The Development and Validation of a Medicines Optimisation Tool for Use in Adults With Severe Mental Illness (OPTIMISE)

Background and Objectives: The life expectancy of people with Severe Mental Illness (SMI) is considerably shorter than those without SMI. Multimorbidity and poorer physical health outcomes contribute significantly to health inequality.. Screening tools could offer an opportunity to assist clinicians in decision making and optimising medicines to protect the physical health of people with SMI. When applied in the clinical setting, screening tools such as STOPP/START and STOPPFrail result in improvements in prescribing and patient outcomes. We aimed to design a medicines optimisation tool (OPTIMISE) to assist optimising medicines and protect the physical health of adults with SMI.

Methods: The OPTIMISE was drafted with reference to the literature, and the Delphi consensus technique used to develop and validate the contents. A 17 member panel of experts from the UK and Ireland completed 2 rounds of Delphi, rating their level of agreement to 83 prescribing indicators using a 5-point Likert scale. Indicators with a median value of 1 or 2 and 75th centile value of ≤2 were accepted for inclusion. Interrater reliability was assessed among 4 healthcare professionals across 20 datasets and the chance corrected level of agreement (kappa) was calculated.

Results: Consensus was achieved after 2 rounds of Delphi validation for the inclusion of 63 prescribing indicators in the final OPTIMISE tool. When interrater reliability of OPTIMISE was assessed between physicians and pharmacists, kappa was 0.75, indicating a substantial level of agreement which is comparable to other medicines optimisation tools. Average time to complete the tool was 9 minutes.

Conclusion: OPTIMISE is a 63 indicator medicines optimisation tool, validated using Delphi methodology, to assist decision making among healthcare professionals treating people with SMI. The tool has the potential to enhance medicines optimisation, and ensure that primary and secondary preventative medicines are considered when clinically indicated. Further validation of this tool is needed, including application of the tool to a larger cohort and in diverse clinical settings. Wider application of OPTIMISE would provide an opportunity to improve prescribing quality, prevent avoidable adverse effects and improve physical health outcomes.