Table 2 Patients’ needs, suggestions and cited barriers for improvement on guidance by health care professionals
Patient needs | Suggestions for improvement of guidance by health care professionals | Barriers |
|---|---|---|
Content of guidance | ||
Before the decision to fill a prescription | ||
Information needed on: - cause of symptoms - treatment options | Shared decision making, incorporating patients’ needs | Patients might not be capable of making a choice in case of severe symptoms |
Incorporate time before initiation of an antidepressant to consider the decision to initiate treatment | ||
The physician should choose the most accurate medication | Provide a protocol for physicians to help select the most accurate medication by using questions on disease symptoms of patients and to assess side effects and laboratory values | |
During the decision to initiate SGA therapy | ||
Information needed on: - rationale behind drug choice - mechanism of action - harm/benefit balance - expected effects and side effects (also during discontinuation) - potential worsening of symptoms during start of treatment | Mention needed information explicitly | Patients might be reluctant to start therapy when knowing potential side effects |
Provide patient leaflets (also within psychiatric institutions) | ||
During the decision to adhere to or to discontinue treatment | ||
Health care professionals should discuss: - worries - side effects - complaints - the patients’ wellbeing - if the patient considers discontinuation - medication use and experiences - the patients’ social network - suicidal thoughts | Evaluate treatment with the patient | Limited time of a consultation |
Provide a guideline for patients to evaluate efficacy, dosage and side effects of the antidepressant | ||
If necessary, discuss the possibility to switch treatment | ||
Evaluation form or questionnaire to assess side effects together with the patient | ||
During the decision to discontinue treatment | ||
Guidance during long term antidepressant use is needed to assess if the dosage needs to be adjusted, and to decide to continue or discontinue treatment | Assess whether it is necessary to continue treatment and provide information on the expected treatment duration | Patients may change their dosage or discontinue treatment without informing their health care professional |
Guide the patient during long-term use and if the decision is to discontinue therapy, give practical tips on how to do so. | ||
Communication aspects | ||
Communication between the health care professional and the patient | ||
- take patients seriously - be empathic - provide direct contact - be accurate - respect the patient - attitude of thinking along - respect the autonomy of the patient | Carefully listen to the patients’ story | Some participants thought psychiatrists were not emphatic enough |
Provide a combination of a psychiatrist with a psychologist | ||
Provide the ability to choose for a male of female health care professional | Some patients may not be assertive enough to request this | |
Mutual trust between the physician and patient | Keep a sound registration of information gathered in previous appointments | Some participants did not trust their physician if they could not recall conversations, medication dosages, gave opposing advice, made mistakes in prescriptions or were chaotic |
Equality between health care professionals and patients | Show equality in posture and respect for the patient | |
Communication between health care professionals | ||
Improvement of communication between health care specialists | Information should be transferred on the patients’ medical history and conflicting ideas between health care professionals should be solved to prevent confusion of the patient | |
For the patient it should be clear which health care professional to consult | Assign a responsible health care specialist to keep track of a patient, assess if the treatment is still adequate and to assess wellbeing of the patient | It was not clear who the responsible health care specialist should be |
Possibility to be admitted to a psychiatric hospital | ||
Organization of guidance | ||
Periodical visits during initiation and (long-term) treatment. It should be known when the next appointment is | Physician should be responsible for initiative of contact and discuss the preferred frequency with the patient | Patient might be not assertive enough to request a consultation |
Longer duration of a consultation | ||
Involve social network during medication initiation | If wanted: involve social network during medication initiation. Physicians and pharmacists should advise not to initiate the antidepressant without a relative or caregiver monitoring them | Not all participants wanted to involve other persons in treatment or did not have a social network |
Possibility to contact a psychiatrist when needed | Daily conversation hour, even by email or by phone, by the physician or pharmacist (also within psychiatric institutions) | Physician might not have time due to high workload |
Provide a stand-by 24-h helpline for patients in need | Inability of helpline operator to have insight into the patients’ medical file | |
Provide an anonymous chat forum leaded by a psychiatrist and not visible for everyone | Reading other patients experiences can make patients anxious and others could write nonsense | |
More privacy in pharmacies | Provide more privacy in pharmacies | |
Checks during repeat prescriptions | Provide an alert for repeat prescriptions | If a stock is inadequate, the patient might receive medication too late |
In case a prescription is not filled, call a patient to ask for the reason | ||
Health care professional should have enough knowledge on treatment | Only psychiatrists should prescribe antidepressants | Some patients have a better relation with their general practitioner |
Some participants did not wat to see their psychiatrists too frequently | ||
Knowledge of general practitioners and pharmacists should be improved | ||