The DEBIT trial: an intervention to reduce antipsychotic polypharmacy prescribing– a cluster randomized controlled trial.

Paul Rogers, A Sipos, G Harrison, A Thompson, S A Sullivan, M Barley, S O Strange, L Moore

Research output: Contribution to journalArticlepeer-review

Abstract

Abstract Background Clinical guidelines advise against prescribing more than one antipsychotic with limited exceptions. Despite this, surveys continue to report high antipsychotic polypharmacy rates. The aim of the study was to investigate the effectiveness of a multi-faceted intervention in reducing prescribing of antipsychotic polypharmacy on general adult psychiatry wards, compared with guidelines alone. Method A pragmatic cluster randomized controlled trial recruited 19 adult psychiatric units (clusters) from the South West of England. Participants were all ward doctors and nurses. The multi-faceted intervention comprised: an educational/CBT workbook; an educational visit to consultants; and a reminder system on medication charts. Results The odds of being prescribed antipsychotic polypharmacy in those patients prescribed antipsychotic medication was significantly lower in the intervention than control group when adjusted for confounders (OR 0.43, 95% CI 0.21–0.90, p=0.028). There was considerable between-unit variation in polypharmacy rates and in the change in rates between baseline and follow-up (5 months after baseline). Conclusion The intervention reduced levels of polypharmacy prescribing compared to guidelines alone although the effect size was relatively modest. Further work is needed to elicit the factors that were active in changing prescribing behaviour.
Original languageEnglish
Pages (from-to)705 - 715
Number of pages10
JournalPsychological Medicine
Volume38
Issue number5
DOIs
Publication statusPublished - 1 May 2008

Keywords

  • antipsychotics
  • evidence-based guidelines
  • polypharmacy
  • randomised controlled trial

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