Background and Objective: Psychotropic drugs are complex, associated with potential serious adverse reactions and drug interactions. Comorbidities are frequent among psychiatric population, leading to increased vulnerability and polypharmacy. Optimizing pharmacotherapy is thereby essential. From a drug safety perspective, weekly medication reviews, in a multidisciplinary context (physicians, nurses and a clinical pharmacist) have been implemented within the psychiatric hospital units.
The aim of this study is to describe the pharmaceutical interventions (PI) carried out in a psychiatric hospital and to evaluate the impact on the routine of the clinical pharmacy unit.
Design: This retrospective, monocentric, observational study, con- sisted in the analysis of the pharmaceutical interventions (PI) collected from January 2017 to December 2020 during the medication reviews, carried out in 3 adult psychiatric and 1 psychogeriatric units (60 patients). PI have been reported according to the classification system from the Swiss Association of Public Health Administration and Hospital Pharmacists. The number of questions reaching the hotline of the clinical pharmacy unit has also been quantified. Results: The number of medication reviews increased from 13 in 2017 to 78, 107 and 125 in 2018, 2019 and 2020, respectively. The number of PI were respectively 56, 583, 893 and 870 in 2017, 2018, 2019 and 2020. The main reasons of interventions were medical questions (23%), adverse effects (15%), inappropriate duration of treatment (14%) and interactions (10%). The 4 main propositions were the same across 2018, 2019 and 2020 and consisted in providing medication information (20–27%), dosage adjustments (15–22%), monitoring (15–18%) and withdrawal of a medication (14–21 %). Depending on the year, between 59 and 75% of the propositions were accepted. Since 2017, the number of hotline questions related to psychiatry was increased by 2-fold in 2018 and 2019 and 3.8-fold in 2020. 75% came from physicians and focused on choice of treatment (19%), therapeutic alternative (18%), administration mode (17%) and dosage (16%).
Conclusion: Clinical pharmacists allow to provide safety use of psychotropic drugs and have a central role in improving therapeutic management. The increasing number of questions reaching the clinical pharmacy unit highlights the need of regular pharmaceutical support in psychotropic prescribing.