The DEBIT trial: an intervention to reduce antipsychotic polypharmacy prescribing in adult psychiatry wards: a cluster randomised controlled trial

Andrew Thompson, Sarah A Sullivan, Maddi Barley, Simon O. Strange, Laurence Moore, Paul Rogers, Atila Sipos, Glynn Harrison

Research output: Contribution to journalArticle (Academic Journal)peer-review

Abstract

Background. Clinical guidelines advise against prescribing more than one antipsychotic with limited exceptions.
Despite this, surveys continue to report high antipsychotic polypharmacy rates. The aim of the study was to investigate
the effectiveness of a multi-faceted intervention in reducing prescribing of antipsychotic polypharmacy on general adult
psychiatry wards, compared with guidelines alone.
Method. A pragmatic cluster randomized controlled trial recruited 19 adult psychiatric units (clusters) from the South
West of England. Participants were all ward doctors and nurses. The multi-faceted intervention comprised: an
educational/CBT workbook; an educational visit to consultants ; and a reminder system on medication charts.
Results. The odds of being prescribed antipsychotic polypharmacy in those patients prescribed antipsychotic medication
was significantly lower in the intervention than control group when adjusted for confounders (OR 0.43, 95% CI
0.21–0.90, p=0.028). There was considerable between-unit variation in polypharmacy rates and in the change in rates
between baseline and follow-up (5 months after baseline).
Conclusion. The intervention reduced levels of polypharmacy prescribing compared to guidelines alone although the
effect size was relatively modest. Further work is needed to elicit the factors that were active in changing prescribing
behaviour.
Original languageEnglish
Pages (from-to)705-15
JournalPsychological Medicine
Volume38
Issue number5
Publication statusPublished - 2008

Keywords

  • Antipsychotics, evidence-based guidelines, polypharmacy, randomized controlled trial.

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