Mental health articles

Teaching medication management to practitioners

In a cluster randomised controlled trial, Gray et al. developed a medicines management training package and taught it to 60 com munity mental health nurses (CMHNs). The educational programme lasted 80 hours and was based on the Compliance Therapy Manual. Community mental health nurses were taught to deliver the intervention to two services users from their caseload who had a diagnosis of schizophrenia and were considered to have poor adherence.

Following training, CMHNs demonstrated signifi cant improvements in their knowledge and skills in compliance therapy. Signifi cant improvements were seen in the psychopathology and attitude to treatment of service users. Methodological considerations cited by the authors include the high 26% attrition rate, and possible biases introduced as a result of the use of self-report and clinician ratings, and the selection of the study’s service users by their CMHNs. Another medication management training programme was developed and evaluated by Harris et al. A 10-day training programme sought to enable 28 community mental health practitioners (CMHP), mainly nurses but with occupational therapists and social workers, to deliver a collaboration-based medicines management programme. The training addressed the components involved in achieving an effective medication regimen and self-management strategies. Issues related to adherence and achieving adherence were confi ned to methods that can be undertaken by ‘moderately experienced clinicians who lack specifi c training in cognitive-behavioural skills’. Community mental health practitioners worked with four of their service users, who had a diagnosis of schizophrenia, over a 9-month period. Service users whose CMHPs undertook the training made signifi cant improvements in their symptoms and perception of their involvement in treatment. Service users can become active participants in developing effective illness management programmes; with increasing responsibility for treatment, they are the pivotal change agent for personal recovery.

A number of essential ingredients and interventions have been identifi ed which enable this process to occur. However, it must be understood that a consequence of increasing the self-effi cacy and empowerment that hese programmes confer may not result in increased adherence but when adherence is increased is it based on the service user’s choice.

Tags: management, medication, practitioners