Communication about adherence to long-term antipsychotic prescribing: an observational study of psychiatric practice

Quirk, Alan; Chaplin, Rob; Hamilton, Sarah; Lelliott, Paul; Seale, Clive

doi:10.1007/s00127-012-0581-y

Cited by 18 publications

(12 citation statements)

References 10 publications

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“…However, our sample of ongoing outpatient consultations may be biased to those encounters where psychiatrists rarely act coercively (Quirk et al . ). Further research is needed to examine more extensively how far psychiatrists attend to their patients’ perspectives in other types of encounters.…”

Section: Resultsmentioning

confidence: 97%

Fitting proposals to their sequential environment: a comparison of turn designs for proposing treatment in ongoing outpatient psychiatric consultations in Japan

Kushida

Yamakawa

2015

Sociology Health & Illness

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This study is an attempt to describe an interactional strategy that psychiatrists use in making decisions for treatment in ongoing outpatient psychiatric consultations in Japan. Using conversation analysis (CA), we compare sequential environments where psychiatrists use two turn designs for proposing a treatment: the inclusive 'we' form (for example 'let's' and 'how about') and the declarative evaluation (for example, 'it might be better'). The inclusive 'we' form is used to create the moment for decision when the sequential environment is ready for decision-making. The declarative evaluation is used to propose a treatment cautiously when the sequential environment is not yet ready for decision-making. Taken together, psychiatrists fit the turn design of a proposal to its sequential environment in such a way as to display their attention to the patients' perspectives. In conclusion, we argue that our finding provides further evidence for the claim made by a growing body of CA research that, unlike the traditional sociological understanding of doctor-patient interaction, doctors do not simply impose their perspectives upon the patients but steer medical encounters to their preferred direction by orienting to the patients' perspectives.

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Section: Resultsmentioning

confidence: 97%

Fitting proposals to their sequential environment: a comparison of turn designs for proposing treatment in ongoing outpatient psychiatric consultations in Japan

Kushida

Yamakawa

2015

Sociology Health & Illness

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“…Psychiatrists' consultations are usually informal and driven by the professional; this avoidance of detailed directed questioning allows any reports of ADRs to be overlooked [111, 112]. Therefore, administration of the ADR Profile by nurses prior to doctors' appointments has potential to bridge this hiatus in care.…”

Section: Discussionmentioning

confidence: 99%

Medication Monitoring for People with Dementia in Care Homes: The Feasibility and Clinical Impact of Nurse-Led Monitoring

Jordan

Gabe

Newson

et al. 2014

The Scientific World Journal

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Objectives. People with dementia are susceptible to adverse effects of medicines. However, they are not always closely monitored. We explored (1) feasibility and (2) clinical impact of nurse-led medication monitoring. Design. Feasibility “before-and-after” intervention study. Setting. Three care homes in Wales. Participants. Eleven service users diagnosed with dementia, taking at least one antipsychotic, antidepressant, or antiepileptic medicine. Intervention. West Wales Adverse Drug Reaction (ADR) Profile for Mental Health Medicines. Outcome Measures. (1) Feasibility: recruitment, retention, and implementation. (2) Clinical impact: previously undocumented problems identified and ameliorated, as recorded in participants' records before and after introduction of the profile, and one month later. Results. Nurses recruited and retained 11 of 29 eligible service users. The profile took 20–25 minutes to implement, caused no harm, and supplemented usual care. Initially, the profile identified previously undocumented problems for all participants (mean 12.7 (SD 4.7)). One month later, some problems had been ameliorated (mean 4.9 (3.6)). Clinical gains included new prescriptions to manage pain (2 participants), psoriasis (1), Parkinsonian symptoms (1), rash (1), dose reduction of benzodiazepines (1), new care plans for oral hygiene, skin problems, and constipation. Conclusions. Participants benefited from structured nurse-led medication monitoring. Clinical trials of our ADR Profile are feasible and necessary.

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“…Thompson and McCabe [38 ▪ ] identified 23 studies relevant to this topic and suggested that future studies should focus on objective assessments of the content of clinical interactions. In one study that did directly assess consultation content, Quirk et al [39 ▪▪ ] analysed recordings of 92 consultations that contained discussion of antipsychotic medications between patients and nine UK psychiatrists. Nonadherence was disclosed in 22 consultations and most frequently resulted in a prescription change in line with the behaviour of the patient [39 ▪▪ ].…”

Section: Nonadherence Is Often a Hidden Problemmentioning

confidence: 99%

“…In one study that did directly assess consultation content, Quirk et al [39 ▪▪ ] analysed recordings of 92 consultations that contained discussion of antipsychotic medications between patients and nine UK psychiatrists. Nonadherence was disclosed in 22 consultations and most frequently resulted in a prescription change in line with the behaviour of the patient [39 ▪▪ ]. The researchers suggest that physicians may avoid risking conflict around medication adherence in order to maintain patients’ engagement with treatment.…”

Section: Nonadherence Is Often a Hidden Problemmentioning

confidence: 99%

Medication nonadherence and psychiatry

Chapman

Horne

2013

Current Opinion in Psychiatry

119

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Purpose of reviewNonadherence to appropriately prescribed medication for psychiatric disorders prevents patients from realizing the full benefits of their treatment and negatively impacts on individuals, their families and the healthcare system. Understanding and reducing nonadherence is therefore a key challenge to quality care for patients with psychiatric disorders. This review highlights findings regarding the prevalence and consequence of nonadherence, barriers to adherence and new intervention methods from 2012 onwards.Recent findingsRecent research has highlighted that nonadherence is a global challenge for psychiatry and has linked nonadherence to poorer outcomes, including hospital admissions, suicide and mortality. Optimizing medication regimens can reduce nonadherence; however, often a complex interplay of factors affects individuals’ motivation and ability to follow their prescription. Psychiatrists can enable patients to develop an accurate model of their illness and treatment and facilitate adherence. However, nonadherence is often a hidden issue within consultations. Novel interventions using new technologies and tailoring techniques may have the potential to reduce nonadherence.SummaryNonadherence remains a significant challenge for patients with psychiatric disorders, physicians and healthcare systems. New developments demonstrate the importance of developing tailored interventions to enable patients to overcome perceptual and practical barriers to adherence.

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Communication about adherence to long-term antipsychotic prescribing: an observational study of psychiatric practice

Cited by 18 publications

References 10 publications

Fitting proposals to their sequential environment: a comparison of turn designs for proposing treatment in ongoing outpatient psychiatric consultations in Japan

Fitting proposals to their sequential environment: a comparison of turn designs for proposing treatment in ongoing outpatient psychiatric consultations in Japan

Medication Monitoring for People with Dementia in Care Homes: The Feasibility and Clinical Impact of Nurse-Led Monitoring

Medication nonadherence and psychiatry

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