The development and validation of a medicines optimisation tool to protect the physical health of people with severe mental illness (OPTIMISE)

Abstract

Background The life expectancy of people with severe mental illness (SMI) is shorter than those without SMI, with multimorbidity and poorer physical health contributing to health inequality. Screening tools could potentially assist the optimisation of medicines to protect the physical health of people with SMI. The aim of our research was to design and validate a medicines optimisation tool (OPTIMISE) to help clinicians to optimise physical health in people with SMI. Methods A review of existing published guidelines, PubMed and Medline was carried out. Literature was examined for medicines optimisation recommendations and also for reference to the management of physical illness in people with mental illness. Potential indicators were grouped according to physiological system. A multidisciplinary team with expertise in mental health and the development of screening tools agreed that 83 indicators should be included in the first draft of OPTIMISE. The Delphi consensus technique was used to develop and validate the contents. A 17-member multidisciplinary panel of experts from the UK and Ireland completed 2 rounds of Delphi consensus, rating their level of agreement to 83 prescribing indicators using a 5-point Likert scale. Indicators were accepted for inclusion in the OPTIMISE tool after achieving a median score of 1 or 2, where 1 indicated strongly agree and 2 indicated agree, and 75th centile value of ≤ 2. Interrater reliability was assessed among 4 clinicians across 20 datasets and the chance corrected level of agreement (kappa) was calculated. The kappa statistic was interpreted as poor if 0.2 or less, fair if 0.21–0.4, moderate if 0.41–0.6, substantial if 0.61–0.8, and good if 0.81–1.0. Results Consensus was achieved after 2 rounds of Delphi for 62 prescribing indicators where 53 indicators were accepted after round 1 and a further 9 indicators were accepted after round 2. Interrater reliability of OPTIMISE between physicians and pharmacists indicated a substantial level of agreement with a kappa statistic of 0.75. Conclusions OPTIMISE is a 62 indicator medicines optimisation tool designed to assist decision making in those treating adults with SMI. It was developed using a Delphi consensus methodology and interrater reliability is substantial. OPTIMISE has the potential to improve medicines optimisation by ensuring preventative medicines are considered when clinically indicated. Further research involving the implementation of OPTIMISE is required to demonstrate its true benefit. Trial registration This article does not report the results of a health care intervention on human participants.

Making meaning of multimorbidity and severe mental illness: A viewpoint

“…Judicious use of pharmacological interventions will also help apply brakes to unnecessary polypharmacy in consumers with multimorbidity. Medication rationalisation tools, such as OPTIMISE by Carolan et al. (2022), can help achieve this through a systematic, evidence-based assessment of the need for pharmacological treatment.…”

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

“…The specialist mental health pharmacist (SMHP) working in the inpatient mental health setting can provide leadership and support for medicines optimisation. People with SMI are less likely to have regular contact with a general medical provider and receive routine physical health screening, monitoring or interventions (Carolan et al 2022). As a result, their time as an inpatient in a mental health setting is an ideal opportunity to optimise both physical and mental health medicines use.…”

Cardiometabolic risk in people under 40 years with severe mental illness: reading between the guidelines

“…Screening and assessment tools can potentially help improve physical outcomes and reduce this inequality [ 17 , 18 ]. A medicines optimisation tool, OPTIMISE, was developed and validated to assist clinicians working in psychiatry to protect the overall physical health of people with SMI.…”

“…OPTIMISE prompts the regular assessment of CV risk in adults with SMI over 40 years using a validated risk assessment tool e.g. SCORE, QRISK2, QRISK3, ensuring that at a minimum, people with SMI are screened for CVD in equal measure with the rest of the population [ 18 ]. In applying this tool in practice, the authors identified that adults under 40 years with SMI are underserved by the current guidelines.…”