Promoting evidence based practice and Systematic reviews

One of the priorities for our academic staff at MPFT is building capacity for evidence based practice. The academic staff have been at the forefront of promoting evidence based practice through training and research. Systematic reviews are considered the highest level of evidence in the practice of Medicine. Academic staff have helped many colleagues in the Trust to develop the capacity to critically appraise literature and learn the methodology of collating evidence and publishing systematic reviews.  Recent examples of published systematic reviews include ‘Barriers to clozapine use’ and ‘Pharmacological ‘interventions for the prevention of depression in high risk conditions’.  At present, there are systematic reviews being carried out exploring; Interventions for people with Tuberculosis and common mental health disorders, the association between trauma and psychosis and academic detailing to improve antipsychotic medication. We are also working on a systematic review exploring COVID-19 and its effects on suicide and self-harm. The protocols for these reviews are published and have greatly helped the colleagues in the Trust to develop skills in critically appraising the published evidence and medical writing.

Understanding and improving clinical practice: The SWITCH Studies

Some antipsychotic medications are higher risk than others and can cause serious physical health problems. These include weight gain and high blood pressure which can increase the risk for diabetes mellitus. Our SWITCH studies looked at current clinical practice to examine whether switching is considered and if so is it being carried out safely and effectively? Working with practising clinicians in the Trust we looked at the case notes of a sample of patients on antipsychotic medication and with a diagnosis of diabetes and examined whether this high risk patient population was offered switching and how the switching was carried out.

The second phase studies involved interviewing GP’s, psychiatrists and mental health nurses to explore their views on switching medication.  Not all participants were aware of the side-effects of antipsychotic drugs, or that different drugs had different risks. The priority was given to mental health and control of symptoms, over physical health. Switching antipsychotics was rarely considered a proactive option; more often switching was reactive to the development of a new physical health condition. The final part of the SWITCH studies, will be interviewing service users, for their views on switching antipsychotic medication.

These studies are examples of how we can systematically examine the current clinical practice for improving the patients’ outcomes. These studies also helped to increase the capacity for research in the Trust.

References

  • Farooq, S., Choudry, A., Cohen, D., Naeem, F., & Ayub, M. (2019). Barriers to using clozapine in treatment-resistant schizophrenia: systematic review. BJPsych bulletin, 43(1), 8-16.
  • Farooq, S., Singh, S. P., Burke, D., Naeem, F., & Ayub, M. (2020). Pharmacological interventions for prevention of depression in high risk conditions: Systematic review and meta-analysis. Journal of Affective Disorders.
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