Insight Matters
Fall 2005

OBPMS Offers Education and Consultation

As reported in the spring issue of Insight Matters, earlier this year, the Ohio Department of Job and Family Services (ODJFS) launched the Ohio Behavioral Pharmacy Management System (OBPMS) program developed by Comprehensive NeuroScience, Inc. (CNS), a nationally recognized leader in the development of “best practices” for psychiatric medication prescribing.

The stated goals of OBPMS are to:

• improve the quality of behavioral health prescribing practices, based on the best-practice guidelines of:
  improving continuity of care;
  eliminating redundant treatments;
  coordinating care among providers; and
  decreasing risks associated with inappropriate use;
• improve patient adherence to medication plans; and
• reduce the rate of spending on Medicaid behavioral health drugs.

For the past several months, the prescribing patterns of Ohio physicians have been compared with nationally recognized guidelines to identify physicians that may benefit from information about best practice standards when compared to the quality indicators.

The intent of the OBPMS is to provide education and peer-to-peer consultation to targeted outlier prescribers. Physicians are provided with an opportunity to provide feedback to ODJFS through use of a feedback form to raise questions about the data received and/or to substantiate the need for their prescribing pattern.

Physicians are also informed when patients fail to refill antipsychotic prescriptions in a timely fashion and when patients are receiving the same class of behavioral health drugs from multiple prescribers.

Currently, there is no distinction between physician specialties when it comes to the comparison of quality indicators and prescribing patterns. The OPA suggested that it would be helpful to differentiate between psychiatrists and other physician specialties as the complexity of the illnesses being treated would likely be different.

The main clinical concerns revealed by the prescriber feedback thus far are:

• patients on high numbers of behavioral health drugs (that ranged from three to 14 different prescriptions per patient);
• long-term use of benzodiazepines,
• multiple prescribers of anticonvulsants/mood stabilizers, and
• switching atypical anti-psychotics without sufficient trial.

Next steps include:

• implementation of a peer consulting process (ODJFS is in the process of building its panel of Ohio reviewers – should be complete by November, 2005);
• initiate use of a BPMS product with community mental health centers and psychiatry residency programs;
• continue to review “Prescriber and Patient Change” reports
• track feedback on quality indicators and make changes where necessary;
• review possibilities for research,
• focus on MR/DD population,
• transition to Medicare Part D, and
• outreach to community mental health centers.

The next OMBPM advisory group meeting will be held in early 2006. In the meantime, send any questions you may have about the project to OPA’s OMBPM advisory group representatives: Alice Hale, M.D. or Marilyn Peters, M.D., at ohiopsych@ohiopsych.org.

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