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Achieving evidence-based prescribing practice in an adult community mental health service

Clare Mental Health Services, Ennis, County Clare

Bangaru Raju, Consultant Psychiatrist

James Connolly Memorial Hospital, Blanchardstown, Dublin

Jean Saunders

Department of Biostatistics, University of Limerick

David Meagher, Consultant Psychiatrist and Clinical Research Tutor

Department of Adult Psychiatry, Midwestern Regional Hospital, Limerick, Ireland, e-mail: meaghermob{at}eircom.net

Declaration of interest

None.

AIMS AND METHOD

Prescribing in everyday practice frequently deviates from evidence-based guidelines. Previous work compared practice in a community mental health service with evidence-based guidelines and identified factors related to suboptimal prescribing. This study reports the impact of a multifaceted intervention on prescribing practice. A Prescribing Practice Quality (PPQ) score was generated from six key aspects of prescribing at initial assessment and again 1 year later after an intervention to reduce suboptimal prescribing practices.

RESULTS

A total of 264 patients were attending the service at both the initial and follow-up phase and were thus exposed to the prescribing intervention. In this population, PPQ scores were significantly lower at follow-up (0.96 v. 0.67, P<0.001). Improved prescribing practice was predicted by receipt of adjunctive supportive inputs, such as anxiety management (P=0.003).

Similarly, mean PPQ scores substantially decreased when the total patient population was considered at each time point (0.75 in 2001 and 0.52 in 2002). These results suggest a reduction in both the initiation and continuation of suboptimal practices.

CLINICAL IMPLICATIONS

Prescribing in real-world settings can be improved by interventions that target multiple aspects of service activity. The provision of supportive inputs is a key factor in improving practice.

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