Using an Integrated Care Pathway for Late-Life Schizophrenia Improves Monitoring of Adverse Effects of Antipsychotics and Reduces Antipsychotic Polypharmacy

• Published in: The American journal of geriatric psychiatry 2019-01, Vol.27 (1), p.84-90
• Main Authors: Abdool, Petal S., Supasitthumrong, T., Patel, K., Mulsant, B.H., Rajji, T.K.
• Format: Article
• Language: English
• Subjects: Aged; Aging; Aging - drug effects; Antipsychotic; Antipsychotic Agents - adverse effects; Antipsychotics; Basal Ganglia Diseases - chemically induced; Basal Ganglia Diseases - epidemiology; Cognitive Dysfunction - chemically induced; Cognitive Dysfunction - epidemiology; Delivery of Health Care, Integrated - statistics & numerical data; Drug Monitoring - statistics & numerical data; Drug therapy; Drug-Related Side Effects and Adverse Reactions - epidemiology; Dyskinesia; Female; Humans; integrated care pathway; Integrative medicine; Male; Mental Health Services - statistics & numerical data; Metabolic Syndrome - chemically induced; Metabolic Syndrome - epidemiology; Middle Aged; monitoring of adverse effects; older age; Ontario - epidemiology; Polypharmacy; Retrospective Studies; Schizophrenia; Schizophrenia - drug therapy; Schizophrenia - epidemiology; Side effects
• ISSN: 1064-7481; 1545-7214
• DOI: 10.1016/j.jagp.2018.09.003

Objective: Antipsychotic use in older patients is associated with many adverse effects, including tardive dyskinesia and extrapyramidal symptoms, which, in turn, increase the risk of falling. Antipsychotics are also associated with metabolic syndrome and cognitive impairment in older patients. Integrated care pathways (ICPs) are designed to manage specific conditions using standardized assessments and measurement-based interventions. This study aims to compare the use of recommended tools to monitor for adverse effects associated with antipsychotics in older patients managed within an ICP and those managed under usual care conditions—i.e., treatment as usual (TAU). Methods: We reviewed and compared the health records of 100 older patients enrolled in an ICP for late-life schizophrenia with those of 100 older patients treated with antipsychotics under TAU conditions. Results: Monitoring rates were significantly higher in the ICP group than in the TAU group for all assessments: extrapyramidal symptoms (94% versus 5%), metabolic disturbances (91% versus 25%), fall risk (82% versus 35%), and cognitive impairment (72% versus 28%). Rates of antipsychotic polypharmacy were also six times higher in the TAU group. Conclusion: Older patients with schizophrenia treated with antipsychotics within an ICP experience higher rates of monitoring and less psychotropic polypharmacy than older patients treated with antipsychotics under TAU conditions. These findings suggest that an ICP can improve the quality of antipsychotic pharmacotherapy in older patients and thus possibly its effectiveness. This needs to be confirmed by a randomized controlled trial.