University of Pittsburgh School of Medicine, 3550 Terrace St, Pittsburgh, PA, 15213, USA; University of Pittsburgh Medical Center Western Psychiatric Hospital, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA.
University of Pittsburgh Medical Center Western Psychiatric Hospital, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA; University of Pittsburgh School of Pharmacy, 3501 Terrace St, Pittsburgh, PA, 15213, USA.
Res Social Adm Pharm. 2021 Oct;17(10):1841-1846. doi: 10.1016/j.sapharm.2020.12.010. Epub 2020 Dec 19.
Chronic anticholinergic medication (ACM) prescribing with antipsychotics when no longer clinically indicated can lead to serious side effects and adversely impact patient quality of life.
Through modifications of previously described deprescribing strategies undertaken in an academic, schizophrenia clinic, this quality improvement (QI) project aimed to bolster ACM deprescription where clinically appropriate among patients with schizophrenia and other psychiatric disorders at a community mental health center.
A multidisciplinary team involving clinical pharmacists and psychiatrists created web streaming video medical education accredited modules, supplemented by small groups sessions and case consultations, and provided these to psychiatrists and nurse practitioners at a community mental health center over a one-year period. Electronic medical record reports were also generated, highlighting patients who were receiving one of two ACM used in the clinic: benztropine and/or trihexyphenidyl; these were periodically distributed to support appropriate deprescription. Patient education infographic material focused on ACM were also created and deployed.
One hundred and twenty-six patients were identified as receiving benztropine or trihexyphenidyl in March 2019. One hundred and six (84%) were on one or both of these medications for at least six months. The mean (±SD) age of the study sample was 53.4 (±12.6) years; a third of the sample was over 60 years. Thirty-seven patients, or 29.4%, had their ACM discontinued or the dosage reduced. Deprescription was not associated with age, sex, race, or diagnosis. Deprescription was not associated with antipsychotic polypharmacy, first versus second generation, or oral versus long acting preparation.
These results suggest that deprescription of ACM in a community mental health center can occur with prescriber education and support. However, results from previous stages of this QI project, where much higher rates of deprescription were demonstrated, indicate the important benefit of more direct clinical pharmacist support and involvement in the process.
在不再具有临床指征的情况下，慢性抗胆碱能药物（ACM）与抗精神病药物联合处方可能导致严重的副作用，并对患者的生活质量产生不利影响。
通过对先前在学术性精神分裂症诊所中描述的减药策略进行修改，本质量改进（QI）项目旨在加强社区心理健康中心的精神分裂症和其他精神障碍患者的 ACM 减药，只要在临床合适的情况下。
一个由临床药师和精神科医生组成的多学科团队创建了流媒体视频医学教育认证模块，并辅以小组会议和案例咨询，并在一年内向社区心理健康中心的精神科医生和执业护士提供这些服务。还生成了电子病历报告，突出显示正在接受诊所中使用的两种 ACM 之一的患者：苯海索和/或苯甲托品；这些报告定期分发以支持适当的减药。还创建并部署了侧重于 ACM 的患者教育信息图材料。
2019 年 3 月，共有 126 名患者被确定为正在接受苯海索或苯甲托品治疗。其中 106 名（84%）至少服用这两种药物中的一种或两种药物超过 6 个月。研究样本的平均（±SD）年龄为 53.4（±12.6）岁；三分之一的样本年龄超过 60 岁。37 名患者（29.4%）停止或减少了 ACM 的使用。减药与年龄、性别、种族或诊断无关。减药与抗精神病药物的联合用药、第一代与第二代药物或口服与长效制剂无关。
这些结果表明，在社区心理健康中心，通过处方医生的教育和支持，可以实现 ACM 的减药。然而，该 QI 项目之前阶段的结果表明，更直接的临床药师支持和参与这一过程具有重要意义，在之前的阶段中，ACM 的减药率更高。
