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


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. PROSPERO REGISTRATION NUMBER: CRD42021280980.

Publication DOI: https://doi.org/10.1136/bmjqs-2023-016615
Divisions: College of Health & Life Sciences > Aston Pharmacy School
College of Health & Life Sciences
Funding Information: This study/project is funded by the NIHR Programme Development Award (203683)
Additional Information: © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
Uncontrolled Keywords: compliance,medication safety,mental health,patient-centred care,shared decision making,Health Policy
Publication ISSN: 2044-5423
Last Modified: 24 May 2024 07:20
Date Deposited: 12 Dec 2023 15:45
Full Text Link:
Related URLs: https://quality ... jqs-2023-016615 (Publisher URL)
http://www.scop ... tnerID=8YFLogxK (Scopus URL)
PURE Output Type: Review article
Published Date: 2023-12-07
Published Online Date: 2023-12-07
Accepted Date: 2023-10-14
Authors: Howe, Jo (ORCID Profile 0000-0002-7567-075X)
MacPhee, Maura
Duddy, Claire
Habib, Hafsah (ORCID Profile 0000-0002-5910-036X)
Wong, Geoff
Jacklin, Simon
Oduola, Sheri
Upthegrove, Rachel
Carlish, Max
Allen, Katherine
Patterson, Emma
Maidment, Ian (ORCID Profile 0000-0003-4152-9704)



Version: Published Version

License: Creative Commons Attribution

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