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

Woodall, A. A., Abuzour, A. S., Wilson, S. A., Mair, F. S. , Buchan, I., Sheard, S. B., Atkinson, P., Joyce, D. W., Symon, P. and Walker, L. E. (2024) Management of antipsychotics in primary care: Insights from healthcare professionals and policy makers in the United Kingdom. PLoS ONE, 19(3), e0294974. (doi: 10.1371/journal.pone.0294974) (PMID:38427674) (PMCID:PMC10906843)

Abstract

Introduction 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. Methods 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. Results 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. Conclusions 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: Articles
• Additional Information: This work was funded by a Research Time Award to AW from Health and Care Research Wales (https://healthandcareresearchwales.org/) (NHS-RTA-21-02).
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Mair, Professor Frances

Creator Roles

Mair, F.: Conceptualization, Formal analysis, Funding acquisition, Investigation, Methodology, Writing – original draft, Writing – review and editing

• Authors: Woodall, A. A., Abuzour, A. S., Wilson, S. A., Mair, F. S., Buchan, I., Sheard, S. B., Atkinson, P., Joyce, D. W., Symon, P., and Walker, L. E.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > General Practice and Primary Care
• Journal Name: PLoS ONE
• Publisher: Public Library of Science
• ISSN: 1932-6203
• ISSN (Online): 1932-6203
• Copyright Holders: Copyright: © 2024 Woodall et al.
• First Published: First published in PLoS ONE 19(3): e0294974
• Publisher Policy: Reproduced under a Creative Commons licence