Establishment of an Ambulatory Pharmacy in a Community Mental Health Center

Thomas E. O'Brien, Pharm.D, M.S., FASHP, Kumar Maharaj, M.S.B.A., R.Ph., BCPP, and David Olson, Ph.D., R.Ph.

University of Rochester-Strong Health

Rochester, New York

The Strong Ties pharmacy opened in 2000 to provide ambulatory pharmacy services to clients with severe and persistent mental illnesses in a community mental health center. These clients face unique challenges as they recover and reintegrate into the community. They are frequently treatment non-adherent, experience more diabetes and nicotine dependence than the general population and require intensive medication management. Prior to 2000, clients lacked access to pharmaceutical care and significant resources were diverted from our health care systems both in obtaining medications and lost revenue. This paper describes the conceptualization, development and implementation of an ambulatory pharmacy that provides a menu of clinical services while generating a positive contribution margin (revenue minus expenses).

Salient features of this pharmacy include a just in time inventory system, a robust treatment adherence program, client and provider education activities, clinical research, training for pharmacy students and wellness initiatives. Components of the treatment adherence program include prospectively refilling medications, notifying treatment providers when clients are medication non-adherent, providing access to medication samples and indigent medication programs. Components of the education programs include the development of client appropriate medication teaching tools, participation in medication groups, and outreach to community providers. Wellness initiatives include diabetes education and smoking cessation.

This model demonstrates that clinical pharmacy can be successfully introduced to ambulatory clinics in health care systems. It provides a template for the introduction of a clinical Pharmacy practice that improves client outcomes, adds revenue to the health care system and enhances the profile of clinical pharmacy in the community.