[Impact of therapeutic advice on prescription of psychotropics for patients with serious mental illness]

Abstract

Introduction: The improvement of prescription constitutes a major challenge for public health. In France, medication is the third cause of serious adverse reaction. The report of the Parliamentary Commission for Evaluation of Health Policy on adequate use of psychotropics mentions their overconsumption. Promoting practices' dissemination and guidelines' respect is one of the missions of the referral psychosocial rehabilitation centers. Therapeutic advice that is offered consists of suggestions for revision in the patient's treatment with the aim of improving the patient's health. To our knowledge, to date no study has focused on the evaluation of therapeutic advice in psychiatry. The present study aimed at analyzing benefits of therapeutic advice for the patients. To this end: (1) a state of things related to actual practices was carried out: psychotropics prescriptions' problems and therapeutic advice proposed by psychiatrists (quantitative and qualitative assessment); (2) the impact of advice on prescription was assessed; (3) patients' benefits were identified.

Method: This monocentric trial was carried out at the referral psychosocial rehabilitation center of Lyon. This audit was a retrospective observation of electronic medical records (software CortexteNet V2.6). This project was developed by a multidisciplinary staff (pharmacists and psychiatrists) during summer 2015. All patients treated in this center between September 2010 and December 2014 were included. The collection of data was made by two auditors (pharmacist students) thanks to a collection grid with six parts: identification and epidemiology of patients with therapeutic advice, coding tips, benefits, quantitative and qualitative assessment of prescriptions before and after advice.

Results: Of the 601 records explored during this study, 66 advices (8.3% of patients) were identified. Patients concerned by therapeutic advice were mainly men with schizophrenia between 35 and 40 years, living in a town and addressed by public psychiatrists. Advice was taken into account in 81.7%, partially in 8.1%, and was beneficial in 97%. The main benefits were clinical improvement (48.5%) and reduction of adverse drug events (36.4%). There were no statistically significant differences between prescriptions (quantitatively and qualitatively) before and after therapeutic advice.

Conclusion: In most cases, prescriptions of psychotropics were adequate since only 66 advices (8.3% of patients) were given. Psychosocial rehabilitation centers give medication prescribing advice and promote respect of the guidelines. The collaboration between rehabilitation's psychiatrists and other psychiatrists optimizes patient management. It reduces iatrogenic disorders and improves quality and safety of care. Very few studies deal with the prescription of psychotropics in adult psychiatry. This work highlights the positive effect of therapeutic advice for this population. Further controlled studies should clarify the benefits of therapeutic advice.

Keywords: Drug prescriptions; Prescription médicale; Psychiatric rehabilitation; Psychiatrie; Psychiatry; Réhabilitation psychosociale; Schizophrenia; Schizophrénie.