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Antipsychotic management in general practice: serial cross-sectional study (2011-2020)
Alan Woodall1, Alex Gampel2, Lauren E Walker3
1Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Liverpool; clinical lead for integrated care, Powys Teaching Health Board, Bronllys, Powys.
Summary
Long-term antipsychotic use is rising, with fewer patients receiving essential psychiatrist reviews. This trend increases cardiometabolic risks and necessitates urgent intervention for patient safety.
Area of Science:
- Psychiatry and General Practice
- Public Health
- Pharmacovigilance
Background:
- Long-term antipsychotic medication use is associated with significant cardiometabolic disease risks.
- Regular review by psychiatrists is crucial for managing ongoing antipsychotic needs and mitigating risks.
Purpose of the Study:
- To analyze trends in antipsychotic prescribing within general practice settings.
- To determine the proportion of patients on long-term antipsychotics who receive annual reviews from psychiatrists.
Main Methods:
- A serial cross-sectional study utilized linked general practice and hospital data from Wales between 2011 and 2020.
- Adult patients (≥18 years) registered with Welsh general practices were analyzed for antipsychotic prescription frequency, psychiatrist review rates, and disease register status.
Main Results:
- The prevalence of adults on long-term antipsychotics increased from 1.055% in 2011 to 1.448% in 2020.
- The proportion of patients receiving annual psychiatrist reviews decreased from 59.6% to 52.0% during the study period.
- Prescribing to patients on serious mental illness registers declined, with more patients managed by GPs without specialist oversight.
Conclusions:
- Increasing long-term antipsychotic use, coupled with reduced psychiatrist involvement and monitoring, poses significant patient risks.
- Patients managed by general practitioners without regular specialist review or on unmonitored registers may miss crucial cardiometabolic monitoring and deprescribing opportunities.
- Urgent attention is required to address these concerning trends in antipsychotic management to ensure patient safety and optimize care.
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