Novel Antipsychotics and Patient Care in State Hospitals

1998 ◽  
Vol 32 (9) ◽  
pp. 906-914 ◽  
Author(s):  
Peter F Buckley

OBJECTIVE: To review and highlight the opportunities and challenges of pharmacologic advances in the use of antipsychotics for the state hospital system. METHODS: A critical review was performed of studies published either as articles or abstracts, on the use of novel antipsychotics, particularly as they relate to the patient population within the state mental hospital system. FINDINGS: The recent availability of new antipsychotic medications within state facilities has resulted in more progressive treatment, reduced recidivism (and consequently cost savings), and preliminary evidence of preferential and superior treatment response in specific patient subgroups (e.g., those with aggression). At the same time, inpatient pharmacy budget increases and uncertainty in guiding the use of novel antipsychotics have influenced the availability of these agents in state hospitals. CONCLUSIONS: State hospital services have, by and large, embraced the developments in pharmacotherapy of schizophrenia. Optimal use of these new agents in this population requires additional information on their relative efficacy in specific patient subgroups.

2000 ◽  
Vol 24 (2) ◽  
pp. 61-64 ◽  
Author(s):  
Jonathan Steele ◽  
Janice Duncan ◽  
Angela Short

Aims and MethodThis paper is based on two audits carried out in 1996 and 1998 atThe State Hospital, Carstairs. Each audit looked at anti-muscarinic drug use within the hospital, in relation to approved prescribing standards issued in 1996. All patients within the hospital on anti-muscarinic drugs were identified at the timeof each audit. These prescriptions were compared with the approved prescribing standards. In the 1998 audit additional information was obtained from the case notes and the consultants, when the approved standards were not met.ResultsThe percentage of patients on regular anti-muscarinic drugs, falling outwith the prescribing standards, reduced between the two audits. However, in 1998 a small number of patients were still outwith the approved prescribing standards set in 1996.ConclusionsAn improvement in the prescribing practice of anti-muscarinics occurred following the introduction of prescribing guidelines. However, the guidelines were not fully met in the 1998 audit. This demonstrates the need for further audit and continued monitoring of anti-muscarinic prescription at the State Hospital.


1954 ◽  
Vol 110 (10) ◽  
pp. 781-783
Author(s):  
G. WILSE ROBINSON

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S658-S658
Author(s):  
Andrew H Karaba ◽  
Paul W Blair ◽  
Kevin M Martin ◽  
Mustapha O Saheed ◽  
Karen C Carroll ◽  
...  

Abstract Background Neuroinvasive West Nile Virus (WNV) often leads to prolonged neurological deficits and carries a high case fatality rate. The CSF IgM (MAC-ELISA) is preferred over the CSF nucleic acid-based test (NAAT) by the CDC due to its higher sensitivity. However, our hospital system was observed to have an over-utilization of NAAT testing compared with MAC-ELISA testing. The primary objective was to compare the number of MAC-ELISA and NAAT WNV tests ordered before and after a diagnostic stewardship intervention. The secondary objectives were to determine whether this change to lead to any cost savings and increased detection of probable cases of WNV-ND. Methods In an effort to increase the use of the MAC-ELISA and to decrease unnecessary NAAT testing, the NAAT test was removed in April 2018 from the test menu in the electronic health record of a health system comprising five hospitals in the Maryland and Washington, D.C. area. NAAT testing remained possible via a paper order form. This study was a retrospective review of WNV testing done on CSF samples from July 2016 through December 2018. The seasonal and yearly number of total tests, positive tests, and total costs were determined from the period of July, 2017 to April, 2018 and were compared with May, 2018 to January, 2019. A paired t-test was performed to evaluate for differences in total testing, total positives, and total costs during non-winter months before and after the intervention. Results A total of 12.59 MAC-ELISA tests/month (95% CI: 10.29, 14.89) increased to 41 tests/month (95% CI: 34.35, 47.65) which was significantly different (P < 0.001). In contrast, there were 46.23 NAAT tests/month (95% CI: 39.55, 52.91) which decreased to 0 NAAT tests/month after the intervention (P < 0.001). This resulted in an average decrease in WNV test spending from $7200 per month to $471 per month (P < 0.001). Preceding the intervention in test ordering, 0.23% of WNV CSF tests were positive (NAAT+MAC-ELISA) while 2.44% WNV CSF tests were positive after the intervention (P = 0.03). Conclusion Elimination of electronic WNV NAAT ordering is an effective way of decreasing inappropriate WNV NAAT testing, decreasing associated costs, and may lead to improved diagnosis of WNV-ND. Disclosures All authors: No reported disclosures.


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