A six-year program run by the NHS Foundation Trust aimed at reducing high rates of inappropriate polypharmacy and overprescribing by physicians and psychiatrists to mental health patients in UK inner cities was successful, according to a study in Therapeutic Advances in Psychopharmacology.
The program took place in “SLAM,” which the researchers described as “an inner city trust which serves a multicultural population of approximately 1.2 million with high rates of immigration and social deprivation.”
“There is no conclusive evidence that either high doses or combinations of antipsychotics are more effective than standard doses or monotherapy alone,” stated the researchers. Over half of the patients in SLAM were being prescribed a high-dose antipsychotic or a combination of antipsychotics, the highest rate in the UK.
The program involved educating and training the psychiatrists and physicians about overprescribing, and then implementing explicit restrictions on drug levels which could only be circumvented through special procedures. All patients’ drug levels were then submitted to regular, independent reviews which eventually became weekly for any patients that were on higher doses.
Another study in the same journal reported on by Mad In America in January found that a training program for physicians at four clinics produced no measurable improvements in patterns of over-prescribing of psychiatric medications; however, that training and education program ran for only one year.
Mace, Shubhra, and David Taylor. “Reducing the Rates of Prescribing High-Dose Antipsychotics and Polypharmacy on Psychiatric Inpatient and Intensive Care Units: Results of a 6-Year Quality Improvement Programme.” Therapeutic Advances in Psychopharmacology 5, no. 1 (February 1, 2015): 4–12. doi:10.1177/2045125314558054. (Abstract)