Improving prescribing practice in psychiatry: The experience of the Prescribing Observatory for Mental Health (POMH-UK)

Abstract

Data from the UK Prescribing Observatory for Mental Health (POMH-UK) suggest that while positive change in prescribing practice can be achieved with focused, audit-based, quality improvement programmes (QIPs) that include feedback of benchmarked performance data and customized change interventions, the time frame for progress is long and improvement generally modest. Improvement may be seen between the baseline audit and re-audit, but supplementary audits conducted in subsequent years can show incremental, sustained improvement in clinical services that have been consistently involved. Audit invariably reveals a marked variation across and within healthcare organizations in the level of compliance with evidence-based clinical practice standards. Additional work has identified various impediments to behavioural change. Some are common to all QIPs, such as the incomplete dissemination of audit results throughout participating organizations and variable uptake of change interventions. Others are specific to particular QIPs, depending on the prescribing issue addressed. For example, in a QIP targeting biochemical monitoring of lithium treatment, the major barrier was the complexity of clinical care arrangements, including multiple interfaces between clinical and laboratory services, which were often not directly or wholly under the control of clinical teams. In this QIP there was little improvement in overall performance against the clinical standards in the total national sample between baseline and re-audit.

Acknowledgements

The Prescribing Observatory for Mental Health: POMH-UK (www.rcpsych.ac.uk/pomh) is based at the College Centre for Quality Improvement at the Royal College of Psychiatrists. Acknowledgments are due to the POMH-UK project team, and the NHS clinicians and administrators involved with the collection of the audit data.

Declaration of interest: Both authors have acted as consultants/advisory board members for the pharmaceutical industry in relation to antipsychotic medication in the last 5 years. The authors alone are responsible for the content and writing of the paper.