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Table 2 Patients’ needs, suggestions and cited barriers for improvement on guidance by health care professionals

From: Guidance by physicians and pharmacists during antidepressant therapy: patients’ needs and suggestions for improvement

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