Background

Antipsychotic polypharmacy (“polypharmacy”) involves the concurrent prescribing of two or more antipsychotics for managing schizophrenia. It occurs frequently despite there being limited clinical evidence for this practice and an increased risk of adverse events. Little is understood about why it occurs outside of treatment guidelines, highlighting a current research gap.

Objective

To explore the factors contributing to non-evidence based polypharmacy practice and possible strategies for addressing these factors.

Methods

Three focus groups were conducted between June and August 2018 with doctors and nurses employed at a mental health unit of a Western Australian public hospital. Participants were asked about their perceptions of polypharmacy, why it occurred and what could limit its prevalence. Thematic inductive analysis was mapped to the Theoretical Domains Framework to identify key underlying themes and to establish potential enablers and barriers for practice change.

Results

Participants understood the risks of polypharmacy and perceived it to largely be perpetuated by external factors, out of which two key themes emerged: system-related issues (e.g.: communication failures whereby de-prescribing plans are not actioned); and patient-related issues (e.g.: misinformed views translating to medication-seeking behaviour). This led to the third theme: a disconnect between clinicians' knowledge and their practices (i.e.: being aware of Australian evidence-based guideline recommendations yet acknowledging polypharmacy still occurred due to the aforementioned issues). Strategies suggested to address these issues included developing medication management plans to bridge communication gaps and managing patients’ medication expectations with education.

Conclusions

Management of schizophrenia is complex, requiring consideration of many patient-related and systemic factors. Polypharmacy has a place in certain contexts, however, must be well considered and closely monitored to allow for early identification of opportunities to rationalise (i.e.: de-prescribe) therapy, where appropriate. Future research objectives will centre on implementing strategies identified from these focus groups to optimise patient outcomes.

中文翻译：

---

非指南依从性抗精神病药多药治疗因素的定性探索

背景

抗精神病药联合用药（“多重用药”）涉及同时开具两种或多种抗精神病药来治疗精神分裂症。尽管这种做法的临床证据有限并且不良事件的风险增加，但它经常发生。关于它为什么会出现在治疗指南之外的原因知之甚少，这凸显了当前的研究差距。

客观的

探讨促成非循证复方用药实践的因素以及解决这些因素的可能策略。

方法

在 2018 年 6 月至 8 月期间，与受雇于西澳大利亚州公立医院心理健康部门的医生和护士进行了三个焦点小组讨论。参与者被问及他们对多种药物的看法，为什么会发生以及什么可以限制其流行。主题归纳分析被映射到理论领域框架，以确定关键的潜在主题，并为实践变革建立潜在的推动因素和障碍。

结果

参与者了解多种药物的风险，并认为它在很大程度上受到外部因素的影响，其中出现了两个关键主题：系统相关问题（例如：沟通失败，未采取取消处方计划）；以及与患者相关的问题（例如：转化为寻求药物行为的错误观点）。这导致了第三个主题：临床医生的知识与他们的实践之间的脱节（即：了解澳大利亚循证指南建议但承认由于上述问题仍然存在多种药物治疗）。建议解决这些问题的策略包括制定药物管理计划以弥合沟通差距和通过教育管理患者的药物期望。

结论

精神分裂症的管理很复杂，需要考虑许多与患者相关的全身因素。多种药物在某些情况下占有一席之地，但是，必须充分考虑和密切监测，以便在适当的情况下尽早发现合理化（即：取消处方）治疗的机会。未来的研究目标将集中在实施从这些焦点小组中确定的策略以优化患者结果。