Hostname: page-component-586b7cd67f-t8hqh Total loading time: 0 Render date: 2024-11-25T14:15:06.607Z Has data issue: false hasContentIssue false
  • English
  • Français

The impact of a change in prescribing policy on antipsychotic prescribing in a general adult psychiatric hospital

Published online by Cambridge University Press:  09 May 2014

J. Kelly ,
F. Kelly ,
K. Santlal  and
S. O’Ceallaigh
J. Kelly*
Affiliation:
Psychiatry Lecturer, Department of Psychiatry, Cork University Hospital, Dublin, Ireland
F. Kelly
Affiliation:
Clinical Lecturer, Trinity College & Senior Registrar, Our Lady’s Hospital Navan, Dublin, Ireland
K. Santlal
Affiliation:
Registrar, St. Patrick’s University Hospital, Dublin, Ireland
S. O’Ceallaigh
Affiliation:
Consultant Psychiatrist, St. Patrick’s University Hospital, Dublin, Ireland, Ireland
*
Address for correspondence: J. Kelly, Psychiatry, Cork University Hospital, Psychiatry Department, Cork University Hospital, Cork, Co. Cork, Ireland. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives

To examine the impact of a change in local prescribing policy on the adherence to evidence-based prescribing guidelines for antipsychotic medication in a general adult psychiatric hospital.

Methods

All adult in-patients had their clinical record and medication sheet reviewed. Antipsychotic prescribed, dose prescribed and documented indications for prescribing were recorded. This was done before and after the implementation of the change in hospital antipsychotic prescribing policy.

Results

There were no significant differences in age, sex, Mental Health Act status, psychiatric diagnosis or documented indications for prescribing multiple or high dose antipsychotics between the two groups. There was an increase in the preferential prescribing of multiple second-generation antipsychotics (p=0.01) in the context of a significant reduction in the prescribing of multiple antipsychotics overall (p=0.02). There were no significant reductions in prescribing of mixed generations of antipsychotics (p=0.12), high dose antipsychotics (p=1.00) or as required (PRN) antipsychotics (p=0.74).

Conclusions

Changes in local prescribing policy can improve adherence to quality prescribing guidelines and cause clinically significant improvements in patterns of prescribing in a general adult psychiatric hospital.

Keywords

Antipsychotic agentsclinical auditinappropriate prescribingphysician prescribing patternsschizophrenia
Type
Original Research
Information
Irish Journal of Psychological Medicine , Volume 31 , Issue 3 , September 2014 , pp. 167 - 173
Copyright
© College of Psychiatrists of Ireland 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Abou-Setta, AM, Mousavi, SS, Spooner, C, Schouten, JR, Pasichnyk, D, Armijo-Olivo, S, Beaith, A, Seida, JC, Dursun, S, Newton, AS, Hartling, L (2012). First-Generation Versus Second-Generation Antipsychotics in Adults: Comparative Effectiveness. Comparative Effectiveness Review No. 63. (Prepared by the University of Alberta Evidence-based Practice Center under Contract No. 290-2007-10021). AHRQ Publication No. 12-EHC054-EF. Rockville, MD: Agency for Healthcare Research and Quality; www.effectivehealthcare.ahrq.gov/reports/final.cfm.Google Scholar
Agid, O, Schulze, L, Arenovich, T, Sajeev, G, Mcdonald, K, Foussias, G, Fervaha, G, Remington, G (2013). Antipsychotic response in first-episode schizophrenia: efficacy of high doses and switching. European Neuropsychopharmacology 23, 1017–1022.Google Scholar
CADTH (2012). Combination and high-dose atypical antipsychotic therapy in patients with schizophrenia: systematic review. CADTH Technology Overviews 2, e2301.Google Scholar
Donnelly, L, Rathbone, J, Adams, CE (2013). Haloperidol dose for the acute phase of schizophrenia. Cochrane Database of Systematic Reviews 8, CD001951.Google Scholar
Donohue, J, O’malley, AJ, Horvitz-Lennon, M, Taub, AL, Berndt, ER, HUSKAMP, HA (2014). Changes in physician antipsychotic prescribing preferences, 2002–2007. Psychiatric Services 65, 315–322.Google Scholar
Edlinger, M, Hausmann, A, Kemmler, G, Kurz, M, Kurzthaler, I, Walch, T, Walpoth, M, Fleischhacker, WW (2005). Trends in the pharmacological treatment of patients with schizophrenia over a 12 year observation period. Schizophrenia Research 77, 25–34.Google Scholar
Essock, SM, Schooler, NR, Stroup, TS, Mcevoy, JP, Rojas, I, Jackson, C, Covell, NH (2011). Effectiveness of switching from antipsychotic polypharmacy to monotherapy. American Journal of Psychiatry 168, 702–708.Google Scholar
Faries, D, Ascher-Svanum, H, Zhu, B, Correll, C, Kane, J (2005). Antipsychotic monotherapy and polypharmacy in the naturalistic treatment of schizophrenia with atypical antipsychotics. BMC Psychiatry 5, 26.Google Scholar
Fishel, AH, Ferreiro, BW, Rynerson, BC, Nickell, M, Jackson, B, Hannan, BD (1994). As-needed psychotropic medications: prevalence, indications, and results. Journal of Psychosocial Nursing and Mental Health Services 32, 27–32.CrossRefGoogle Scholar
Goodwin, G, Fleischhacker, W, Arango, C, Baumann, P, Davidson, M, de Hert, M, Falkai, P, Kapur, S, Leucht, S, Licht, R, Naber, D, O’keane, V, Papakostas, G, Vieta, E, Zohar, J (2009). Advantages and disadvantages of combination treatment with antipsychotics ECNP Consensus Meeting, March 2008, Nice. European Neuropsychopharmacology 19, 520–532.Google Scholar
Goren, JL, Parks, JJ, Ghinassi, FA, Milton, CG, Oldham, JM, Hernandez, P, Chan, J, Hermann, RC (2008). When is antipsychotic polypharmacy supported by research evidence? Implications for QI. Joint Commission Journal on Quality and Patient Safety 34, 571–582.Google Scholar
Howes, OD, Egerton, A, Allan, V, Mcguire, P, Stokes, P, Kapur, S (2009). Mechanisms underlying psychosis and antipsychotic treatment response in schizophrenia: insights from PET and SPECT imaging. Current Pharmaceutical Design 15, 2550–2559.Google Scholar
Howes, OD, Vergunst, F, Gee, S, Mcguire, P, Kapur, S, Taylor, D (2012). Adherence to treatment guidelines in clinical practice: study of antipsychotic treatment prior to clozapine initiation. British Journal of Psychiatry 201, 481–485.Google Scholar
Joint Formulary Committee, British Medical Association, Royal Pharmaceutical Society of Great Britain (2012). British National Formulary (BNF) March 2012, Edited by Joint Formulary Committee, Pharmaceutical Press, London.Google Scholar
Jones, PB, Barnes, TR, Davies, L, Dunn, G, Lloyd, H, Hayhurst, KP, Murray, RM, Markwick, A, Lewis, SW (2006). Randomized controlled trial of the effect on quality of life of second- vs first-generation antipsychotic drugs in schizophrenia: cost utility of the latest antipsychotic drugs in schizophrenia study (CUtLASS 1). Archives of General Psychiatry 63, 1079–1087.Google Scholar
Kane, JM (2008). An evidence-based strategy for remission in schizophrenia. Journal of Clinical Psychiatry 69 (Suppl. 3): 25–30.Google Scholar
Kane, JM, Correll, CU, Goff, DC, Kirkpatrick, B, Marder, SR, Vester-Blokland, E, Sun, W, Carson, WH, Pikalov, A, Assuncao-Talbott, S (2009). A multicenter, randomized, double-blind, placebo-controlled, 16-week study of adjunctive aripiprazole for schizophrenia or schizoaffective disorder inadequately treated with quetiapine or risperidone monotherapy. Journal of Clinical Psychiatry 70, 1348–1357.Google Scholar
Leucht, S, Cipriani, A, Spineli, L, Mavridis, D, Orey, D, Richter, F, SAMARA, M, Barbui, C, Engel, RR, Geddes, JR, Kissling, W, Stapf, MP, Lassig, B, Salanti, G, Davis, JM (2013). Comparative efficacy and tolerability of 15 antipsychotic drugs in schizophrenia: a multiple-treatments meta-analysis. Lancet 382, 951–962.Google Scholar
Leucht, S, Tardy, M, Komossa, K, Heres, S, Kissling, W, Davis, JM (2012). Maintenance treatment with antipsychotic drugs for schizophrenia. Cochrane Database of Systematic Reviews 5, CD008016.Google Scholar
Lieberman, JA, Stroup, TS, Mcevoy, JP, Swartz, MS, Rosenheck, RA, Perkins, DO, Keefe, RS, Davis, SM, Davis, CE, Lebowitz, BD, Severe, J, Hsiao, JK (2005). Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. New England Journal of Medicine 353, 1209–1223.Google Scholar
Lochmann van Bennekom, MW, Gijsman, HJ, Zitman, FG (2013). Antipsychotic polypharmacy in psychotic disorders: a critical review of neurobiology, efficacy, tolerability and cost effectiveness. Journal of Psychopharmacology 27, 327–336.Google Scholar
National Institute for Health and Clinical Excellence (NICE) (2009). Schizophrenia. Core Interventions in the Treatment and Management of Schizophre nia in Adults in Primary and Secondary Care. London (UK): National Institute for Health and Clinical Excellence (NICE); March 2009, 41p. (NICE clinical guideline; no. 82).Google Scholar
Patel, MX, Bishara, D, Jayakumar, S, Zalewska, K, Shiers, D, Crawford, MJ, Cooper, SJ (2014). Quality of prescribing for schizophrenia: evidence from a national audit in England and Wales. European Neuropsychopharmacology 24(4), 499–509.Google Scholar
Paton, C, Barnes, TR, Cavanagh, MR, Taylor, D, Lelliott, P (2008). High-dose and combination antipsychotic prescribing in acute adult wards in the UK: the challenges posed by p.r.n. prescribing. British Journal of Psychiatry 192, 435–439.CrossRefGoogle ScholarPubMed
Ray, WA, Chung, CP, Murray, KT, Hall, K, Stein, CM (2009). Atypical antipsychotic drugs and the risk of sudden cardiac death. New England Journal of Medicine 360, 225–235.CrossRefGoogle ScholarPubMed
RCPSYCH (2006). Consensus statement on the use of high-dose antipsychotic medication, Council Report CR138, Royal College of Psychiatrists.Google Scholar
Rosenheck, R, Lin, H (2014). Noninferiority of perphenazine vs. three second-generation antipsychotics in chronic schizophrenia. Journal of Nervous and Mental Disease 202, 18–24.Google Scholar
SPUH (2011). Prescribing and monitoring of antipsychotic medication including high dose antipsychotic medication. Policy No. CLIN 0007.Google Scholar
Stone, JM, Raffin, M, Morrison, P, Mcguire, PK (2010). Review: the biological basis of antipsychotic response in schizophrenia. Journal of Psychopharmacology 24, 953–964.Google Scholar
Tandon, R, Belmaker, RH, Gattaz, WF, Lopez-Ibor, JJ JR, Okasha, A, Singh, B, Stein, DJ, Olie, JP, Fleischhacker, WW, Moeller, HJ (2008). World Psychiatric Association Pharmacopsychiatry Section statement on comparative effectiveness of antipsychotics in the treatment of schizophrenia. Schizophrenia Research 100, 20–38.Google Scholar
Tani, H, Uchida, H, Suzuki, T, Fujii, Y, Mimura, M (2013). Interventions to reduce antipsychotic polypharmacy: a systematic review. Schizophrenia Research 143, 215–220.Google Scholar
Taylor, DM, Smith, L, Gee, SH, Nielsen, J (2012). Augmentation of clozapine with a second antipsychotic – a meta-analysis. Acta Psychiatrica Scandinavica 125, 15–24.Google Scholar
Tiihonen, J, Lonnqvist, J, Wahlbeck, K, Klaukka, T, Niskanen, L, Tanskanen, A, Haukka, J (2009). 11-year follow-up of mortality in patients with schizophrenia: a population-based cohort study (FIN11 study). Lancet 374, 620–627.Google Scholar
Tyrer, P, Kendall, T (2009). The spurious advance of antipsychotic drug therapy. Lancet 373, 4–5.Google Scholar
Wunderink, L, Nieboer, RM, Wiersma, D, Sytema, S, Nienhuis, FJ (2013). Recovery in remitted first-episode psychosis at 7 years of follow-up of an early dose reduction/discontinuation or maintenance treatment strategy: long-term follow-up of a 2-year randomized clinical trial. JAMA Psychiatry 70(9), 913–920.Google Scholar