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Best Practices: An Intervention to Promote Evidence-Based Prescribing at a Large Psychiatric Hospital

The authors are affiliated with Western Psychiatric Institute and Clinic and the Department of Psychiatry, University of Pittsburgh School of Medicine. Dr. Fabian is also with the Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy. Send correspondence to Dr. Ghinassi, Western Psychiatric Institute and Clinic, 3811 O'Hara St., Pittsburgh, PA 15213-2593 (e-mail: ghinassifa{at}upmc.edu). This work was previously presented at the Institute on Psychiatric Services, New Orleans, October 11–14, 2007. William M. Glazer, M.D., is editor of this column.

An intervention to affect prescribing behavior was implemented at a large psychiatric hospital. Articles providing support for appropriate dosing of quetiapine were distributed to physicians, and peer discussions about prescribing practices were held. From April 2005 through December 2006, low-dose quetiapine prescriptions (200 mg per day) were flagged. For four months, physicians writing low-dose prescriptions received personal feedback from the unit medical director, who encouraged appropriate alternatives. New low-dose prescriptions fell from 107 in July 2005 to 23 in December 2006. Monthly costs for quetiapine prescriptions declined by approximately $8,000. The intervention appeared to bring physicians' behavior more in line with evidence-based practices.

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