AbstractsMedical & Health Science

Continuity of pharmaceutical care for psychiatric patients

by Heshu Abdullah-Koolmees

Institution: Universiteit Utrecht
Year: 2015
Keywords: Pharmaceutical care; medication; hospitalization; somatic; discharge; discontinuation; rehospitalization; rehospitalization prediction
Record ID: 1257788
Full text PDF: http://dspace.library.uu.nl:8080/handle/1874/311180


Psychiatric diseases are common. The effective treatment of a psychiatric disease, its (somatic) side effects and any concurrent somatic diseases is important for the patient’s overall health and wellbeing. The studies conducted in psychiatric patients generally focus on the continuation of psychiatric medication, but not on the continuation of somatic medications. These studies show that psychiatric patients commonly discontinue their psychiatric medication. However, studies on the overall continuity of pharmaceutical care in patients admitted to and discharged from a psychiatric hospital are scarce and fragmented. Based on the current knowledge, the overall objective of this thesis was to assess the continuation of pharmaceutical care in psychiatric patients. The use of somatic medications is high in psychiatric patients admitted to psychiatric hospitals. We found that 67.5-76.9% of the patients admitted to a psychiatric hospital in the Netherlands were using at least one somatic medication. It is commonly acknowledged that the risk of discontinuation of medication is high when patients are admitted to or discharged from general hospitals. As indicated by the studies in this thesis, the risk of discontinuity of somatic medication is high when patients are admitted to or discharged from a psychiatric hospital. 38.9% of the patients using somatic medication discontinued the use of at least one somatic medication during the first week of psychiatric hospitalization. For instance, 34.9% of the cardiovascular and acid-and bowel-related medications were discontinued during this first week. In addition, we found that the monitoring of pharmacotherapy may fail during admission to psychiatric hospitals as in almost 25% of the hospitalized patients either anticoagulant medication and/or International Normalized Ratio (INR) monitoring was discontinued. At discharge we found that at least a single medication is discontinued in almost 70% of psychiatric patients. Of all patients using antipsychotics, 25.2% discontinued the use of their antipsychotic medications, and of all patients using cardiovascular medications, 28.4% discontinued a cardiovascular drug. Obviously, the continuity of pharmaceutical care is important for the treatment and stabilization of psychiatric diseases after discharge. Therefore, we assessed the association between adherence to antipsychotics and psychiatric rehospitalization in patients with psychotic disorders during the first year after discharge. Patients who did not initiate antipsychotic medication use during the follow up had a higher risk of rehospitalization (RR = 3.7; 95% CI: 2.4-5.5) when compared to patients who did initiate use. For patients who initiated the use of psychiatric medication during the first month after the discharge, those who discontinued use had a twofold (RR = 2.3; 95% CI: 1.2-4.5) risk for rehospitalization during 2nd to 12th month after discharge when compared to those continuing use. It is important to identify which patients are at a greater risk for…