Impact of feedback from pharmacists in reducing antipsychotic polypharmacy in schizophrenia

Abstract

The objective was to examine effects of active interventions on physician's prescribing of antipsychotic polypharmacy. Prescriptions for patients with schizophrenia at the Centre for Addiction and Mental Health, Canada were collected in 2006 (n = 648) and 2008 (n = 778). During the intervening period, a pharmacist monitored prescriptions with antipsychotic polypharmacy and contacted corresponding prescribers to provide education on risks of polypharmacy. Moreover, educational sessions on polypharmacy were presented to inpatient and outpatient teams. A three-fold decrease in the prevalence of antipsychotic polypharmacy was observed between 2006 (18.3%) and 2008 (6.6%). Thus, active monitoring of prescriptions with educational interventions could reduce antipsychotic polypharmacy.Key words: antipsychotic, monitoring, polypharmacy, prescription, schizophrenia.A NTIPSYCHOTIC POLYPHARMACY FOR the treatment of schizophrenia is common in realworld clinical settings despite limited empirical support.1 It is recognized that evidence-based guidelines alone do not influence clinical practice and it is challenging determining the optimal intervention(s) to use to positively influence clinical practice.2 A recent systematic review found that prompts from pharmacists or pharmacy systems were effective in changing a variety of prescribing practices. 2The present study was designed in the context of an ongoing double-blind placebo-controlled study in order to study the safety of reduction to monotherapy in patients maintained on two antipsychotic drugs. When antipsychotic polypharmacy was detected using the pharmacy database, a pharmacist called the prescribing physician with a scripted message. Concurrently, research staff held regular educational sessions with multidisciplinary teams consisting of a balanced discussion of the unknown efficacy and safety of maintaining patients previously stabilized on two antipsychotics. We report a change in prevalence rates of antipsychotic polypharmacy following these interventions. METHODSSystematic reviews of antipsychotic prescriptions were completed in 2006 and 2008 within all inpatient wards and ambulatory clinics within the Schizophrenia Program at the Centre for Addiction and Mental Health (CAMH). The inpatient and outpatient pharmacies within the centre use a single pharmacy database where prescription information is entered and stored. For the cross-sectional aspect of the study, individual prescriptions from the Schizophrenia Program were reviewed by a pharmacist

Variation in Long-Term Antipsychotic Polypharmacy and High-Dose Prescribing Across Physicians and Hospitals

“…These mechanisms, which have shown some, albeit limited, effectiveness, could target physicians who seem to have the greatest propensity to prescribe high doses or antipsychotic polytherapy (40,41). More broadly, these mechanisms could target entire hospital departments in cases where the data suggest that physicians in these departments tend as a group to systematically keep a greater proportion of their patients on high doses or antipsychotic polypharmacy (42,43).…”

Frequency and correlates of antipsychotic polypharmacy among patients with schizophrenia in Denmark: A nation-wide pharmacoepidemiological study

“…For example, a systematic review of interventions for reducing APP concluded that assertive interventions, such as pharmacists' contacting psychiatrists prescribing APP, were more effective than passive interventions, such as education (Hazra et al, 2011;Tani et al, 2013). Further, attitudes towards and experience with switching to monotherapy seem to be important.…”

Antipsychotic polypharmacy: A Japanese survey of prescribers' attitudes and rationales

“…There are studies that examined the impact of interventions to convert APP to antipsychotic monotherapy; from educational interventions (Baandrup et al, 2010) to more aggressive ones including active prescription monitoring and direct feedback (Hazra et al, 2011; Laska et al, 1980; Thompson et al, 2008). As passive interventions have shown to have limited efficacy, while more active interventions have a larger effect on decreasing APP (Fleischhacker and Uchida, 2012; Tani et al, in press), the results of this study are potentially helpful in informing more specific approaches, such as identifying specific target doctor populations, concerns that are underestimated, or justifications that are overestimated.…”