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The DEBIT trial: an intervention to reduce antipsychotic polypharmacy prescribing in adult psychiatry wards – a cluster randomized controlled trial

Published online by Cambridge University Press:  10 September 2007

A. Thompson ,
S. A. Sullivan ,
M. Barley ,
S. O. Strange ,
L. Moore ,
P. Rogers ,
A. Sipos  and
G. Harrison
A. Thompson
Affiliation:
Academic Unit of Psychiatry, University of Bristol, Bristol, UK
S. A. Sullivan*
Affiliation:
Academic Unit of Psychiatry, University of Bristol, Bristol, UK
M. Barley
Affiliation:
Academic Unit of Psychiatry, University of Bristol, Bristol, UK
S. O. Strange
Affiliation:
Academic Unit of Psychiatry, University of Bristol, Bristol, UK
L. Moore
Affiliation:
Cardiff Institute of Society, Health and Ethics, Cardiff University, Cardiff, UK
P. Rogers
Affiliation:
School of Care Sciences, University of Glamorgan, Pontypridd, UK
A. Sipos
Affiliation:
Academic Unit of Psychiatry, University of Bristol, Bristol, UK
G. Harrison
Affiliation:
Academic Unit of Psychiatry, University of Bristol, Bristol, UK
*
*Address for correspondence: Ms S. Sullivan, Academic Unit of Psychiatry, University of Bristol, Bristol BS6 6JL, UK. (Email: sarah.sullivan@bristol.ac.uk)
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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.

Keywords

Antipsychoticsevidence-based guidelinespolypharmacyrandomized controlled trial
Type
Original Articles
Information
Psychological Medicine , Volume 38 , Issue 5 , May 2008 , pp. 705 - 715
Copyright
Copyright © Cambridge University Press 2007

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