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Switching antipsychotics to support the physical health of people with severe mental illness: A qualitative study of healthcare professionals' perspectives

Nash, Annabel; Kingstone, Tom; Farooq, Saeed; Tunmore, Jessica; Chew-Graham, Carolyn A

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Authors

Annabel Nash

Jessica Tunmore



Abstract

OBJECTIVES: The side effects of antipsychotic medications (APs) can increase the risk of developing physical health conditions. Some APs pose a higher risk than others. Evidence suggests switching to lower risk APs can support physical health outcomes. We sought to explore the views of healthcare professionals about switching antipsychotics to support physical health in people with severe mental illness (SMI). DESIGN: A qualitative study with semi-structured interviews conducted with general practitioners (GPs), psychiatrists and mental health nurses. The main focus was to explore participants' views on the physical health of people with SMI, the impact of APs and decision-making about switching medication to support physical health. Data were analysed thematically using principles of constant comparison. SETTINGS: Participants recruited through primary care and one mental health trust in the West Midlands. PARTICIPANTS: Interviews were conducted with 9 GPs, 10 psychiatrists and 4 mental health nurses. RESULTS: Awareness and knowledge of AP side-effects and risk profiles varied considerably between primary and secondary care clinicians. GPs reported limited awareness, while psychiatrists and nurses demonstrated a comprehensive understanding of AP risk profiles and side-effects. Mental health and control of symptoms were prioritised. Switching to promote physical health was considered as a reactive intervention, once side-effects or complications developed. There were a range of views over where responsibility lay for monitoring physical health and consideration of switching. Collaboration between primary and secondary care was identified as a way to address this. CONCLUSIONS: This study presents multidisciplinary perspectives on awareness, decision making, perceived responsibility and barriers to switching APs to support physical health. Collaborative approaches that involve liaison between primary and secondary care, but tailored to the individual patient, may support switching, and present an opportunity to intervene to address the physical health inequalities experienced by individuals with SMI.

Citation

Nash, A., Kingstone, T., Farooq, S., Tunmore, J., & Chew-Graham, C. A. (2021). Switching antipsychotics to support the physical health of people with severe mental illness: A qualitative study of healthcare professionals' perspectives. BMJ Open, e042497 - ?. https://doi.org/10.1136/bmjopen-2020-042497

Journal Article Type Article
Acceptance Date Jan 22, 2021
Online Publication Date Feb 26, 2021
Publication Date Feb 26, 2021
Publicly Available Date May 30, 2023
Journal BMJ Open
Publisher BMJ Publishing Group
Pages e042497 - ?
DOI https://doi.org/10.1136/bmjopen-2020-042497
Keywords mental health, primary care, psychiatry, qualitative research, schizophrenia & psychotic disorders
Publisher URL https://bmjopen.bmj.com/content/11/2/e042497.info

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