scholarly journals Achieving evidence-based prescribing practice in an adult community mental health service

2006 ◽  
Vol 30 (2) ◽  
pp. 51-55 ◽  
Author(s):  
Maria Moran ◽  
Bangaru Raju ◽  
Jean Saunders ◽  
David Meagher
Keyword(s):  
Mental Health ◽  
Mental Health Service ◽  
Community Mental Health ◽  
Health Service ◽  
Evidence Based ◽  
Community Mental Health Service ◽  
Prescribing Practice ◽  
Evidence Based Guidelines ◽  
The Impact

Aims and MethodPrescribing in everyday practice frequently deviates from evidence-based guidelines. Previous work compared practice in a community mental health service with evidence-based guidelines and identified factors related to suboptimal prescribing. This study reports the impact of a multifaceted intervention on prescribing practice. A Prescribing Practice Quality (PPQ) score was generated from six key aspects of prescribing at initial assessment and again 1 year later after an intervention to reduce suboptimal prescribing practices.ResultsA total of 264 patients were attending the service at both the initial and follow-up phase and were thus exposed to the prescribing intervention. In this population, PPQ scores were significantly lower at follow-up (0.96v.0.67,P<0.001). Improved prescribing practice was predicted by receipt of adjunctive supportive inputs, such as anxiety management (P=0.003).Similarly, mean PPQ scores substantially decreased when the total patient population was considered at each time point (0.75 in 2001 and 0.52 in 2002). These results suggest a reduction in both the initiation and continuation of suboptimal practices.Clinical ImplicationsPrescribing in real-world settings can be improved by interventions that target multiple aspects of service activity. The provision of supportive inputs is a key factor in improving practice.

scholarly journals Sub-optimal prescribing in an adult community mental health service: prevalence and determinants

2003 ◽  
Vol 27 (07) ◽  
pp. 266-270 ◽  
Author(s):  
David Meagher ◽  
Maria Moran
Keyword(s):  
Mental Health ◽  
Mental Health Service ◽  
Health Service ◽  
Quality Score ◽  
Evidence Based ◽  
Community Mental Health Service ◽  
Prescribing Practice ◽  
Quality Of Prescribing ◽  
Evidence Based Guidelines

Aims and Method To compare prescribing practice in a community mental health service with evidence-based guidelines and identify factors related to sub-optimal prescribing. All current patients (n=640) were assessed regarding six key aspects of prescribing (polypharmacy, high-dose treatment, use of thioridazine/maintenance benzodiazepine/maintenance hypnotic or routine anticholinergic treatment). The relationship of quality of prescribing practice to demographic, illness and service variables was examined by regression analysis. Results Five-hundred and five (79%) patients were receiving psychotropic medication. Of these, 232 (46%) had evidence of sub-optimal prescribing practice. Mean prescribing practice quality score was 0.75 ± 0.99. Maintenance benzodiazepine/ hypnotic (31%) and anticholinergic (30%) use were particularly common. Prescribing practice quality score was higher in those receiving depot antipsychotic treatment (P &lt; 0.01) and in older patients (P &lt; 0.01). Scores were significantly lower in patients whose principal medical contacts were with a consultant rather than a junior doctor (P &lt; 0.001). Clinical Implications Prescribing practices in real-world settings frequently deviate from evidence-based guidelines. The quality of prescribing is related to patient, illness and service variables. In particular, greater contact with consultant staff is linked to better practices. Patients receiving depot antipsychotics are especially liable to less judicious prescribing practice.

scholarly journals Sub-optimal prescribing in an adult community mental health service: prevalence and determinants

2003 ◽  
Vol 27 (7) ◽  
pp. 266-270 ◽  
Author(s):  
David Meagher ◽  
Maria Moran
Keyword(s):  
Mental Health ◽  
Mental Health Service ◽  
Health Service ◽  
Quality Score ◽  
Evidence Based ◽  
Community Mental Health Service ◽  
Prescribing Practice ◽  
Quality Of Prescribing ◽  
Evidence Based Guidelines

Aims and MethodTo compare prescribing practice in a community mental health service with evidence-based guidelines and identify factors related to sub-optimal prescribing. All current patients (n=640) were assessed regarding six key aspects of prescribing (polypharmacy, high-dose treatment, use of thioridazine/maintenance benzodiazepine/maintenance hypnotic or routine anticholinergic treatment). The relationship of quality of prescribing practice to demographic, illness and service variables was examined by regression analysis.ResultsFive-hundred and five (79%) patients were receiving psychotropic medication. Of these, 232 (46%) had evidence of sub-optimal prescribing practice. Mean prescribing practice quality score was 0.75 ± 0.99. Maintenance benzodiazepine/ hypnotic (31%) and anticholinergic (30%) use were particularly common. Prescribing practice quality score was higher in those receiving depot antipsychotic treatment (P < 0.01) and in older patients (P < 0.01). Scores were significantly lower in patients whose principal medical contacts were with a consultant rather than a junior doctor (P < 0.001).Clinical ImplicationsPrescribing practices in real-world settings frequently deviate from evidence-based guidelines. The quality of prescribing is related to patient, illness and service variables. In particular, greater contact with consultant staff is linked to better practices. Patients receiving depot antipsychotics are especially liable to less judicious prescribing practice.

The impact of an expanding community mental health service on patterns of bed usage: evaluation of a four-year period of implementation

1982 ◽  
Vol 12 (1) ◽  
pp. 177-190 ◽  
Author(s):  
H. Häfner ◽  
J. Klug
Keyword(s):  
Mental Health ◽  
Mental Health Service ◽  
Community Mental Health ◽  
Health Service ◽  
International Standards ◽  
Community Mental Health Service ◽  
Case Register ◽  
National Differences ◽  
The Impact

SynopsisIn the city of Mannheim the introduction of an extensive community mental health service has been shown, by means of case-register data over 4½ years, to have led to a considerable increase in utilization, mainly at the out-patient level of care. The rates of admission to hospital increased very little. Due to the simultaneous decline in long-term bed occupancy, the overall need for psychiatric beds remained stable at a rate of about 1·2/1000, a rate which is very low by international standards.The sharp decline in the ‘old’ long-stay population was followed by a smaller increase in ‘new’ long-stay patients which it has not been possible to prevent. These patients are, however, admitted for a long-term stay significantly later than formerly, and their diagnostic composition has changed significantly.The increase in the bed requirements for short- and medium-term stay patients resulted from different sources: an increasing morbidity in some groups of disorders, the rising utilization in case of emergencies and severe crises, and the transfer of long-stay patients to alternative care services. The level of these needs was very similar in Mannheim, Salford, Samsø and Camberwell, whereas the rates for long-term beds still show clear national differences.

Effectiveness of a 10-week group program based on Dialectical Behaviour Therapy skills among patients with personality and mood disorders: findings from a pilot study

2017 ◽  
Vol 25 (5) ◽  
pp. 466-470 ◽  
Author(s):  
Agatha M Conrad ◽  
Anoop Sankaranarayanan ◽  
Terry J Lewin ◽  
Anna Dunbar
Keyword(s):  
Mental Health ◽  
Mental Health Service ◽  
Mental Health Services ◽  
Community Mental Health ◽  
Health Service ◽  
Health Services ◽  
Community Mental Health Service ◽  
Behaviour Therapy ◽  
Dialectical Behaviour Therapy ◽  
The Impact

Objectives: Community mental health services are often required to manage people experiencing repeated crises. Personality disorders are not uncommon, accounting for up to one-third of such presentations. These patients are often difficult to treat, leading to a revolving-door phenomenon. This study evaluated the effectiveness of a pilot intervention in reducing psychological symptoms and distress, and examined the impact of the intervention on mental health service utilization. Methods: A pre- versus post-treatment evaluation was conducted of the effectiveness of a 10-week group psychological intervention based on Dialectical Behaviour Therapy skills, conducted in a regional Australian community mental health service with patients diagnosed with either Cluster B personality disorder or a mood disorder. Results: Of those who completed the program ( N = 38 patients), 84% were female, with an average age of 35.13 years. Participants were active clients of the service for an average of 58.3 weeks prior to the program. They demonstrated significant improvements in quality of life and self-control, and a reduction in hopelessness, cognitive instability and dependence on mental health services. Conclusions: Limiting the Dialectical Behaviour Therapy program to a short-term skills-based group component was successful with the targeted patient group; however, more research is required to establish the generalizability of these results.

Effects of Community Mental Health Service in Subjects with Early Psychosis: One-Year Prospective Follow Up

2015 ◽  
Vol 52 (6) ◽  
pp. 724-730 ◽  
Author(s):  
Eun-Jin Na ◽  
Nam-In Kang ◽  
Mi-Young Kim ◽  
Yin Cui ◽  
Hee-Eon Choi ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Service ◽  
Community Mental Health ◽  
Health Service ◽  
Early Psychosis ◽  
Community Mental Health Service ◽  
One Year

Patient-controlled benzodiazepine dose reduction in a community mental health service

2005 ◽  
Vol 22 (2) ◽  
pp. 42-45 ◽  
Author(s):  
Bangaru Raju ◽  
David Meagher
Keyword(s):  
Mental Health ◽  
Mental Health Service ◽  
Community Mental Health ◽  
Health Service ◽  
Dose Reduction ◽  
Community Mental Health Service ◽  
Anxiety Management ◽  
Valuable Adjunct ◽  
Benzodiazepine Use

AbstactObjectives: We report a patient-controlled benzodiazepine discontinuation programme in a generic multidisciplinary community mental health service.Method: A prescribing audit identified suboptimal benzodiazepine use which stimulated a discontinuation programme [prescribing policy, psychoeducation, anxiety management] to encourage benzodiazepine cessation. Benzodiazepine status was re-assessed at 12 and 24 month follow-ups.Results: 158 patients were receiving benzodiazepines at study onset. At 12 month follow-up, 68 of these were still receiving benodiazepines. This was due to discontinuation (n = 32), dose reduction (n = 26) and service dropout (n = 71). Benzodiazepine status at follow-up was predicted by attendance at anxiety management sessions (p = 0.01) and shorter duration of benzodiazepine use (p = 0.005). Patients attending anxiety management sessions were 2.5 times more likely to reduce use. Discontinuation followed four patterns: (a) rapid and complete discontinuation (n = 19); (b) total discontinuation in a gradual manner (n = 13); (c) partial dose reduction without total discontinuation (n = 18) and (d) almost total discontinuation with continued low-dose use (n = 8). The patients that achieved total discontinuation were younger (p = 0.01) and in receipt of benzodiazepine agents for a shorter duration (p = 0.009). At 24 month follow-up only three patients had relapsed into benzodiazepine use and a further 13 had achieved total discontinuation.Conclusions: Many chronic benzodiazepine users can achieve lasting discontinuation with patient-controlled dose tapering. Patient refusal and service dropout are common during discontinuation programmes. Anxiety management is a valuable adjunct to discontinuation.

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