What Not to Prescribe: APA List Aims to Make Patients Safer

Caroline Cassels

September 20, 2013

The American Psychiatric Association (APA) has released a list of specific uses of common antipsychotic medications that are potentially unnecessary and sometimes harmful.

"As clinicians, we know we can improve the care we deliver by engaging our patients in conversation about their care. The recommendations from APA released today provide valuable information to help patients and physicians start important conversations about treatment options and make informed choices about their healthcare," APA president Jeffrey Lieberman, MD, said in a statement.

The APA's list is part of an initiative from the American Board of Internal Medicine (ABIM) Foundation called Choosing Wisely, which has brought together leading specialty societies to develop 30 new evidence-based lists of tests and procedures that may be overused in their specific field.

"When the Choosing Wisely campaign was launched in 2012, we were at the threshold of a national dialogue on waste and overuse in our healthcare system," Richard J. Baron, MD, president and CEO of the ABIM Foundation, said in a statement.

"Thanks to the leadership of physician groups and consumer partners, the campaign has inspired conversations about what care is truly necessary in doctors' offices, communities, hospitals, and health systems across the country," Dr. Baron added.

The APA's list includes 5 recommendations:

  • Don't prescribe antipsychotic medications to patients for any indication without appropriate initial evaluation and appropriate ongoing monitoring

  • Don't routinely prescribe 2 or more antipsychotic medications concurrently

  • Don't use antipsychotics as first choice to treat behavioral and psychological symptoms of dementia

  • Don't routinely prescribe antipsychotic medications as a first-line intervention for insomnia in adults

  • Don't routinely prescribe antipsychotic medications as a first-line intervention for children and adolescents for any diagnosis other than psychotic disorders

The purpose of the list, said Dr. Lieberman, "is not to preclude the use of antipsychotic medications for these indications and populations but to suggest that other treatment options should be considered first, and patients should be engaged in discussion of the rationale for use and the potential benefits and risks."

"The American Psychiatric Association has shown tremendous leadership by releasing its list of common uses of medication that aren't always necessary," said Dr. Baron. "The content of this list and all of the others developed through the Choosing Wisely effort are helping physicians and patients across the country engage in conversations about what care they need and what we can do to reduce waste and overuse in our healthcare system and improve overall health."

To date, more than 80 national and state medical specialty societies, regional health collaboratives, and consumer partners have joined the Choosing Wisely effort promoting conversations about appropriate care. During the next year, more than 30 other specialty society partners will release Choosing Wisely lists. Some of the participating organizations include the following:

  • American College of Surgeons

  • American Academy of Orthopaedic Surgeons

  • Society of General Internal Medicine

  • American Academy of Family Physicians

  • American College of Emergency Physicians

  • American Association of Clinical Endocrinology/The Endocrine Society

  • American Society of Hematology

  • American Geriatrics Society

  • American Academy of Allergy, Asthma, and Immunology

To view the complete APA list and additional details about the recommendations and evidence supporting them, visit www.psychiatry.org/choosingwisely. Also, see more on the Choosing Wisely national effort.

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