States in Action Archive
Texas Medication Algorithm Project

The Texas Medication Algorithm Project (TMAP) was designed to ensure consistent and appropriate pharmaceutical-based treatment for individuals with depression, bipolar disorder, and schizophrenia and for children with attention deficit hyperactivity disorder. The program aims to reduce the wide disparities in medication treatment patterns and work with physicians to adopt best prescribing practices. The TMAP guidelines emphasize evidence-based, consensually agreed-upon treatment algorithms that are used consistently by all providers with whom a patient is in contact. Also significant to the TMAP program are patient and family education programs that focus on disease management and patient-centered care.

Since 2004, when this program was highlighted in Stretching State Health Care Dollars: State Efforts to Improve Care Management, the program has continued to grow both in and outside of the state. Within the state, researchers have been using findings from a number of National Institutes for Mental Health–sponsored studies to update the medication algorithms for the four conditions. Also, the Texas Department of Mental Health and Mental Retardation, which oversees the program, is working with a vendor to design a Web-based training tool that clinicians could use to train online and receive certification in the TMAP practices.[1] The department also has been training clinicians in Hawaii and Tennessee on how to design and implement similar programs for their states.

A large-scale evaluation of the program indicates better health outcomes among patients whose providers utilized the TMAP protocols. The study compared 547 patients at 14 clinics who were treated under TMAP to a control group. While both sets of patients improved, the improvements among those whose physicians used the TMAP algorithms were twice as high as the improvements among patients in the control group, according to clinicians' measurements, and three times as high when described by the patients themselves.[2] For example, patients with major depressive disorder who were treated according to the TMAP guidelines showed significantly greater improvement in terms of energy levels, ability to partake in daily activities, sleep, and decision-making.[3]

References
[1] The department developed TMAP in collaboration with the University of Texas at Southwestern.
[2] Clinician measures included three standardized tests that are regularly used to determine levels of depression.
[3] Madhukar H. Trivedi et al., "Clinical Results for Patients With Major Depressive Disorder in the Texas Medication Algorithm Project," Archives of General Psychiatry. 2004 (61): 669–80.

For More Information
Contact: Steve Schon, M.D., Medical Director, Texas Department of Mental Health and Mental Retardation, TMAP Project Co-Director, (512) 206-4502

Visit: Texas Department of State Health Services, including the page on the implementation phase of TMAP.


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