Antipsychotic polypharmacy prescribing and risk of hospital readmission

• Published in: Psychopharmacology Vol. 235; no. 1; pp. 281 - 289
• Main Authors: Kadra, Giouliana, Stewart, Robert, Shetty, Hitesh, MacCabe, James H., Chang, Chin-Kuo, Kesserwani, Jad, Taylor, David, Hayes, Richard D.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.01.2018; Springer; Springer Nature B.V
• Subjects: Adult; Adults; Aged; Antipsychotic agents; Antipsychotic Agents - therapeutic use; Antipsychotics; Biomedical and Life Sciences; Biomedicine; Causes of; Clozapine; Clozapine - therapeutic use; Complications and side effects; Drug Therapy, Combination; Female; Hospital admission and discharge; Humans; Male; Mental disorders; Mental health; Mental health care; Middle Aged; Neurosciences; Original Investigation; Patient Readmission - statistics & numerical data; Pharmacology/Toxicology; Polypharmacy; Proportional Hazards Models; Psychiatry; Psychopharmacology; Psychotropic drugs; Regression Analysis; Retrospective Studies; Risk Factors; Antipsychotics; Readmission; Polypharmacy; Co-prescribing; Rehospitalisation
• ISSN: 0033-3158; 1432-2072
• DOI: 10.1007/s00213-017-4767-6

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.