Quality of prescribing for schizophrenia: evidence from a national audit in England and Wales.
The National Audit of Schizophrenia (NAS) examined the quality of care received in England and Wales. Part of the audit set out to determine whether six prescribing standards, set by the national clinical guidelines for schizophrenia, were being implemented and to prompt improvements in care. Mental Health Trusts and Health Boards provided data obtained from case-notes for adult patients living in the community with schizophrenia or schizoaffective disorder. An audit of practice tool was developed for data collection. Most of the 5055 patients reviewed were receiving pharmacological treatment according to national guidelines. However, 15.9% of the total sample (95%CI: 14.9-16.9) were prescribed two or more antipsychotics concurrently and 10.1% of patients (95%CI: 9.3-10.9) were prescribed medication in excess of recommended limits. Overall 23.7% (95%CI: 22.5-24.8) of patients were receiving clozapine. However, there were many with treatment resistance who had no clear reason documented as to why they had not had a trial of clozapine (430/1073, 40.1%). In conclusion, whilst most people were prescribed medication in accordance with nationally agreed standards, there was considerable variation between service providers. Antipsychotic polypharmacy, high dose prescribing and clozapine underutilisation in treatment resistance were all key concerns which need to be further addressed.
Institute of Psychiatry, King׳s College London, Department of Psychosis Studies, Box 68, 16 De Crespigny Park, London SE5 8AF, United Kingdom. Electronic address: maxine.patel@kcl.ac.uk.
Maxine X
MX
Patel
Pharmacy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, United Kingdom. Electronic address: delia.bishara@slam.nhs.uk.
Delia
D
Bishara
College Centre for Quality Improvement, Royal College of Psychiatrists, 21 Prescot Street, London E1 8BB, United Kingdom. Electronic address: sjayakumar@cru.rcpsych.ac.uk.
Simone
S
Jayakumar
College Centre for Quality Improvement, Royal College of Psychiatrists, 21 Prescot Street, London E1 8BB, United Kingdom. Electronic address: kzalewska@cru.rcpsych.ac.uk.
Krysia
K
Zalewska
College Centre for Quality Improvement, Royal College of Psychiatrists, 21 Prescot Street, London E1 8BB, United Kingdom. Electronic address: NAS@cru.rcpsych.ac.uk.
David
D
Shiers
Faculty of Medicine, Imperial College London, Centre for Mental Health, Claybrook Centre. 37, Claybrook Road, London W6 8LN, United Kingdom. Electronic address: m.crawford@imperial.ac.uk.
Mike J
MJ
Crawford
College Centre for Quality Improvement, Royal College of Psychiatrists, 21 Prescot Street, London E1 8BB, United Kingdom. Electronic address: NAS@cru.rcpsych.ac.uk.
Stephen J
SJ
Cooper
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D003024:Clozapine / Q000008:administration & dosage / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D004351:Drug Resistance; D004359:Drug Therapy, Combination / Q000009:adverse effects; D004739:England; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011618:Psychotic Disorders / Q000188:drug therapy*; D012559:Schizophrenia / Q000188:drug therapy*; D014852:Wales; D055815:Young Adult
D014150:Antipsychotic Agents; D003024:Clozapine
Antipsychotic; Dose; Prescribing; Schizophrenia