New research urges policy changes in antipsychotic medication management

Researchers from the University of Liverpool have called for reforms in the management of antipsychotic medication (APM) to support both patients and healthcare professionals.

Produced with collaborators at Powys Teaching Health Board, Leeds University and Glasgow University, a new paper identifies gaps in care for patients with serious mental illness.

white medication pill on orange plastic container

APM is increasingly prescribed to patients with serious mental illness, due in part to fewer side effects including uncontrollable physical movement. However, they can increase the risk of obesity and heart disease and therefore require physical health monitoring.

But despite this, many patients prescribed antipsychotics are discharged to primary care without planned psychiatric review.

The new study explores the perceptions of GPs, psychiatrists and managers/directors of policy regarding reasons for the increasing prevalence and management of antipsychotics in primary care.

Through interviews, a number of concerns were highlighted by participants. It was found that GPs lacked confidence to manage antipsychotic medications alone and psychiatrists lacked skills to address cardiometabolic risks. Communication barriers were also identified between services.

Pressures to discharge from hospital were reported, resulting in patients in primary care becoming ‘trapped’ on antipsychotics, inhibiting opportunities to deprescribe. Organisational and contractual barriers between services were also acknowledged with concerns this would exacerbate risk.

Socioeconomic deprivation and lack of access to non-pharmacological interventions were seen as driving overprescribing, with professionals voicing fears of criticism if a catastrophic event occurred after stopping an antipsychotic.

Contributing author Professor Iain Buchan, associate pro-vice chancellor for innovation at the University of Liverpool, said: ‘Our research has found that sadly, people prescribed antipsychotic medication experience fragmented, suboptimal care.

‘But there are opportunities to improve care for this population. Our paper outlines these suggestions including a hybrid form of contractual shared care for people taking antipsychotics so that they are not left in primary care on these drugs unnecessarily.

‘Changes to Royal College of General Practitioners and Royal College of Psychiatrists curriculum could also be implemented to improve knowledge and skills needed to manage patients on antipsychotics well.

‘The University of Liverpool and Mersey Care NHS Foundation Trust recently established the Mental Health Research for Innovation Centre (M-RIC) to drive better care in high priority situations such as this. Artificial intelligence will play an important role in how medicines are prescribed and used in future. We have embedded M-RIC in the new Civic Health Innovation Labs, concentrating data scientists and AI engineers on problems such as this.’

Image: James Yarema

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