Pharmaceutical care in a long-stay psychiatric hospital

The aim of this study was to evaluate implementation of services provided by a clinical pharmacist for long-term-hospitalised patients with schizophrenia in a pharmaceutical-care-naive developing country.

This was a prospective, healthcare-system, interventional, 'before-and-after' study. Long-term (≥6 months) inpatients with schizophrenia were included. A clinical pharmacist reviewed the full patient notes, identified drug-related problems (DRPs), and proposed interventions using a DRP Registration Form (PCNE classification V6.2). Acceptance rate and outcomes of interventions were assessed.

For 49 patients, 71 DRPs were identified, ranging from one to four problems/patient (1.43±0.68), predominantly related to tolerability and treatment effectiveness. The DRPs were mostly caused (N=184) by inappropriate drug selection (64%) or dose (23.4%): too many drugs for indication (N=33); a non-cost-effective choice (N=29); inappropriate combination (N=27); an inappropriate drug (N=23); lack of therapeutic drug monitoring (N=14); subtherapeutic (N=13) or supratherapeutic (N=11) dosing. Excessive treatment duration was observed for 14 DRPs. The clinical pharmacist proposed 182 interventions (70% at the drug level): discontinuation of medication (N=58); dosage change (N=35); other interventions (monitoring) (N=35); a change of drug (N=18) or instructions for use (N=9); and/or introduction of a new drug (N=7). Physicians accepted 91 interventions and refused 36. Finally, 38 DRPs were solved (25 completely and 13 partially), for 25 a solution was either not needed or not possible, and, for eight, the outcome was not known.

The study underlines the high potential for pharmaceutical care to improve prescribing practices in developing countries without shared pharmacist-physician decision-making.