West London NHS Trust, London, UK.
Dept of Psychiatry, Imperial College London, London, UK.
Community Ment Health J. 2021 Nov;57(8):1566-1578. doi: 10.1007/s10597-021-00780-2. Epub 2021 Feb 5.
Personalised care involves shared decision making (SDM) across all levels including choice in medication. However, there are a number of barriers which prevent its effective implementation in routine mental health settings. Therefore, we undertook a study to benchmark current practice across clinical services of a large urban mental health provider. The study formed part of the trust-wide 'Supported Decision Making in Medication' Co-Production Project and aims to inform future recommendations in delivering against contemporary best practice, guidance and policy. A survey exploring the views and experiences of service users and prescribers on shared and supported decision-making in medication was carried out in West London NHS Trust. Questionnaires were fully co-designed and co-delivered by a group of health professionals and individuals with lived experience. There were 100 responses from service users and 35 from prescribers. There was some good practice where both parties reported good quality conversations concerning dialogic styles, collaborative process, information provided and range of choice offered. However, prescriber's perception of their practice was not always mirrored by service user feedback whose experiences often depended upon the prescriber, the time available or the part of the service. Generally, service user experience fell short of the good practice cited by clinicians though there was noticeable variability. Commitment from organizations and increasing understanding from practitioners are vital in transforming SDM from rhetoric into reality. From our findings a further challenge is to ensure that prescribers and service users have the time, information and tools to implement it consistently.
个性化护理涉及各级别的共同决策（SDM），包括药物选择。然而，有许多障碍阻碍了其在常规心理健康环境中的有效实施。因此，我们进行了一项研究，以对大型城市心理健康服务提供商的临床服务进行当前实践基准测试。该研究是信托范围内“药物共同决策支持”共同制定项目的一部分，旨在为提供当代最佳实践、指南和政策提供信息。在伦敦西部 NHS 信托中，进行了一项调查，以探索服务使用者和处方者对药物共同和支持决策的看法和经验。问卷由一组医疗保健专业人员和有生活经验的个人共同完全设计和提供。有 100 名服务使用者和 35 名处方者做出了回应。在对话风格、协作过程、提供的信息和提供的选择范围方面，双方都有一些良好的实践经验。然而，处方者对其实践的看法并不总是反映服务使用者的反馈，服务使用者的经验往往取决于处方者、可用时间或服务的一部分。一般来说，服务使用者的体验不如临床医生提到的良好实践，尽管存在明显的差异。组织的承诺和从业者的理解增加对于将 SDM 从空谈转变为现实至关重要。根据我们的发现，进一步的挑战是确保处方者和服务使用者有时间、信息和工具来一致地实施它。
