Appropriateness of psychotropic drug prescriptions in the elderly: structuring tools based on data extracted from the hospital information system to understand physician practices

Abstract

Background The appropriateness of psychotropic prescriptions in the elderly is a major quality-of-care challenge at hospital. Quality indicators have been developed to prevent inappropriate psychotropic prescriptions. We aimed to select and automatically calculate such indicators, from the Bordeaux University Hospital information system, and to analyze the appropriateness of psychotropic prescription practices, in an observational study. Methods Experts selected indicators of the appropriateness of psychotropic prescriptions in hospitalized elderly patients, according to guidelines from the French High Authority for Health. The indicators were reformulated to focus on psychotropic administrations. The automated calculation of indicators was analyzed by comparing their measure to data collected from a clinical audit. In elderly patients hospitalized between 2014 and 2015, we then analyzed the evolution of the appropriateness of psychotropic prescription practices during hospital stay, using methods of visualization, and described practices by considering patients’ characteristics. Results Two indicators were automated to detect overuse and misuse of psychotropic drugs. Indicators identified frequent inappropriate drug administrations, but practices tended to become more appropriate after quality-of-care improvement actions. In the majority of patients (85%), there was no inappropriate administration of psychotropic drugs during hospital stay; for the remaining 15% with at least one inappropriate administration, physicians tended to limit overuse or misuse during hospital stay. Inappropriate administrations were more frequent in patients suffering from psychiatric disorders, dependence and associated complications or morbidities. Conclusions The automated indicators are structuring tools for the development of a drug prescription monitoring system. Inappropriate psychotropic administrations were limited by physicians during hospital stay; some inappropriate prescriptions might be explained by clinical characteristics of patients. Electronic supplementary material The online version of this article (10.1186/s12913-019-4064-7) contains supplementary material, which is available to authorized users.

Prevalence of potentially harmful multidrug interactions on medication lists of elderly ambulatory patients

“…It is not uncommon for patients to be prescribed three or more psychotropic medications, likely reflecting the increasing prevalence of psychotropic polypharmacy [56]. Given the amplifying effect of psychotropic drugs, it is essential to assess the necessity and suitability of their use in elderly patients [57][58][59][60][61].Trazadone, one of the most prescribed psychotropic medications participating in multidrug interactions (Table 2) and associated with serotonin syndrome and seizures, is one of the least efficacious medications in treating depression and is associated with a higher suicide rate than other psychotropic medications [62][63][64][65][66]. Despite the warnings, nearly 3 million Medicare beneficiaries received prescriptions for trazodone in 2019 of which over 400,000 would be expected to be exposed to an MDI including that drug (Table 2).…”