32 January 1999 Jrnl. Prac. Psych. and Behav. Hlth. The Texas Medication Algorithm Project (TMAP) is a collaborative initiative involving the Texas Department of Mental Health and Mental Retardation, Texas medical schools and universi- ties, and patient advocacy organizations. Its goal is to develop and evaluate the clinical and economic impact of using medication treatment algorithms in the treatment of individuals in the public sector with schizophrenia, bipolar disorder, and major depressive disorder. In this article, the authors describe three key strategies used in Phases 2 and 3 of the TMAP that they believe were critical to the implementation of the project. Strategy 1 involved gaining acceptance and support for the project by involving important stakeholders. Strategy 2 involved providing clinicians and care recipients with the education and assistance that was needed to implement algorithm-based treatment. Strategy 3 involved providing administrative supports and making design changes in the system that were needed to implement the project. (J Pract Psychiatry Behav Health 1999;5:32–36) KEY WORDS: medication treatment algorithms, Texas Medication Algorithm Project (TMAP), stakeholders, schizophrenia, bipolar disorder, major depressive disor- der, patient/family education he medication treatment of individuals with severe and persistent mental illnesses (particu- larly schizophrenic, major depressive, and bipo- lar disorders) has advanced remarkably over the last 20 years. Practitioners, administrators, and patients are now faced with determining which medications to choose and in what sequences, combinations, and doses they should be used to obtain maximum benefits (i.e., reductions in symptoms, improvements in functioning). One approach to this problem has been to develop disease management protocols, or clinical practice guidelines, which describe recommended treatment options or proce- dures for managing these illnesses. Evidence-based treat- ment guidelines provide recommendations based on a synthesis of the scientific literature concerning treat- ments for particular disorders. Treatment or medication algorithms take practice guidelines to a greater level of specificity by providing step-by-step elaboration on issues such as treatment sequencing, preferred dosages, and progress assessment. They thus provide clinicians with a framework that can enhance treatment planning and decision-making for individual patients. There are both clinical and administrative reasons to believe that imple- menting such algorithms in mental health systems will be useful in improving outcomes, containing costs, making costs predictable, and increasing the effectiveness with which limited resources are used. 1–3 The Texas Medication Algorithm Project (TMAP) is an outgrowth of discussions about the substantial variation in the medication management of patients with severe and persistent mental illnesses in the Texas public men- tal health system. TMAP is a collaborative initiative involving the Texas Department of Mental Health and Mental Retardation (TDMHMR), Texas medical schools and universities, and patient advocacy organizations. Its goal is to develop and evaluate the clinical and economic impact of using medication treatment algorithms in the treatment of individuals in the public sector with schizo- phrenia and bipolar and major depressive disorders. The project has four phases: 1. Development (based on scientific evidence and clinical consensus) of specific, step-wise sequences of when and how to use various psychotropic medications for each of these disorders 2. A feasibility trial to evaluate the suitability, applica- bility, and resources needed to implement these algo- rithms and to provide preliminary estimates of their effectiveness 3. A prospective comparison of the clinical and economic costs and benefits of using the medication algorithms versus treatment-as-usual 4. Implementation of the algorithms on a system-wide basis These phases have been discussed in other publications on the project. 1–3 In this article, we focus on a few key STEVEN P. SHON, MD MARCIA G. TOPRAC, PhD M. LYNN CRISMON, PharmD A. JOHN RUSH, MD Strategies for Implementing Psychiatric Medication Algorithms in the Public Sector SHON and TOPRAC: Texas Department of Mental Health and Mental Retardation; CRISMON: University of Texas at Austin College of Pharmacy; RUSH: University of Texas Southwest Medical Center. Copyright © Lippincott Williams & Wilkins Inc., Baltimore, MD Please send correspondence and reprint requests to: Steven P. Shon, MD, Medical Director, Texas Department of Mental Health and Mental Retardation, 909 W. 45th Street, Austin, TX 78751. T T