What is Medication Management

I recently had to send out an e-mail reminding my medication management client visits are only 25 minutes and I cannot go over that time. If I start the day going over by 5 minutes by the end of the day that time can be as much as 30 minutes to an hour.  This is not fair to anyone.

Today I came across an article title Beyond “Med management” Torrey, Griesemer, & Carpenter-Song (2016). The article pointed out that medication management appointments often occur in 15-to-20-minute increments. Most larger hospitals use psychiatrist and psychiatric mental health nurse practitioners just for medication management visits. The obvious reason behind this is money. The less amount of time I spent with a client, the more clients I can see in an hour, therefore the hospitals make more revenue.

Torrey et al. pointed out most clients do not understand the difference between medication management and therapy. When a client asks, “Are we going to talk about my life” or “Are we going to talk about medication?” the prescriber often says we need to talk about medications. The number one reason clients come to me seeking a new provider is they feel their current prescriber does not listen to them. I believe the reason for this is that 15-to-20-minute time restraint the larger hospitals implement is not enough time to address all questions. The client often leaves the prescribers office frustrated and oftentimes not even having questions answered. One prescriber even noted in the study they avoided questions such as “How are you doing?” or “How is it going?” because this leaves them with no time to discuss medication (Torrey et al., 2016).

The above reason is one of many as to why I do not want to work for a large hospital. In my office, I make the rules. When I read in the study that clients feel they have a relationship with their therapist but with their prescriber they don't even talk to them it saddens me. One client even described getting their mental health medication “As going through a McDonald's drive through, getting your prescription, and going on about your way (Torrey et al., 2016).

I can say as far as my practice I tried to do 50/50 therapy and medication management. The psychiatrist who are my mentors and collaborators also balance therapy with medication management which is why I enjoy working with them so much. I feel we have the same belief system at heart and are always looking out for the best interests of our clients. Patients need to be heard and they need time to express symptoms and side effects they might be having from a medication. Another fascinating point the study pointed out was clients are less likely to take their medication or follow the prescriber’s recommendations if they do not feel listened to (Torrey et al., 2016).

I think it's obvious we know how we got here with a shortage of prescribers and lack of funding for mental health. One of the suggestions the study offered was prescribers perform a good history, vital signs, and other basic information before the medication management appointment. I am proud to say this practice was implemented from the beginning. With new clients or clients who are having a medication change, the appointments are weekly 45 minutes until they feel they are on the right medication at the safest dose and are not experiencing side effects. Also, when doing phone screenings one of the questions Brittany ask is “Do you have a therapist?” The reason that question is so important is because I can only take on so many therapy clients at a time. Most of the work I do involves trauma and years of therapy depending on the situation. So, unless someone moves away or terminates the therapy relationship it is very rare I have an opening for a new therapy client.

As much as my clients hate to do the pages of new client paperwork, I cannot express how important this is to me as a provider. I ensure all these questions and screening tools are reviewed prior to the appointment. I also request and review all records from previous providers, therapist included. I also initiate a collaboration of care with therapists and primary care providers for my clients to receive the best care possible. I am a prescriber who does care deeply about my relationship with all of my clients and want to work with them to help build them up and give their life a sense of purpose.

The best advice I can give clients is to join your local psychiatric organizations such as NAMI. Advocate for funding for mental health. Begin to advocate to remove the stigma of mental health. Began to advocate that mental health is just as important as cancer and heart disease and the same amount of funds allocated for those illnesses should be allocated for mental illness as well.

Torrey W.C., Griesemer I., Carpenter-Song E.A. Beyond "Med Management".

           Psychiatric Services. (2016). Jun 1;68(6):618-620. doi: 1       0.1176/appi.ps.201600133. Epub 2017 Mar 1. PMID: 28245703.

Robin Trivette, PMHNP-BC, PLLC

Robin Trivette, MSN-Ed., PMHNP-BC

Phone: 919-297-8438

Brittany Trivette, CPC, RMA, Office Manager

brittanytrivette@durhampsychiatricservices.com

Phone: (919) 780-4543 

Fax: (919) 882-0901

515 Keisler Dr.

Suite 104

Cary, NC 27518

@RobinPMHNP

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