A realist review of medication optimisation of community dwelling service users with serious mental illness

Howe, Jo, MacPhee, Maura, Duddy, Claire, Habib, Hafsah, Wong, Geoff, Jacklin, Simon, Oduola, Sheri ORCID: https://orcid.org/0000-0002-7227-9536, Upthegrove, Rachel, Carlish, Max, Allen, Katherine, Patterson, Emma and Maidment, Ian (2023) A realist review of medication optimisation of community dwelling service users with serious mental illness. BMJ Quality & Safety. ISSN 2044-5415

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Abstract

Background: Severe mental illness (SMI) incorporates schizophrenia, bipolar disorder, non-organic psychosis, personality disorder or any other severe and enduring mental health illness. Medication, particularly antipsychotics and mood stabilisers are the main treatment options. Medication optimisation is a hallmark of medication safety, characterised by the use of collaborative, person-centred approaches. There is very little published research describing medication optimisation with people living with SMI. Objective: Published literature and two stakeholder groups were employed to answer: What works for whom and in what circumstances to optimise medication use with people living with SMI in the community? Methods: A five-stage realist review was co-conducted with a lived experience group of individuals living with SMI and a practitioner group caring for individuals with SMI. An initial programme theory was developed. A formal literature search was conducted across eight bibliographic databases, and literature were screened for relevance to programme theory refinement. In total 60 papers contributed to the review. 42 papers were from the original database search with 18 papers identified from additional database searches and citation searches conducted based on stakeholder recommendations. Results: Our programme theory represents a continuum from a service user’s initial diagnosis of SMI to therapeutic alliance development with practitioners, followed by mutual exchange of information, shared decision-making and medication optimisation. Accompanying the programme theory are 11 context-mechanism-outcome configurations that propose evidence-informed contextual factors and mechanisms that either facilitate or impede medication optimisation. Two mid-range theories highlighted in this review are supported decision-making and trust formation. Conclusions: Supported decision-making and trust are foundational to overcoming stigma and establishing ‘safety’ and comfort between service users and practitioners. Avenues for future research include the influence of stigma and equity across cultural and ethnic groups with individuals with SMI; and use of trained supports, such as peer support workers.

Item Type: Article
Additional Information: Funding Information: This study/project is funded by the NIHR Programme Development Award (203683).
Uncontrolled Keywords: compliance,medication safety,mental health,patient-centred care,shared decision making,health policy,sdg 3 - good health and well-being ,/dk/atira/pure/subjectarea/asjc/2700/2719
Faculty \ School: Faculty of Medicine and Health Sciences > School of Health Sciences
UEA Research Groups: Faculty of Medicine and Health Sciences > Research Centres > Population Health
Faculty of Science > Research Groups > Norwich Epidemiology Centre
Faculty of Medicine and Health Sciences > Research Groups > Norwich Epidemiology Centre
Faculty of Medicine and Health Sciences > Research Groups > Health Promotion
Related URLs:
Depositing User: LivePure Connector
Date Deposited: 12 Dec 2023 01:20
Last Modified: 18 Jul 2024 02:07
URI: https://ueaeprints.uea.ac.uk/id/eprint/93948
DOI: 10.1136/bmjqs-2023-016615

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