Dr. Rush opened with a discussion of problems associated with implementing treatment algorithms in the Texas Medication Algorithm Project.
Categorizing those problems as administrative, clinical, procedural, and/or attitudinal, Dr. Rush then suggested solutions for problems of each type.
For example, limited physician time can be addressed by shifting the role functions of caseworkers or nurses to provide additional assistance.
In addition, physician unfamiliarity with algorithm medications can be addressed via telephone-based supervision.

Dr. Rush noted that the Texas Medication Algorithm Project dealt with wide practice variation across physicians by using a simplified medical record as a checklist system.
This checklist is available on the Texas Medication Algorithm Project's website: http://www.mhmr.state.tx.us/centraloffice/medicaldirector/tmap.html

He reminded the audience that many patients have difficulty with adherence. The patient's misunderstanding or lack of information about medications and other treatments can lead to incorrect conceptualizations of both illness and treatment.
The Texas Medication Algorithm Project trains patients and their families about the disorder using pamphlets, videos, and weekly monitoring of symptoms and side effects. This information is available on the website.

Dr. Rush stated that implementation of an algorithm is more likely to be successful when it is simple. He recommended a uniform, essential checklist containing only the information necessary for treatment and follow-up. In addition, he reported that the Texas Medication Algorithm provides physicians with a uniform charting system.
Dr. Rush uses this system to determine the success of algorithm implementation. This algorithm is currently being implemented across the state of Texas. All information on the algorithm is available on the website.

Dr. Rush pointed out that the algorithm is designed to help clinicians and patients make decisions about treatment.
It does not determine whether the choice of medication was appropriate, whether the dosage and duration of treatment were adequate, or whether the patient achieved maximum benefit at each step of the algorithm.
Physicians unfamiliar with algorithms can get answers to those questions via telephone consultations, he stated.

Dr. Rush recommended that physicians receive training in the use of the algorithm to help them implement it in their practices.