The role of trust and hope in antipsychotic medication reviews between GPs and service users a realist review

BMC Psychiatry

L. M. Grünwald¹  J. Moncrieff²  C. Duddy³  N. Crellin⁴  R. Byng⁵ 

[1] Division of Psychiatry, University College London, 149 Tottenham Court Rd, Bloomsbury, W1T 7NF, London, UK;Comprehensive Clinical Trials Unit, 90 High Holborn, WC1V 6LJ, London, UK;Division of Psychiatry, University College London, 149 Tottenham Court Rd, Bloomsbury, W1T 7NF, London, UK;Research and Development Department, North East London Foundation Trust, Maggie Lilley Suite, Goodmayes Hospital, Barley Lane, Ilford, IG3 8XJ, Essex, UK;Nuffield Department of Primary Care Health Sciences, University of Oxford Radcliffe Observatory Quarter, Woodstock Road, OX2 6GG, Oxford, UK;Nuffield Trust, 59 New Cavendish Street, W1G 7LP, London, UK;Peninsula Medical School, University of Plymouth, Drake Circus, Plymouth, PL4 8AA, Devon, UK;

关键词: Primary care;    General practice;    Antipsychotic medication;    Medication review;    Severe mental illness (SMI);    Schizophrenia;    Psychosis;    Stigma;    Trust;    Shared decision making (SDM);   

DOI  :  10.1186/s12888-021-03355-3

来源: Springer

【 摘 要 】

BackgroundIncreasing number of service users diagnosed with schizophrenia and psychosis are being discharged from specialist secondary care services to primary care, many of whom are prescribed long-term antipsychotics. It is unclear if General Practitioners (GPs) have the confidence and experience to appropriately review and adjust doses of antipsychotic medication without secondary care support.AimTo explore barriers and facilitators of conducting antipsychotic medication reviews in primary care for individuals with no specialist mental health input.Design & settingRealist review in general practice settings.MethodA realist review has been conducted to synthesise evidence on antipsychotic medication reviews conducted in primary care with service users diagnosed with schizophrenia or psychosis. Following initial scoping searches and discussions with stakeholders, a systematic search and iterative secondary searches were conducted. Articles were systematically screened and analysed to develop a realist programme theory explaining the contexts (C) and mechanisms (M) which facilitate or prevent antipsychotic medication reviews (O) in primary care settings, and the potential outcomes of medication reviews.ResultsMeaningful Antipsychotic medication reviews may not occur for individuals with only primary care medical input. Several, often mutually reinforcing, mechanisms have been identified as potential barriers to conducting such reviews, including low expectations of recovery for people with severe mental illness, a perceived lack of capability to understand and participate in medication reviews, linked with a lack of information shared in appointments between GPs and Service Users, perceived risk and uncertainty regarding antipsychotic medication and illness trajectory.ConclusionsThe review identified reciprocal and reinforcing stereotypes affecting both GPs and service users. Possible mechanisms to counteract these barriers are discussed, including realistic expectations of medication, and the need for increased information sharing and trust between GPs and service users.

【 授权许可】

CC BY