Antipsychotic prescribing for vulnerable populations: a clinical audit at an acute Australian mental health unit at two-time points
Abstract Background Antipsychotics are recognised as a critical intervention for schizophrenia and bipolar disorder. Guidelines globally endorse the routine practice of antipsychotic monotherapy, at the minimum effective dose. Even in treatment-resistant schizophrenia, clozapine use is endorsed befo...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2017-04-01
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| Series: | BMC Psychiatry |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12888-017-1295-1 |
| _version_ | 1828401163668553728 |
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| author | Sara S McMillan Sara Jacobs Louise Wilson Theo Theodoros Gail Robinson Claire Anderson Gabor Mihala Amanda J Wheeler |
| author_facet | Sara S McMillan Sara Jacobs Louise Wilson Theo Theodoros Gail Robinson Claire Anderson Gabor Mihala Amanda J Wheeler |
| author_sort | Sara S McMillan |
| collection | DOAJ |
| description | Abstract Background Antipsychotics are recognised as a critical intervention for schizophrenia and bipolar disorder. Guidelines globally endorse the routine practice of antipsychotic monotherapy, at the minimum effective dose. Even in treatment-resistant schizophrenia, clozapine use is endorsed before combining antipsychotics. This aim of this study was to review antipsychotic polytherapy alone, high-dose therapy alone, polytherapy and high-dose prescribing patterns in adults discharged from an inpatient mental health unit at two time-points, and the alignment of this prescribing with clinical guideline recommendations. Additionally, associations with polytherapy and high-dose antipsychotic prescribing, including patient and clinical characteristics, were explored. Methods A retrospective clinical audit of 400 adults (200 patients at two different time-points) discharged with at least one antipsychotic. Preliminary findings and education sessions were provided to physicians between Cohorts. Outcomes (polytherapy alone, high-dose therapy alone, polytherapy and high-dose therapy) were compared between study Cohorts using chi-squared and rank-sum tests. Associations between outcomes and covariates were assessed using multivariable logistic regression. Results Most patients (62.5%) were discharged on a single antipsychotic within the recommended dose range. There was a clear preference for prescribing second generation antipsychotics, and in this respect, prescribing is aligned with current evidence-based guidelines. However, sub-optimal prescribing practices were identified for both Cohorts in relation to polytherapy and high-dose antipsychotic rates. Involuntary treatment, frequent hospitalisations and previous clozapine use significantly increased the risk of all three prescribing outcomes at discharge. Conclusions In a significant minority, antipsychotic prescribing did not align with clinical guidelines despite increased training, indicating that the education program alone was ineffective at positively influencing antipsychotic prescribing practices. Further consideration should be given when prescribing antipsychotics for involuntary patients, people with frequent hospitalisations, and those who have previously trialled clozapine. |
| first_indexed | 2024-12-10T09:42:26Z |
| format | Article |
| id | doaj.art-a402bd77f1294e23a08c314ad4193ef7 |
| institution | Directory Open Access Journal |
| issn | 1471-244X |
| language | English |
| last_indexed | 2024-12-10T09:42:26Z |
| publishDate | 2017-04-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Psychiatry |
| spelling | doaj.art-a402bd77f1294e23a08c314ad4193ef72022-12-22T01:53:57ZengBMCBMC Psychiatry1471-244X2017-04-0117111010.1186/s12888-017-1295-1Antipsychotic prescribing for vulnerable populations: a clinical audit at an acute Australian mental health unit at two-time pointsSara S McMillan0Sara Jacobs1Louise Wilson2Theo Theodoros3Gail Robinson4Claire Anderson5Gabor Mihala6Amanda J Wheeler7Menzies Health Insitute, Griffith UniversityDivision of Pharmacy Practice and Policy, School of Pharmacy, University of NottinghamDivision of Pharmacy Practice and Policy, School of Pharmacy, University of NottinghamFaculty of Medicine, University of QueenslandMenzies Health Insitute, Griffith UniversityDivision of Pharmacy Practice and Policy, School of Pharmacy, University of NottinghamMenzies Health Insitute, Griffith UniversityMenzies Health Insitute, Griffith UniversityAbstract Background Antipsychotics are recognised as a critical intervention for schizophrenia and bipolar disorder. Guidelines globally endorse the routine practice of antipsychotic monotherapy, at the minimum effective dose. Even in treatment-resistant schizophrenia, clozapine use is endorsed before combining antipsychotics. This aim of this study was to review antipsychotic polytherapy alone, high-dose therapy alone, polytherapy and high-dose prescribing patterns in adults discharged from an inpatient mental health unit at two time-points, and the alignment of this prescribing with clinical guideline recommendations. Additionally, associations with polytherapy and high-dose antipsychotic prescribing, including patient and clinical characteristics, were explored. Methods A retrospective clinical audit of 400 adults (200 patients at two different time-points) discharged with at least one antipsychotic. Preliminary findings and education sessions were provided to physicians between Cohorts. Outcomes (polytherapy alone, high-dose therapy alone, polytherapy and high-dose therapy) were compared between study Cohorts using chi-squared and rank-sum tests. Associations between outcomes and covariates were assessed using multivariable logistic regression. Results Most patients (62.5%) were discharged on a single antipsychotic within the recommended dose range. There was a clear preference for prescribing second generation antipsychotics, and in this respect, prescribing is aligned with current evidence-based guidelines. However, sub-optimal prescribing practices were identified for both Cohorts in relation to polytherapy and high-dose antipsychotic rates. Involuntary treatment, frequent hospitalisations and previous clozapine use significantly increased the risk of all three prescribing outcomes at discharge. Conclusions In a significant minority, antipsychotic prescribing did not align with clinical guidelines despite increased training, indicating that the education program alone was ineffective at positively influencing antipsychotic prescribing practices. Further consideration should be given when prescribing antipsychotics for involuntary patients, people with frequent hospitalisations, and those who have previously trialled clozapine.http://link.springer.com/article/10.1186/s12888-017-1295-1AuditAntipsychoticsMental Illness |
| spellingShingle | Sara S McMillan Sara Jacobs Louise Wilson Theo Theodoros Gail Robinson Claire Anderson Gabor Mihala Amanda J Wheeler Antipsychotic prescribing for vulnerable populations: a clinical audit at an acute Australian mental health unit at two-time points BMC Psychiatry Audit Antipsychotics Mental Illness |
| title | Antipsychotic prescribing for vulnerable populations: a clinical audit at an acute Australian mental health unit at two-time points |
| title_full | Antipsychotic prescribing for vulnerable populations: a clinical audit at an acute Australian mental health unit at two-time points |
| title_fullStr | Antipsychotic prescribing for vulnerable populations: a clinical audit at an acute Australian mental health unit at two-time points |
| title_full_unstemmed | Antipsychotic prescribing for vulnerable populations: a clinical audit at an acute Australian mental health unit at two-time points |
| title_short | Antipsychotic prescribing for vulnerable populations: a clinical audit at an acute Australian mental health unit at two-time points |
| title_sort | antipsychotic prescribing for vulnerable populations a clinical audit at an acute australian mental health unit at two time points |
| topic | Audit Antipsychotics Mental Illness |
| url | http://link.springer.com/article/10.1186/s12888-017-1295-1 |
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