Development and Delivery of a Quality Improvement Program to Reduce Antipsychotic Polytherapy

Gören, Jessica L.; Beck, Stuart; Mills, Barry J.; Shtasel, Derri; Dufresne, Robert L.

doi:10.18553/jmcp.2010.16.6.393

Cited by 7 publications

(8 citation statements)

References 30 publications

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“…Antipsychotics are often part of important drug-drug interactions as shown by , which found that antipsychotics were commonly part of pXDDIs. Although the potential reduction of pXDDIs as a result of involving CPs has the results of a study of US psychiatric hospitals, which are in line with our results (Gören JL et al, 2010). These findings are very important in the field of evidence-based medicine, because the patients in our study population are not included in the existing treatment guidelines despite representing a sizable part of the patients in clinical practice (Goodwin G et al, 2009;Stahl SM, 2013).…”

Section: Clinical Pharmacist's Recommendations and Adherence To Treatsupporting

confidence: 86%

“…The results also illustrate the importance of a clinical pharmacy service in complex cases of patients with excessive polypharmacy. Some studies showed that interventions in this field are meaningful for the optimization of antipsychotic therapy, although older adults with polypharmacy were not the main focus group (Gören JL et al 2010;Stuhec M 2014).…”

Section: Clinical Pharmacist's Recommendations and Adherence To Treatmentioning

confidence: 99%

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Positive impact of clinical pharmacist interventions on antipsychotic use in patients on excessive polypharmacy evidenced in a retrospective cohort study

Štuhec¹,

Gorenc

2019

Global Psychiatry

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Objectives: Although antipsychotic prescribing in elderly patients using polypharmacy has not been studied in well-designed clinical trials and meta-analyses, there is an urgent need to monitor prescribing practice in this population. One of the possible approaches to optimize pharmacotherapy may be the involvement of clinical pharmacists (CPs). The aim of this research was to examine whether the involvement of a CP can improve treatment guidelines adherence and change the total number of medications per patient in older patients who are treated with excessive polypharmacy that includes antipsychotics. Methods: This cohort retrospective study included older patients (65 years or older) treated with at least one antipsychotic and excessive polypharmacy (10 or more medications concurrently) between 2012 and 2014 in primary care. The main outcome measures were antipsychotic treatment guidelines' adherence and the total number of medications per patient after the CP's interventions. Only interventions including antipsychotics were studied in detail (i.e., discontinuation, switching, initiation, dose adjustment, change of another medication because of a drug-related problem). Data on diagnoses, patient pharmacotherapy and the CP's interventions were obtained from clinical records and medical reviews. Age and acceptance of the CP's interventions were used as predictive factors for antipsychotic treatment guidelines' adherence. Results: Forty-nine patients were included. The CP suggested 21 different interventions of which nine (42.8%) were accepted by the general practitioners. The number of medications that patients received decreased after the CP's interventions (N of medications before: 15.4; N of medications after: 12.0, p < 0.05). The acceptance of the CP's recommendations, but not age, improved antipsychotic treatment guidelines' adherence (p = 0.041). Conclusions: These results show that a collaborative care approach including a CP in primary care significantly improved the adherence to treatment guidelines. The results also support the implementation of this service in the Slovenian healthcare system, although more studies are needed.

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Section: Clinical Pharmacist's Recommendations and Adherence To Treatsupporting

confidence: 86%

Section: Clinical Pharmacist's Recommendations and Adherence To Treatmentioning

confidence: 99%

Positive impact of clinical pharmacist interventions on antipsychotic use in patients on excessive polypharmacy evidenced in a retrospective cohort study

Štuhec¹,

Gorenc

2019

Global Psychiatry

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“…This finding, however, also poses concerns when the appropriateness of this rationale is not scientifically validated and also demonstrates lower performance on the publicly reported measures of antipsychotic medication use (HBIPS 4 and 5). 18 As hospitals are required to report their performance on standardized core measures, 19 the implication of not meeting minimum requirements from payers and accreditation agencies will result in below-target measure rates. TJC uses the HBIPS 5 measure rate in a hospital’s overall evaluation of performance, with a target of 85% compliance on best practices for all patients and all conditions.…”

Section: Discussionmentioning

confidence: 99%

“…18 Previous research shows that when questionable prescribing practices are brought into focus, they are likely to change. 11 , 19 – 22 Since the implementation of the HBIPS measures in 2011, there has been a nationwide trend toward reduction of antipsychotic polypharmacy in psychiatric inpatient hospitals. 23…”

mentioning

confidence: 99%

Antipsychotic Medication Prescribing Practices Among Adult Patients Discharged From State Psychiatric Inpatient Hospitals

Ortiz

Hollen

Schacht

2016

Journal of Psychiatric Practice

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“…Multiple studies have demonstrated that this method reduced psychotropic medication polypharmacy (17,18). Education may also be effective, especially if the outcomes are perceived to be serious (19).…”

Section: Strategies To Improve Quality Of Prescribingmentioning

confidence: 99%

Public-Academic Partnerships: A Program to Improve the Quality of Antipsychotic Prescribing in a Community Mental Health System

Brunette

Nesnera²,

Swain³

et al. 2011

Psychiatric Services

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State mental health authorities can use public-academic partnerships to create professional roles in which leaders can track trends, identify problems, and carry out quality improvement projects to address key issues. Leaders with positions in both academic institutions and state mental health authorities ensure access to resources, technical expertise, and key relationships to improve quality. The authors describe a public-academic partnership in New Hampshire and a quality improvement program it carried out. The program encourages providers at community mental health centers to adopt prescribing practices that limit the cardiometabolic side effects of antipsychotic medicines.

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Development and Delivery of a Quality Improvement Program to Reduce Antipsychotic Polytherapy

Cited by 7 publications

References 30 publications

Positive impact of clinical pharmacist interventions on antipsychotic use in patients on excessive polypharmacy evidenced in a retrospective cohort study

Positive impact of clinical pharmacist interventions on antipsychotic use in patients on excessive polypharmacy evidenced in a retrospective cohort study

Antipsychotic Medication Prescribing Practices Among Adult Patients Discharged From State Psychiatric Inpatient Hospitals

Public-Academic Partnerships: A Program to Improve the Quality of Antipsychotic Prescribing in a Community Mental Health System

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