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Sub-optimal prescribing in an adult community mental health service: prevalence and determinants

Department of Adult Psychiatry, St Anne's Day Hospital, Roxboro Road, Limerick, Ireland

Maria Moran, Senior Registrar in Psychiatry

Declaration of interest

None.

AIMS AND METHOD

To compare prescribing practice in a community mental health service with evidence-based guidelines and identify factors related to sub-optimal prescribing. All current patients (n=640) were assessed regarding six key aspects of prescribing (polypharmacy, high-dose treatment, use of thioridazine/maintenance benzodiazepine/maintenance hypnotic or routine anticholinergic treatment). The relationship of quality of prescribing practice to demographic, illness and service variables was examined by regression analysis.

RESULTS

Five-hundred and five (79%) patients were receiving psychotropic medication. Of these, 232 (46%) had evidence of sub-optimal prescribing practice. Mean prescribing practice quality score was 0.75±0.99. Maintenance benzodiazepine/hypnotic (31%) and anticholinergic (30%) use were particularly common. Prescribing practice quality score was higher in those receiving depot antipsychotic treatment (P<.01) and in older patients (P<.01). Scores were significantly lower in patients whose principal medical contacts were with a consultant rather than a junior doctor (P<.001).

CLINICAL IMPLICATIONS

Prescribing practices in real-world settings frequently deviate from evidence-based guidelines. The quality of prescribing is related to patient, illness and service variables. In particular, greater contact with consultant staff is linked to better practices. Patients receiving depot antipsychotics are especially liable to less judicious prescribing practice.

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