A Pharmacy Led Program to Review Anti-Psychotic Prescribing for People with Dementia

Anne Child1, Amy Clarke2, Chris Fox3 and Ian Maidment4

Author Affiliations

1 Avante Care and Support, De Gelsey House, 1 Jubilee Way, Faversham, Kent, ME13 8GD, UK

2 NHS Medway, 50 Pembroke Court, Chatham Maritime, Chatham, Kent, ME4 4EL, UK

3 Faculty of Medicine and Health Sciences, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK

4 Pharmacy, School of Life and Health Sciences, Aston University, Aston Triangle, Birmingham, B4 7ET, UK

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BMC Psychiatry 2012, 12:155 doi:10.1186/1471-244X-12-155

Published: 25 September 2012

Abstract

Background

Anti-psychotics, prescribed to people with dementia, are associated with approximately 1,800 excess annual deaths in the UK. A key public health objective is to limit such prescribing of anti-psychotics.

Methods

This project was conducted within primary care in Medway Primary Care Trust (PCT) in the UK. There were 2 stages for the intervention. First, primary care information systems including the dementia register were searched by a pharmacy technician to identify people with dementia prescribed anti-psychotics. Second, a trained specialist pharmacist conducted targeted clinical medication reviews in people with dementia initiated on anti-psychotics by primary care, identified by the data search.

Results

Data were collected from 59 practices. One hundred and sixty-one (15.3%) of 1051 people on the dementia register were receiving low-dose anti-psychotics. People with dementia living in residential homes were nearly 3.5 times more likely to receive an anti-psychotic [25.5% of care home residents (118/462) vs. 7.3% of people living at home (43/589)] than people living in their own homes (p < 0.0001; Fisher’s exact test). In 26 practices there was no-one on the dementia register receiving low-dose anti-psychotics.

Of the 161 people with dementia prescribed low-dose anti-psychotics, 91 were receiving on-going treatment from local secondary care mental health services or Learning Disability Teams. Of the remaining 70 patients the anti-psychotic was either withdrawn, or the dosage was reduced, in 43 instances (61.4%) following the pharmacy-led medication review.

Conclusions

In total 15.3% of people on the dementia register were receiving a low-dose anti-psychotic. However, such data, including the recent national audit may under-estimate the usage of anti-psychotics in people with dementia. Anti-psychotics were used more commonly within care home settings. The pharmacist-led medication review successfully limited the prescribing of anti-psychotics to people with dementia.

Citation