Matthieu Lebrat, Ahava Cohen, Rachel Megard, Nicolas Franck, Claude Dussart, Marion Perin-Dureau
MPMRs in psychiatric inpatient settings may improve prescribing practices, particularly by reducing high-risk and potentially inappropriate medications. While the overall reduction in total medications was modest, targeted decreases in psychotropics and anticholinergics suggest clinically meaningful benefits for patient safety and medication appropriateness. Further research with randomized designs is warranted to confirm these findings and explore long-term outcomes.
PURPOSE: Multi-professional medication reviews (MPMRs) are structured, collaborative processes designed to optimize medication management and promote evidence-based practice. Yet, their impact in psychiatric settings remains understudied. This study aimed to retrospectively assess the impact of hospital-based MPMRs on medication prescriptions in psychiatric inpatients.
METHODS: An observational, retrospective, pre-post study in four psychiatric wards of a French university hospital was conducted. Participants had two hospital stays: one before and one after MPMR implementation (August 2017-December 2023). Data collection was performed from electronic medical records. The primary outcome was the change in the number of prescribed medications between admission and discharge, compared pre- and post-MPMR implementation. Secondary outcomes included changes in specific drug classes. Data were analyzed using paired tests and mixed linear models (MLM), adjusting for age, sex, hospitalization duration, and ward.
RESULTS: MPMR implementation was associated with a significant reduction in the total number of prescribed medications (-1.1 drugs, p = 0.044 or 0.001 with a MLM, Cohen's d = 0.18). Significant decreases were observed in overall psychotropic medications (-1.5, p < 0.001), benzodiazepines (-0.8, p < 0.001), antipsychotics (-0.3, p < 0.05), anticholinergics (-0.7, p ≤ 0.05), and laxatives (-0.2, p ≤ 0.05). No significant changes were found for antidepressants, mood stabilizers, or analgesics. Sex differences were noted in overall psychotropic deprescribing, with men showing greater reduction.
CONCLUSION: MPMRs in psychiatric inpatient settings may improve prescribing practices, particularly by reducing high-risk and potentially inappropriate medications. While the overall reduction in total medications was modest, targeted decreases in psychotropics and anticholinergics suggest clinically meaningful benefits for patient safety and medication appropriateness. Further research with randomized designs is warranted to confirm these findings and explore long-term outcomes.