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The DEBIT trial: an intervention to reduce antipsychotic polypharmacy prescribing in adult psychiatry wards – a cluster randomized controlled trial

  • A. Thompson (a1), S. A. Sullivan (a1), M. Barley (a1), S. O. Strange (a1), L. Moore (a2), P. Rogers (a3), A. Sipos (a1) and G. Harrison (a1)
  • DOI:
  • Published online: 10 September 2007

Clinical guidelines advise against prescribing more than one antipsychotic with limited exceptions. Despite this, surveys continue to report high antipsychotic polypharmacy rates. The aim of the study was to investigate the effectiveness of a multi-faceted intervention in reducing prescribing of antipsychotic polypharmacy on general adult psychiatry wards, compared with guidelines alone.


A pragmatic cluster randomized controlled trial recruited 19 adult psychiatric units (clusters) from the South West of England. Participants were all ward doctors and nurses. The multi-faceted intervention comprised: an educational/CBT workbook; an educational visit to consultants; and a reminder system on medication charts.


The odds of being prescribed antipsychotic polypharmacy in those patients prescribed antipsychotic medication was significantly lower in the intervention than control group when adjusted for confounders (OR 0.43, 95% CI 0.21–0.90, p=0.028). There was considerable between-unit variation in polypharmacy rates and in the change in rates between baseline and follow-up (5 months after baseline).


The intervention reduced levels of polypharmacy prescribing compared to guidelines alone although the effect size was relatively modest. Further work is needed to elicit the factors that were active in changing prescribing behaviour.

Corresponding author
*Address for correspondence: Ms S. Sullivan, Academic Unit of Psychiatry, University of Bristol, Bristol BS6 6JL, UK. (Email:
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J Avorn , SB Soumerai , DE Everitt , D Ross-Degnan , MH Beers , D Sherman , SR Salem-Schatz , D Fields (1992). A randomized trial of a program to reduce the use of psychoactive drugs in nursing homes. New England Journal of Medicine 327, 168173.

D Berings , L Blondeel , H Habraken (1994). The effect of industry-independent drug information on the prescribing of benzodiazepines in general practice. European Journal of Clinical Pharmacology 46, 501505.

LA Bero , R Grilli , JM Grimshaw , E Harvey , AD Oxman , MA Thomson (1998). Getting research findings into practice: closing the gap between research and practice: an overview of systematic reviews of interventions to promote the implementation of research findings. British Medical Journal 317, 465468.

F Centorrino , M Eakin , W-M Bahk , JP Kelleher , J Goren , P Salvatore , S Egli , RJ Baldessarini (2002). Inpatient antipsychotic drug use in 1998, 1993 and 1989. American Journal of Psychiatry 159, 19321935.

O Freudenreich , DC Goff (2002). Antipsychotic combination therapy in schizophrenia. A review of efficacy and risks of current combinations. Acta Psychiatrica Scandinavica 106, 323330.

PS Gill , M Makela , KM Vermeulen , N Freemantle , G Ryan , C Bond , T Thorsen , FM Haaifer-Ruskamp (1999). Changing doctor prescribing behaviour. Pharmacy World and Science 21, 158167.

JM Grimshaw , MP Eccles , AE Walker , RE Thomas (2002). Changing physicians' behavior: what works and thoughts on getting more things to work. Journal of Continuing Education in the Health Professions 22, 237243.

M Harrington , P Lelliott , C Paton , C Okacha , R Duffett , T Sensky (2002). The results of a multi-centre audit of the prescribing of antipsychotic drugs for in-patients in the UK. Psychiatric Bulletin 26, 414418.

H Ito , A Koyama , T Higuchi (2005). Polypharmacy and excessive dosing: psychiatrists' perceptions of antipsychotic drug prescription. British Journal of Psychiatry 187, 243247.

P McGorry , E Killackey , K Elkins , M Lambert , T Lambert (2003). Summary Australian and New Zealand clinical practice guideline for the treatment of schizophrenia. Australian Psychiatry 11, 136158.

JO Prochaska , CC DiClemente (1986). Towards a Comprehensive Model of Change. In Treating Addictive Behaviours: Processes of Change (ed. W. R. Miller and N. Heather ), pp. 327. Plenum Press: New York.

WA Ray , DG Blazer , W Schaffner , CF Federspiel (1987). Reducing antipsychotic drug prescribing for nursing home patients: a controlled trial of the effect of an educational visit. American Journal of Public Health 77, 14481450.

SB Soumerai , J Avorn (1990). Principles of educational outreach (‘academic detailing’) to improve clinical decision making. Journal of the American Medical Association 263, 549556.

SM Stahl (2002). Antipsychotic polypharmacy: evidence based or eminence based? Acta Psychiatrica Scandinavica 106, 321322.

EC Van Eijk , J Avorn , AJ Porsius , A de Boer (2001). Reducing prescribing of highly anticholingeric antidepressants for elderly people: randomised trial of group versus individual academic detailing. British Medical Journal 322, 654657.

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