Drug therapy in patients subject to outpatient compulsory mental health care

Abstract

Rationale, aims and objectives: The use of coercion in mental health services is controversial. Little is known about drug therapy in patients subject to ambulant compulsory mental healthcare. The purpose of this study was to describe the drug therapy and follow-up in patients subject to ambulant compulsory mental healthcare at Sorlandet Hospital, Norway and, if possible, to improve drug therapy through specific advice from a consultant pharmacist.

Method: Relevant information was obtained from the medical records of the included patients. Drug reviews were processed. Identified drug-related problems (DRPs) were presented to the interdisciplinary treatment teams and initiatives were documented.

Results: Of the 101 patients subject to ambulant compulsory mental healthcare, 77 patients met the inclusion criteria. On average each patient used 3.6 drugs overall. All patients were using at least one antipsychotic agent, 83 % used depot injections. We identified 68 DRPs in 51 patients. Of these, 54 DRPs were concurred by the psychiatrist treating the patient. The most common type of concurred DRP was "lack of monitoring". The most common initiative was "discussion in the multidisciplinary team or with the patient".

Conclusion: Even though the indication was clear, drugs were not always prescribed. Or they were prescribed in too low doses, according to the request of the patient. Among the presented DRPs a high proportion was concurred on, but few alterations were made immediately. A pharmacist can contribute to improving drug therapy, but pharmacists are not currently regular members of the interdisciplinary treatment team.