Qual Saf Health Care 18:55-58 doi:10.1136/qshc.2007.024471
  • Original Article

A pilot study testing a medication algorithm to reduce polypharmacy

  1. L A Mistler1,2,
  2. T A Mellman3,
  3. R E Drake1,4
  1. 1
    Department of Psychiatry, Dartmouth Medical School, Hanover, New Hampshire, USA
  2. 2
    VA National Quality Scholars Fellowship Program, VA Medical Center, White River Junction, Vermont, USA
  3. 3
    Department of Psychiatry, Howard University, Washington, DC, USA
  4. 4
    Departments of Community & Family Medicine and of Psychiatry, Dartmouth Medical School, Hanover, New Hampshire, USA
  1. Dr L A Mistler, VA Quality Scholars Program (11Q), VA Medical Center, White River Junction, VT 05009, USA; lisa.a.mistler{at}
  • Accepted 11 March 2008


Background: Polypharmacy is common in the treatment of persons with severe mental illness, yet it is not an evidence-based practice. To address this, an attempt was made to reduce medications for patients already receiving polypharmacy during an episode of acute psychiatric hospitalization.

Methods: A medication-reduction algorithm was developed , based on the best available evidence regarding indications for and efficacy of medications and principles of collaborative care. A feasibility pilot study was conducted using a matched case-control design for 12 patients treated with the algorithm and 12 patients treated as usual.

Results: The intervention patients were discharged on significantly fewer medications than controls; symptom reduction and length of stay did not differ significantly.

Conclusion: A collaborative approach to reducing polypharmacy may reverse the trend to add medications during hospitalization.


  • Funding: The Dartmouth Medical School Quality Research Grant Program provided LAM with support to present this project as a poster at the Fifth Annual Summer Institute on Evidence Based Practices in San Antonio, TX, 29 June to 1 July 2006.

  • Competing interests: None for the first and third authors; speakers’ bureau for Takeda Pharmaceuticals Limited for the second author.

  • Ethics approval: Ethics approval was obtained from The Dartmouth Medical School and New Hampshire State Committees for the Protection of Human Subjects.

  • Patient consent: Obtained.