title: Compliance of psychotropic drug prescription with clinical practice guidelines in older inpatients.
abstract: Several practice guidelines were published by French regulatory agencies between 2006 and 2009 to improve psychotropic drug use in older patients. The objectives of the study were to assess compliance with these guidelines in older patients hospitalized in psychiatric units and to identify characteristics associated with compliance. A cross-sectional study was conducted in 117 patients aged 65 years and older hospitalized in two psychiatric departments of a public hospital, at three dates randomly chosen between January and May 2014. Medical and sociodemographic characteristics were collected from electronic medical records. In all, 8% of psychotropic prescriptions were compliant with guidelines. A total of 98% of antidepressant prescriptions complied with guidelines for product selection (no tricyclics) and 72% for initial dosage (half of that recommended for younger adults). Regarding benzodiazepines, short half-life drugs were chosen in 73% of treatments, low maintenance dosage was found in 64% of treatments, and a discontinuous administration rhythm was noted in 33% of treatments. Regarding antipsychotics, initial dosage was a quarter of the allowed initial dosage for younger adults in 39% of prescriptions and metabolic blood testing was performed in 17% of prescriptions. Neurological and cognitive tolerance was monitored in 41% and 61% of prescriptions, respectively. Few clinical factors were found to be associated with compliance or noncompliance with guidelines in older psychiatric inpatients. Practice guidelines on psychotropic drug prescription were partially respected in older inpatients. Practitioners should take into account the risks associated with non-recommended patterns of psychotropic drug use in this vulnerable population.
authors.affiliation: Inserm U657, Inserm, Bordeaux, F-33000, France.|Université de Bordeaux, F-33000, Bordeaux, France.
authors.forename: Fanny
authors.initials: F
authors.lastname: Etchepare
authors.affiliation: Inserm U657, Inserm, Bordeaux, F-33000, France.
authors.forename: Elodie
authors.initials: E
authors.lastname: Pambrun
authors.affiliation: Inserm U657, Inserm, Bordeaux, F-33000, France.|Université de Bordeaux, F-33000, Bordeaux, France.|Centre Hospitalier Universitaire, F-33000, Bordeaux, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Bégaud
authors.affiliation: Inserm U657, Inserm, Bordeaux, F-33000, France.|Université de Bordeaux, F-33000, Bordeaux, France.|Centre Hospitalier Charles Perrens, F-33000 Bordeaux, France.
authors.forename: Hélène
authors.initials: H
authors.lastname: Verdoux
authors.affiliation: Inserm U657, Inserm, Bordeaux, F-33000, France.|Université de Bordeaux, F-33000, Bordeaux, France.|Centre Hospitalier Charles Perrens, F-33000 Bordeaux, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Tournier
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015510:Clinical Medicine / Q000592:standards*; D003430:Cross-Sectional Studies; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D057286:Electronic Health Records; D005260:Female; D005602:France; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008297:Male; D055118:Medication Adherence; D015999:Multivariate Analysis; D017410:Practice Guidelines as Topic; D011567:Psychiatric Department, Hospital / Q000706:statistics & numerical data; D011619:Psychotropic Drugs / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000627:therapeutic use*; D011897:Random Allocation; D012959:Socioeconomic Factors
chemical_list: D011619:Psychotropic Drugs
keywords: antidepressant; antipsychotic; benzodiazepine; older people; practice guidelines; psychotropic drugs