Summary:
In psychiatric outpatients with diabetes, physician-led medication reviews through interdisciplinary dialogue significantly reduced the number of drugs and potentially inappropriate prescriptions (PIPs) compared to usual care without structured medication review, though it was associated with no significant differences in overall healthcare-related costs.
| PICO | Description |
|---|---|
| Population | Forty-eight outpatients with severe mental disorders and comorbid diabetes receiving routine psychiatric care in Denmark. |
| Intervention | Physician-led medication reviews conducted through interdisciplinary dialogue involving psychiatrists and clinical pharmacologists. |
| Comparison | Standard care without structured medication review, reflecting usual clinical practice. |
| Outcome | The intervention group experienced a reduction in the median number of prescribed medications and PIPs by 1, while the control group saw an increase by 2. No statistically significant difference in overall healthcare costs was observed, although the intervention group had fewer phone contacts with healthcare services (median 6.5 vs. 14). |
Clinical Context
Patients with severe mental disorders face substantially elevated rates of diabetes and other cardiometabolic conditions, driven by multiple factors including psychotropic medication side effects, lifestyle factors associated with mental illness, and healthcare access barriers. This population commonly experiences polypharmacy as treatments for psychiatric conditions accumulate alongside medications for physical health comorbidities. Polypharmacy increases risks for drug-drug interactions, adverse effects, medication non-adherence, and potentially inappropriate prescriptions that provide limited benefit relative to their risks. Traditional healthcare delivery often results in fragmented care where psychiatric and medical providers manage their respective domains without comprehensive medication review. Interdisciplinary medication review represents a systematic approach to evaluating the entire medication regimen, identifying opportunities for deprescribing, and optimizing therapy. This study evaluated whether structured physician-led medication reviews could improve prescribing quality and reduce healthcare utilization in this complex patient population.
Clinical Pearls
- Physician-led medication review reduced both total medication count and potentially inappropriate prescriptions, demonstrating that systematic evaluation can successfully address polypharmacy in this complex population.
- The control group experienced medication increases during the same period, highlighting the tendency toward prescription accumulation without structured review interventions.
- Healthcare phone contacts were substantially reduced in the intervention group (median 6.5 vs. 14), suggesting that medication optimization may decrease patient-initiated healthcare seeking.
- Overall healthcare costs showed no significant difference between groups, indicating that the intervention can be implemented without increasing healthcare expenditure.
Practical Application
Healthcare systems serving patients with severe mental illness and medical comorbidities should consider implementing structured medication review programs. The involvement of both psychiatrists and clinical pharmacologists provides comprehensive expertise for evaluating complex regimens spanning psychiatric and medical domains. The cost-neutrality finding supports program implementation from a resource allocation perspective, while the prescribing quality improvements provide clinical justification. For individual clinicians, this study reinforces the value of periodic comprehensive medication review, particularly for patients whose medication lists have grown over time without systematic reassessment. The reduced healthcare contacts observed may reflect better disease stability or improved patient confidence following thorough medication review and optimization.
Broader Evidence Context
This study contributes to growing evidence supporting systematic medication review interventions across various patient populations. Deprescribing initiatives have demonstrated benefits in elderly populations and nursing home residents, and this research extends similar principles to psychiatric outpatients with medical comorbidities. The finding that healthcare utilization decreased without cost increases aligns with literature suggesting that better care coordination and medication optimization can maintain quality while reducing unnecessary interactions. The cost-minimization analysis approach appropriately addresses payer and health system perspectives on resource allocation for this type of quality improvement intervention.
Study Limitations
- The sample size of 48 patients limits statistical power, particularly for detecting differences in healthcare cost outcomes which typically have high variance.
- The study was conducted within the Danish healthcare system, and findings may not directly transfer to different healthcare financing and delivery structures.
- Clinical outcomes such as psychiatric stability, diabetes control, and adverse events were not primary endpoints, leaving uncertainty about the health impact of medication changes.
- The intervention required interdisciplinary collaboration between psychiatrists and clinical pharmacologists, which may not be feasible in all healthcare settings.
- Follow-up duration was not specified, limiting assessment of outcome sustainability.
Bottom Line
Physician-led medication reviews through interdisciplinary dialogue successfully reduce medication burden and potentially inappropriate prescriptions in psychiatric outpatients with diabetes without increasing healthcare costs. Healthcare systems should consider implementing structured medication review programs for this complex patient population.
Source: Christensen, Johan Frederik Mebus, et al. “Facilitating the Implementation of Physician-Led Medication Reviews for Patients With Severe Mental Disorder and Diabetes: A Cost-Minimization Analysis.” Basic & Clinical Pharmacology & Toxicology. Read article here.
