A Multidisciplinary Lithium Clinic:The Pharmacist's Role

Abstract

Lithium is the treatment of choice in acute mania, and in the prophylaxis of recurrent affective disorder. Lithium has a narrow therapeutic range with potentially serious toxic effects, therefore should be closely monitored to ensure its safe and effective use. The concept of the lithium clinic is well established as a specialist centre which can provide optimum and cost-effective care for lithium patients. The inclusion of a pharmacist in the lithium team has several potential advantages, including the efficient use of the therapeutic drug monitoring service, an awareness of potential drug and disease interactions, and the provision of patient counselling. A multidisciplinary lithium clinic was set up in North Staffordshire in February 1990,and this study took place over a period of three years from that date. Patients’ knowledge and understanding of their lithium therapy was assessed by interview on entry to the clinic, and a repeat assessment took place at least six months later. Monitoring of serum lithium levels, renal and thyroid function was evaluated, and patient satisfaction was also measured. The lithium clinic monitored lithium levels more frequently than the out-patient clinic. Renal and thyroid function were regularly monitored by the lithium clinic, with all results being readily accessible. The knowledge and understanding of patients was significantly improved after counselling by the pharmacist, and patients and consultants expressed their satisfaction with the clinic. In conclusion, the lithium clinic was shown to provide an effective lithium monitoring service which was superior to the out-patient clinic. The addition of a pharmacist to the lithium team provided the added benefits of improved monitoring of drug and disease interactions, better use of the therapeutic drug monitoring service, and most importantly, the promotion of improved patient knowledge and understanding of their lithium therapy by counselling.