An exploratory study of the role of trust in medication management within mental health services

Maidment, Ian; Brown, Patrick; Calnan, Michael

doi:10.1007/s11096-011-9510-5

Cited by 20 publications

(30 citation statements)

References 21 publications

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“…This echoes other research, which has found that service users with SMI value the opportunity to collaborate with those providing their care and are prepared to engage with SDM within the current patient-professional relationship [ 47 ]. SDM can also improve treatment knowledge amongst service users with schizophrenia potentially reducing the risk of medication errors [ 18 , 64 – 66 ].…”

Section: Discussionmentioning

confidence: 99%

“…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 ].…”

Section: Introductionmentioning

confidence: 99%

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Mental health pharmacists views on shared decision-making for antipsychotics in serious mental illness

et al. 2016

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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 decision-making (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 Semi-structured 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 inter-professional 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 inter-professional approach to SDM.Electronic supplementary materialThe online version of this article (doi:10.1007/s11096-016-0352-z) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Mental health pharmacists views on shared decision-making for antipsychotics in serious mental illness

et al. 2016

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“…The one who was adamant about him coming off the lorazepam had this one mind set. Trust develops over time, from seeing the same practitioner in whom they are confident, underscoring the importance of continuity of care to practice and practitioner relationships: [153][154][155][156][157] The patient-provider relationship is the fundamental starting point for patient centred care delivery. Central to the patient-provider relationship is trust.…”

Section: Box 28 Conflicting Information Provided By Practitioners To mentioning

confidence: 99%

Medication management in older people: the MEMORABLE realist synthesis

Maidment

Lawson

Wong

et al. 2020

Health Serv Deliv Res

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Background The number and proportion of older people in the UK are increasing, as are multimorbidity (potentially reducing quality of life) and polypharmacy (increasing the risk of adverse drug events). Together, these complex factors are challenging for older people, informal carers, and health and care practitioners. Objectives MEMORABLE (MEdication Management in Older people: Realist Approaches Based on Literature and Evaluation) aimed to understand how medication management works and propose improvements. Design A realist approach informed three work packages, combining a realist review of secondary data with a realist evaluation of primary interview data, in a theory-driven, causal analysis. Setting The setting was in the community. Participants Older people, informal carers, and health and care practitioners. Interventions Studies relating to medication management and to reviewing and reconciling medications; and realist-informed interviews. Main outcome measures Not applicable. Data sources MEDLINE, CINAHL (Cumulative Index of Nursing and Allied Health Literature) and EMBASE were searched (all searched from January 2009 to July 2017; searched on 1 August 2017). Supplementary articles were identified by the Research Team. Data were also obtained through interviews. Review methods Searches of electronic databases were supplemented by citation-tracking for explanatory contributions, as well as accessing topic-relevant grey literature. Following RAMESES (Realist And Meta-narrative Evidence Syntheses: Evolving Standards) guidelines, articles were screened and iteratively analysed with interview data, to generate theory-informed (normalisation process theory) explanations. Results Developing a framework to explain medication management as a complex intervention across five stages: identifying problem (Stage 1), starting, changing or stopping medications (Stage 3) and continuing to take medications (Stage 4), where older people, sometimes with informal carers, make individual decisions and follow routines that fit medication management into their day-to-day lives, engendering a sense of control. In getting diagnosis and/or medications (Stage 2) and reviewing/reconciling medications (Stage 5), older people and practitioners share decision-making in time-limited contacts: involving four steps – sense-making, relationships, action and reflection/monitoring (normalisation process theory); and conceptualising burden – through a detailed analysis of Stage 5, generating a theoretical framework and identifying five burden types amendable to mitigation: ambiguity, concealment, unfamiliarity, fragmentation and exclusion. Proposing interventions: risk identification – a simple way of identifying older people and informal carers who are not coping, at risk and who need appropriate help and support; and individualised information – a short, personalised record and reference point, co-produced and shared by older people, informal carers and practitioners that addresses the experience of living with multimorbidities and polypharmacy. Limitations Few studies directly address the complexity of medication management as a process and how it works. Limitations included, having identified the overall complexity, the need to focus the analysis on reviewing/reconciling medications (Stage 5), the exclusion of non-English-language literature, the focus on non-institutionalised populations and the broad definition of older people. Conclusions MEMORABLE explored the complexity of medication management. It highlighted the way interpersonal stages in the medication management process, notably reviewing/reconciling medications, contribute to the mitigation of burdens that are often hidden. Future work Co-produced studies to scope and trial the two proposed interventions; studies to extend the detailed understanding of medication management, linked to burden mitigation; and a study to clarify the medication management outcomes wanted by older people, informal carers and practitioners. Study registration This study is registered as PROSPERO CRD42016043506. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 26. See the NIHR Journals Library website for further project information.

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“…These enable the ‘treatment’ of psychotic symptoms and are the cornerstone of modern medical approaches to dealing with severe mental illness and risk attributed to it. Clearly the effectiveness of these ‘risk management tools’ depends upon the extent to which prescribed medication is co‐operated with by the service‐user, yet once again the orientation of services towards control may tend towards undermining concordance: where ‘a perceived threat to an individual's freedom generates a motivational state aimed at recapturing the affected freedom and preventing the loss of others’ and where a corresponding non‐concordance results (Fogarty 1997: 1277; Maidment et al . 2011).…”

Section: Problems Inherent To Managing Risk: the Limitations And Undementioning

confidence: 99%

Trust as a Means of Bridging the Management of Risk and the Meeting of Need: A Case Study in Mental Health Service Provision

Brown

Calnan

2012

Soc Policy Adm

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Shifts in public policy towards an increasing focus on risk have been deemed problematic at a number of levels, particularly the tendency for concerns over reputational risk to institutions to trump the interests and needs of service-users. This article explores the tension between these two dimensions, of risk and need, in a case study of local mental health services -a setting where conflicting objectives to manage risk and meet need are apparent. Media-driven pressure to ward against the 'risk' represented by service-users tends towards more coercive policy which may obstruct the meeting of need, which in turn may undermine service-user engagement and hinder risk management. Drawing on qualitative data from interviews with service-users, professionals and managers, the article explores the process of trust and its facilitative role in meeting need and managing risk. Findings suggest that while existing foci on risk are at times counter-productive, trust plays a significant role in service-users' initial and ongoing engagement, communication and co-operation with professionals. Yet inherent obstacles to trust within mental healthcare contexts remain, due to cultural pressures on professionals, the nature of the illness experience and negative past experiences of in-patient care.

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An exploratory study of the role of trust in medication management within mental health services

Abstract: Safe management of medication is facilitated by trust. However, this trust may be difficult to develop and maintain, exposing service users to adverse events and worsening adherence. Practice and policy should be oriented towards developing trust.

Cited by 20 publications

References 21 publications

Mental health pharmacists views on shared decision-making for antipsychotics in serious mental illness

Mental health pharmacists views on shared decision-making for antipsychotics in serious mental illness

Medication management in older people: the MEMORABLE realist synthesis

Trust as a Means of Bridging the Management of Risk and the Meeting of Need: A Case Study in Mental Health Service Provision

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