As the Director of WomenCare Mental Health Program, I’ve been involved in the development of the Medication Alliance Clinic within the UCSF Women’s Health practice. I serve as the Medical Director of this unique model of co-management of depression which utilizes psychiatric clinical pharmacists to manage the antidepressant prescriptions for women with depression. The Medication Alliance Clinic (MAC) maximizes the coordination among primary care, ob-gyn, psychiatry, and clinical pharmacists to treat women with depression. The model was initially developed by the UCSF School of Pharmacy and tested in a controlled investigation within the Kaiser Permanente System. The results from the Kaiser experience with this model demonstrated superior clinical and economic outcomes as well as improved patient and provider satisfaction. The clinical impact and economic viability of this treatment program has yet to be examined outside of the confines of a closed staff model. Our group (myself, Patrick Finley, Pharm D, and Luriko Ajari, Pharm D; both faculty members of the UCSF School of Pharmacy) will be gathering outcome measures including patient satisfaction, treatment response and medication adherence. Initially, as a pilot project, the MAC operated only within UCSF Women’s Health Primary Care. However, the program was then rolled out to the UCSF OB/GYN practice, and we plan to work closely with Patricia Robertson, MD and Becky Abel, LCSW to develop testable interventions for women with post-partum depression.
In my role as Director of the Adult Psychiatry Clinic at UCSF/LPPI from 2003-2007, I was actively involved in the development and expansion of the Depression Center at UCSF and its initiatives to develop research protocols within the clinic. I helped facilitate the implementation of a standardized battery of screening instruments completed by all patients when they first initiated an evaluation at the APC. As an additional project, in 2006-7, I worked directly with Dr. Sarah Polfliet (a PGY-4 at the time) and Dr. Alla Spivak, a psychiatry faculty member, to study residents’ knowledge-base regarding neuroleptic medications. This study compared residents’ knowledge using a survey tool; half of the residents received standard didactic training, and the others received enhanced training including videotaped instruction on how to follow patients for extrapyramidal symptoms. This project demonstrated significant efficacy for the enhanced instruction, and a manuscript describing the findings was submitted to Academic Psychiatry and is now being revised based on reviewers’ comments.
Beginning in July, 2007, I changed my career path and became the Director of the UCSF General Adult Psychiatry Residency Training Program. As a result, my focus on educational research has deepened. Over the past year, I’ve worked with a group of residents to develop and widely disseminate a curriculum on trainee coping after a patient suicide. We presented descriptions of this unique curriculum at regional and national meetings in 2007. Additional data was collected when this curriculum was fully delivered for the first time in January, 2009, and a manuscript, including an assessment of a brief version of the curriculum’s impact on residents’ knowledge and comfort with this topic, is in final stages of preparation. The program will be presented at Workshop at the Association of Academic Psychiatry Annual meeting in 2009. In addition to residency education, I have been involved in undergraduate medical education as the coordinator of the LGBT Health Curriculum for 2nd year medical students. I plan to repeat a study done on the impact of this curriculum by Dr. Patricia Robertson et al in the early 2000s.