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Medication optimisation in severe mental illness (MEDIATE): protocol for a realist review

Jacklin

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Abstract

INTRODUCTION: Severe mental illness (SMI) is associated with significant morbidity and mortality. People living with SMI often receive complex medication regimens. Optimising these regimens can be challenging. Non-adherence is common and addressing it requires a collaborative approach to decision making. MEDIATE uses a realist approach with extensive engagement with experts-by-experience to make sense of the complexities and identify potential solutions.Realist research is used to unpack and explain complexity using programme theory/theories that contain causal explanations of outcomes, expressed as context-mechanism-outcome-configurations. The programme theory/theories will enable MEDIATE to address its aim of understanding what works, for whom, in what circumstances, to optimise medication use with people living with SMI. METHOD AND ANALYSIS: MEDIATE will be conducted over six stages. In stage 1, we will collaborate with our service user/family carer lived experience group (LEG) and practitioner stakeholder group (SG), to determine the focus. In stage 2, we will develop initial programme theories for what needs to be done, by whom, how and why, and in what contexts to optimise medication use. In stage 3, we will develop and run searches to identify secondary data to refine our initial programme theories.Stage 4 involves selection and appraisal: documents will be screened by title, abstract/keywords and full text against inclusion and exclusion criteria. In stage 5, relevant data will extracted, recorded and coded. Data will be analysed using a realist logic with input from the LEG and SG. Finally, in stage 6, refined programme theories will be developed, identifying causal explanations for key outcomes and the strategies required to change contexts to trigger the key mechanisms that produce these outcomes. ETHICS AND DISSEMINATION: Primary data will not be collected, and therefore, ethical approval is not required. MEDIATE will be disseminated via publications, conferences and form the basis for future grant applications. PROSPERO REGISTRATION NUMBER: CRD42021280980.

Journal Article Type Article
Acceptance Date Dec 23, 2021
Publication Date Jan 24, 2022
Publicly Available Date Mar 28, 2024
Journal BMJ OPEN
Publisher BMJ Publishing Group
Volume 12
Issue 1
Article Number ARTN e058524
Pages e058524 - ?
DOI https://doi.org/10.1136/bmjopen-2021-058524
Publisher URL https://bmjopen.bmj.com/content/12/1/e058524

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