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The Imperative of Involving Nurses When Reviewing Psychiatric Medication: a Qualitative Study of Implementing
Johan Frederik Mebus Meyer Christensen1,2,3, Elisabeth Mebus Meyer Christensen2,4, Ulla Christensen5
1Research Unit for Clinical Psychopharmacology, Mental Health Services West, Copenhagen University Hospital-Central and West Zealand Hospital, Slagelse, Region Zealand, Denmark.
Background:
We previously found that implementing medication reviews by a physician specialised in clinical pharmacology at interdisciplinary conferences with prescribing physicians and nurses led to a relative reduction in the number of drugs and potentially inappropriate prescriptions (PIPs) in psychiatric outpatients with diabetes. Adhering to the framework of health technology assessments (HTAs) and to facilitate direct implementation, we subsequently demonstrated the intervention as cost neutral.
Aim:
This study aimed to identify contextual, organisational and interprofessional barriers and facilitators in implementing the intervention focusing on nurses' role at interdisciplinary conferences.
Methods:
We conducted semi-structured interviews with available staff and four patients from the intervention group. We conducted a primary thematic analysis with HTA as a framework, while a secondary analysis situated the themes into a contextual understanding.
Results:
Interdisciplinary dialogue tailors pharmacological recommendations to patients adhering to clinical pragmatism rather than generic prescription guidelines. It enables professional growth and reciprocal learning and levels out an inherent doctor-nurse hierarchy. However, when conferences were online or hybrid, nurses did not benefit to the same extent and had the feeling of being set aside.
Conclusion:
Interdisciplinary medication reviews in psychiatry may improve the clinical relevance of pharmacological decision-making and level out an inherent physician-nurse hierarchy in psychiatry.
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