Equity and quality use of medicines in people who present to the Psychiatric Alcohol and Non-Prescription Drug...

To evaluate quality use of medicines (QUM) in patients admitted to the Psychiatric Alcohol and Non-Prescription Drug Assessment (PANDA) Unit through analysis of polypharmacy risk, prescribing safety indicators and national QUM indicators.

Retrospective review of electronic medical records for 787 patients (1245 episodes) admitted to PANDA Unit, St Vincent's Hospital Sydney, November 2020-December 2021. We assessed polypharmacy risk using NSW Therapeutic Advisory Group's Inappropriate Polypharmacy Risk Assessment Tool, evaluated nine prescribing safety indicators (PSIs) and assessed four national quality use of medicines indicators (NQUMIs) in a randomly selected subset of 103 patients.

Mean age was 40.2 years; 67.2% were male. Alcohol-related diagnoses comprised 32.1% of presentations. Medium-risk (43.5%) and high-risk (37.2%) polypharmacy were prevalent, largely reflecting protocol-driven prescribing for acute presentations. Co-prescription of QT-prolonging drugs with antipsychotics affected 17.2% of patients, with 64.7% associated with rapid sedation protocols; only one case of potential QT prolongation was documented. Major gaps were identified in medication reconciliation (40.8% had documented medication history) and discharge documentation (13.1% of discharge summaries contained complete medication information). Patients experiencing homelessness demonstrated poorer outcomes across all QUM indicators, with no discharge summaries meeting quality standards.

While PANDA demonstrated appropriate protocol-driven prescribing for acute psychiatric presentations, substantial gaps in medication reconciliation and discharge communication highlight challenges in care transitions for priority populations. Standard polypharmacy and prescribing safety indicators may require adaptation for acute psychiatric settings to distinguish appropriate acute prescribing from potentially inappropriate practices.