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Human-centered approach optimizes prescribing of antipsychotics

Using a human-centered design that includes providers’ input could help optimize guideline-based prescribing of antipsychotics for young people, researchers wrote in Psychiatric Services.

“Lack of timely access to evidence-based psychotherapies leads to substitution with medication,” Andrea L. Hartzler, PhD, associate professor of biomedical informatics and medical education at University of Washington School of Medicine, and colleagues wrote. “For example, less than half of youths initiating an antipsychotic medication received psychosocial treatment in the previous 90 days. We need to improve the quality of prescribing and care received by youths.”

Currently, the Safer Use of Antipsychotics in Youth (SUAY) project is testing an algorithm-based workflow that encompasses peer consultation and care navigation, with faster access to psychotherapy for youths who were prescribed antipsychotics for nonpsychotic disorders.

Hartzler and colleagued interviewed pediatric and adolescent providers for input on how this proposed workflow would fit into practice. They conducted 1-hour, audio-recorded interviews to determine prescribing needs and barriers (prompted by asking about prior prescribing experiences that resulted in critical incidents), design preferences for the proposed workflow and demographics. They analyzed survey data, descriptive statistics and interview recordings for themes about workflow barriers and design opportunities.

Overall, 15 participants described two major barriers — possible interruptions to clinical practice and threats to professional autonomy — even though they believed the workflow improved the formalization of consultative practices in the electronic health record.

The participants reported that a thorough, thoughtful consultation was more important than efficiency even if it requires time outside of patient visits. They expressed concern about care delays and safety as a result of implementing a hard stop for every antipsychotic order until documentation of the consultation. Behavioral health providers also were concerned about a blanket requirement for peer consultation. To address these barriers, providers suggested training, information flows and checklists to guide prescribing.

Using participants’ input, Hartzler and colleagues identified three ways to optimize workflow:

• provide à la carte order sets in the alert to customize resources to different needs;
• expedite passive review of orders to cut disruptions and target behavior change; and
• foster self-acknowledgment of completed consultation to protect autonomy.

“Providers’ input, which reflects the needs and preferences of future users, helped us arrive at a more acceptable solution with increased likelihood of adoption,” they wrote. “Our work illustrates a structured process for negotiating difficult design choices in which systemwide charges and individual priorities may conflict. Human-centered design helped us engage providers in the formative design of our future system that will positively impact their work.” – by Savannah Demko

Disclosure: One author reports funding from Janssen Pharmaceuticals.