Mental health pharmacists views on shared decision

Authors: Mediha Younas Eleanor Bradley Nikki Holmes Dolly Sud Ian D Maidment

Publish Date: 2016/07/23

Volume: 38, Issue: 5, Pages: 1191-1199

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Abstract

Background People diagnosed with serious mental illnesses SMIs such as schizophrenia and bipolar affective disorder are frequently treated with antipsychotics National guidance advises the use of shared decisionmaking SDM in antipsychotic prescribing There is currently little data on the opinions of health professionals on the role of SDM Objective To explore the views and experiences of UK mental health pharmacists regarding the use of SDM in antipsychotic prescribing in people diagnosed with SMI Setting The study was conducted by interviewing secondary care mental health pharmacists in the UK to obtain qualitative data Methods Semistructured interviews were recorded An inductive thematic analysis was conducted using the method of constant comparison Main outcome measure Themes evolving from mental health pharmacists on SDM in relation to antipsychotic prescribing in people with SMI Results Thirteen mental health pharmacists were interviewed SDM was perceived to be linked to positive clinical outcomes including adherence service user satisfaction and improved therapeutic relations Despite more prescribers and service users supporting SDM it was not seen as being practised as widely as it could be this was attributed to a number of barriers most predominantly issues surrounding service user’s lacking capacity to engage in SDM and time pressures on clinical staff The need for greater effort to work around the issues engage service users and adopt a more interprofessional approach was conveyed Conclusion The mental health pharmacists support SDM for antipsychotic prescribing believing that it improves outcomes However barriers are seen to limit implementation More research is needed into overcoming the barriers and measuring the benefits of SDM along with exploring a more interprofessional approach to SDMAt least one in four people in the UK will experience a mental health problem and up to two percent of the population will be diagnosed with a serious mental illness SMI during their lifetime 1 For the purposes of this research SMI is considered to include diagnoses that are treated with antipsychotics typically schizophrenia and bipolar affective disorder 2 The adverse effects of antipsychotics can decrease adherence rates 3Adherence the currently accepted term used for medicationtaking behaviour is defined ‘as the extent to which the patient’s action matches the agreed recommendations’ 4 Adherence presumes agreement about the proposed medication between the prescriber and the person taking the medicine emphasising the importance of shared decisionmaking SDM 4 A third to a half of all medications for longterm conditions are not taken as recommended and treatment adherence is one of the biggest challenges in mental health 4 5 Adherence in SMI is very poor estimated nonadherence rates for people diagnosed with schizophrenia range from 40 to 75  6 7 Studies have found that 75  of people with chronic schizophrenia discontinue their medication within 18 months 8 and nonadherence rates in bipolar disorder range between 20 and 60  with a mean of 41  9 10 Antipsychotic prescribing lends itself to SDM because the adverse event profile is the main factor in the choice of antipsychotics 11SDM is defined by the NHS as ‘the conversation that happens between a patient and their healthcare professional to reach a healthcare choice together’ where both parties consider what is important to the other when selecting treatment There are ethical clinical and economic arguments for SDM 12 it represents a method of healthcare communication that promotes patientcentred care and sharing expertise between clinicians and service users 13 14 The most accepted model is that of Charles and colleagues which emphasises patient autonomy informed consent and empowerment 15 SDM is founded on partnership and opposed to a paternalistic model of healthcare 16 A recent Department of Health White Paper stated that ‘care should be personalised to reflect peoples’ needs not those of the professional or the system’ and patients should be involved in treatment decisions 17 People diagnosed with SMI can be fully engaged with making decisions and seek a more collaborative approach thus treatment decisions should be made by the service user and the healthcare professional working together and considering both the likely benefits and possible adverse effects of the medication 11 18

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