Effect of pharmacist intervention on physician prescribing in patients with chronic schizophrenia: a descriptive pre/post study.
BACKGROUND
Although pharmacotherapy is one of the most important treatments for schizophrenia, the prominent levels of antipsychotic polypharmacy and high-dose regimens used in Japan are thought to be inconsistent with treatment regimens used in other countries. In this study, we evaluated the effect of pharmacist intervention on physician prescribing in patients with chronic schizophrenia.


METHODS
Participants comprised 52 inpatients at Sawa Hospital (Osaka, Japan), treated with at least one antipsychotic agent, who received pharmacist intervention for 1 year (2012). We compared the dose and the number of antipsychotics prescribed, and the rate of concurrent prescribing of anti-Parkinson, benzodiazepine and mood-stabilizer medication, pre- and post-pharmacist intervention. As an indicator of psychosis symptoms, the rate of seclusion room use was recorded. Additionally, we evaluated the impact of pharmacist intervention on medicine costs. Continuous variables were analyzed by Wilcoxon signed-rank sum tests, and categorical data were analyzed using Fisher's exact tests.


RESULTS
Compared with pre-intervention, the dose (982.6 mg pre vs. 857.6 mg post; p < 0.01) and the number of antipsychotics (2.0 pre vs. 2.0 post; p < 0.05) at 1 year were significantly lower post-intervention. The seclusion room use rate was not significantly different but tended to be lower post-intervention than pre-intervention (p < 0.1). The cost (in USD) for all medicines (10.33 pre vs. 8.76 post; p < 0.05), antipsychotics (8.04 pre vs. 6.48 post; p < 0.05), and psychotropics (9.24 pre vs. 7.68 post; p < 0.01) were significantly lower post-intervention than pre-intervention.


CONCLUSIONS
Pharmacist intervention has the potential to optimize medication prescribing and reduce medication costs in patients with chronic schizophrenia. It might be suggested that clinical practitioners as well as medical hospital administrators consider the pharmacists' ability to rationalize medication therapy in schizophrenia.
Faculty of Clinical Pharmacy, School of Pharmaceutical Science, Kobe Gakuin University, 1-1-3 Minatojima, Chuo-ku, Kobe, 650-8586, Japan. yhashi@pharm.kobegakuin.ac.jp.|Department of Pharmacy, Sawa Hospital, 1-9-1 Shiroyama-cho, Toyonaka, Osaka, 561-0803, Japan. yhashi@pharm.kobegakuin.ac.jp.
Yasuhiko
Y
Hashimoto
Department of Pharmacy, Sawa Hospital, 1-9-1 Shiroyama-cho, Toyonaka, Osaka, 561-0803, Japan.
Masami
M
Tensho
D000328:Adult; D000368:Aged; D000978:Antiparkinson Agents / Q000191:economics / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000191:economics / Q000627:therapeutic use*; D001569:Benzodiazepines / Q000191:economics / Q000627:therapeutic use; D002908:Chronic Disease; D016527:Drug Costs; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D005260:Female; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007564:Japan; D008875:Middle Aged; D010595:Pharmacists; D010607:Pharmacy Service, Hospital / Q000191:economics; D019338:Polypharmacy; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000706:statistics & numerical data*; D024382:Professional Role; D011618:Psychotic Disorders / Q000188:drug therapy / Q000191:economics; D012149:Restraint, Physical / Q000706:statistics & numerical data; D012559:Schizophrenia / Q000188:drug therapy* / Q000191:economics
D000978:Antiparkinson Agents; D014150:Antipsychotic Agents; D001569:Benzodiazepines
Medication cost; Pharmacist; Pharmacist intervention; Schizophrenia