Improving medication management and prescribing project

The aim of this project is:

• for consumers (tāngata whaiora) with serious mental illness get the support they need to manage their medicines after being discharged from a mental health and addiction (MHA) inpatient setting
• to test the ‘Optimise medicines on transition’ assessment tool; once refined, we aim to make the tool available to the MHA sector by June 2024.^[1]

Why this work is important

While medication is commonly used in people with serious mental illness, there are important issues relating to adherence (taking the medicine as directed) and side effects for those on psychiatric medication. If people do not take their medicines as directed, they may be more likely to be readmitted to an inpatient setting and experience a mental health relapse.^{[2, 3, 4, 5]}

Medication prescribing rates are increasing, especially in young people. For instance, the number of people dispensed antipsychotic medication increased from 661,119 in 2020/21 to 701,889 in 2021/22.^[6]

People with a mental health condition are less likely than others to be able to get health care (see a doctor or nurse) when needed (28 percent vs 18 percent). They are also less likely to be included in the medication decisions in which they would like to be involved.^[5]

Consumer focus

This national project focuses on consumers discharged from an MHA inpatient setting. Consumers will be assessed at their first follow-up appointment in the community to identify if they need extra support to manage their medicines and determine whether their medicines are affecting their wellbeing.

Testing the assessment tool

From October 2023, we will work with a small number of self-identified Te Whatu Ora districts to test the ‘Optimise medicines on transition’ assessment tool to identify MHA consumers who may need extra support to manage their medicines after being discharged from an MHA inpatient setting.

This is a different approach from those used in the other priority areas of our MHA quality improvement programme because we have a limited timeframe for the project (nine months) due to programme funding ending in June 2024.

The project will follow established Māori engagement, consumer engagement and quality improvement methodology.

What districts will do

We will be asking participating districts to identify and form testing teams that include:

• a project lead/project management
• project team members (ie, case managers/care providers)
• data entry support
• a project sponsor. (Having an executive project sponsor raises the profile of the project and communicates to other staff that the project is a priority for the organisation.)

Support for testing sites

We will support the district testing sites by providing:

• an initial 2-hour online ‘setting the scene’ information session on Wednesday 18 October 2023
• tools, advice and guidance to support preparation and testing
• monthly online networking meetings to discuss progress and findings
• national quality improvement expertise and advice for testing teams
• additional support to sites as needed (eg, support with troubleshooting)
• analysis of data captured at test sites
• a 2-hour online feedback session in March 2024 (date to be confirmed).

References

1. The assessment tool has been adapted from: (1) Acomb C, Laverty U, Smith H, et al. 2013. Medicines optimisation on discharge: The Integrated Medicines oPtimisAtion on Care Transfer (IMPACT) project. International Journal of Pharmacy Practice Suppl 2: 30–137 [research poster 0171] and (2) Barnett N, Athwal D, Rosenbloom K, et al. 2016. PREVENT Tool. London North West Healthcare NHS Trust Medicines Support Service. URL: www.nhs.uk/NHSEngland/keogh-review/Documents/quick-guides/background-docs/29-LWNH-nhs-trust-prevent-tool-copyright.pdf.
2. Australian Commission on Safety and Quality in Health Care. 2013. Literature Review: Medication safety in Australia. Sydney: Australian Commission on Safety and Quality in Health Care.
3. Tirupati S, Chua L. 2007. Obesity and metabolic syndrome in a psychiatric rehabilitation service. Australian and New Zealand Journal of Psychiatry 41: 606–10.
4. Vecchio D, Spence C. 2014. A review of antipsychotic polypharmacy, high-dose prescribing and evaluation of adherence to local physical health monitoring guidelines, within the assertive community team (ACT) at Rockingham Kwinana mental health service. Australian and New Zealand Journal of Psychiatry 48: 125–6.
5. Young S, Taylor M, Lawrie S. 2015. ‘First do no harm’: a systematic review of the prevalence and management of antipsychotic effects. Journal of Psychopharmacology 29(4): 353–62.
6. Te Hiringa Mahara New Zealand Mental Health and Wellbeing Commission. 2023. Te Huringa Tuarua 2023: Mental Health and Addiction Service Monitoring Report. URL: www.mhwc.govt.nz/our-work/our-reports.