Is involuntary treatment a predictor of higher psychotropic medication use? A clinical audit

Abstract

Background: Involuntary treatment has previously been associated with worse clinical outcomes; however, limited literature exists investigating psychotropic polypharmacy and high-dose prescribing in this vulnerable population.

Objectives: This session aims to investigate the relationship between involuntary treatment and rates of psychotropic polypharmacy and/or high-dose prescribing practices in a large metropolitan mental health unit over 4 years.

Methods: A retrospective clinical audit encompassing 800 adults from a metropolitan Queensland inpatient mental health unit was undertaken. Data were collected for 200 patients, discharged on at least one psychotropic agent, at four different time points: cohort 1 (on or before 31 January 2014), cohort 2 (2015), cohort 3 (2016) and cohort 4 (2017). The number of prescribed medicines and total daily dose was reviewed for alignment with current clinical guidelines. Outcomes (psychotropic polypharmacy and high-dose prescribing) were compared by patient voluntary/involuntary status using χ2 and rank-sum tests. Associations between outcomes and covariates were assessed using binomial logistic regression analysis.

Findings: Patients treated involuntarily were 58.5 times more likely to be prescribed antipsychotic polypharmacy (two or more antipsychotics) at discharge than those treated voluntarily. Involuntary treatment was also associated with longer hospital admissions [odds ratio: 1.1; 95% confidence interval (1.043, 1.095); p < 0.001].

Conclusions: Implicit review of justifications for increased medication burden and longer duration of admission in those treated involuntarily is required to ensure that clinical outcomes and overall quality of life are optimized for this vulnerable population. Clearly documented medication histories, reconciliation at discharge and directions for medication management after discharge are necessary to ensure quality use of medicines.