Background

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.

Objectives

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.

Methods

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.

Results

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.

Conclusions

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.

中文翻译：

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在社区心理健康环境中停用抗胆碱能药物：一项质量改进计划

背景

慢性抗胆碱能药物 (ACM) 在不再有临床指征时使用抗精神病药会导致严重的副作用并对患者的生活质量产生不利影响。

目标

通过对先前描述的在学术精神分裂症诊所进行的处方减药策略的修改，该质量改进 (QI) 项目旨在支持社区精神卫生中心精神分裂症和其他精神疾病患者在临床上适当的 ACM 处方药。

方法

一个由临床药剂师和精神病医生组成的多学科团队创建了网络流媒体视频医学教育认证模块，辅以小组会议和案例咨询，并在一年的时间内将这些提供给社区心理健康中心的精神病医生和执业护士。还生成了电子病历报告，突出显示接受临床使用的两种 ACM 之一的患者：苯甲托品和/或苯海索；这些被定期分发以支持适当的处方。还创建和部署了以 ACM 为重点的患者教育信息图表材料。

结果

2019 年 3 月，126 名患者被确定为接受苯甲托品或苯海索。 106 名 (84%) 使用这些药物中的一种或两种至少六个月。研究样本的平均 (±SD) 年龄为 53.4 (±12.6) 岁；三分之一的样本超过 60 年。37 名患者或 29.4% 的患者停用了 ACM 或减少了剂量。减药与年龄、性别、种族或诊断无关。处方减量与抗精神病药多药治疗、第一代与第二代或口服与长效制剂无关。

结论

这些结果表明，在开处方者的教育和支持下，社区精神卫生中心可能会出现 ACM 的取消处方。然而，该 QI 项目前几个阶段的结果表明，处方药的开药率要高得多，这表明更直接的临床药剂师支持和参与该过程的重要好处。