Acceptability of shared medication coordination in social psychiatric residence consultations: a qualitative interview study

When various physicians prescribe medications to a single patient, insufficient medication coordination (MedCo) may lead to drug interactions and side effects, especially in patients living with severe mental disorders such as schizophrenia. A Danish social psychiatric residence has addressed this issue with an annual MedCo programme based on shared decision-making, involving residents in shared residence consultations and organised MedCo (The Shared MedCo intervention). Nevertheless, despite more than a decade in operation, challenges remain in transferring this intervention to other residences, and the underlying reasons for its limited acceptability remain unclear. Consequently, this study aimed to investigate the acceptability of shared MedCo for residents treated under the shared responsibility by multiple physicians and involving residents, residence carer staff, GPs, psychiatrists, pharmacists and decision-makers. We employed individual qualitative semi-structured in-depth interviews. The investigation was guided by the seven constructs of the ‘Theoretical Framework of Acceptability’ and analysed based on Malterud’s ‘Systematic text condensation’. A total of 43 interviews were conducted from August to December 2022. Less significant acceptability constructs were linked to ethicality, intervention coherence and perceived effectiveness. More significant acceptability constructs were associated with affective attitude, burden, opportunity costs and self-efficacy. Key barriers included the siloed nature of healthcare, medication change, resident involvement, inadequate performance support, professional vs. layman language, geographic distances and time-consuming activities. Key facilitators included consultations hosted and managed in the residence, leader support, supported resident involvement, organised coordination activities, pharmacist and carer staff contributions, sufficient time, clinical routine, and job-satisfaction. Further facilitators were defined roles, expectations and procedures, and feelings of relatedness, security, trust, hope and meaningfulness. Various barriers and facilitators influence participants' acceptance of shared MedCo. Understanding these factors can assist future implementers in effectively accommodating the implementation of shared MedCo.