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Variation between services in polypharmacy and combined high dose of antipsychotic drugs prescribed for in-patients

Royal College of Psychiatrists' Research Unit, 83 Victoria Street, London SW1H 0HW

Carol Paton, Chief Pharmacist

Oxleas NHS Trust, Bexley Hospital

Maria Konsolaki, Statistician

Royal College of Psychiatrists' Research Unit

Tom Sensky, Reader in Psychological Medicine

Imperial College School of Medicine

Chike Okocha, Consultant Psychiatrist and Senior Lecturer in Psychiatry

Queen Elizabeth Hospital

Declaration of interest

C. P. has very occasionally received speaker fees from Eli Lilly and Pfizer. Over the past year she has been involved with research projects funded by Novartis, Ely Lilly and Janssen—Cilag, but has not received any personal income from those projects. T. S. has been paid honoraria by numerous pharmaceutical companies for contributions to educational events. In 2000 he attended a meeting as a participant, in an advisory board for Pfizer. The views expressed do not necessarily reflect those of the Royal College of Psychiatrists.

See editorial, pp. 401-402, and pp. 411-418, this issue.

AIMS AND METHOD

A 1-day census provided an opportunity to examine the variation between 44 mental health services in the frequency of prescribing high doses and polypharmacy of antipsychotic drugs to in-patients on acute psychiatric wards.

RESULTS

The proportion of patients prescribed a high dose ranged 0-50% and simultaneous use of more than one antipsychotic drug ranged 12-71%. A number of case-mix variables explained 26% and 40%, respectively, of the variance between services on these two indicators of prescribing practice.

CLINICAL IMPLICATIONS

Services with high rates of prescription of high dose or polypharmacy might consider a review of clinical practice and of service-level factors that might affect prescribing.

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