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

‘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

Adherence to Long Term Therapies. Evidence for Action. World Health Organisation. 2003

‘A worldwide problem of striking magnitude’

50%Non adherence

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

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

“Realising the Value”Wood S et al. At the Heart of Health.

Realising the Value of People and Communities. The Kings Fund. March 2016

Recovery

OptimisationActivation

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

Levels of ActivationLevel 1 Level 2 Level 3 Level 4

Predisposed to be Passive

Building knowledge and

confidence

Taking action Maintainingbehaviours,

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

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.

Royal Pharmaceutical Society. Medicines optimisation: Helping patients to make the most of medicines. 2013.

How can we Support Activation and Optimisation?

Provide information

Supporting an interactive consultation

Shared decision making

Actively manage side effects

Engage more frequently

Provide Information

Choice and Medication

http://www.choiceandmedication.org/stjohnofgodhospital

www.headmeds.org.uk

Support an Interactive Consultation

Shared Decision Making

“No Decision About Me

Without Me”

Angela Coulter, 2011

Coulter A and Collins A. Making Shared Decision Making a Reality. The Kings Fund. 2011

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

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. 2011Stacey D et al. Decision aids for people facing health treatment or screening decisions . Cochrane

Database of Systematic Reviews. 2014. Art No CD001431

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”

Actively Manage Side Effects

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

National Lithium patient information packs are available to order from KPW Print Tel: 090642297

Engage More Frequently

www.bloomprogram.ca New Medicines Service, NHS www.mentalhealthproject.com.au

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

Do Clinicians Engage?

Do we monitor medication side effects?

What about physical health?

Deprescribing?

Medication safety

Medicines reconciliation?

Quality improvement?

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

“Using medications is not a moral issue. We must find what works for us at this time in our lives”

Patricia Deegan, PhD