Sometimes PMR notes were entered in the EMR when
the patient did not have an upcoming appointment with
the prescriber. As a result, there were instances when recommendations could not be implemented due to time
and workload constraints. Many providers acknowledged
the importance of shared medical decision making and
preferred to wait to make medication adjustments until
patients could be seen in the clinic.
Psychotropic medication review is a continually developing process, and these results illustrate provider response to the initial 5 months of a new service. During
the time frame, PMR notes had been entered for all veterans identified as using antipsychotics or benzodiazepines in the setting of dementia but for only a fraction of
those identified as using benzodiazepines who were aged
> 75 years. It is reasonable to expect that as prescribers
become more familiar with the PMR process and its intentions, they may be more likely to acknowledge recommendations and to respond with the appropriate
Psychotropic medication reviews were initiated as part
of a PGY-2 psychiatric pharmacy residency project, and
as such, the impact on the CPS workflow was not evaluated. Although this study suggests that the use of PMR
was effective in improving evidence-based prescribing, it
does not evaluate whether this process is sustainable in
the long-term for the CPS.
The results of this study illustrate the value of a psychiatric CPS. Through the implementation of a simple PMR
service, CPSs were able to impact evidence-based prescribing and related documentation. With nearly 50% of
the recommendations accepted, the authors believe that
use of the PMR is an effective way to deliver provider education and improve safe prescribing practices. Further
review of the PMR process will be needed to evaluate the
impact and sustainability on CPS workflow. l
This study is the result of work supported with resources
and the use of facilities at the Lexington VAMC.
The authors report no actual or potential conflicts of interest with regard to this article.
The opinions expressed herein are those of the authors
and do not necessarily reflect those of Federal Prac-
titioner, Frontline Medical Communications Inc., the
U.S. Government, or any of its agencies. This article
may discuss unlabeled or investigational use of certain
drugs. Please review complete prescribing information
for specific drugs or drug combinations—including
indications, contraindications, warnings, and adverse
effects—before administering pharmacologic therapy to
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5. Billioti de Gage S, Moride Y, Ducruet T, et al. Benzodiazepine use and risk of Alzheimer’s disease: case-control study. BMJ. 2014;349:g5205.
Figure. Sample Psychotropic Mediciation