Medication Patterns in a Geriatric Psychiatry Outpatient Clinic

Abstract

<h3>Introduction</h3> To date, little has been published about the specific pharmacological prescribing patterns in a geriatric psychiatry outpatient clinic. This retrospective chart review was conducted as part of a QI/PI project intended to examine prescribing patterns and more granular details of psychotropic drug initiation and discontinuation among geriatric psychiatry outpatients. The study intended to identify clinical patterns, unmet patient needs, trends, and opportunities to optimize clinical care and improve patient outcomes. The poster is a preliminary summary of identified trends. <h3>Methods</h3> As part of a quality improvement chart review project examining pharmacological treatments and clinical outcomes at two teaching geriatric psychiatry clinics, we set out to review the electronic medical records of one hundred patients seen in a geriatric psychiatry teaching service. Patients were selected if they were 65 years of age or older and had a minimum of six documented outpatient visits or visits spanning a minimum of six months. Data was collected for a maximum duration of twelve months. Data from any inpatient stays was excluded. Our dataset included basic demographic data such as age, sex, and marital status, as well as diagnoses, MMSE scores, and medications extracted from chart documentation at each clinic visit. <h3>Results</h3> At the point of this interim analysis, our population was 75.1 years old (+/- 8.6 years SD), 69% female, 41% widowed, 31% married, 28% single, 90% Caucasian, and had 14.1 ys of education (+/- 2.9 yrs SD). Common medical comorbidities included hypertension (72%), hyperlipidemia (62%), arrhythmias (24%), and 38% were being treated with an anticoagulant. The top three most commonly prescribed medication classes at baseline were: 1) Antidepressants (43%), followed by 2) Benzodiazepines (16%), 3) shared by two classes Antiepileptics/Lithium and Antipsychotics (13% each). The top three most commonly prescribed medications at baseline were: 1) mirtazapine (10%), 2) shared by two drugs, bupropion and quetiapine (7% each), and 3) escitalopram (6%). The reviewed patients had an average of 9 visits over an average 9 month long review period. When first seen at the clinic, patients were already taking an average of 2.6 psychotropic drugs. That number was 2.9 at the end of the followup period. Over the course of the review period, patients on average discontinued 1 drug and started 2 new ones, generating an average of 7.4 orders for medication initiation, discontinuation, or dose adjustments. <h3>Conclusions</h3> These preliminary chart review results reflect the challenges posed by the psychopharmacological management of elderly patients. Patients frequently arrive at our clinic following treatment failures or complications, and often on psychotropic polypharmacy. Due to fluctuations in patients' conditions and the need to titrate medications slowly, patients require numerous medications changes and dose adjustments, necessitating frequent visits. The clinic advises to minimize benzodiazepine use. Our data suggests that a significant proportion of patients (15%) come to our clinic while being treated with benzodiazepines, and our review suggests that in the short term efforts to wean them off their benzodiazepines are not successful. <h3>Secondary Rationale</h3> N/A <h3>This research was funded by</h3> No funding was obtained for this study.