Medicines reconciliation at the community mental health team–general practice interface: quality improvement study

Abstract

Aims and methodTo increase the proportion of patients with no psychotropic drug discrepancies at the community mental health team (CMHT)–general practice interface. Three CMHTs participated. Over a 14 month period, quality improvement methodologies were used: individual patient-level feedback to patient's prescribers, run charts and meetings with CMHTs.ResultsOne CMHT improved medicines reconciliation accuracy and demonstrated significant reductions in prescribing discrepancies. One in three (119/356) patients had ≥1 discrepancy involving 20% (166/847) of all prescribed psychotropics. Discrepancies were graded as: ‘fatal’ (0%), ‘serious’ (17%) and ‘negligible/minor harm’ (83%) but were associated with extra avoidable prescribing costs. For medicines routinely supplied by secondary care, 68% were not recorded in general practice electronic prescribing systems.Clinical implicationsImprovements in medicines reconciliation accuracy were achieved for one CMHT. This may have been partly owing to a multidisciplinary team approach to sharing and addressing prescribing discrepancies. Improving prescribing accuracy may help to reduce avoidable drug-related harms to patients.

Understanding the medication safety challenges for patients with mental illness in primary care: a scoping review

“…A total of 11/77 (14.3%) studies reported other DRP epidemiological data which were medication errors (11/11), preventable adverse drug reactions (2/11) and preventable adverse drug events (1/11) [ 26 , 54 , 55 , 74 , 85 , 88 , 95 , 96 , 106 , 118 , 124 ]. The two most frequently cited study settings were nursing homes (4/11, 36.4%) [ 54 , 55 , 118 , 124 ] and general practice (4/11, 36.4%%) [ 26 , 74 , 88 , 106 ].…”

“…Depression was the most cited psychiatric diagnosis (7/11, 63.6%). The study age of interest were commonly older patients with 5/11 (38.5%) reporting population ages of 65 and over [ 54 , 55 , 106 , 118 , 124 ], 3/11 (27.3%) studies examined an adult population [ 85 , 95 , 96 ], 2/11 (18.2%) studies did not specify a study population age range [ 26 , 88 ], and one study (9.1%) examined a paediatric population ≤ 18 [ 74 ]. The study populations were patients with mental illness - including dementia specific (8/11, 72.7%) [ 55 , 74 , 85 , 88 , 95 , 96 , 106 , 118 ], elderly with comorbidities (2/11, 18.2%) [ 54 , 124 ], and 1/11 (9.1%) examined a general population clinical database [ 26 ].…”

“…The study age of interest were commonly older patients with 5/11 (38.5%) reporting population ages of 65 and over [ 54 , 55 , 106 , 118 , 124 ], 3/11 (27.3%) studies examined an adult population [ 85 , 95 , 96 ], 2/11 (18.2%) studies did not specify a study population age range [ 26 , 88 ], and one study (9.1%) examined a paediatric population ≤ 18 [ 74 ]. The study populations were patients with mental illness - including dementia specific (8/11, 72.7%) [ 55 , 74 , 85 , 88 , 95 , 96 , 106 , 118 ], elderly with comorbidities (2/11, 18.2%) [ 54 , 124 ], and 1/11 (9.1%) examined a general population clinical database [ 26 ]. The most cited medication error type was drug-drug interactions (7/11, 63.6%) [ 54 , 55 , 95 , 96 , 106 , 118 , 124 ], followed by dosage errors/dose too high/low (5/11, 45.5%) [ 54 , 88 , 95 , 96 , 106 ], then monitoring errors (4/11, 36.4%) [ 26 , 74 , 88 , 96 ].…”

“…Rubio-Valera et al found the intervention group were more likely to remain adherent at 3 and 6 months, however, this did not reach statistical significance [ 99 ]. Johnson et al trialled a three part quality improvement intervention in three CMHTs, and reported that one of the teams achieved a reduced medication discrepancy rate and a non-statistically significant improvement but the other two did not [ 85 ]. Raynsford et al reported a total of 104 interventions for different DRPs such as adherence issues, high dose/multiple antipsychotics, physical health monitoring issues and drug errors.…”

Design and Evaluation of Peer Supervision for Community Mental Health Workers: A Task-Shifting Strategy in Low-Resource Settings

“…Most of the research findings related to the first category, where each of the aspects identified concerned the significance of supervisory support in mediating the shift from theory or training to practice. For instance, it helped that supervisors emphasized the importance of dignity in high-quality care based on their practical experience, which is corroborated by a large body of literature, as this built on what had already been learnt in training (Dronet, 2016 ; Johnson et al, 2019 ; Kilbourne et al, 2018 ; Tomlinson, 2015 ). Of the other aspects of performance, it is possible to make a generalization that also forms the most interesting finding of this research: a large element of the support that the supervisors provided was passing on connectivity and understanding between the new LMHWs and the broader community.…”