Use of Academic Detailing With Audit and Feedback to Improve Antipsychotic Pharmacotherapy

Brunette, Mary F.; Cotes, Robert O.; Nesnera, Alexander de; McHugo, Gregory J.; Dzebisashvili, Nino; Xie, Haiyi; Bartels, Stephen J.

doi:10.1176/appi.ps.201700536

Cited by 8 publications

(4 citation statements)

References 43 publications

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“…A study by Mary Brunette et al showed that providing clinical staff with educational courses and audits, combined with feedback on the accuracy of prescribed medications, reduced the phenomenon of polypharmacotherapy in psychiatry. According to the authors of the study, thanks to these practices, the phenomenon of antipsychotic polypharmacotherapy decreased from 13.1% to 10.9% [26]. Another study showed that patient-directed education is a very important tool in reducing excessive polypharmacotherapy.…”

Section: Discussionmentioning

confidence: 97%

Polypharmacotherapy in Psychiatry: Global Insights from a Rapid Online Survey of Psychiatrists

Ordak

Tkacz

Golub

et al. 2022

JCM

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In recent years, an increase in the problem of polypharmacotherapy in psychiatric patients has been observed, including the widespread problem of groups of people taking new psychoactive substances. One reason for this problem may be the poor knowledge of pharmacological interactions in psychiatry. The aim of this study was to explore the opinions and knowledge of psychiatrists from around the world on various aspects related to polypharmacotherapy. A total of 1335 psychiatrists from six continents were included in the study. The respondents’ opinion on the problem of hepatotoxicity in psychiatry was also examined. The greatest discrepancy among psychiatrists from different continents in the answers given concerned the definition of polypharmacotherapy (p < 0.001) and the approach to hepatotoxicity (p < 0.001). It is noteworthy that only about 20% of the psychiatrists surveyed (p < 0.001) believe that polypharmacotherapy is associated with a higher rate of patients’ hospitalisations. The most commonly used type of polypharmacy by psychiatrists was antidepressants and antipsychotics. Most of them also stated that polypharmacy was associated with reduced patient compliance with the doctor’s recommendations related to taking medications due to the increased complexity of the therapy. The continent that diversified the analysed questions to the greatest extent was Africa. Future educational activities for trainee psychiatrists should include more discussion of polypharmacotherapy in psychiatry.

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Section: Discussionmentioning

confidence: 97%

Polypharmacotherapy in Psychiatry: Global Insights from a Rapid Online Survey of Psychiatrists

Ordak

Tkacz

Golub

et al. 2022

JCM

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“…In a case note review of 154 cases, Unwin and Deb (2008) also reported poor documentation related to capacity issues and acquisition of consent. Periodic audit of antipsychotic prescribing practice has been advocated to be a valuable tool for promoting best practices for the use of antipsychotics (Adesola et al , 2013; Botvinik et al , 2004; Brunette et al , 2018; Fernando et al , 1997; Haw et al , 2008; Marshall, 2004; McMillan et al , 2017; Mortimer et al , 2005; Patel et al , 2014; Paton et al , 2016; Wheeler et al , 2009; Wightman et al , 2011).…”

Section: Discussionmentioning

confidence: 99%

“…An audit from Nigeria revealed that high dose prescribing was common among inpatients (Adesola et al , 2013). Several other studies have also identified the importance of auditing antipsychotic prescribing (Botvinik et al , 2004; Brunette et al , 2018; Hassiotis et al , 2018; Haw et al , 2008; Lennox et al , 2007; Lunsky et al , 2007; Mortimer et al , 2005; Olashore et al , 2017; Patel et al , 2014; Wightman et al , 2011).…”

Section: Introductionmentioning

confidence: 99%

Antipsychotic prescribing for patients with intellectual disabilities and challenging behaviours

Elhusein

Eltorki

Abdallah

et al. 2021

AMHID

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Purpose Review of antipsychotic prescribing practices, rationale and follow-up using an internationally standardized audit can be an effective tool to encourage and monitor best practices. The purpose of this study is to audit the current prescribing pattern for people with intellectual disabilities and challenging behaviours in Qatar. Design/methodology/approach This study was based on the challenging behaviour management guidelines recommended by the Royal College of Psychiatrists. All current electronic medical records in the Mental Health Service-Hamad Medical Corporation were examined to identify patients with intellectual disabilities who received antipsychotics for challenging behaviour. Demographic variables, such as age, sex and nationality, were collected. In addition, details of psychiatric diagnoses, prescribed psychotropic medications and diagnoses of epilepsy were also collected. For patients who were prescribed antipsychotic medication, the clinical rationale for such medication was collected along with evidence of side effect monitoring to allow performance against the audit standards to be measured. Findings This is the first audit on prescribing practices in people with intellectual disability and challenging behaviour in the state of Qatar. The results of this study regarding the pattern of prescribing practices for patients with intellectual disability and challenging behaviour reflect the limitation in knowledge and experience among non-specialist practitioners within mental health service. The result may be helpful to support the development of specialist service provision to improve the care for such vulnerable group. The result may also help other medical centres and clinicians by providing an improved understanding of possible deviations from the best medical practices. Originality/value This is the first audit on prescribing practices in people with intellectual disability and challenging behaviour in the state of Qatar. The study is also noteworthy as, to the best of the authors’ knowledge, it is one of only a few studies on antipsychotic prescribing for patients with intellectual disability and challenging behaviour in the Middle East; therefore, it will be useful in raising awareness and promoting the best practices in the Middle East region. This study is also among the first few studies that were designed based on the four audit standards by the Royal College of Psychiatrists in this area.

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“…Studies have also found that report cards can improve medication management associated with antipsychotic prescribing. For example, one study demonstrated a reduction in antipsychotic polypharmacy in community mental health centers and a second study found an increase in metabolic monitoring in a large outpatient clinic [24,25]. Of note, a third study found no impact of report cards on high-dose antipsychotic prescribing or polypharmacy [26].…”

Section: Introductionmentioning

confidence: 99%

Incorporating clinician insight and care plans into an audit and feedback initiative for antipsychotic prescribing to Medicaid-enrolled youth in Philadelphia

Candon,

Shen,

Rothbard

et al. 2024

BMC Health Serv Res

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Background Audit and feedback (A/F), which include initiatives like report cards, have an inconsistent impact on clinicians’ prescribing behavior. This may be attributable to their focus on aggregate prescribing measures, a one-size-fits-all approach, and the fact that A/F initiatives rarely engage with the clinicians they target. Methods In this study, we describe the development and delivery of a report card that summarized antipsychotic prescribing to publicly-insured youth in Philadelphia, which was introduced by a Medicaid managed care organization in 2020. In addition to measuring aggregate prescribing behavior, the report card included different elements of care plans, including whether youth were receiving polypharmacy, proper medication management, and the concurrent use of behavioral health outpatient services. The A/F initiative elicited feedback from clinicians, which we refer to as an "audit and feedback loop." We also evaluate the impact of the report card by comparing pre-post differences in prescribing measures for clinicians who received the report card with a group of clinicians who did not receive the report card. Results Report cards indicated that many youth who were prescribed antipsychotics were not receiving proper medication management or using behavioral health outpatient services alongside the antipsychotic prescription, but that polypharmacy was rare. In their feedback, clinicians who received report cards cited several challenges related to antipsychotic prescribing, such as the logistical difficulties of entering lab orders and family members’ hesitancy to change care plans. The impact of the report card was mixed: there was a modest reduction in the share of youth receiving polypharmacy following the receipt of the report card, while other measures did not change. However, we documented a large reduction in the number of youth with one or more antipsychotic prescription fill among clinicians who received a report card. Conclusions A/F initiatives are a common approach to improving the quality of care, and often target specific practices such as antipsychotic prescribing. Report cards are a low-cost and feasible intervention but there is room for quality improvement, such as adding measures that track medication management or eliciting feedback from clinicians who receive report cards. To ensure that the benefits of antipsychotic prescribing outweigh its risks, it is important to promote quality and safety of antipsychotic prescribing within a broader care plan.

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Use of Academic Detailing With Audit and Feedback to Improve Antipsychotic Pharmacotherapy

Abstract: Polypharmacy decreased among young and older adults after academic detailing with audit and feedback. Although further research is needed, this low-intensity intervention may help mental health systems reduce antipsychotic polypharmacy.

Cited by 8 publications

References 43 publications

Polypharmacotherapy in Psychiatry: Global Insights from a Rapid Online Survey of Psychiatrists

Polypharmacotherapy in Psychiatry: Global Insights from a Rapid Online Survey of Psychiatrists

Antipsychotic prescribing for patients with intellectual disabilities and challenging behaviours

Incorporating clinician insight and care plans into an audit and feedback initiative for antipsychotic prescribing to Medicaid-enrolled youth in Philadelphia

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