dolores keating , head of pharmacy services, saint john of god hospital
TRANSCRIPT
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
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
“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”
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
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