Antipsychotic polypharmacy prescribing and risk of hospital readmission
Objectives The aim of this study was to determine if there was an association between being discharged on antipsychotic polypharmacy (APP) and risk of readmission into secondary mental health care. Methods Using data from the South London and Maudsley (SLAM) case register, service users with serious...
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Published in | Psychopharmacology Vol. 235; no. 1; pp. 281 - 289 |
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Main Authors | , , , , , , , |
Format | Journal Article |
Language | English |
Published |
Berlin/Heidelberg
Springer Berlin Heidelberg
01.01.2018
Springer Springer Nature B.V |
Subjects | |
Online Access | Get full text |
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Summary: | Objectives
The aim of this study was to determine if there was an association between being discharged on antipsychotic polypharmacy (APP) and risk of readmission into secondary mental health care.
Methods
Using data from the South London and Maudsley (SLAM) case register, service users with serious mental illness (SMI), discharged between 1st January 2007 and 31th December 2014, were followed up for 6 months. Patients were classified as receiving either monotherapy or polypharmacy at index discharge. Multivariable Cox regression models were constructed, adjusting for sociodemographic, socioeconomic, clinical and service use factors.
Results
We identified 5523 adults who had been admitted at least once to SLAM, of whom 1355 (24.5%) were readmitted into secondary mental health care. In total, 15% (
n
= 826) of patients were discharged on APP and 85% (
n
= 4697) on monotherapy. Of these, 30.9% (
n
= 255) and 23.4% (
n
= 1100) were readmitted respectively. Being discharged on APP was associated with a significantly increased risk of readmission, in comparison to patients discharged on monotherapy (HR = 1.4, 1.2–1.7,
p
< 0.001). This association was maintained in the fully adjusted model and following several sensitivity analyses. We further established that patients receiving clozapine APP (
n
= 200) were at a significantly increased risk for readmission in comparison to patients on clozapine monotherapy (HR = 1.8, 1.2–2.6,
p
= 0.008).
Conclusions
Our results suggest that patients discharged on APP are more likely to be readmitted into hospital within 6 months in comparison to those discharged on monotherapy. This needs to be considered in treatment decisions and the reasons for the association clarified. |
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ISSN: | 0033-3158 1432-2072 |
DOI: | 10.1007/s00213-017-4767-6 |