Who is prescribed valproate and how carefully is this treatment reviewed in UK mental health services? Data from a clinical audit
Background: The licensed indications for valproate are narrow, yet this medication is commonly prescribed in mental health services. Objectives: To explore the target symptoms/behaviours for which valproate is prescribed and how well the efficacy and tolerability of this treatment are monitored in r...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
SAGE Publishing
2022-07-01
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| Series: | Therapeutic Advances in Psychopharmacology |
| Online Access: | https://doi.org/10.1177/20451253221110016 |
| _version_ | 1817998253579304960 |
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| author | Carol Paton Leslie Citrome Emilio Fernandez-Egea Olivia Rendora Thomas R.E. Barnes |
| author_facet | Carol Paton Leslie Citrome Emilio Fernandez-Egea Olivia Rendora Thomas R.E. Barnes |
| author_sort | Carol Paton |
| collection | DOAJ |
| description | Background: The licensed indications for valproate are narrow, yet this medication is commonly prescribed in mental health services. Objectives: To explore the target symptoms/behaviours for which valproate is prescribed and how well the efficacy and tolerability of this treatment are monitored in routine clinical practice. Design: An audit-based quality improvement (QI) programme in UK mental health services. Methods: Information on valproate prescribing was collected from clinical records using a bespoke data collection tool. Results: Sixty-four NHS mental health Trusts/healthcare organisations submitted data on valproate treatment for 5320 patients. Valproate was clearly prescribed for a licensed indication in 1995 (38%) patients, off-label in 1987 (37%) while the indication was uncertain/not available in 1338 (25%). Of the 919 patients started on valproate treatment within the past year, between a half and two-thirds had each of the relevant baseline physical health checks documented. In 539 (59%) of these patients, valproate was prescribed for an unlicensed indication; the prescription was recognised as off-label in 363 (67%), 20 (6%) of whom were documented as having had this explained to them. Of 631 patients prescribed valproate for between 3 months and a year, early on-treatment assessments of response and side effects were documented in 441 (70%) and 332 (53%), respectively. Of 4401 patients treated for more than a year, annual on-treatment reviews of clinical response and side effects were documented in 2771 (63%) and 2140 (49%), respectively. Conclusion: Our data suggest the majority of prescriptions for valproate in mental health services are not for a licensed indication. Furthermore, patients rarely receive an explanation that their valproate prescription is off-label, perhaps partly because the licensed indications are not widely understood by prescribers. Given the very limited evidence for efficacy for the off-label uses of valproate, failure to routinely conduct early on-treatment and annual reviews of the benefits and side effects of this medication may result in patients remaining on ineffective and poorly tolerated treatment by default. |
| first_indexed | 2024-04-14T02:50:13Z |
| format | Article |
| id | doaj.art-7b44539d79554e6185cbe69d7138a12a |
| institution | Directory Open Access Journal |
| issn | 2045-1261 |
| language | English |
| last_indexed | 2024-04-14T02:50:13Z |
| publishDate | 2022-07-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Therapeutic Advances in Psychopharmacology |
| spelling | doaj.art-7b44539d79554e6185cbe69d7138a12a2022-12-22T02:16:18ZengSAGE PublishingTherapeutic Advances in Psychopharmacology2045-12612022-07-011210.1177/20451253221110016Who is prescribed valproate and how carefully is this treatment reviewed in UK mental health services? Data from a clinical auditCarol PatonLeslie CitromeEmilio Fernandez-EgeaOlivia RendoraThomas R.E. BarnesBackground: The licensed indications for valproate are narrow, yet this medication is commonly prescribed in mental health services. Objectives: To explore the target symptoms/behaviours for which valproate is prescribed and how well the efficacy and tolerability of this treatment are monitored in routine clinical practice. Design: An audit-based quality improvement (QI) programme in UK mental health services. Methods: Information on valproate prescribing was collected from clinical records using a bespoke data collection tool. Results: Sixty-four NHS mental health Trusts/healthcare organisations submitted data on valproate treatment for 5320 patients. Valproate was clearly prescribed for a licensed indication in 1995 (38%) patients, off-label in 1987 (37%) while the indication was uncertain/not available in 1338 (25%). Of the 919 patients started on valproate treatment within the past year, between a half and two-thirds had each of the relevant baseline physical health checks documented. In 539 (59%) of these patients, valproate was prescribed for an unlicensed indication; the prescription was recognised as off-label in 363 (67%), 20 (6%) of whom were documented as having had this explained to them. Of 631 patients prescribed valproate for between 3 months and a year, early on-treatment assessments of response and side effects were documented in 441 (70%) and 332 (53%), respectively. Of 4401 patients treated for more than a year, annual on-treatment reviews of clinical response and side effects were documented in 2771 (63%) and 2140 (49%), respectively. Conclusion: Our data suggest the majority of prescriptions for valproate in mental health services are not for a licensed indication. Furthermore, patients rarely receive an explanation that their valproate prescription is off-label, perhaps partly because the licensed indications are not widely understood by prescribers. Given the very limited evidence for efficacy for the off-label uses of valproate, failure to routinely conduct early on-treatment and annual reviews of the benefits and side effects of this medication may result in patients remaining on ineffective and poorly tolerated treatment by default.https://doi.org/10.1177/20451253221110016 |
| spellingShingle | Carol Paton Leslie Citrome Emilio Fernandez-Egea Olivia Rendora Thomas R.E. Barnes Who is prescribed valproate and how carefully is this treatment reviewed in UK mental health services? Data from a clinical audit Therapeutic Advances in Psychopharmacology |
| title | Who is prescribed valproate and how carefully is this treatment reviewed in UK mental health services? Data from a clinical audit |
| title_full | Who is prescribed valproate and how carefully is this treatment reviewed in UK mental health services? Data from a clinical audit |
| title_fullStr | Who is prescribed valproate and how carefully is this treatment reviewed in UK mental health services? Data from a clinical audit |
| title_full_unstemmed | Who is prescribed valproate and how carefully is this treatment reviewed in UK mental health services? Data from a clinical audit |
| title_short | Who is prescribed valproate and how carefully is this treatment reviewed in UK mental health services? Data from a clinical audit |
| title_sort | who is prescribed valproate and how carefully is this treatment reviewed in uk mental health services data from a clinical audit |
| url | https://doi.org/10.1177/20451253221110016 |
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