Background and Importance Approximately 38% of European population has a mental health disorder that requires chronic and complex treatment, which have a high risk of long-term toxicity. Moreover, in the therapeutic groups used, it is advisable to carry out a progressive decrease in the dose until the drug is withdrawn.
Aim and Objectives To evaluate a medication review and deprescription programme in patients who have prescribed three or more drugs for pathologies under mental health follow-up.
Material and Methods Descriptive and prospective study, carried out with three cohorts in each of which patients had to have three or more concomitant prescriptions of: antidepressants (A), neuroleptics (B) and benzodiazepines (C); followed by the mental health unit of a tertiary hospital.
Pharmacy service obtained the lists in May 2022 through Information Processing Module to know the consume through electronic prescription, and posted on a corporate application, so that each doctor could access the individualised review during the current year. Four months later, a section was made to study the degree of strategy's implementation.
Demographic data(age; sex) and review's percentages were collected, analysing deprescription (one/two drugs), treatment maintenance (by reason of severity/prescription on demand/de-escalation phase/other reasons), dose changes and new drug's prescription (substitution/addition).
Results Study population obtained of 338 patients (mean age: 51years; men:55.3%): 34 (10.1%) (A), 81 (53.5%) (B) and 123 (36.4%) (C). The results obtained: 53.9% reviewed [(A): 44.1%; (B): 58%;(C):50.4%], 34% pending review [(A):26.5%; (B): 31.5%; (C):39.9%] and 12.1% excluded (review not applicable). Some drugs was deprescribed in 17.6% [(A):20%; (B):17.1%; (C):17.7%]:14.8% (one) and 2.8% (two). Same prescriptions' number was maintained in 82.4% [(A):80%;(B): 82.9%; (C):82.3%]:75.3% severity, 15.3% scheduled demand, 8.7% de-escalation and 0.7% other. Dose changes were reported in 12.1% [(A):6.7%; (B):15.2%; (C): 8.1%]: all of them decreased. Finally, 1.7% of new prescriptions were obtained [(A):6.7%;(B):1%; (C):1.6%]: all of substitution. In no case was the prescriptions number increased.
Conclusion and Relevance This tool provided has allowed prescribers to access and review the population susceptible to deprescription. The degree of acceptance has been good. In the majority of patients the prescriptions were maintained, but in 1/5 the patient’s medication deprescription was performed. The study should be extended until the review of the entire selected population.
Periodic reviews can make a high impact on these patients' health as well as a positive economic impact. Furthermore, it would be useful to create our own drug review/deprescription algorithms and to implement this strategy in other units.
Conflict of Interest No conflict of interest
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