Sarah T. Melton, PharmD,BCPP,CGP, Associate Professor at the Appalachian College of Pharmacy (ACP), was awarded the Innovative Practice Award at the College of Psychiatric and Neurologic Pharmacists  (CPNP) Annual meeting held April 19-22 at The Hyatt Regency, Jacksonville, Florida.  The purpose of the CPNP award is to recognize excellent investigators and practitioners presenting abstracts during the meeting.  Dr. Melton presented her innovative practice during a platform presentation and displayed her poster during the first two days of the meeting.

Dr. Melton is a board certified psychiatric pharmacist and certified geriatric pharmacist.  She completed a Fellowship in Psychiatric Pharmacy Practice in 1996 at the Virginia Commonwealth/Medical College of Virginia School of Pharmacy and has been practicing in the field of mental health since that time.  Dr. Melton practice is based at C-Health P.C. in Lebanon, Virginia.

The title of Dr. Melton’s presentation was “Role of the Pharmacist in Collaborative Care for Mental Health and Addiction Treatment in Medically Underserved Appalachia.”  In her presentation, Dr. Melton discussed how mental health diagnoses for serious psychiatric and addiction disorders are proportionately higher in Appalachia than the rest of the nation. The rate of increase in abuse of opiates and synthetics is Appalachia is higher than the rest of the country, especially in Appalachia coal mining areas.  In addition, the utilization rates of hospital inpatient services, private physicians, and emergency room services for mental health or addiction are all higher in the Appalachian region than outside of Appalachia.  Barriers to treatment for addiction and mental illness exist within the Appalachian regions that limit access to care.  Case studies show a number of specific barriers to accessing treatment including: stigma; transportation availability; limited payment options; privacy issues; choice of facilities; and cultural and family barriers.

Many patients in the Appalachia region access their primary care physician for treatment of mental health or addiction disorders.  The shortage of psychiatrists and psychiatric outpatient treatment facilities clearly offers opportunities for psychiatric pharmacists to collaborate with primary care physicians and clinical licensed counselors to provide a bridge for psychiatric care to this underserved population.

C-Health, PC is a private, family practice clinic with three physicians, six nurse practitioners, one physician assistant, a licensed professional counselor, and 2 clinical pharmacists.  The clinic is affiliated with the Appalachian College of Pharmacy and provides introductory and advanced pharmacy practice experiential rotations.  As an experiential teaching site, the pharmacy practice program at C-Health, PC is committed to the education and professional socialization of pharmacy graduates capable of meeting diverse patient care needs of the medically underserved, particularly those in the Appalachian region.  The practice is supported by collaborative partnerships and strives to achieve excellence in education, scholarship, professionalism and service activities involving patients and the community.

Patient-centered pharmaceutical care is the primary focus of the psychiatric pharmacist at C-Health.  The pharmacist is part of a multidisciplinary team, working closely with members of the team on a daily basis. Dr. Melton receives consults from the providers and sees patients by appointment. She works thorough a collaborative practice agreement and sees adults and children with various psychiatric and neurologic conditions including depression, bipolar, anxiety, eating, schizoaffective, attention deficit-hyperactivity, sleeping, seizure, dementia, and addiction disorders. In addition, the pharmacy team plays a key role in group visits in the areas of chronic pain, tobacco abuse, and opiate dependence.

Dr. Melton teaches the didactic component of Pharmacotherapy of Neurologic and Psychiatric Disorders at ACP. Therefore, she is aware of the knowledge base of each student that rotates through C-Health.  This allows students to quickly build upon didactic knowledge base through real-life experiences with patients in the ambulatory care setting. This experiential rotation prepares students for future encounters with patients with mental health and neurologic disorders. As more than 75% of graduates stay in the Appalachian region, exposure to these prevalent disorders is invaluable.  Over 25 students rotate through C-Health yearly in the ambulatory care setting.

 “It was exciting to be able to present what we are doing in the areas of mental health and addiction in Appalachia by using a collaborative, interdisciplinary team approach in the primary care setting,” Dr. Melton stated. “We are using cutting edge technology to deliver care that is focused directly on the needs of the patient.  By using the team approach that includes a focus not only medication therapy, but psychosocial treatments as well, I hope we are helping to break down the stigma and cultural barriers to treatment of mental illness in Appalachia.

Dr. Susan Mayhew, Dean of the College of Pharmacy offered that the program developed by Dr. Melton and the other providers at C-Health, PC “is a valuable component of the experiential program at ACP.  The innovative practice is a fulfillment of the mission of ACP, which is to address the health-related needs of rural and underserved communities, particularly those in Appalachia, through education, service, and scholarship.” 

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