Ecological assessment of clinicians antipsychotic prescription habits in psychiatric inpatients: a novel web-and Mobile Phone-based prototype for a dynamic clinical decision support system Articles uri icon

authors

  • BERROUIGUET, SOFIAN
  • BARRIGON ESTEVEZ, MARIA LUISA
  • BRANDT, SARA A.
  • NITZBURG, GEORGE C.
  • OVEJERO, SANTIAGO
  • ALVAREZ GARCIA, RAQUEL
  • CARBALLO, JUAN
  • WALTER, MICHEL
  • BILLOT, ROMAIN
  • LENCA, PHILIPPE
  • DELGADO GOMEZ, DAVID
  • ROPARS, JULIETTE
  • CALLE GONZALEZ, IVAN DE LA
  • COURTET, PHILIPPE
  • BACA GARCIA, ENRIQUE

publication date

  • January 2017

start page

  • 1

end page

  • 9

issue

  • 1, e25

volume

  • 19

International Standard Serial Number (ISSN)

  • 1439-4456

Electronic International Standard Serial Number (EISSN)

  • 1438-8871

abstract

  • Background: Electronic prescribing devices with clinical decision support systems (CDSSs) hold the potential to significantly improve pharmacological treatment management.

    Objective: The aim of our study was to develop a novel Web- and mobile phone-based application to provide a dynamic CDSS by monitoring and analyzing practitioners' antipsychotic prescription habits and simultaneously linking these data to inpatients' symptom changes.

    Methods: We recruited 353 psychiatric inpatients whose symptom levels and prescribed medications were inputted into the MEmind application. We standardized all medications in the MEmind database using the Anatomical Therapeutic Chemical (ATC) classification system and the defined daily dose (DDD). For each patient, MEmind calculated an average for the daily dose prescribed for antipsychotics (using the N05A ATC code), prescribed daily dose (PDD), and the PDD to DDD ratio.

    Results: MEmind results found that antipsychotics were used by 61.5% (217/353) of inpatients, with the largest proportion being patients with schizophrenia spectrum disorders (33.4%, 118/353). Of the 217 patients, 137 (63.2%, 137/217) were administered pharmacological monotherapy and 80 (36.8%, 80/217) were administered polytherapy. Antipsychotics were used mostly in schizophrenia spectrum and related psychotic disorders, but they were also prescribed in other nonpsychotic diagnoses. Notably, we observed polypharmacy going against current antipsychotics guidelines.

    Conclusions: MEmind data indicated that antipsychotic polypharmacy and off-label use in inpatient units is commonly practiced. MEmind holds the potential to create a dynamic CDSS that provides real-time tracking of prescription practices and symptom change. Such feedback can help practitioners determine a maximally therapeutic drug treatment while avoiding unproductive overprescription and off-label use.

subjects

  • Pharmacy
  • Psychology
  • Statistics

keywords

  • clinical decision-making; antipsychotic agents; software; mobile applications; off-label use; prescriptions