Impact of clinical pharmacy on the psychotropic drugs prescription in neurological rehabilitation: A retrospective study

Abstract

Psychotropic drugs are frequently prescribed in neuro-rehabilitation. In our institution, they account for 18% of prescriptions. For several years, clinical pharmacy activities were developed in collaboration with physicians and psychiatrists. The aim of this study is to evaluate the impact of this approach by the retrospective measure of psychotropic drugs consumption over 4 years, and link them to the evolution of hospital stays recorded through the PMSI (Programme de médicalisation des systèmes d’information, France). The study took place over the period 2010–2013. It included three steps: 1/Monitoring of psychotropic drugs consumption (antipsychotics, anxiolytics, hypnotics and antidepressants) of 9 units (225 beds), by value and treatment days calculated from the daily average dosage (THERIAQUE); 2/Identification of hospitalised patients with at least one diagnosis code of either depression, anxiety, insomnia, and/or psychotic disorders; 3/Analysis of patient data with regard to drug consumption. From 2010 to 2013, the cost of psychotropic drugs was reduced by 24%, from 17,617 to 13,366 euros. The number of treatment days decreased by 30% from 84,765 to 59,466 days. The most significant decline was for hypnotic drugs (–62%) (28,110 to 10,623 days), and anxiolytic drugs (–37%) (28,958 to 18,343 days). The usage of antidepressant drugs increased by 21% (19,996 to 24,154 days), while the usage of antipsychotic drugs was stable (6346 days in 2013). During the same period, the overall number of patients with psychological diagnosis code hospital stays increased by 146% (213 to 523). It can be further detailed as follows: +380% for patients with an anxiety disorder (60 to 287), +71% for patients with depressive symptoms (78 to 133). Stays of patients with psychotic disorders remained stable. This study illustrates that a clinical pharmacy action targeted on psychotropic drugs prescriptions in collaboration with physicians and psychiatrists has reduced their consumption in neuro-rehabilitation. This decrease concerns mainly anxiolytic drugs and hypnotic drugs, despite the rise in number of hospital stays of patients with anxiety disorders. These results follow the recent recommendations of the ANSM (Agence nationale de sécurité du médicament, France).