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Improving quality of antipsychotic polypharmacy: a pilot study
Hanne Høilund1, David P Galea1, Petter Andreas Ringen1
1Department for Inpatient Treatment, Adult Mental Health, Clinic for Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.
Nordic Journal of Psychiatry
|November 15, 2019
Summary
Antipsychotic polypharmacy (APP) is common in psychiatric care. A simple intervention of education and feedback significantly reduced APP rates, improving adherence to guidelines.
Area of Science:
- Psychiatry
- Clinical Pharmacy
Background:
- Antipsychotic polypharmacy (APP) involves prescribing multiple antipsychotics concurrently.
- APP is linked to increased side effects and uncertain benefits, with guidelines advising against it.
- Despite recommendations, APP remains prevalent with limited evidence on effective interventions.
Purpose of the Study:
- To determine the prevalence and documentation quality of APP in specialized psychiatric care.
- To assess the feasibility and impact of a targeted intervention to improve APP prescribing practices.
Main Methods:
- A study examined medical records from an inpatient psychiatric department before and after an intervention.
- The intervention included physician feedback on prescribing and education regarding current guidelines.
- Prescription and documentation data were compared between intervention and control wards.
Main Results:
- At baseline, 43% of patients were on APP, with only 27% documented satisfactorily.
- Following the intervention, APP prevalence decreased from 42% to 29% in the intervention group.
- Satisfactory documentation of APP improved in both groups, but the intervention did not show a significant interaction effect on documentation quality.
Conclusions:
- Antipsychotic polypharmacy is highly prevalent in inpatient psychiatric settings, particularly for psychotic disorders.
- Current documentation of APP is often insufficient.
- Simple educational interventions and feedback can effectively reduce APP rates and improve guideline adherence.
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