Purpose The objective of this study was to quantify the rate at which newly-initiated antipsychotic therapy is continued on discharge from the Intensive Care Unit and describe risk factors for continuation post ICU discharge. Materials and Methods Retrospective cohort study of all patients receiving an antipsychotic in the Intensive Care Units of a large academic medical center from January 1, 2005, to October 31, 2011. Chart review was conducted to ascertain whether a patient was newly-started on antipsychotic therapy and whether therapy was continued post ICU discharge. Results A total of 39,248 ICU admissions over the 7 year period were evaluated. Of these, 4468 (11%) were exposed to antipsychotic therapy, of which 3119 (8%) were newly-initiated. In the newly-initiated cohort, 642 (21%) were continued on therapy on discharge from the hospital. Type of drug (use of quetiapine versus no use of quetiapine, odds ratio 3.2, 95% CI 2.5–4.0, p<0.0001 and use of olanzapine OR 2.4, 95% CI 2.0–3.1 p=<0.0001) were significant risk factors for continuing antipsychotics on discharge, despite adjustment for clinical factors. Conclusions Antipsychotic use is common in the intensive care unit setting, and a significant number of newly-initiated patients have therapy continued upon discharge from the hospital.

Dual antiplatelet therapy (DAPT) is a class I guideline indication after percutaneous coronary intervention (PCI). Our population is high-risk for low medication adherence. With a multidisciplinary team we developed a telephone-based intervention to improve DAPT adherence post-PCI. Patients undergoing PCI at our center were contacted by nursing staff via telephone at 1 week, 30 days, and 60 days post-procedure. Calls included a reminder of the importance of DAPT and elicited any patient concerns. Concerns were relayed to the team who could take appropriate action. For patients filling their medications at any pharmacies within our closed system the proportion of days covered (PDC) was calculated. These were compared to data for patients undergoing PCI in the seven months prior to program initiation. Information on interventions performed as a result of calls was also collected. During the study period, 452 patients underwent PCI. Of these, 70% were contacted and 244 filled their prescription at our system pharmacies. Twelve-month median PDC was 74%, with 45% of patients having PDC > 80%. There was no significant difference when compared to the group prior to the intervention, median PDC 79% and 50% of patients having PDC > 80%. In 26 patients calls led to interventions, removing barriers that would have otherwise prevented continued adherence. A telephone-based reminder system led to directed interventions in nearly 1 in 10 patients contacted. It was not able to significantly improve PDC when compared to a contemporary sample. This highlights the difficulty in using PDC to detect barriers to adherence.

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