Managing patients on atypical antipsychotics in primary care

Woodall, Alan

doi:10.1002/psb.1952

Cited by 6 publications

(8 citation statements)

References 17 publications

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“…In some countries (e.g., Norway), APM is often initiated by GPs [19]. In the UK, APM initiation is usually undertaken by psychiatrists; where the patient remains under secondary care (psychiatric clinic or hospital), psychiatrists optimise APM, and GPs manage cardiometabolic risks [20,21]. Unfortunately, many patients with SMI who attend psychiatric appointments are less likely to see GPs for monitoring [20,21].…”

Section: Introductionmentioning

confidence: 99%

“…In the UK, APM initiation is usually undertaken by psychiatrists; where the patient remains under secondary care (psychiatric clinic or hospital), psychiatrists optimise APM, and GPs manage cardiometabolic risks [20,21]. Unfortunately, many patients with SMI who attend psychiatric appointments are less likely to see GPs for monitoring [20,21]. Many health systems, mainly designed to manage acute illness, struggle to provide continuity of care to patients with SMI [22].…”

Section: Introductionmentioning

confidence: 99%

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Management of antipsychotics in primary care: Insights from healthcare professionals and policy makers in the United Kingdom

Woodall,

Abuzour,

Wilson

et al. 2024

PLoS ONE

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Introduction Antipsychotic medication is increasingly prescribed to patients with serious mental illness. Patients with serious mental illness often have cardiovascular and metabolic comorbidities, and antipsychotics independently increase the risk of cardiometabolic disease. Despite this, many patients prescribed antipsychotics are discharged to primary care without planned psychiatric review. We explore perceptions of healthcare professionals and managers/directors of policy regarding reasons for increasing prevalence and management of antipsychotics in primary care. Methods Qualitative study using semi-structured interviews with 11 general practitioners (GPs), 8 psychiatrists, and 11 managers/directors of policy in the United Kingdom. Data was analysed using thematic analysis. Results Respondents reported competency gaps that impaired ability to manage patients prescribed antipsychotic medications, arising from inadequate postgraduate training and professional development. GPs lacked confidence to manage antipsychotic medications alone; psychiatrists lacked skills to address cardiometabolic risks and did not perceive this as their role. Communication barriers, lack of integrated care records, limited psychology provision, lowered expectation towards patients with serious mental illness by professionals, and pressure to discharge from hospital resulted in patients in primary care becoming ‘trapped’ on antipsychotics, inhibiting opportunities to deprescribe. Organisational and contractual barriers between services exacerbate this risk, with socioeconomic deprivation and lack of access to non-pharmacological interventions driving overprescribing. Professionals voiced fears of censure if a catastrophic event occurred after stopping an antipsychotic. Facilitators to overcome these barriers were suggested. Conclusions People prescribed antipsychotics experience a fragmented health system and suboptimal care. Several interventions could be taken to improve care for this population, but inadequate availability of non-pharmacological interventions and socioeconomic factors increasing mental distress need policy change to improve outcomes. The role of professionals’ fear of medicolegal or regulatory censure inhibiting antipsychotic deprescribing was a new finding in this study.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Management of antipsychotics in primary care: Insights from healthcare professionals and policy makers in the United Kingdom

Woodall,

Abuzour,

Wilson

et al. 2024

PLoS ONE

View full text Add to dashboard Cite

show abstract

“…In some countries, such as Norway, APM are regularly initiated by GPs [19]. In the UK however, APM initiation is mainly undertaken by psychiatrists; traditionally, where the patient remains under secondary care (outpatient clinic or hospital care led by a psychiatrist), psychiatrists optimise APM, and GPs mainly monitor cardiometabolic risk [20, 21]. Unfortunately, many patients with SMI who attend psychiatric appointments are less likely to attend their GP for physical health follow-up [20, 21].…”

Section: Introductionmentioning

confidence: 99%

“…In the UK however, APM initiation is mainly undertaken by psychiatrists; traditionally, where the patient remains under secondary care (outpatient clinic or hospital care led by a psychiatrist), psychiatrists optimise APM, and GPs mainly monitor cardiometabolic risk [20, 21]. Unfortunately, many patients with SMI who attend psychiatric appointments are less likely to attend their GP for physical health follow-up [20, 21]. Many international health systems, mainly designed to manage acute rather than chronic illness, struggle to provide continuity of care to patients with chronic mental illness [22].…”

Section: Introductionmentioning

confidence: 99%

Management of Antipsychotics in Primary Care: Insights from Healthcare Professionals and Policy Makers in the UK

Woodall,

Abuzour,

Wilson

et al. 2023

Preprint

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IntroductionAntipsychotic medication is increasingly prescribed to patients with serious mental illness. Patients with serious mental illness often have cardiovascular and metabolic comorbidities, and antipsychotics independently increase the risk of cardiometabolic disease. Despite this, many patients prescribed antipsychotics are discharged to primary care without planned psychiatric review. We explore perceptions of healthcare professionals and managers/planners of policy regarding management of antipsychotics in primary care.MethodsQualitative study using semi-structured interviews with 11 general practitioners (GPs), 8 psychiatrists, and 11 managers/planners of policy in the United Kingdom. Interviews were studied using inductive thematic analysis.ResultsRespondents reported competency gaps that impaired ability to manage patients prescribed antipsychotic medications holistically, arising from inadequate postgraduate training and professional development. GPs lacked confidence to manage antipsychotic medications alone; psychiatrists lacked skills to address cardiometabolic risks and did not perceive this as their role. Communication barriers, lack of integrated care records, limited psychology provision, lowered expectation of patients with serious mental illness by professionals, and pressure to discharge from hospital resulted in patients in primary care becoming ‘trapped’ on antipsychotics, inhibiting opportunities to deprescribe. Organisational and contractual barriers between organisations exacerbate this risk, with socioeconomic deprivation and lack of access to non-pharmacological alternatives driving overprescribing. GPs and psychiatrists voiced professional fears of being blamed if an event causing harm occurred after stopping an antipsychotic, which inhibited deprescribing. A range of actions to overcome these barriers were suggested.ConclusionsPeople prescribed antipsychotics experience a fragmented health system and suboptimal care. Many simple steps could be taken to improve quality of care for this population but inadequate availability of non-pharmacological alternatives and socioeconomic factors increasing mental distress need key policy changes to improve the current situation.

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“…Around 90.0% of patients with mental illness are treated solely within the community (13) and 40.0% of general practitioner (GP) appointments may concern mental health (14). Community care settings are integral to the prescribing, monitoring and dispensing of psychotropic drugs (15)(16)(17)(18), and this sector therefore has a pivotal role in the care and supply of medication for patients with mental illness. Over recent years there has been increased research activity exploring medication safety concerns in secondary care mental health settings (19)(20)(21)(22)(23)(24), with patient and system wide risk factors and contributors identified such as patient behaviours, impaired cognition (23,25), lack of continuity of care and communication issues (20,23).…”

Section: Introductionmentioning

confidence: 99%

unDerstandIng the cauSes of mediCation errOrs and adVerse drug evEnts for patients with mental illness in community caRe (DISCOVER): a qualitative study

Ayre,

Lewis,

Phipps

et al. 2023

Front. Psychiatry

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BackgroundIt is estimated that 237 million medication errors occur in England each year with a significant number occurring in the community. Our understanding of the causes of preventable medication errors and adverse drug events (ADE) affecting patients with mental illness is limited in this setting. Better understanding of the factors that contribute to errors can support the development of theory-driven improvement interventions.MethodsRemote qualitative semi-structured interviews with 26 community-based healthcare professionals in England and Wales were undertaken between June–November 2022. Recruitment was undertaken using purposive sampling via professional networks. Interviews were guided by the critical incident technique and analysed using the framework method. Any data that involved speculation was not included in the analysis. Independent analysis was carried out by the research team to extract themes guided by the London Protocol.ResultsA total of 43 medication errors and 12 preventable ADEs were discussed, with two ADEs having an unknown error origin. Prescribing errors were discussed most commonly (n = 24), followed by monitoring errors (n = 8). Six contributory factor themes were identified: the individual (staff); the work environment; the teams/interfaces; the organisation and management; the patient; and the task and technology. The individual (staff) factors were involved in just over 80% of all errors discussed. Participants reported a lack of knowledge regarding psychotropic medication and mental illnesses which accompanied diffusion of responsibility. There were difficulties with team communication, particularly across care interfaces, such as ambiguity/brevity of information being communicated and uncertainty concerning roles which created confusion amongst staff. Unique patient social/behavioural contributory factors were identified such as presenting with challenging behaviour and complex lifestyles, which caused difficulties attending appointments as well as affecting overall clinical management.ConclusionThese findings highlight that the causes of errors are multifactorial with some unique to this patient group. Key areas to target for improvement include the education/training of healthcare professionals regarding neuropharmacology/mental illnesses and enhancing communication across care interfaces. Future research should explore patient perspectives regarding this topic to help develop a holistic picture. These findings can be used to guide future intervention research to ameliorate medication safety challenges for this patient group.

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Managing patients on atypical antipsychotics in primary care

Cited by 6 publications

References 17 publications

Management of antipsychotics in primary care: Insights from healthcare professionals and policy makers in the United Kingdom

Management of antipsychotics in primary care: Insights from healthcare professionals and policy makers in the United Kingdom

Management of Antipsychotics in Primary Care: Insights from Healthcare Professionals and Policy Makers in the UK

unDerstandIng the cauSes of mediCation errOrs and adVerse drug evEnts for patients with mental illness in community caRe (DISCOVER): a qualitative study

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