title: The DEBIT trial: an intervention to reduce antipsychotic polypharmacy prescribing in adult psychiatry wards - a cluster randomized controlled trial.
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.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Academic Unit of Psychiatry, University of Bristol, Bristol, UK.
authors.forename: A
authors.initials: A
authors.lastname: Thompson
authors.forename: S A
authors.initials: SA
authors.lastname: Sullivan
authors.forename: M
authors.initials: M
authors.lastname: Barley
authors.forename: S O
authors.initials: SO
authors.lastname: Strange
authors.forename: L
authors.initials: L
authors.lastname: Moore
authors.forename: P
authors.initials: P
authors.lastname: Rogers
authors.forename: A
authors.initials: A
authors.lastname: Sipos
authors.forename: G
authors.initials: G
authors.lastname: Harrison
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D016000:Cluster Analysis; D003134:Commitment of Persons with Psychiatric Disorders; D003479:Curriculum; D004359:Drug Therapy, Combination; D004363:Drug Utilization / Q000706:statistics & numerical data*; D004739:England; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D007318:Inservice Training; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D011329:Prisoners; D011567:Psychiatric Department, Hospital / Q000706:statistics & numerical data*; D011618:Psychotic Disorders / Q000188:drug therapy*