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Medication administration and management: Directly observed therapy 

Medication administration and management: Directly observed therapy
Chapter:
Medication administration and management: Directly observed therapy
Author(s):

Catherine M. Knox

DOI:
10.1093/med/9780199360574.003.0030_update_001

Update:

Added data about the number of inmates with a mental health diagnosis who were on medication at the time of arrest;

Expanded the discussion of formulary management;

Added additional material from several recent studies on medication adherence;

Referenced 2016 American Psychiatric Association guidelines for Psychiatric Services in Correctional Facilities related to medication management;

Updated references.

Updated on 28 September 2017. The previous version of this content can be found here.
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date: 17 January 2020

The courts and professional organizations recognize access to clinically appropriate and timely treatment with psychotropic medication as an essential element of an adequate correctional mental health system. While receiving treatment, incarcerated patients must be monitored and supervised clinically so that optimal patient outcomes are achieved. For many mentally ill inmates incarceration is an opportunity to receive treatment that was not accessible in the community; in one study only one third of those diagnosed with schizophrenia or bipolar disorder were receiving medication at the time of arrest compared to two thirds during incarceration. There are many steps, people, and processes involved in getting medication to the patient within a correctional facility. The major components of pharmacy services are prescribing, dispensing, distribution and continuity. The structural aspects of medication administration can also be altered to improve adherence. These include simplifying the medication regime by reducing the number of doses each day, changing to a long acting preparation, and administering medication at times and in ways that are safer and more convenient for the patient and yet clinically acceptable. Reducing reasons for medication discontinuity due to transfers and schedule conflicts also reduces the incidence of adverse events and optimizes treatment efficacy. Almost universally, all medication administration to psychiatric patients in jails and prisons is through directly observed therapy. This allows for opportunities and challenges for correctional patient care in medication lines and on cell blocks or dormitories. This chapter reviews the structural, procedural, and clinical concerns of medication administration and management in jails and prisons.

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