Use of Academic Detailing With Audit and Feedback to Improve Antipsychotic Pharmacotherapy
| Autor: | Nino Dzebisashvili, Alexander de Nesnera, Stephen J. Bartels, Haiyi Xie, Gregory McHugo, Robert O. Cotes, Mary F Brunette |
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| Rok vydání: | 2018 |
| Předmět: |
Adult
Male medicine.medical_specialty Time Factors Adolescent Community Mental Health Centers medicine.medical_treatment Guidelines as Topic Article Academic detailing 03 medical and health sciences Young Adult 0302 clinical medicine Pharmacotherapy medicine Humans New Hampshire Practice Patterns Physicians' Psychiatry Antipsychotic Generalized estimating equation Aged Polypharmacy Aged 80 and over Evidence-Based Medicine business.industry Medicaid Mental Disorders Middle Aged Quality Improvement Drug Utilization United States 030227 psychiatry Audit and feedback Psychiatry and Mental health Female business 030217 neurology & neurosurgery Antipsychotic Agents |
| Zdroj: | Psychiatric services (Washington, D.C.). 69(9) |
| ISSN: | 1557-9700 |
| Popis: | OBJECTIVE: Second generation antipsychotic medications vary in their propensity to cause serious cardiometabolic side effects. In addition, polypharmacy (use of two or more antipsychotics) may lead to additive side effects and has not been shown to be consistently more effective than monotherapy. This study examined academic detailing with audit and feedback to improve antipsychotic prescribing practices, including antipsychotic polypharmacy and high cardiometabolic risk (“high risk”) medication utilization. METHOD: Four intervention sessions were provided over two years to community mental health psychiatric care providers. Segmented regression within the general estimating equation model framework used Medicaid pharmacy claims to examine prescribing patterns before and after the intervention among all beneficiaries (67,721 person-months) over the five-year period. RESULTS: After the intervention, the raw proportion of people on polypharmacy decreased from 13.1 to 10.9% of beneficiaries with antipsychotic claims, whereas high risk and low risk antipsychotic use did not change. The final adjusted polypharmacy model showed that, after the intervention, antipsychotic polypharmacy decreased among young adults and adults over 40 years compared to beneficiaries aged 30–39 years (β= −0.02, p = 0.04 and β= −0.02, p= 0.007). The raw proportion of beneficiaries on high and low risk agents did not change, although final adjusted models demonstrated changes in some diagnostic and risk groups of benficiaries. CONCLUSIONS: Polypharmacy decreased in young and older adults after academic detailing with audit and feedback. Although further research is needed, this low intensity intervention may be useful for mental health systems wishing to reduce antipsychotic polypharmacy. |
| Databáze: | OpenAIRE |
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