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Impact of a national audit on child and adolescent psychiatrists' prescribing practices
L Bond1,2, J Z Ong1, F McNicholas1,2,3
1School of Medicine & Medical Science, University College Dublin, Dublin, Ireland.
Background:
A look back review of South Kerry Child and Adolescent Mental Health Services (CAMHS) in Ireland, known as the 'Maskey report' (MR), highlighted substandard prescribing practices. The aim of this 'Maskey Impact Study' (MIS) was to explore changes to child and adolescent psychiatrists' prescribing practices following the MR.
Method:
The study was cross-sectional and mixed method. A study specific questionnaire was distributed electronically to psychiatrists working in CAMHS (n = 160).
Results:
102 psychiatrists participated in the study (response rate 63.8%). Perceived improvement in prescribing practices included improved medical record keeping (63.7%), consent documentation (53.9%), medication information provision (41.2%) and physical health monitoring (60.8%). However, 43.1% of psychiatrists reported a reluctance to prescribe medication even when clinically indicated and 50% were more likely to avoid off-label use. Most respondents reported increased stress levels (80.4%) with higher stress being significantly associated with reticence in prescribing (χ2 = 11.746, p < .001) and avoiding off-label use (χ2 = 15.392, p < 0.001). Thematic analysis highlighted increased medication hesitancy, enforced 'meaningless' bureaucracy and medication mistrust among families.
Discussion:
Although improvements reported are welcomed, the increased hesitancy of medication use, avoidance of prescribing more than one medication, and avoidance of off-label use, is of concern with potential unintended adverse consequences. Reluctance in prescribing may deprive youth of access to evidence-based treatments and limit exposure of NCHDs to the safe practice of consultant-initiated psychopharmacology. Further research will be important to determine if this impacts clinical care. Continued education in psychopharmacology is essential along with increased public awareness of the evidence for medication, to help restore public confidence and trust in psychopharmacology.
Insights
Following a critical report on prescribing, child and adolescent psychiatrists showed improved documentation but increased hesitancy in medication use. This reluctance may impact evidence-based treatment access for youth.
Area of Science:
- Child and Adolescent Psychiatry
- Psychopharmacology
- Healthcare Quality Improvement
Background:
- A review of South Kerry Child and Adolescent Mental Health Services (CAMHS) identified substandard prescribing practices.
- The 'Maskey report' (MR) prompted an investigation into subsequent changes in prescribing.
- The 'Maskey Impact Study' (MIS) aimed to assess these practice changes.
Purpose of the Study:
- To evaluate the impact of the 'Maskey report' on child and adolescent psychiatrists' prescribing practices.
- To identify improvements and challenges in psychotropic medication prescribing.
- To understand the factors influencing prescribing decisions post-report.
Main Methods:
- A cross-sectional, mixed-method study design.
- Electronic distribution of a study-specific questionnaire to 160 psychiatrists in CAMHS.
- Response rate of 63.8% (102 participants) with subsequent thematic analysis.
Main Results:
- Perceived improvements in record keeping, consent, information provision, and physical health monitoring.
- Significant reluctance to prescribe indicated medication (43.1%) and avoid off-label use (50%).
- Increased stress levels (80.4%) associated with prescribing hesitancy and off-label avoidance; thematic analysis revealed medication mistrust and bureaucracy.
Conclusions:
- While documentation improved, increased medication hesitancy and avoidance of off-label use are concerning.
- Reluctance in prescribing may limit access to evidence-based treatments for young patients.
- Further research and education are needed to restore confidence in psychopharmacology and ensure optimal clinical care.
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