Quality of prescribing for schizophrenia: Evidence from a national audit in England and Wales |
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| Affiliation: | 1. Institute of Psychiatry, King׳s College London, Department of Psychosis Studies, Box 68, 16 De Crespigny Park, London SE5 8AF, United Kingdom;2. Pharmacy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, United Kingdom;3. College Centre for Quality Improvement, Royal College of Psychiatrists, 21 Prescot Street, London E1 8BB, United Kingdom;4. Faculty of Medicine, Imperial College London, Centre for Mental Health, Claybrook Centre. 37, Claybrook Road, London W6 8LN, United Kingdom;1. Department of Clinical Sciences, Faculty of Veterinary Medicine, Urmia University, Nazloo Road, Urmia 57153 1177, Iran;2. Department of Clinical Sciences, Faculty of Veterinary Medicine, Urmia Branch, Islamic Azad University, Urmia, Iran;3. Department of Veterinary Pathology, Western College of Veterinary Medicine, University of Saskatchewan, 52 Campus Drive, Saskatoon, Saskatchewan S7N 5B4, Canada;1. New York State Office of Mental Health, New York, NY;2. National Committee for Quality Assurance, Washington, DC;3. Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York, NY;4. New York State Office of Mental Health and School of Public Health, State University of New York–Albany, Albany, NY;5. Department of Pediatrics, The Ohio State University College of Medicine and Nationwide Children''s Hospital, Columbus, Ohio |
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| Abstract: | 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. |
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| Keywords: | Schizophrenia Antipsychotic Dose Prescribing |
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