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

Abstract

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.

Shared decision-making interventions in the choice of antipsychotic prescription in people living with psychosis (SHAPE): Protocol for a realist review

“…Reasons for exclusion of each study will be noted, for example if records are classified by the research team as having low relevance to the programme theory. For those articles deemed to meet the inclusion criteria, IF will retrieve the full text and classify documents into high and low relevance, depending on their relevance to the programme theory, and based on established methods previously employed [ 45 , 46 ]. Briefly, full-text documents will be assigned a star rating of one to five, based on a global judgement of each document’s relevance and rigour.Documents assigned a one- or two-star rating will be deemed irrelevant and not included in the review.…”

“…articles with the most potential to inform the programme theory. As the review progresses, these conceptual codes will be analysed to develop context-mechanism-outcome configurations (CMOC) [ 45 ]. Allocation of codes will be both inductive and deductive.…”

“…Retroductive coding will also be applied i.e. where codes are created based on an interpretation of data to infer potential hidden causal mechanisms for outcomes [ 33 , 45 , 47 ]. Each new element of coded data will be used to refine the programme theory, as appropriate.…”