Management of antipsychotics in primary care: Insights from healthcare professionals and policy makers in the United Kingdom.

Woodall, Alan A ORCID: 0000-0003-2933-0508, Abuzour, Aseel S, Wilson, Samantha A, Mair, Frances S, Buchan, Iain, Sheard, Sally B ORCID: 0000-0001-8116-9120, Atkinson, Paul ORCID: 0000-0001-8740-6561, Joyce, Dan W, Symon, Pyers and Walker, Lauren E (2024) Management of antipsychotics in primary care: Insights from healthcare professionals and policy makers in the United Kingdom. PloS one, 19 (3). e0294974-e0294974.

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Abstract

<h4>Introduction</h4>Antipsychotic medication is increasingly prescribed to patients with serious mental illness. Patients with serious mental illness often have cardiovascular and metabolic comorbidities, and antipsychotics independently increase the risk of cardiometabolic disease. Despite this, many patients prescribed antipsychotics are discharged to primary care without planned psychiatric review. We explore perceptions of healthcare professionals and managers/directors of policy regarding reasons for increasing prevalence and management of antipsychotics in primary care.<h4>Methods</h4>Qualitative study using semi-structured interviews with 11 general practitioners (GPs), 8 psychiatrists, and 11 managers/directors of policy in the United Kingdom. Data was analysed using thematic analysis.<h4>Results</h4>Respondents reported competency gaps that impaired ability to manage patients prescribed antipsychotic medications, arising from inadequate postgraduate training and professional development. GPs lacked confidence to manage antipsychotic medications alone; psychiatrists lacked skills to address cardiometabolic risks and did not perceive this as their role. Communication barriers, lack of integrated care records, limited psychology provision, lowered expectation towards patients with serious mental illness by professionals, and pressure to discharge from hospital resulted in patients in primary care becoming 'trapped' on antipsychotics, inhibiting opportunities to deprescribe. Organisational and contractual barriers between services exacerbate this risk, with socioeconomic deprivation and lack of access to non-pharmacological interventions driving overprescribing. Professionals voiced fears of censure if a catastrophic event occurred after stopping an antipsychotic. Facilitators to overcome these barriers were suggested.<h4>Conclusions</h4>People prescribed antipsychotics experience a fragmented health system and suboptimal care. Several interventions could be taken to improve care for this population, but inadequate availability of non-pharmacological interventions and socioeconomic factors increasing mental distress need policy change to improve outcomes. The role of professionals' fear of medicolegal or regulatory censure inhibiting antipsychotic deprescribing was a new finding in this study.

Item Type:	Article
Uncontrolled Keywords:	Humans, Antipsychotic Agents, Administrative Personnel, Primary Health Care, Delivery of Health Care, General Practitioners, United Kingdom
Divisions:	Faculty of Health and Life Sciences Faculty of Humanities and Social Sciences > School of Histories, Languages and Cultures Faculty of Health and Life Sciences > Institute of Population Health
Depositing User:	Symplectic Admin
Date Deposited:	12 Mar 2024 08:41
Last Modified:	12 Mar 2024 10:46
DOI:	10.1371/journal.pone.0294974
Open Access URL:	https://doi.org/10.1371/journal.pone.0294974
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3179267