Division of Psychiatry, University College London, 149 Tottenham Court Rd, Bloomsbury, London, W1T 7NF, UK.
Comprehensive Clinical Trials Unit, 90 High Holborn, London, WC1V 6LJ, UK.
BMC Psychiatry. 2021 Aug 4;21(1):390. doi: 10.1186/s12888-021-03355-3.
Increasing number of service users diagnosed with schizophrenia and psychosis are being discharged from specialist secondary care services to primary care, many of whom are prescribed long-term antipsychotics. It is unclear if General Practitioners (GPs) have the confidence and experience to appropriately review and adjust doses of antipsychotic medication without secondary care support.
To explore barriers and facilitators of conducting antipsychotic medication reviews in primary care for individuals with no specialist mental health input.
DESIGN & SETTING: Realist review in general practice settings.
A realist review has been conducted to synthesise evidence on antipsychotic medication reviews conducted in primary care with service users diagnosed with schizophrenia or psychosis. Following initial scoping searches and discussions with stakeholders, a systematic search and iterative secondary searches were conducted. Articles were systematically screened and analysed to develop a realist programme theory explaining the contexts (C) and mechanisms (M) which facilitate or prevent antipsychotic medication reviews (O) in primary care settings, and the potential outcomes of medication reviews.
Meaningful Antipsychotic medication reviews may not occur for individuals with only primary care medical input. Several, often mutually reinforcing, mechanisms have been identified as potential barriers to conducting such reviews, including low expectations of recovery for people with severe mental illness, a perceived lack of capability to understand and participate in medication reviews, linked with a lack of information shared in appointments between GPs and Service Users, perceived risk and uncertainty regarding antipsychotic medication and illness trajectory.
The review identified reciprocal and reinforcing stereotypes affecting both GPs and service users. Possible mechanisms to counteract these barriers are discussed, including realistic expectations of medication, and the need for increased information sharing and trust between GPs and service users.
越来越多被诊断患有精神分裂症和精神病的服务使用者从专科二级保健服务出院到初级保健，其中许多人被开处长期抗精神病药物。目前尚不清楚全科医生（GP）是否有信心和经验在没有二级保健支持的情况下适当审查和调整抗精神病药物的剂量。
探讨在没有专门心理健康服务的情况下，在初级保健中进行抗精神病药物审查的障碍和促进因素。
在一般实践环境中进行现实主义审查。
对在初级保健中对被诊断为精神分裂症或精神病的服务使用者进行抗精神病药物审查进行了现实主义审查。在最初的范围搜索和与利益相关者讨论之后，进行了系统的搜索和迭代的二次搜索。对文章进行了系统筛选和分析，以制定一个现实的方案理论，解释在初级保健环境中促进或阻碍抗精神病药物审查（O）的背景（C）和机制（M），以及药物审查的潜在结果。
只有初级保健医疗投入的个体可能无法进行有意义的抗精神病药物审查。已经确定了几种相互增强的机制，这些机制可能成为进行此类审查的障碍，包括对严重精神疾病患者康复的期望较低，对理解和参与药物审查的能力缺乏认识，与全科医生和服务使用者之间的约会中缺乏信息共享，对抗精神病药物和疾病轨迹的潜在风险和不确定性的认识。
该审查确定了影响全科医生和服务使用者的相互强化的刻板印象。讨论了可能的机制来对抗这些障碍，包括对药物的现实期望，以及增加全科医生和服务使用者之间的信息共享和信任的必要性。
