Improving medication review and cardiovascular risk management in patients using antipsychotics in general practice– a pilot study

Karlijn Van Den Brule-Barnhoorn, Kirsti Jakobs, Sietske Grol, Jan Van Lieshout, Marion Biermans, Erik Bischoff

Keywords: atypicial antipsychotic medication; cardiovascular risk; medication review; transmural; multidisciplinary

Background:

Patients using atypical antipsychotic medication (APM) have a significant increased cardiovascular risk (CVR). However, monitoring of CVR in general practice (GP) is insufficient due to lack of knowledge and time. TACTIC is a one-time transmural intervention aimed at reducing inappropriate APM use and CVR in patients in GP. TACTIC consists of an information meeting, a multidisciplinary meeting with the patient, and a follow-up consultation with the GP in which an individualized treatment plan is drawn up. We investigated the feasibility of TACTIC in a qualitative pilot study in order to optimize the intervention for application in an upcoming RCT.

Research questions:

What are barriers and facilitators for the feasibility of TACTIC according to patients and healthcare professionals? What are suggestions of improvement for the intervention?

Method:

Patients, selected through purposive sampling, were invited for individual interviews. Healthcare professionals were invited for focus group interviews. Interviews were semi-structured and interview guides were based on the Normalization Process Theory. We used the Framework Method for analysis of our data, in order to identify themes. We applied the COnsolidated criteria for REporting Qualitative research (COREQ) guideline.

Results:

We conducted eight individual and two focus group interviews, with eleven healthcare professionals in total. This resulted in a number of important facilitating factors: personal approach, clear information meeting, and a summary with advice from the psychiatrist after the multidisciplinary meeting. Barriers appeared to be the high work load for GPs when recruiting participants, the relative short duration of the multidisciplinary meeting and the tension/anxiety patients felt during participation. Suggestions for improvement included indication, management of patients’ expectations, communication and data flow between healthcare professionals.

Conclusions:

This qualitative analysis uncovered various barriers and facilitators, and useful suggestions for improvement, which we will use to further develop the TACTIC intervention in preparation for the upcoming RCT.

Points for discussion:

Suggestions for how to recruit participants, especially because the target group consists of patients who are generally more difficult to reach and motivate.

Regarding inclusion criteria: what patient group qualifies for the TACTIC intervention? Which patients benefit most? Should we include every patient on APM or patients having a CVR of e.g. 5% or higher?

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