A thematic analysis assessing clinical decision-making in antipsychotic prescribing for schizophrenia.

BACKGROUND: In recent decades atypical antipsychotics have increased treatment options available for schizophrenia, however there is conflicting evidence concerning the trade-off between clinical efficacy and side effects for the different classes of antipsychotics. There has been a consistent increase in atypical antipsychotic prescribing compared to typical, despite evidence showing that neither class is superior. This leads to the question of whether prescribers are selective in their uptake of research evidence and clinical guidelines and if so, what influences their choice.. This study aims to identify the factors that contribute to the prescribing choice and how these can be used to aid knowledge translation and guideline implementation. METHODS: A thematic analysis study was conducted using data from 11 semi-structured interviews with clinicians with experience in prescribing for schizophrenia. RESULTS: The analysis identified five themes underpinning prescribing behaviour: (1) ownership and collaboration; (2) compromise; (3) patient involvement; (4) integrating research evidence; and (5) experience. CONCLUSION: The themes mapped to various degrees onto current models of evidence-based decision making and suggest that there is scope to re-think the guideline implementation frameworks to incorporate recurring themes salient to clinicians who ultimately use the guidelines. This will further translation of future evidence into clinical practice, accelerating clinical progress.

A quantitative analysis of antipsychotic prescribing trends for the treatment of schizophrenia in England and Wales.

OBJECTIVE: This study aims to assess the current antipsychotic prescribing trends for the treatment of schizophrenia and to compare them with available guidelines and research evidence. DESIGN: An observational retrospective quantitative analysis. SETTING: Data were collected from the prescribing cost analysis for the period between 2007 and 2014, including all drugs from the British National Formulary 4.2.1 and 4.2.2. Prescriptions were included from primary and secondary healthcare settings in England and Wales. PARTICIPANTS: None. MAIN OUTCOME MEASURES: Defined daily doses of antipsychotics were used to compare popularity of individual drugs and classes of antipsychotics. RESULTS: There is a consistent increase in the proportion of atypical antipsychotics prescribed, compared to typical antipsychotics, between 2007 and 2014, with atypicals accounting for 79.9% of total antipsychotics prescribed in 2014. CONCLUSION: The consistent popularity of atypical antipsychotics is not concordant with the current National Institute for Health and Care Excellence guidelines for the treatment of schizophrenia or the most recent research evidence.