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      Implementing a digital clinical decision support tool for side effects of antipsychotics: a focus group study

      ,   , , , ,

      Evidence Based Mental Health

      BMJ

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          Abstract

          Background

          In medicine, algorithms can inform treatment decisions by combining the most up-to-date evidence about side effect profiles of medications, which are comparable in efficacy. Their use provides opportunities for improved shared clinician–patient decision-making when initiating therapy. We designed a decision support tool (DST) that incorporated the latest evidence regarding antipsychotic side effects. The tool allowed patients to select one side effect commonly associated with antipsychotics that they wished to avoid; the tool then provided a list of suggested medications and ones to avoid.

          Objective

          To explore qualitatively the acceptability and usefulness of the DST from the perspectives of patients and psychiatrists.

          Methods

          This qualitative study took place at a mental health and community hospital in Oxford, UK, in 2018. Four patients/carers and four psychiatrists were recruited to two focus groups to explore their perceptions of the tool. Data were thematically analysed.

          Findings

          Findings demonstrated a high degree of acceptability and potential usability of the DST for patients and psychiatrists. The main themes to emerge relating to the DST were ‘prescribing preferences and practices’, ‘consideration and awareness of side effects’, ‘app content, layout and accessibility’, ‘influence on clinical practice’ and ‘role in decision-making’.

          Conclusions

          A proof-of-concept clinical study will incorporate the recommendations produced from the findings into the tool’s design.

          Clinical implications

          Digital DSTs provide opportunities for the most up-to-date information on medication side effects to be used as the basis for shared clinician–patient decision-making. This tool has the potential to improve adherence to psychiatric medication, with benefits to clinical outcomes and healthcare resourcing.

          Related collections

          Most cited references 11

          • Record: found
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          Tools to Promote Shared Decision Making in Serious Illness: A Systematic Review.

          Serious illness impairs function and threatens survival. Patients facing serious illness value shared decision making, yet few decision aids address the needs of this population.
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            Impact of present and past antipsychotic side effects on attitude toward typical antipsychotic treatment and adherence.

             R D Mass,  P Eide,  A M Karow (2004)
            (1) determine which antipsychotic side effects (SE) schizophrenic patients consider the most distressing during treatment with typical antipsychotics, (2) measure the impact of actual and past SE on patients' attitude toward antipsychotics and (3) assess the influence of both on adherence. The 213 schizophrenics, treated with conventional antipsychotics, were recruited in two psychiatric hospitals in Hamburg. Subjects were assessed about type and severity of present and past side effects and their attitude and adherence to antipsychotic treatment. The 82 (39%) patients presented present SE while 131 (61%) did not. Sexual dysfunctions (P < 0.001), extrapyramidal (P < 0.05) and psychic side effects (P < 0.05) were rated as significantly subjectively more distressing than sedation or vegetative side effects. Patients presenting with present SE compared with patients without present SE had a significantly more negative general attitude toward antipsychotics (P < 0.05), were more doubtful about their efficacy (P < 0.01) and were less likely to encourage a relative to take such a medication in case of need (P < 0.001). A regression analysis indicated that nonadherence was mainly influenced by negative general and efficacy attitudes toward antipsychotics and the experience of past or present antipsychotic side effects. All antipsychotic side effects, present or past, can have a durable negative impact on patient's attitude toward antipsychotic treatment and adherence. Non-adherence is mainly determined, among other factors, by these negative attitudes, which are partly influenced by the experience of past or present antipsychotic-induced side effects.
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              • Record: found
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              Network meta-analyses should be the highest level of evidence in treatment guidelines.

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                Author and article information

                Journal
                Evidence Based Mental Health
                Evid Based Mental Health
                BMJ
                1362-0347
                1468-960X
                April 25 2019
                May 2019
                May 2019
                April 15 2019
                : 22
                : 2
                : 56-60
                Article
                10.1136/ebmental-2019-300086
                30987972
                © 2019

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