Nash Annabel, Kingstone Tom, Farooq Saeed, Tunmore Jessica, Chew-Graham Carolyn A
Research and Innovation Department, Midlands Partnership NHS Foundation Trust, Stafford, UK.
School of Life Sciences and Education, Staffordshire University, Stoke-on-Trent, UK.
BMJ Open. 2021 Feb 26;11(2):e042497. doi: 10.1136/bmjopen-2020-042497.
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).
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.
Participants recruited through primary care and one mental health trust in the West Midlands.
Interviews were conducted with 9 GPs, 10 psychiatrists and 4 mental health nurses.
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.
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.
抗精神病药物（APs）的副作用会增加患身体健康问题的风险。某些抗精神病药物带来的风险高于其他药物。有证据表明，换用风险较低的抗精神病药物有助于改善身体健康状况。我们试图探讨医疗保健专业人员对于为支持严重精神疾病（SMI）患者的身体健康而更换抗精神病药物的看法。
一项定性研究，对全科医生（GPs）、精神科医生和心理健康护士进行半结构化访谈。主要重点是探讨参与者对严重精神疾病患者身体健康、抗精神病药物的影响以及为支持身体健康而更换药物的决策的看法。使用持续比较原则对数据进行主题分析。
通过西米德兰兹郡的初级保健机构和一家心理健康信托机构招募参与者。
对9名全科医生、10名精神科医生和4名心理健康护士进行了访谈。
初级和二级医疗临床医生对抗精神病药物副作用和风险概况的认识和了解差异很大。全科医生表示认识有限，而精神科医生和护士对抗精神病药物风险概况和副作用有全面的了解。心理健康和症状控制被列为优先事项。一旦出现副作用或并发症，将换用药物以促进身体健康视为一种应对性干预措施。对于监测身体健康和考虑换药的责任归属存在多种观点。初级和二级医疗之间的合作被视为解决这一问题的一种方式。
本研究呈现了关于抗精神病药物换药以支持身体健康的认识、决策、感知责任和障碍的多学科观点。涉及初级和二级医疗之间联络但针对个体患者量身定制的协作方法，可能有助于换药，并提供了一个干预机会，以解决严重精神疾病患者所经历的身体健康不平等问题。
