Forget‐Me‐Not: Evaluation of a Post Hospital Antipsychotic Deprescribing Intervention in Dementia and Delirium
Cathy Ngo, Stephanie Gibson, Hiba Ali, Mahesan Anpalahan, Ken Teo, Rohith Valsalan, Paul Wembridge, Emily Schembri, Gary YipABSTRACT
Objective
To evaluate the impact of a joint hospital pharmacist and medical physician deprescribing intervention on antipsychotic cessation and/or dose reduction 12 weeks post hospital discharge.
Methods
This prospective cohort study was conducted at a Victorian metropolitan hospital network. Patients discharged from General Medicine, with delirium or dementia and prescribed at least one antipsychotic were eligible. The control group (July to November 2021) received written information about antipsychotic use in dementia and/or delirium. The intervention group (May to December 2022) received the same written information and a pharmacist/physician antipsychotic review after hospital discharge. Deprescribing recommendations were communicated to General Practitioners (GPs) for consideration and action. Antipsychotic prescription was recorded at 12 weeks post‐discharge.
Results
Sixty‐two per cent of control group patients ( n = 81) and 75% of intervention group patients ( n = 77) were alive at the 12‐week follow‐up. For surviving patients, there was no difference in complete antipsychotic cessation between groups (32% control vs. 17% intervention, p = 0.07); however, the control group had greater total dose reduction (42% vs. 17%, p = 0.005).
Conclusion
The intervention did not reduce antipsychotic prescription at 12 weeks, compared to standard care. Rather, on the outcome of antipsychotic dose reduction, standard care was better. These were unexpected findings. Differences in clinical diagnosis and specific antipsychotic prescribed may be confounding factors, warranting further analysis. A negative outcome is important to report as new practices should have robust evidence before consideration for wider implementation.