Challenge of optimising medication in people with severe mental illness

Maidment, Ian; Sud, Dolly; Chew‐Graham, Carolyn

doi:10.1136/bmjqs-2021-013847

Cited by 3 publications

(3 citation statements)

References 15 publications

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“…96 Medication optimisation is an important component of patient safety, especially for SUs with SMI, where medication is a key treatment strategy. 16 Our programme theory and CMOCs highlight how person-centred care approaches such as providing relevant, useful information and support through practitioners and others can lead to safe medication use (ie, medication optimisation). The CMOCs outlined above provide testable, causal explanations for outcomes, detailing by whom, when and how these happen.…”

Section: Discussionmentioning

confidence: 99%

“…15 Multidisciplinary care delivery for SMI is more effective when SUs play a central role in medication decision-making. 16 Failure to optimise medication is often attributed to SU non-adherence, practitioner underprescribing or overprescribing or overtreatment, including polypharmacy. 2 16-18 Management of SMI is particularly challenging with reported non-adherence rates as high as 50%.…”

Section: What This Study Addsmentioning

confidence: 99%

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A realist review of medication optimisation of community dwelling service users with serious mental illness

Howe,

MacPhee,

Duddy

et al. 2023

BMJ Qual Saf

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BackgroundSevere mental illness (SMI) incorporates schizophrenia, bipolar disorder, non-organic psychosis, personality disorder or any other severe and enduring mental health illness. Medication, particularly antipsychotics and mood stabilisers are the main treatment options. Medication optimisation is a hallmark of medication safety, characterised by the use of collaborative, person-centred approaches. There is very little published research describing medication optimisation with people living with SMI.ObjectivePublished literature and two stakeholder groups were employed to answer: What works for whom and in what circumstances to optimise medication use with people living with SMI in the community?MethodsA five-stage realist review was co-conducted with a lived experience group of individuals living with SMI and a practitioner group caring for individuals with SMI. An initial programme theory was developed. A formal literature search was conducted across eight bibliographic databases, and literature were screened for relevance to programme theory refinement. In total 60 papers contributed to the review. 42 papers were from the original database search with 18 papers identified from additional database searches and citation searches conducted based on stakeholder recommendations.ResultsOur programme theory represents a continuum from a service user’s initial diagnosis of SMI to therapeutic alliance development with practitioners, followed by mutual exchange of information, shared decision-making and medication optimisation. Accompanying the programme theory are 11 context-mechanism-outcome configurations that propose evidence-informed contextual factors and mechanisms that either facilitate or impede medication optimisation. Two mid-range theories highlighted in this review are supported decision-making and trust formation.ConclusionsSupported decision-making and trust are foundational to overcoming stigma and establishing ‘safety’ and comfort between service users and practitioners. Avenues for future research include the influence of stigma and equity across cultural and ethnic groups with individuals with SMI; and use of trained supports, such as peer support workers.PROSPERO registration numberCRD42021280980.

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Section: Discussionmentioning

confidence: 99%

Section: What This Study Addsmentioning

confidence: 99%

A realist review of medication optimisation of community dwelling service users with serious mental illness

Howe,

MacPhee,

Duddy

et al. 2023

BMJ Qual Saf

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“…Medication optimisation is ‘a person-centred approach to safe and effective medicines use, to ensure the best possible outcomes’ 4. Medication optimisation with people living with SMI is required for the treatments for both mental and physical health needs 5. Essentially, medication optimisation involves ensuring that people are taking medications that are required, and not taking medications that are not required.…”

Section: Introductionmentioning

confidence: 99%

Medication optimisation in severe mental illness (MEDIATE): protocol for a realist review

et al. 2022

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IntroductionSevere mental illness (SMI) is associated with significant morbidity and mortality. People living with SMI often receive complex medication regimens. Optimising these regimens can be challenging. Non-adherence is common and addressing it requires a collaborative approach to decision making. MEDIATE uses a realist approach with extensive engagement with experts-by-experience to make sense of the complexities and identify potential solutions.Realist research is used to unpack and explain complexity using programme theory/theories that contain causal explanations of outcomes, expressed as context–mechanism–outcome–configurations. The programme theory/theories will enable MEDIATE to address its aim of understanding what works, for whom, in what circumstances, to optimise medication use with people living with SMI.Method and analysisMEDIATE will be conducted over six stages. In stage 1, we will collaborate with our service user/family carer lived experience group (LEG) and practitioner stakeholder group (SG), to determine the focus. In stage 2, we will develop initial programme theories for what needs to be done, by whom, how and why, and in what contexts to optimise medication use. In stage 3, we will develop and run searches to identify secondary data to refine our initial programme theories.Stage 4 involves selection and appraisal: documents will be screened by title, abstract/keywords and full text against inclusion and exclusion criteria. In stage 5, relevant data will extracted, recorded and coded. Data will be analysed using a realist logic with input from the LEG and SG. Finally, in stage 6, refined programme theories will be developed, identifying causal explanations for key outcomes and the strategies required to change contexts to trigger the key mechanisms that produce these outcomes.Ethics and disseminationPrimary data will not be collected, and therefore, ethical approval is not required. MEDIATE will be disseminated via publications, conferences and form the basis for future grant applications.PROSPERO registration numberCRD42021280980.

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Pharmacist-led medicines optimisation service in an inpatient mental health setting

Hynes-Ryan,

Carolan,

Feeney

et al. 2023

Ir. j. psychol. Med.

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Medicines optimisation ensures that people get the best possible outcomes from their medicines. As those with severe mental illness (SMI) are frequently prescribed psychotropic medicines with potentially significant side-effects, poor adherence to treatment and physical morbidity are common. This results in suboptimal symptom control, physical health problems and negative health outcomes. The specialist mental health pharmacist (SMHP) is best placed to provide leadership for medicines optimisation in the inpatient mental health setting. By adopting a patient-centred approach to providing information, improving adherence, screening, initiating and maintaining medicines, and supporting self-advocacy, the SMHP can ensure the patients’ experience of taking medicines is optimised. As there is currently limited understanding of what a baseline clinical pharmacy service in a mental health setting looks like, we aim to outline a framework for pharmacist-led medicines optimisation for those with SMI. This framework is suitable to be scaled and adapted to other settings.

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Challenge of optimising medication in people with severe mental illness

Cited by 3 publications

References 15 publications

A realist review of medication optimisation of community dwelling service users with serious mental illness

A realist review of medication optimisation of community dwelling service users with serious mental illness

Medication optimisation in severe mental illness (MEDIATE): protocol for a realist review

Pharmacist-led medicines optimisation service in an inpatient mental health setting

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