric certification In ND, APRNs are independent practitioners with no physician collaborative agreement requirements. In DHS, we can set privileges, however.
How have we managed? Each CMHC has a medical director Most CMHCs have multiple prescribers Good intra/inter-professional collaboration. Willingness to ask for help.
What’s new? • Clozapine Clinic/Consultative Model • Telepsychiatry • Psychiatry Residency • Jointly funded State/University position for supervision. • Plan to establish a system wide “medical/clinical staff” • Statewide Health Information Network
Clozapine Clinic • Dedicated: Consultation • - Nurse Initiation and referral back • - Psychiatric Supervisor - Psychiatric Pharm D. Ongoing Care • - Psychiatric Resident Re: Integrated care, we do • - *Social Worker/Case not yet have a psychiatric Manager… medical home, nor a lab within our center. - LAIA We do have telepharmacy, where all of our nurses are also certified pharmacy assistants
Telepsychiatry • All CMHCs have the same: o EHR o Electronic prescribing system
Psychiatry Residency • 1/3 of our state’s current practicing psychiatrists trained in our residency program • 2 additional slots per year were added to the residency program, with emphasis on rural and tele- psychiatry • In addition, elective and scheduled rotation through the clozapine clinic
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