Impact of triplicate prescription program on psychotropic prescribing patterns in long-term care facilities

Authors: Zullich SG, Grasela TH, Fiedler-Kelly J, Gengo FM
Publication: Ann Pharmacother
Keywords: administration & dosage, drug, female, humans, Long-Term Care, male, Medical Records, New York, Prescriptions, prospective studies, Psychotropic Drugs, research support, Retrospective Studies, Syndrome, therapy
Division: Clinical Pharmacology and Pharmacometrics (CPP)

Abstract

OBJECTIVE:
To assess the impact of the effect of the New York state triplicate prescription program on psychotropic prescribing patterns in selected long-term care facilities over a one-year period.

DESIGN:
Retrospective study for changes in psychotropic drug use patterns before and after implementation of the triplicate prescription program.

SETTING:
Eight private and two public long-term care facilities in the western New York area.

PATIENTS:
All residents in the long-term care facilities with complete medical records for a one-year period were reviewed.

OUTCOME MEASUREMENTS:
Charts were reviewed for changes in psychotropic drug patterns and incidence in adverse events such as falls, hip fractures, hospital admission, signs or symptoms of benzodiazepine (BZD) withdrawal syndrome, or behavioral outburst.

MAIN RESULTS:
BZD use declined precipitously from 25 percent of psychotropic drug orders to 10 percent six months after implementation of the program. The decline in BZD use was accompanied by an increase in the number of orders for alternative psychotropic agents. Although 22 percent of the patients previously receiving BZDs were discontinued from these drugs, more than half of these patients were switched to alternative therapy, including tricyclic antidepressants and antipsychotic drugs. The majority of patients who discontinued BZDs did so without tapering of the dosage; however, few experienced minor withdrawal symptoms and no patient experienced seizures or required hospitalization following discontinuation. The risk of falls, hospital admission for any reason, or combined events was not significantly altered despite a reduction in BZD use. There was a trend, however, for a reduction in falls after implementation of the program.

CONCLUSIONS:
This study documents that psychotropic drug prescribing patterns were significantly affected by the triplicate prescription program. BZD use declined; however, use of alternative psychotropic drugs increased. Despite changes in psychotropic prescribing patterns, we found no significant risk of adverse events. Further study to evaluate the long-term effect of alternative psychotropic drugs is necessary.

By Zullich SG, Thaddeus H. Grasela, Jill Fiedler-Kelly, Gengo FM