Results of a pilot cluster randomised trial of the use of a Medication Review Tool for people taking antipsychotic medication

Abstract

BackgroundGovernment policy encourages increasing involvement of patients in their long-term care. This paper describes the development and pilot evaluation of a ‘Medication Review Tool’ designed to assist people to participate more effectively in discussions about antipsychotic drug treatment.MethodsThe Medication Review Tool developed consisted of a form to help patients identify pros and cons of their current antipsychotic treatment and any desired changes. It was associated with a website containing information and links about antipsychotics. For the trial, participants diagnosed with psychotic disorders were recruited from community mental health services. Cluster randomisation was used to allocate health professionals (care co-ordinators) and their associated patients to use of the Medication Review Tool or usual care. All participants had a medical consultation scheduled, and those in the intervention group completed the Medication Review Tool, with the help of their health professional prior to this, and took the completed Form into the consultation. Two follow-up interviews were conducted up to three months after the consultation. The principal outcome was the Decision Self Efficacy Scale (DSES). Qualitative feedback was collected from patients in the intervention group.ResultsOne hundred and thirty patients were screened, sixty patients were randomised, 51 completed the first follow-up assessment and 49 completed the second. Many patients were not randomised due to the timing of their consultation, and involvement of health professionals was inconsistent. There was no difference between the groups on the DSES (-4.16 95 % CI -9.81, 1.49), symptoms, side effects, antipsychotic doses or patient satisfaction. Scores on the Medication Adherence Questionnaire indicated an increase in participants’ reported inclination to adherence in the intervention group (coefficient adjusted for baseline values -0.44; 95 % CI -0.76, -0.11), and there was a small increase in positive attitudes to antipsychotic medication (Drug Attitude Inventory, adjusted coefficient 1.65; 95 % CI -0.09, 3.40). Qualitative feedback indicated patients valued the Tool for identifying both positive and negative aspects of drug treatment.ConclusionsThe trial demonstrated the design was feasible, although challenges included service re-configurations and maintaining health professional involvement. Results may indicate a more intensive and sustained intervention is required to facilitate participation in decision-making for this group of patients.Trial registrationCurrent controlled trials ISRCTN12055530, Retrospectively registered 9/12/2013.

Experiences of taking neuroleptic medication and impacts on symptoms, sense of self and agency: a systematic review and thematic synthesis of qualitative data

“…Clinicians have been found to underestimate the impact of the adverse effects of neuroleptics on patients' quality of life [66,67], which may contribute to the difficulties of achieving a more collaborative approach to decision-making with people with severe mental disorders [65,68]. A fuller understanding of how neuroleptic drugs impact on important aspects of people's experience and feelings about themselves, and how these effects are entwined with effects on symptoms will enable clinicians to better recognise and respond to patients' concerns.…”

Association of Focused Medication Review With Optimization of Psychotropic Drug Prescribing

“… 23 , 24 Four studies were cluster RCTs (n = 712 participants) 23 , 24 , 25 , 26 , 27 and the remaining 22 were before-after study designs (n = 7844 participants). 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 Studies were conducted in North America (15 studies), 28 , 30 , 31 , 32 , 33 , 35 , 36 , 37 , 39 , 42 , 43 , 46 , 47 , 48 , 49 Europe (10 studies) 23 , 25 , 26 , 27 , 29 , 38 , 40 , 41 , 44 , 45 and Australasia (1 study). 34 A total of 19 studies 23 , 26 , 27 , 28 ,…”

“…The first was one-off medication review, usually undertaken by a single professional and including a single class of psychotropic drug. 23 , 25 , 38 , 40 , 41 , 42 , 43 , 44 , 45 The second model was a longitudinal program of regular medication review, often by a multidisciplinary team who reviewed the participant’s psychotropic drug regimen in a series of meetings. 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 39 The third type of focused psychotropic medication review was 2-stage, in which those at high risk of suboptimal drug therapy were identified using a rule applied to the electronic patient record and then directed to clinician medication review.…”

A structured medication review tool to promote psychotropic medication optimisation for adults with intellectual disability: feasibility study

“…Reasons for not recruiting people who were referred to the research team were noted. As this was a feasibility study, a formal sample size calculation was not performed but our a priori estimate was that 100 people with ID would be recruited based on previous feasibility studies that have trialled similar interventions in community settings 14…”