Adult Attention Deficit and Hyperactivity Disorder Clinic: An Interprofessional Collaboration

Abstract Objective To review the experience of a pharmacist-led interprofessional Attention Deficit and Hyperactivity Disorder (ADHD) Clinic in a large integrated health care system. Setting Kaiser Permanente Northwest (KPNW) is a non-profit managed healthcare system that provides integrated care to over 625,000 members in Oregon and Southwest Washington. Most healthcare encounters occur within KPNW facilities by KPNW health care professionals or support staff using a common electronic medical record. Practice Description A team-based adult ADHD service was implemented with collaboration between the mental health, primary care and pharmacy departments. Patients were assessed by a psychiatrist for diagnosis and care guidance. A pharmacist, working under collaborative drug therapy management (CDTM), then initiated and managed the patient's medications via telephone encounters until the patient was stable. The care of the patient was then transitioned back to primary care and not added to psychiatry's case load. Results There were 914 patients who were treated by Adult ADHD Clinic since initiation of the service in the fall of 2015. Of those patients, 610 patients were successfully stabilized by the ADHD pharmacist. The ADHD pharmacists conducted 2,634 patient encounters over the study period and averaged 3.7 telephone follow-ups per each successful patient, with follow-ups approximately every 2 weeks. The organization realized a cost savings of $761,280 during this time frame based on the cost of a mental health provider adjusting and addressing ADHD medications versus pharmacy staff working to stabilize the patient. Conclusion The implementation of a collaborative adult ADHD service has demonstrated a successful alliance of primary care, mental health, and pharmacy in a large managed care organization. In addition to increased efficiency and evidence-based practice, the Adult ADHD Clinic resulted in significant cost-savings and improved access to mental health care.