Medication Self-Management in Hospitalised Patients with Schizophrenia or Bipolar Disorder: The Perceptions of Patients and Healthcare Providers

Abstract

Aim(s): The aim of the study was to explore perspectives of hospitalised patients with schizophrenia or a bipolar disorder and their healthcare providers on medication self-management. Methods: In a qualitative descriptive design, semi-structured interviews were used. Forty-nine interviews were completed (nurses n = 18; psychiatrists n = 3; hospital pharmacists n = 2; patients n = 26). Data analysis was iterative using an inductive and thematic approach. Results: From the thematic analysis of the interviews, three main themes emerged: monitoring and shared decision-making, relationship based on trust, and patient satisfaction and rehabilitation; as well as three sub-themes: available tools, patient readiness, and safety. Regular monitoring and follow-ups were considered conditions for medication self-management. All stakeholders considered that the patient, the nursing staff, and the psychiatrist should all be involved in the process of medication self-management. All healthcare providers emphasized the importance of regular re-evaluations of the patient and were worried about medication errors and misuse. Most patients considered medication self-management during hospitalisation to increase their confidence, self-reliance, and satisfaction. Many participants thought it would make a positive contribution to the recovery process. Discussion: All stakeholders were positive towards medication self-management under specific conditions. According to the participants, medication self-management offered many benefits, including the implementation of more structure for the patient, an ameliorated preparatory phase towards discharge, and an actual improvement of future adherence. All participants considered medication self-management to contribute to more profound medication knowledge and an overall improvement of their health literacy. Implications and future perspectives: These findings will be used to develop a medication self-management tool in hospitalised patients with schizophrenia or bipolar disorders.

The attitude of healthcare providers towards medication self‐management in hospitalized patients diagnosed with schizophrenia or bipolar disorders

“…Nurses were more willing than psychiatrists. These findings were in line with those of previous qualitative research (Loots et al, 2022). Psychiatrists were more worried about the risks associated with MSM in the hospital, such as the difficulty in assessing the patients, the social aspect (e.g., peer pressure and medication mix‐ups,…), and medication errors (Loots et al, 2022).…”

“…These findings were in line with those of previous qualitative research (Loots et al, 2022). Psychiatrists were more worried about the risks associated with MSM in the hospital, such as the difficulty in assessing the patients, the social aspect (e.g., peer pressure and medication mix‐ups,…), and medication errors (Loots et al, 2022). Besides the insight gained into the willingness of healthcare providers toward MSM, the results indicated that some implementation aspects are lacking.…”

“…Nurses and psychiatrists agreed that the patient would feel more autonomous and independent. Our study confirms previous research, indicating that the patients' abilities to MSM could be better assessed during hospitalization (Loots et al, 2022; Vanwesemael et al, 2018). Nurses, hospital pharmacists, and patients suggested that MSM could be beneficial to the hospital and the hospital image due to the potential positive experiences and higher patient satisfaction.…”

“…The literature clearly describes that an assessment is always needed to objectively evaluate the actual competencies of the patient. This assessment should consider various aspects, such as patients' specific conditions, mental and physical condition, and possible side‐effects of their current medication (Loots et al, 2022; Vanwesemael et al, 2018). When comparing our results with those of the literature, it is possible to draw some conclusions.…”

Facilitators and Barriers of Medication Adherence Based on Beliefs of Persons with Bipolar Disorder: A Qualitative Study

“…Our study highlights the importance given by patients to take part in the decision about the treatment they should receive, especially in long-term follow-up (chronic phase). Others clinical studies have demonstrated the effectiveness of the decision shared by people who have BD [36,37] and other chronic psychotic disorders such as schizophrenia, showing effectiveness and improvement in the quality of decisions based on the increase in knowledge and participation, and observing a greater congruency with the values and preferences of the participant, as well as an increase in user satisfaction [37][38][39]. This shared decision making should be viewed as a dynamic process, where information is shared and reflected, and support is provided.…”