Prescribing pattern and indicators for performance in a psychiatric practice

AIMS To assess the prescribing pattern and to measure some specific aspects of the behaviour of the prescribers (psychiatrists) before and after educational interventions using core drug use indicators. METHODS In the present randomized retrospective controlled pre-post intervention prescription survey of schizophrenia and depression, 100 prescriptions each for schizophrenia and depression were obtained before and after each intervention. The prescriptions were analyzed for the following prescriber-specific indicators: number of drugs prescribed, prescribing by generic names, prescriptions for essential drugs, antiparkinsonian and benzodiazepines, nature of drugs and number of combinations prescribed. Based on the results of pre-intervention data, two interactional workshops were conducted 1 and 6 months after pre-intervention data collection. The first workshop focused on the results of the prescription audit feedback and reasons thereof. The second workshop focused, in addition, on appropriate management of schizophrenia and depression using consensus treatment guidelines with the aim of evolving a consensus on the treatment in a given hospital setting. RESULTS Before intervention, the essential drugs accounted for 80.95 and 96.91% of the total number of drugs prescribed in depression and schizophrenia, respectively. Prescription for essential drugs improved further significantly in the post intervention period to 95.26% (P<0.04) for depression; whereas, in schizophrenia, prescriptions for essential drugs declined to 80.95%. The average number of drugs prescribed per encounter marginally declined in both schizophrenia (2.46±0.94 to 2.34±0.65) and depression (2.09±0.79 to 2.00±0.65) after the second intervention. The patients receiving two or more drugs from the same group together declined from 12 to 9% in schizophrenia, but increased from 5 to 10% in depression after intervention. Trihexyphenidyl, an antiparkinsonian drug, was co-prescribed (90%) with antipsychotic agents (98%) in schizophrenia; however, use of benzodiazepines declined significantly after intervention to 28% compared to 48% in the pre-intervention period. Also, benzodiazepine use was high (68%) and remained so (70%) after interventions in depression cases. CONCLUSION The present study demonstrates excessive use of antiparkinsonian agents in schizophrenia and benzodiazepines in depression. Monitoring for the use of antiparkinsonian and benzodiazepines can form an important component for measuring specific aspects of prescriber's behaviour, which can be used as an indicator for comparisons at different time intervals and between health facilities.