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PRACTICE GUIDELINES
GUIDELINES OF PRACTICE FOR MEDICATION MANAGEMENT
IN PSYCHIATRY
The Guidelines of Practice for Medication Management in Psychiatry were
developed by the TSPP Professional Practices Committee. Draft #1 was published
in the December 1997/January 1998 TSPP Newsletter and was further modified by
the Professional Practices Committee on February 7, 1998, November 13, 1998, and
February 27, 1999. The TSPP Executive Council adopted these Guidelines on
February 28, 1999. An amendment to this document was approved by the TSPP
Executive Council on May 28, 2000.
I General
A. The Professional Standards Committee of the Texas Society of Psychiatric
Physicians consider these guidelines as a basic framework for the conduct of
Medication Management for outpatient psychiatric patients.
B. These guidelines are provided as a supplement to the Guidelines of Practice
for Adult Outpatient Psychiatric Services. Their purpose is to guide
psychiatrists in the provision of medication management for patients who may
receive mental health treatment from non-psychiatric physicians or non-physician
mental health providers. These guidelines are not intended to be used in
isolation from the Guidelines of Practice for Adult Outpatient Psychiatric
Services.
C. These guidelines assume that the psychiatrist providing Medication Management
will be afforded adequate time for the provision of Medication Management and
not be subject to arbitrary limits of time.
II Relationship with patient
A. The psychiatrist providing Medication Management will conduct a comprehensive
diagnostic evaluation consistent with guidelines published by the American
Psychiatric Association (Am J Psychiatry 1995;152:11S:63-80).
B. The psychiatrist providing Medication Management will develop a comprehensive
treatment plan that includes a choice of medication.
C. The psychiatrist providing Medication Management will offer the patient a
clear explanation for any diagnosis and recommended treatment. This explanation
will include a rationale for all elements of the treatment plan including
medication and psychosocial interventions.
D. The psychiatrist providing Medication Management will explicitly identify
those components of treatment the psychiatrist will provide, and those
components that will be provided by other non-psychiatric physicians or
non-physician mental health providers.
E. The psychiatrist providing Medication Management will obtain the patient’s
appropriate consent to communicate with other non-psychiatric physicians or
non-physician mental health providers involved in the treatment of the patient.
F. The psychiatrist providing Medication Management will exercise the highest
professional standards in the choice of medications and the management of
continuing treatment with medications. These tasks may not be delegated to
non-physician mental health providers, and require direct and ongoing personal
contact with the patient at appropriate intervals. At the same time, the
psychiatrist providing Medication Management may receive reports from other
non-psychiatric physicians or non-physician mental health providers that inform
the psychiatrist of decisions about the frequency and nature of visits with the
patient.
G. The psychiatrist providing Medication Management will provide those
psychological interventions necessary for eliciting accurate, reliable and
appropriate information about the patient’s clinical status and response to
treatment; encouraging compliance with recommended treatments including those
elements of treatment provided by other non-psychiatric physicians or
non-physician mental health providers; and responding to any acute developments
that cannot be deferred to a future appointment.
H. The psychiatrist providing Medication Management will provide instruction and
education about the patient’s diagnosis and recommended treatments.
I. The psychiatrist providing Medication Management will provide explicit
instructions for emergency coverage for evenings, weekends and vacations.
J. The psychiatrist providing Medication Management will attempt to arrange for
the hospitalization and treatment of any patient for whom outpatient treatment
is unsafe or inadequate.
K. The psychiatrist providing Medication Management will seek appropriate
consultation for any problem identified outside his/her area of expertise
including appropriate medical evaluation or psychological testing.
L. The psychiatrist providing Medication Management will monitor the progress of
his/her patient who is seen by non-psychiatric physicians or non-physician
mental health providers. This may be accomplished by periodic review of the
other treatment with the patient and/or communication with other non-psychiatric
physicians or non-physician mental health providers involved in the treatment of
the patient. In the event that the psychiatrist concludes that a treatment
provided by another non-psychiatric physician or non-physician mental health
provider is not in the patient’s best interest, the psychiatrist must so inform
the patient of this conclusion and the reasons for so concluding. If possible,
the psychiatrist should first discuss this conclusion with the other
non-psychiatric physician or non-physician mental health provider. The patient
retains the right to continue such treatment. If so, the psychiatrist should
consider terminating or transferring treatment of the patient.
III Relationship with collaborating clinicians
A. Whenever possible, the psychiatrist providing Medication Management will
maintain a collaborative relationship with other non-psychiatric physicians or
non-physician mental health providers involved in the treatment of the patient
that is consistent with guidelines published by the American Psychiatric
Association (Am J Psychiatry 1980;137:1489-1491).
IV Documentation
A. The psychiatrist providing Medication Management will maintain written
documentation of the diagnostic assessment; of the treatment plan; of periodic
assessments of the patient’s status and progress; of any communication with
collaborating non-psychiatric physicians or non-physician mental health
providers; and of the details of the agreement with the patient regarding the
scope of treatment provided by the psychiatrist and the scope of treatment
provided by other non-psychiatric physicians or non-physician mental health
providers.
B. The psychiatrist providing Medication Management may provide a written
description of the agreement with the patient to the patient with a copy to be
retained in the patient’s record.
V Source Documents
1. Fromm-Reichman F. Problems of therapeutic management in a psychiatric
hospital. Psychoanal Quart 1947;16:325-356.
2. American Psychiatric Association. Position statement on psychiatrists
relationships with nonmedical mental health professionals. Am J Psych
1973;130:386-390.
3. American Psychiatric Association. Guidelines for psychiatrists in
consultative, supervisory, or collaborative relationships with nonmedical
therapists. Am J Psych 1980;137:1489-1491.
4. Brill NQ. Delineating the role of the psychiatrist on the psychiatric team.
Hosp
Comm Psych 1977;28:542-544.
5. Ribner DS. Psychiatrists and community mental health centers: current issues
and trends. Hosp Comm Psych 1980;31:338-341.
6. Vasile RG, Gutheil TG. The psychiatrist as medical backup: ambiguity in the
delegation of clinical responsibility. Am J Psych 1979;136:1292-1296.
7. Firman GJ. The psychiatrist - nonmedical psychotherapy team: opportunities of
therapeutic synergy. J Oper Psych 1982;13:31-36.
8. Pilette WL The rise of three-party treatment relationships. Psychotherapy
1988;25:420-423.
9. Bradley SS. Nonphysician psychotherapist - physician pharmacotherapist: a new
model for concurrent treatment. Psych Clin N Am 1990;13:307-322.
10. Bascue LO, Zlotowski M. Psychologists’ practices related to medication. J
Clin Psychology 1980;36:821-825.
11. Beitman BD, Chiles J, Carlin A. The pharmacotherapy-psychotherapy triangle:
psychiatrist, nonmedical psychotherapist, and patient. J Clin Psych
1984;45:458-459.
12. Chiles JA, Carlin AS, Benjamin GA, Beitman BD. A physician, a nonmedical
psychotherapist, and a patient: the pharmacotherapy-psychotherapy triangle. In
Beitman BD, Klerman GL. Integrating Pharmacotherapy and Psychotherapy.
Washington DC, American Psychiatric Press, 1991, pp. 105-118.
13. Mcnutt ER, Severino SK, Shomer J. Dilemmas of interdisciplinary outpatient
care: an approach towards their amelioration. J Psych Ed 1987;11:59-65.
14. Goldberg RS, Riba M, Tasman A. Psychiatrists’ attitudes toward prescribing
medication for patients treated by nonmedical therapists. Hosp Comm Psych
1991;42:276-280.
15. Riba M, Goldberg RS, Tasman A. Medication backup in psychiatry residency
programs. Acad Psych 1993;17:32-35.
16. Grant SH, Riba MB. Contact between psychotherapists and psychiatric
residents who provide medication backup. Psych Serv 1995;46:774-777.
17. Weiner HK, Riba MB. Medication backup: attitudes and practices of
psychiatrists and residents. Psych Serv 1997;48:536-538.
18. Appelbaum PS. General guidelines for psychiatrists who prescribe medication
for patients treated by nonmedical therapists. Hosp Comm Psych 1991;42:281-282.
19. Woodward B, Duckworth KS, Gutheil TG. The pharmacotherapist-psychotherapist
collaboration. In Oldham JM, Riba MB, Tasman A. Review of Psychiatry vol 12.
Washington DC, American Psychiatric Press, 1993, pp. 631-649.
20. Lazarus J, Macbeth J, Wheeler N. Divided treatment in the managed care
arena: Legal and ethical risks. Psychiatric Practice and Managed Care 1997;3:3.
Notes:
1 On May 28, 2000, the TSPP Executive Council approved a name
change of the Professional Standards Committee to the Professional Practices
Committee.
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FEDERATION
OF TEXAS PSYCHIATRY