Dolores Keating , Head of Pharmacy Services, Saint John of God Hospital
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This document discusses engaging with medication and supporting patient activation and optimization. It emphasizes adopting a person-centered approach to medication use that involves providing information, supporting interactive consultations, shared decision making, actively managing side effects, and engaging with patients more frequently. This helps patients build knowledge, confidence, and skills to better manage their own healthcare and medications. The document also highlights barriers clinicians face in adopting these approaches and the need for quality improvement initiatives focused on medication safety.
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Dolores Keating , Head of Pharmacy Services, Saint John of God Hospital
- 1. Engaging with Medication Dolores Keating BSc(Pharm), MSc, DipPsychPharm, MPSI, MCMHP Head of Pharmacy Services, Saint John of God Hospital, Project Director, Mental Health First Aid Ireland, Training and Research Programme, Honorary Senior Clinical Lecturer, School of Pharmacy, Royal College of Surgeons in Ireland
- 2. ‘The most useful thing is medication and not just bunging someone on it and leaving them; monitoring it, changing it, adjusting it as needed’ Schizophrenia. The Abandoned Illness. Schizophrenia Commission. 2012
- 3. Adherence to Long Term Therapies. Evidence for Action. World Health Organisation. 2003 ‘A worldwide problem of striking magnitude’ 50% Non adherence
- 4. Non-Adherence Schizophrenia 0 10 20 30 40 50 60 70 80 90 100 1 month 1 year 2 years Leucht s et al. Epidemiology, clinical consequences and psychosocial treatment of non-adherence in schizophrenia. J Clin Psychiatry 2006; 67 Suppl 5:3-8
- 5. Community Drugs Schemes SSRI & SNRI prescribing 0.00% 5.00% 10.00% 15.00% 20.00% 25.00% 30.00% 35.00% Duration of antidepressant use - percentage of patients 1 2 3 4 5 6 7 8 9 10 11 12
- 7. “Realising the Value” Wood S et al. At the Heart of Health. Realising the Value of People and Communities. The Kings Fund. March 2016
- 9. Patient Activation – Knowledge, skills and confidence a person has in managing their own health and healthcare Hibbard, J, Gilburt G. Supporting people to manage their health. An introduction to patient activation. The Kings Fund. 2014
- 10. Levels of Activation Level 1 Level 2 Level 3 Level 4 Predisposed to be Passive Building knowledge and confidence Taking action Maintaining behaviours, pushing further “My doctor is in charge of my health” “I could be doing more” “I’m part of my healthcare team” “I’m my own advocate” Hibbard, J, Gilburt G. Supporting people to manage their health. An introduction to patient activation. The Kings Fund. 2014
- 11. Medicines Optimisation – a person-centred approach to safe and effective medicines use, to ensure people obtain the best possible outcomes from their medicines Royal Pharmaceutical Society. Medicines optimisation: Helping patients to make the most of medicines. 2013.
- 12. Royal Pharmaceutical Society. Medicines optimisation: Helping patients to make the most of medicines. 2013.
- 13. How can we Support Activation and Optimisation? Provide information Supporting an interactive consultation Shared decision making Actively manage side effects Engage more frequently
- 19. Support an Interactive Consultation
- 23. “No Decision About Me Without Me” Angela Coulter, 2011 Coulter A and Collins A. Making Shared Decision Making a Reality. The Kings Fund. 2011
- 24. Clinician’s Expertise Service User’s Expertise Diagnosis Experience Of Illness Disease Aetiology Social Circumstances Prognosis Attitude to Risk Treatment Options Values Outcome Probabilities Preferences
- 25. Decision Aid • Description of the condition and the symptoms • The likely prognosis with and without treatment • The treatment and self management support options and outcome probabilities • What’s known from the evidence and not known (uncertainties) • Illustrations to help people understand what it might be like to experience some of the most frequent side effects or complications of the treatment options • A means of helping people clarify their preferences Coulter A and Collins A. Making Shared Decision Making a Reality. The Kings Fund. 2011 Stacey D et al. Decision aids for people facing health treatment or screening decisions . Cochrane Database of Systematic Reviews. 2014. Art No CD001431
- 27. Barriers “No time to do it” “We already do it” “Patient’s don’t want it” “Not appropriate for those with low health literacy” “It’s irrelevant and ineffective”
- 28. Actively Manage Side Effects
- 29. Hynes C et al. Glasgow antipsychotic side effects scale for clozapine- Development and validation of a clozapine specific side effects scale. Schizophrenia Res. 2015. 168: 505-513
- 30. National Lithium patient information packs are available to order from KPW Print Tel: 090642297
- 32. www.bloomprogram.ca New Medicines Service, NHS www.mentalhealthproject.com.au
- 33. Providing support through social networks Enabling communication with clinicians, family members and caregivers Providing guidance based on information entered by the user Displaying and summarising health information Recording and tracking health information Reminding or alerting users Providing educational information Supporting behaviour change through rewards Sing K et al. Developing a Framework for Evaluating the Patient engagement, Quality and Safety of Mobile Health Application. Issue Brief (The Commonwealth Fund). 2016; 5, 1-11 Mobile Health Applications
- 34. Do Clinicians Engage? Do we monitor medication side effects? What about physical health? Deprescribing? Medication safety Medicines reconciliation? Quality improvement?
- 35. Medication Safety Enable increased focus on quality and safe practice associated with medication management in mental health services Scope out project to identify priority areas Mental Health Division Operational Plan, 2016
- 36. “Using medications is not a moral issue. We must find what works for us at this time in our lives” Patricia Deegan, PhD
Editor's Notes
- People’s experience of tking medication hasn’t always been posistive. There is often a period of tial and error, people talk about their concerns around medication being dismissed, a lack of information about the intentions when using the medication and the risks involved….not very empowering is it? Medication is much more useful if we engage with it.
- People generally don’t take medication as it was intended….not unique to psychychiatry…WHO said if we just used the medicines we have the way they we are supposed to then we wouldn’t need many more developments at all. Putting the medicines into one of these contraptions will help if forgetfulness is an issue but if a person just doesn’t want to take that medication well, that’s not going to solve the problem. Adherence internationally averages 50%
- 30% of people collect only one month of their medication and never get it again only to be replaces the next month with the exact same number of people who do exactly the same thing.
- Patient activation is defined as….. Measure it….not reliant on educational background or sociodemographic factors….can’t make assumptions about anyone with regard to how much they want to be involved
- Aim to understand the personal experience. How do we translate the evidence that we have to the individual.
- Individualised information best.
- Group based information
- Group based information….confidence
- Decision Support Centre. Common ground approach
- What all of this does is support shared decision making. Engagment, activation, optimisation, empowerment.
- A good decision aid will include all evidence based options, recognise uncertainties, have good risk communication. Visualisation of risks or likely benefits. What if I do nothing? Future care
- Time and resources Inflexible systems Clinical culture Need to continue to engage
- Hope
- Using the most accessible healthcare professional to help people particularly in the early stages of using medicines…many of the difficulties are likely to arise
- We have certainly prescribed, administered and dispensed medication….but have we engaged? We seem to have forgotten that even in services that have access to psychological approached, medications are still used. It’s the most frequent intervention in healthcare. Just as we share capabilities with our service users, we share responsibilities as well. We need to do our jobs better. It causes a lot of harm when it’s not used well. Do we use and interpret the knowledge and evidence we have to help people on an individual basis.
- Isn’t this a wonderful opportunity…to see the best of what has happened internationally and locally, use what we can and build on it. People around the world. Opportunity to lead not just within mental health but across healthcare. And we’ve actually had a headstart on this. Opportunity to support both primary and secondary care. I can see it….Future Hea We have a responsibility to be fabulous at it. Opportunity for a really impactful programme of work.
- If a medication is something a person chooses to use to support their recovery…then lets’s use it well together. Lets work together to engage with medication