title: Effectiveness of a cognitive behavioural workbook for changing beliefs about antipsychotic polypharmacy: analysis from a cluster randomized controlled trial.
abstract: OBJECTIVE
  Educational workbooks have been used in psychiatry to influence patient but not clinician behaviour. Targeted education interventions to change prescribing practice in other areas of medicine have only looked at changes in prescribing and not attitudes or beliefs related to the prescribing. We aimed to examine whether clinicians' beliefs about a common prescribing issue in psychiatry (antipsychotic polypharmacy prescription) changed alongside behaviour as a result of a complex intervention.
  
  
  METHODS
  Medical and nursing staff were recruited from 19 general adult psychiatry units in the south-west of the UK as part of a cluster randomized controlled trial. A questionnaire was used to assess beliefs on the prescribing of antipsychotic polypharmacy as a secondary outcome before and after completion of a cognitive behavioural 'self-help' style workbook (one part of a complex intervention). A factor analysis suggested three dimensions of the questionnaire that corresponded to predetermined themes. The data were analysed using a random-effects regression model (adjusting for clustering) controlling for possible confounders.
  
  
  RESULTS
  There was a significant change in beliefs on both of the factors: antipsychotic polypharmacy (coefficient = -0.89, P < 0.01) and rapid tranquilization (coefficient = -0.68, P = 0.01) specifically targeted by the workbook. There was a modest but statistically significant change in antipsychotic polypharmacy prescribing (odds ratio 0.43, 95% confidence intervals 0.21-0.90).
  
  
  CONCLUSIONS
  The workbook appeared to change staff beliefs about antipsychotic polypharmacy, but achieving substantial changes in clinician behaviour may require further exploration of other factors important in complex prescribing issues.
authors.affiliation: Academic Unit of Psychiatry, University of Bristol, Bristol, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Thompson
authors.forename: Sarah
authors.initials: S
authors.lastname: Sullivan
authors.forename: Maddi
authors.initials: M
authors.lastname: Barley
authors.forename: Laurence
authors.initials: L
authors.lastname: Moore
authors.forename: Paul
authors.initials: P
authors.lastname: Rogers
authors.forename: Attila
authors.initials: A
authors.lastname: Sipos
authors.forename: Glynn
authors.initials: G
authors.lastname: Harrison
mesh_terms: D000293:Adolescent; D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D016000:Cluster Analysis; D015928:Cognitive Behavioral Therapy / Q000193:education*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D019338:Polypharmacy; D015397:Program Evaluation; D011795:Surveys and Questionnaires; D013664:Teaching Materials; D006113:United Kingdom; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents