Psychotropic drug utilization and audit in two Italian psychiatric services

Abstract

SynopsisThe utilization of psychotropic drugs is a topic of increasing interest. This paper describes a study of psychotropic drug use in two acute psychiatric in-patient services in Cremona, northern Italy. Almost all patients surveyed received one or more psychotropic drugs, and there was evidence of a substantial level of polypharmacy. Women patients were prescribed more psychotropic drugs than the men, while the relationship between drug prescription and psychiatric diagnosis differed between the two services. During the second phase of the study, the medical staff were aware that their prescribing was being monitored. However, this knowledge appeared to have little effect on their patterns of prescribing. The findings of Barton (1978) are thus not supported.

The prescription of psychotropic drugs in psychiatric residential facilities: a national survey in Italy

“…RFs host a population of long‐stay, chronic patients, and yet these patients were receiving many medications simultaneously. Other large‐scale studies conducted in Italy have consistently found high rates of psychotropic polypharmacy (1, 3, 5, 7, 11, 12, 15–16), which did not change even when prescriptions were monitored (1). Although in difficult clinical conditions (i.e.…”

“…Many drug utilization studies have shown considerable variations in prescribing patterns of psychotropic drugs, with high rates of polypharmacy (1, 2); these patterns have been confirmed over time by studies performed in different settings and different nations, also sampling large patient populations and/or extending observation periods (3–15).…”

“…Even in Italy several psychotropic drug utilization studies carried out in a variety of mental health services have consistently shown questionable prescribing practices, with high rates of polypharmacy and frequently weak correlations between diagnoses and medication regimes (1, 3, 5, 7, 11, 12, 15–19). However, data about prescribing practices for patients living in psychiatric residential facilities (RFs), which in Italy have completely replaced mental hospitals (MHs) for the care of long‐term patients, are completely missing, although such facilities care for a large number of individuals (more than 15 000 in the year 2000) (20).…”

Concomitant Psychotropic Medication for Youths

“…Efforts in academic institutions to slow the use of multiple psychotropic medications have been tried and are usually partially successful. However, these results appear to be poorly maintained over time (147)(148)(149), a consequence due in all likelihood to an array of complex factors that continue to stimulate the use of concomitant psychotropic medication. These include a relatively weak response to the initial psychotropic agent, the influence of open studies reporting that concomitant psychotropic medication for youths is useful, the ready application of findings from adult concomitant psychotropic medication studies to youths, the failure to publish negative findings, a reluctance to gradually withdraw an add-on psychotropic medication that initially appeared to be beneficial, and the inability of many physicians to reduce a complex regimen that the previous clinician initiated.…”

Significance of prescription elements and determination of prescription errors in psychiatry outpatient department of a tertiary care hospital

“…When a patient comes for an office visit, the physician or other authorized health professional prescribes medication 67% of the times and on an average of one prescription per office visit is written because more than one prescription may be written at a single visit. 14 The average number of drugs per prescription in an audit is an important index of the scope for review and educational intervention in prescribing practices. This is especially important in psychiatry as studies have shown that polypharmacy was common and psychotherapeutic drugs have been over-prescribed and misused.…”