Epidemiologia e Psichiatria Sociale

Original Papers

Drug prescription in Italian Residential Facilities

Rodolfo Tomasia1, Giovanni de Girolamoa2 c1, Giovanni Santonea3, Angelo Picardia4, Rocco Miccioloa5, Domenico Semisaa6, Silva Favaa7 and Gruppo Progresa8

a1 Servizio Psichiatrico, AS di Bolzano, Bolzano

a2 Dipartimento di Salute Mentale, AUSL di Bologna, Bologna

a3 Clinica Psichiatrica, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, “Umberto I, G.M. Lancisi, G. Salesi”, Ancona

a4 Centro Nazionale di Epidemiologia, Sorveglianza e Promozione della Salute, Istituto Superiore di Sanità, Roma

a5 Cattedra di Biostatistica, Università di Trento, Trento

a6 Dipartimento di Salute Mentale, Bari

a7 Servizio di Psicologia Clinica, Distretto di Faenza, ASL di Ravenna, Ravenna

a8 II Gruppo PROGRES include: Coordinatori Nazionali, G. de Girolamo, A. Picardi, P. Morosini (Progetto Nazionale Salute Mentale, lstituto Superiore di Sanità, Roma); Biostatistico, R. Micciolo (Università di Trento); Coordinatori Regionali, P. Argentino, G. Borsetti, M. Casacchia, P. Ciliberti, G. Civenti, A. Colotto, G. Dell'Acqua, W. Di Munzio, G. Fagnano, A. Fioritti, N. Longhin, M. Miceli, M. Nicotera, M. Pisetta, R. Putzolu, E. Rossi, M.E. Rotunno, D. Semisa, R. Tomasi, P. Tulli, E. Zanalda, Ricercatori: F. Amaddeo, C. Barbini, F. Basile, G. Bazzacco, R. Bracco, A. Calvarese, G. Canuso, E. Caroppo, L. Caserta, M. Colangione, S. Damiani, T. De Donatis, F. Di Donato, V. Di Michele, R. Esposito, M. Facchini, I. Falloon, S. Ferraro, P. Fracchiolla, P. Gabriele, D. Gallicchio, G. Giardina, A. Greco, F. Grilletti, S. Guzzo, A.M. Lerario, M.R. Marinelli, C. Marino, E. Monzani, F. Picco, L. Pinciaroli, C.A. Rossetti, P. Rubatta, G. Santone, F. Scorpiniti, V. Scrofani, M. Stefani, A. Svettini, A. Zaffarano, M. Cellini, A. Galli, K. Pesaresi, G. Pitzalis, L. Tarantino.

SUMMARY

Aims — To investigate in a representative national sample (N=2,962) of patients living in Residential Facilities (RFs) patterns of polypharmacy as well as related variables, association between diagnoses and therapeutic patterns, and the rate of adverse events. Methods — Structured interviews focusing on each patient were conducted by trained research assistants with the manager and staff of each RF. Patients were rated with the HoNOS and the SOFAS, and comprehensive information about their sociodemographic and clinical status, and their pharmacological regimes were collected. Results — Conventional antipsychotics and second-generation antipsychotics were prescribed to 65% and 43% of the sample, respectively. Benzodiazepines were prescribed to two-thirds of the sample, while antidepressants were the least-used class of psychotropics. Polypharmacy was common: on average, each treated patient was taking 2.7 drugs (±1.1); antipsychotic polypharmacy was also common. Many prescriptions were loosely related to specific diagnoses. Antiparkinsonianian drugs were prescribed to approximately 1/4 of the sample. Mild or severe adverse events in the previous month were reported for 9.9% and 1.4% of the sample, respectively. About 15% of patients suffered from tardive dyskinesia. Conclusions — Psychotropic drug prescription patterns for severe patients living in RFs are only sometimes satisfactory and offer the opportunity of improvement. Specific actions are required to improve prescription patterns for severe patients in RFs.

Declaration of Interest: in the past two years GdG has received two speaker fees from Janssen-Cilag and from Eli Lilly; GS has received one speaker fee from Solvay. RM, AP, SF and RT have received no fees or other financial support from pharmaceutical companies.

(Received June 25 2004)

(Revised September 21 2004)

(Accepted September 29 2004)

Correspondence

c1 Address for correspondence: Dr. G. de Girolamo, Dipartimento di Salute Mentale, Viale Pepoli 5, 40123 Bologna. Fax: +39-051-658.4178 E-mail: gdg@iss.it