1
|
Cui J, Guo S, Kan WS, Zhang L, He X, Chen R, Chen N, Xun K. Protocol for a scoping review of the role of siblings in supporting middle-aged and older people with early-acquired severe mental illness. BMJ Open 2023; 13:e076645. [PMID: 37865407 PMCID: PMC10603443 DOI: 10.1136/bmjopen-2023-076645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 10/06/2023] [Indexed: 10/23/2023] Open
Abstract
INTRODUCTION For older individuals who developed severe mental illness (SMI) during late adolescence or early adulthood (referred to as early-acquired SMI), the combination of ageing and SMI presents persistent health and psychosocial challenges. This group, with a higher likelihood of being unmarried or experiencing marriage dissolution, often lacks social and economic resources to address the difficulties they face in later life. In recent years, there has been a growing interest in understanding the role of siblings in supporting the ageing process of individuals with early-acquired SMI. However, to date, no reviews have investigated the role of siblings in assisting their middle-aged and older brothers or sisters with SMI as they age within community settings. Our scoping review aims to explore and synthesise the existing literature on sibling support for individuals with early-acquired SMI, with the goal of informing further advancements in research, practice and policy. METHODS AND ANALYSIS The methodological framework developed by Arksey and O'Malley will inform this scoping review. Four groups of search keywords, derived from four related concepts (sibling, SMI, support and ageing), will be employed. Additionally, a group of keywords related to unrelated life stages and diseases will be used to exclude irrelevant articles. A search will be carried out across major online databases, namely PubMed, Scopus, PsycINFO, Ovid MEDLINE, ProQuest and Google Scholar to identify the articles between 2000 and 2023. English-language studies meeting specific eligibility criteria will be identified following a review of titles and abstracts and will then undergo a full-text review. The data from the selected articles will be extracted using a customised data-charting framework and content analysis will be conducted. ETHICS AND DISSEMINATION There are no requirements for ethical approval. The findings of this review will be shared through professional connections, academic conferences and scholarly journals.
Collapse
Affiliation(s)
- Jialiang Cui
- Department of Social Work, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Siyuan Guo
- School of Humanities and Social Sciences, Zhongkai University of Agriculture and Engineering, Guangzhou, Guangdong, China
| | - Wan Sang Kan
- Department of Social and Behavioural Sciences, City University of Hong Kong, Hong Kong, Hong Kong
| | - Lin Zhang
- Department of Social Work, Shandong University, Jinan, Shandong, China
- School of Law and Sociology, Qinghai Normal University, Xining, China
| | - Xin He
- Department of Social Work and Social Policy, Renmin University, Beijing, China
| | - Renxing Chen
- Department of Public Administration, Shandong University, Qingdao, Shandong, China
| | - Na Chen
- Department of Social Work, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Kangwei Xun
- Discipline of Social Work and Social Policy, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
- Living with Disability Research Centre, La Trobe University, Melbourne, Victoria, Australia
| |
Collapse
|
2
|
Pemovska T, Jovanović N. Physical health of individuals with psychosis - a mixed method study. Int Rev Psychiatry 2022; 34:827-836. [PMID: 36645188 DOI: 10.1080/09540261.2022.2151341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
People with psychosis have poorer physical health than the general population and this aspect of care delivery has largely been neglected. The IMPULSE trial (ISRCTN 11913964) investigated a psychosocial intervention prompting people with psychosis to discuss their physical health concerns with mental health clinicians. This mixed-method study explored a series of clinical meetings over 6 months to understand how physical health is discussed, what actions are taken, and if these translated into benefits for the participating individuals with psychosis. 221 individuals with psychosis were included, attending 847 clinical meetings over 6 months. Results show that, when prompted, most participants (54%) took up the opportunity to discuss their physical health at least once. These individuals were keen to make changes such as adopt healthy diet, stop smoking, lose weight, etc. Despite taking steps to achieve these goals, after 6 months no improvement was detected in subjective satisfaction with physical health, severity of physical health problems or satisfaction with services. Adopting healthier lifestyle behaviours is difficult even in motivated individuals. Future research is needed to determine innovative approaches to promote lifestyle change in individuals with psychosis.
Collapse
Affiliation(s)
- Tamara Pemovska
- Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom.,NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, United Kingdom
| | - Nikolina Jovanović
- Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
| |
Collapse
|
3
|
Sud D, Laughton E, McAskill R, Bradley E, Maidment I. The role of pharmacy in the management of cardiometabolic risk, metabolic syndrome and related diseases in severe mental illness: a mixed-methods systematic literature review. Syst Rev 2021; 10:92. [PMID: 33789745 PMCID: PMC8015120 DOI: 10.1186/s13643-021-01586-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 01/06/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Individuals with severe mental illness, e.g. schizophrenia have up to a 20% shortened life expectancy compared to the general population. Cardiovascular disease, due to cardiometabolic risk and metabolic syndrome, accounts for most of this excess mortality. A scoping search revealed that there has not been a review of published studies on the role of pharmacy in relation to cardiometabolic risk, metabolic syndrome and related diseases (e.g. type 2 diabetes) in individuals with severe mental illness. METHODS A mixed-methods systematic review was performed. Eleven databases were searched using a comprehensive search strategy to identify English-language studies where pharmacy was involved in an intervention for cardiometabolic risk, metabolic syndrome or related diseases in severe mental illness in any study setting from any country of origin. First, a mapping review was conducted. Then, implementation strategies used to implement the study intervention were classified using the Cochrane Effective Practice and Organisation of Care Taxonomy. Impact of the study intervention on the process (e.g. rate of diagnosis of metabolic syndrome) and clinical (e.g. diabetic control) outcomes were analysed where possible (statistical tests of significance obtained for quantitative outcome parameters reported). Quality assessment was undertaken using a modified Mixed Methods Appraisal Tool. RESULTS A total of 33 studies were identified. Studies were heterogeneous for all characteristics. A total of 20 studies reported quantitative outcome data that allowed for detailed analysis of the impact of the study intervention. The relationship between the total number of implementation strategies used and impact on outcomes measured is unclear. Inclusion of face-to-face interaction in implementation of interventions appears to be important in having a statistically significantly positive impact on measured outcomes even when used on its own. Few studies included pharmacy staff in community or general practitioner practices (n = 2), clinical outcomes, follow up of individuals after implementation of interventions (n = 3). No studies included synthesis of qualitative data. CONCLUSIONS Our findings indicate that implementation strategies involving face-to-face interaction of pharmacists with other members of the multidisciplinary team can improve process outcomes when used as the sole strategy. Further work is needed on clinical outcomes (e.g. cardiovascular risk reduction), role of community pharmacy and qualitative studies. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018086411.
Collapse
Affiliation(s)
- Dolly Sud
- School of Life and Health Sciences, Aston University, Birmingham, B4 7ET, UK.
| | - Eileen Laughton
- Pharmacy Department, Leicestershire Partnership NHS Trust, Bradgate Mental Health Site, Glenfield Hospital, Groby Road, Leicester, Leicestershire, LE3 9EJ, UK
| | - Robyn McAskill
- Pharmacy Department, Leicestershire Partnership NHS Trust, Bradgate Mental Health Site, Glenfield Hospital, Groby Road, Leicester, Leicestershire, LE3 9EJ, UK
| | - Eleanor Bradley
- College of Health, Life and Environmental Sciences, University of Worcester, Henwick Grove, Worcester, WR2 6AJ, UK
| | - Ian Maidment
- School of Life and Health Sciences, Aston University, Birmingham, B4 7ET, UK
| |
Collapse
|
4
|
Brown T, May A, Beverley-Stone M. The adaptation and implementation of the Health Improvement Profile to Australian standards in public mental health settings. J Psychiatr Ment Health Nurs 2020; 27:628-639. [PMID: 32037667 DOI: 10.1111/jpm.12616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 02/04/2020] [Accepted: 02/07/2020] [Indexed: 12/24/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: The Health Improvement Profile (HIP) is a one-page form developed in the United Kingdom as a tool for mental health nurses to assess service user's physical health needs. The HIP screens service users' physical health and provides recommendations that clinicians can provide service users with in order to improve their physical health. There was evidence supporting the effectiveness of the HIP; however, the majority of HIP studies to date involve the screening tool being completed by nurses. In Australia, a large proportion of mental health clinicians providing case management to service users in community settings are not nurses. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This paper shows that the HIP can be adjusted to suit the needs of Australian service users and can be utilized by clinicians from a variety of disciplines. It also shows that both clinicians and Australian service users find the HIP helpful and argues for it being made available for all service users. It has clearly shown a need to target flu vaccine programmes at service users. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The HIP has been shown to be a suitable and acceptable screening tool for different clinicians to assess multiple lifestyle risk factors at once, which can be used across different diagnoses and settings. This study, for example, demonstrated a need to focus on promoting the flu vaccine and smoking cessation, as well as encouraging service users to visit eye and dental health services. ABSTRACT: Introduction Health Improvement Profile (HIP) studies to date primarily focused on the screening tool being completed by nurses. This paper explores the HIP in two different settings, with an emphasis on expanding physical health roles for all mental health clinicians. Aim The aim of the present study was to adapt the HIP to Australian standards and implement it at a large mental health service. Method This is an evaluation of the implementation of the HIP over a two-month pilot period. Clinicians and service users were surveyed on their experience of the HIP. Results The community team completed the HIP with 34 (15%) service users. The inpatient unit completed the HIP with 137 (54%) service users. Results from the HIP clearly show priority areas for health interventions. Feedback from clinicians and service users was predominately positive. Discussion We found the HIP to be an acceptable screening tool that encompasses multiple lifestyle risk factors. Implications for practice This study clearly demonstrates the utility of the HIP as a workable and acceptable screening tool with real world applicability. In our pilot, for example, we identified the need for the promotion of influenza vaccinations amongst service users, as well as the ongoing need to target smoking cessation and substance use.
Collapse
Affiliation(s)
- Trudy Brown
- Northern Area Mental Health Service, The Northern Hospital, Epping, Vic., Australia.,NorthWestern Mental Health, The Royal Melbourne Hospital, Parkville, Vic., Australia
| | - Alexis May
- NorthWestern Mental Health, The Royal Melbourne Hospital, Parkville, Vic., Australia.,Mid West Area Mental Health Service, Sunshine, Vic., Australia
| | - Matthew Beverley-Stone
- NorthWestern Mental Health, The Royal Melbourne Hospital, Parkville, Vic., Australia.,Mid West Area Mental Health Service, Sunshine, Vic., Australia
| |
Collapse
|
5
|
Lamontagne-Godwin F, Burgess C, Clement S, Gasston-Hales M, Greene C, Manyande A, Taylor D, Walters P, Barley E. Interventions to increase access to or uptake of physical health screening in people with severe mental illness: a realist review. BMJ Open 2018; 8:e019412. [PMID: 29440160 PMCID: PMC5829934 DOI: 10.1136/bmjopen-2017-019412] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 11/15/2017] [Accepted: 12/07/2017] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To identify and evaluate interventions aimed at increasing uptake of, or access to, physical health screening by adults with severe mental illness; to examine why interventions might work. DESIGN Realist review. SETTING Primary, secondary and tertiary care. RESULTS A systematic search identified 1448 studies, of which 22 met the inclusion criteria. Studies were from Australia (n=3), Canada (n=1), Hong Kong (n=1), UK (n=11) and USA (n=6). The studies focused on breast cancer screening, infection preventive services and metabolic syndrome (MS) screening by targeting MS-related risk factors. The interventions could be divided into those focusing on (1) health service delivery changes (12 studies), using quality improvement, randomised controlled trial, cluster randomised feasibility trial, retrospective audit, cross-sectional study and satisfaction survey designs and (2) tests of tools designed to facilitate screening (10 studies) using consecutive case series, quality improvement, retrospective evaluation and pre-post audit study designs. All studies reported improved uptake of screening, or that patients had received screening they would not have had without the intervention. No estimation of overall effect size was possible due to heterogeneity in study design and quality. The following factors may contribute to intervention success: staff and stakeholder involvement in screening, staff flexibility when taking physical measurements (eg, using adapted equipment), strong links with primary care and having a pharmacist on the ward. CONCLUSIONS A range of interventions may be effective, but better quality research is needed to determine any effect size. Researchers should consider how interventions may work when designing and testing them in order to target better the specific needs of this population in the most appropriate setting. Behaviour-change interventions to reduce identified barriers of patient and health professional resistance to screening this population are required. Resource constraints, clarity over professional roles and better coordination with primary care need to be addressed.
Collapse
Affiliation(s)
| | - Caroline Burgess
- Primary Care and Public Health Sciences, King's College London, London, UK
| | | | | | - Carolynn Greene
- College of Nursing, Midwifery and Healthcare, University of West London, London, UK
| | - Anne Manyande
- School of Human and Social Sciences, University of West London, London, UK
| | - Deborah Taylor
- College of Nursing, Midwifery and Healthcare, University of West London, London, UK
| | - Paul Walters
- Department of Research and Development, Dorset HealthCare University NHS Foundation Trust, Bournemouth, UK
| | - Elizabeth Barley
- School of Human and Social Sciences, University of West London, London, UK
| |
Collapse
|
6
|
Ilyas A, Chesney E, Patel R. Improving life expectancy in people with serious mental illness: should we place more emphasis on primary prevention? Br J Psychiatry 2017; 211:194-197. [PMID: 28882826 PMCID: PMC5623876 DOI: 10.1192/bjp.bp.117.203240] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 04/23/2017] [Accepted: 05/26/2017] [Indexed: 12/31/2022]
Abstract
People with serious mental illness have a reduced life expectancy that is partly attributable to increased cardiovascular disease. One approach to address this is regular physical health monitoring. However, physical health monitoring is poorly implemented in everyday clinical practice and there is little evidence to suggest that it improves physical health. We argue that greater emphasis should be placed on primary prevention strategies such as assertive smoking cessation, dietary and exercise interventions and more judicious psychotropic prescribing.
Collapse
Affiliation(s)
- Athif Ilyas
- Athif Ilyas, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Edward Chesney, BM, BCh, Rashmi Patel, BM, BCh, PhD, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Edward Chesney
- Athif Ilyas, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Edward Chesney, BM, BCh, Rashmi Patel, BM, BCh, PhD, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Rashmi Patel
- Athif Ilyas, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Edward Chesney, BM, BCh, Rashmi Patel, BM, BCh, PhD, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| |
Collapse
|
7
|
Khokhar MA, Khokhar WA, Clifton AV, Tosh GE. Oral health education (advice and training) for people with serious mental illness. Cochrane Database Syst Rev 2016; 9:CD008802. [PMID: 27606629 PMCID: PMC6457656 DOI: 10.1002/14651858.cd008802.pub3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND People with serious mental illness not only experience an erosion of functioning in day-to-day life over a protracted period of time, but evidence also suggests that they have a greater risk of experiencing oral disease and greater oral treatment needs than the general population. Poor oral hygiene has been linked to coronary heart disease, diabetes, and respiratory disease and impacts on quality of life, affecting everyday functioning such as eating, comfort, appearance, social acceptance, and self esteem. Oral health, however, is often not seen as a priority in people suffering with serious mental illness. OBJECTIVES To review the effects of oral health education (advice and training) with or without monitoring for people with serious mental illness. SEARCH METHODS We searched the Cochrane Schizophrenia Group's Trials Register (5 November 2015), which is based on regular searches of MEDLINE, EMBASE, CINAHL, BIOSIS, AMED, PubMed, PsycINFO, and clinical trials registries. There are no language, date, document type, or publication status limitations for inclusion of records in the register. SELECTION CRITERIA All randomised clinical trials focusing on oral health education (advice and training) with or without monitoring for people with serious mental illness. DATA COLLECTION AND ANALYSIS We extracted data independently. For binary outcomes, we calculated risk ratio (RR) and its 95% confidence interval (CI), on an intention-to-treat basis. For continuous data, we estimated the mean difference (MD) between groups and its 95% CI. We employed a fixed-effect model for analyses. We assessed risk of bias for included studies and created 'Summary of findings' tables using GRADE. MAIN RESULTS We included three randomised controlled trials (RCTs) involving 1358 participants. None of the studies provided useable data for the key outcomes of not having seen a dentist in the past year, not brushing teeth twice a day, chronic pain, clinically important adverse events, and service use. Data for leaving the study early and change in plaque index scores were provided. Oral health education compared with standard careWhen 'oral health education' was compared with 'standard care', there was no clear difference between the groups for numbers leaving the study early (1 RCT, n = 50, RR 1.67, 95% CI 0.45 to 6.24, moderate-quality evidence), while for dental state: no clinically important change in plaque index, an effect was found. Although this was statistically significant and favoured the intervention group, it is unclear if it was clinically important (1 RCT, n = 40, MD - 0.50 95% CI - 0.62 to - 0.38, very low quality evidence).These limited data may have implications regarding improvement in oral hygiene. Motivational interview + oral health education compared with oral health educationSimilarly, when 'motivational interview + oral health education' was compared with 'oral health education', there was no clear difference for the outcome of leaving the study early (1 RCT, n = 60 RR 3.00, 95% CI 0.33 to 27.23, moderate-quality evidence), while for dental state: no clinically important change in plaque index, an effect favouring the intervention group was found (1 RCT, n = 56, MD - 0.60 95% CI - 1.02 to - 0.18 very low-quality evidence). These limited, clinically opaque data may or may not have implications regarding improvement in oral hygiene. Monitoring compared with no monitoringFor this comparison, only data for leaving the study early were available. We found a difference in numbers leaving early, favouring the 'no monitoring' group (1 RCT, n = 1682, RR 1.07, 95% CI 1.00 to 1.14, moderate-quality evidence). However, these data are problematic. The control denominator is implied and not clear, and follow-up did not depend only on individual participants, but also on professional caregivers and organisations - the latter changing frequently resulting in poor follow-up, but not a good reflection of the acceptability of the monitoring to patients. For this comparison, no data were available for 'no clinically important change in plaque index'. AUTHORS' CONCLUSIONS We found no evidence from trials that oral health advice helps people with serious mental illness in terms of clinically meaningful outcomes. It makes sense to follow guidelines and recommendations such as those put forward by the British Society for Disability and Oral Health working group until better evidence is generated. Pioneering trialists have shown that evaluative studies relevant to oral health advice for people with serious mental illness are possible.
Collapse
Affiliation(s)
- Mariam A Khokhar
- University of SheffieldOral Health and Development15 Askham CourtGamston Radcliffe RoadNottinghamUKNG2 6NR
| | - Waqqas Ahmad Khokhar
- Leicestershire Partnership NHS TrustDepartment of PsychiatryLeicesterLeicestershireUK
| | - Andrew V Clifton
- De Montfort UniversityFaculty of Health and Life Sciences3.10 Edith Murphy HouseThe GatewayLeicesterUKLE1 9BH
| | - Graeme E Tosh
- Rotherham, Doncaster and South Humber NHS Foundation Trust (RDASH)General Adult DivisionFerham ClinicKimberworth RoadRotherhamSouth YorkshireUKS61 1AD
| | | |
Collapse
|
8
|
Abstract
BACKGROUND People with a serious mental illness are more likely to smoke more and to be more dependent smokers than the general population. This may be due to a wide range of factors that could include a common aetiology to both smoking and the illness, self medication, smoking to alleviate adverse effects of medications, boredom in the existing environment, or a combination of these factors. It is important to undertake this review to facilitate improvements in both the health and safety of people with serious mental illness who smoke, and to reduce the overall burden of costs (both financial and health) to the smoker and, eventually, to the taxpayer. OBJECTIVES To review the effects of smoking cessation advice for people with serious mental illness. SEARCH METHODS We searched the Cochrane Schizophrenia Group Specialized Trials Register up to 2 April 2015, which is based on regular searches of CENTRAL, BIOSIS, PubMed, MEDLINE, EMBASE, CINAHL, PsycINFO, and trial registries. We also undertook unsystematic searches of a sample of the component databases (BNI, CINHAL, EMBASE, MEDLINE, and PsycINFO), up to 2 April 2015, and searched references of all identified studies SELECTION CRITERIA We planned to include all randomised controlled trials (RCTs) that focussed on smoking cessation advice versus standard care or comparing smoking cessation advice with other more focussed methods of delivering care or information. DATA COLLECTION AND ANALYSIS The review authors (PK, AC, and DB) independently screened search results but did not identify any trials that fulfilled the inclusion criteria of this review. MAIN RESULTS We did not identify any RCTs that evaluated advice regarding smoking cessation for people with serious mental illness. The excluded studies illustrate that randomisation of packages of care relevant to smokers with serious mental illness is possible. AUTHORS' CONCLUSIONS People with serious mental illness are more likely to smoke than the general population. Yet we could not find any high quality evidence to guide the smoking cessation advice healthcare professionals pass onto service users. This is an area where trials are possible and needed.
Collapse
Affiliation(s)
- Priya Khanna
- Northumberland, Tyne and Wear NHS Foundation TrustRehabilitation and Recovery, Adult PsychiatryNewcastleUK
| | - Andrew V Clifton
- University of HuddersfieldSchool of Human and Health SciencesQueensgateHuddersfieldSouth West YorkshireUKHD1 3DH
| | - David Banks
- Queen Margaret UniversitySchool of Health SciencesQueen Margaret DriveMusselburghEdinburghUKEH21 6UU
| | - Graeme E Tosh
- Rotherham, Doncaster and South Humber NHS Foundation Trust (RDASH)General Adult DivisionFerham ClinicKimberworth RoadRotherhamSouth YorkshireUKS61 1AD
| | | |
Collapse
|
9
|
McKenna B, Furness T, Wallace E, Happell B, Stanton R, Platania-Phung C, Edward KL, Castle D. The effectiveness of specialist roles in mental health metabolic monitoring: a retrospective cross-sectional comparison study. BMC Psychiatry 2014; 14:234. [PMID: 25196125 PMCID: PMC4156616 DOI: 10.1186/s12888-014-0234-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 08/07/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND People with serious mental illness (SMI) exhibit a high prevalence of cardiovascular diseases. Mental health services have a responsibility to address poor physical health in their consumers. One way of doing this is to conduct metabolic monitoring (MM) of risk factors for cardiovascular diseases. This study compares two models of MM among consumers with SMI and describes referral pathways for those at high risk of cardiovascular diseases. METHODS A retrospective cross-sectional comparison design was used. The two models were: (1) MM integrated with case managers, and (2) MM integrated with case managers and specialist roles. Retrospective data were collected for all new episodes at two community mental health services (CMHS) over a 12-month period (September 2012 - August 2013). RESULTS A total of 432 consumers with SMI across the two community mental health services were included in the analysis. At the service with the specialist roles, MM was undertaken for 78% of all new episode consumers, compared with 3% at the mental health service with case managers undertaking the role. Incomplete MM was systemic to both CMHS, although all consumers identified with high risk of cardiovascular diseases were referred to a general practitioner or other community based health services. The specialist roles enabled more varied referral options. CONCLUSIONS The results of this study support incorporating specialist roles over case manager only roles for more effective MM among new episode consumers with SMI.
Collapse
Affiliation(s)
- Brian McKenna
- NorthWestern Mental Health, The Royal Melbourne Hospital, Level 1 North, City Campus, Grattan Street, Parkville, Victoria 3050 Australia ,School of Nursing, Midwifery and Paramedicine, Australian Catholic University, 115 Victoria Parade, Fitzroy, Victoria 3065 Australia
| | - Trentham Furness
- NorthWestern Mental Health, The Royal Melbourne Hospital, Level 1 North, City Campus, Grattan Street, Parkville, Victoria 3050 Australia ,School of Nursing, Midwifery and Paramedicine, Australian Catholic University, 115 Victoria Parade, Fitzroy, Victoria 3065 Australia
| | - Elizabeth Wallace
- NorthWestern Mental Health, The Royal Melbourne Hospital, Level 1 North, City Campus, Grattan Street, Parkville, Victoria 3050 Australia
| | - Brenda Happell
- Institute for Health and Social Science Research Centre for Mental Health Nursing Innovation, School of Nursing and Midwifery, CQUniversity, Bruce Highway, Rockhampton, Queensland 4702 Australia
| | - Robert Stanton
- Institute for Health and Social Science Research Centre for Mental Health Nursing Innovation, School of Nursing and Midwifery, CQUniversity, Bruce Highway, Rockhampton, Queensland 4702 Australia
| | - Chris Platania-Phung
- Institute for Health and Social Science Research Centre for Mental Health Nursing Innovation, School of Nursing and Midwifery, CQUniversity, Bruce Highway, Rockhampton, Queensland 4702 Australia
| | - Karen-leigh Edward
- St. Vincent’s Private Hospital Melbourne Nursing Research Unit, St. Vincent’s Private Hospital Melbourne, 59-61 Victoria Parade, Fitzroy, Victoria 3065 Australia ,Faculty of Health Sciences, Australian Catholic University, 115 Victoria Parade, Fitzroy, Victoria 3065 Australia
| | - David Castle
- Faculty of Health Sciences, Australian Catholic University, 115 Victoria Parade, Fitzroy, Victoria 3065 Australia ,St. Vincent’s Hospital Mental Health, St. Vincent’s Private Hospital Melbourne, 59-61 Victoria Parade, Fitzroy, Victoria 3065 Australia ,Department of Psychiatry, University of Melbourne, Grattan Street, Parkville, Victoria 3050 Australia
| |
Collapse
|
10
|
Abstract
Policies and guidelines from across the international community are attempting to galvanise action to address the unacceptably high morbidity and mortality rates amongst people with a serious mental illness (SMI). Primary care has a pivotal role to play in translating policy into evidence based practice in conjunction with other providers of health care services. This paper explores the current and potential of role of primary care providers in delivering health care to people with SMI. A review of research in the following key areas of primary health care provision is provided: access, screening and preventative care, routine monitoring and follow-up, diagnosis and delivery of treatments in accordance with guidelines and delivery of interventions. There is undoubtedly a need for further research to establish the effectiveness of primary care interventions and the organisation of services. Equally, understanding how primary care services can deliver high quality care and promoting effective working at the interface with other services must be priorities.
Collapse
Affiliation(s)
- Claire Planner
- Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, M13 9PL, United Kingdom,
| | | | | |
Collapse
|
11
|
Pearsall R, Hughes S, Geddes J, Pelosi A. Understanding the problems developing a healthy living programme in patients with serious mental illness: a qualitative study. BMC Psychiatry 2014; 14:38. [PMID: 24524248 PMCID: PMC4098648 DOI: 10.1186/1471-244x-14-38] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 02/03/2014] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND People with serious mental illness are at an increased risk of physical ill health. Mortality rates are around twice those of the general population with higher levels of cardiovascular disease, metabolic disease, diabetes, and respiratory illness. Although genetics may have a role in the physical health problems of these patients, lifestyle and environmental factors such as smoking, obesity, poor diet, and low levels of physical activity play a prominent part. METHODS A qualitative grounded theory approach was used to understand the problems experienced by these individuals when asked to attend a healthy living programme. Three main areas were explored: the influence of potential barriers, health problems, and general attitudes towards healthy living. RESULTS Thirteen patients were interviewed during the study. Many did not recall receiving an initial invitation letter to the programme. Several believed that there was no necessity to attend as they had already had recent routine health checks by their general practitioner. The patients' current level of mental and physical health was important with symptoms such as depression, anxiety or arthritis affecting interest in the programme. Patients described that they found smoking enjoyable or calming in its effect. Dietary intake was determined by taste or gaining pleasure in eating certain types of food. Several lessons were learnt during this research that may aid future research and practice. Participation seemed to be better if the approach was first made by the patient's own community keyworker. This contact may have provided a greater opportunity to explain the purpose and importance of the programme. Alternative appointments should be considered when certain patients are in better physical and mental health. Healthy living programmes need to be flexible and adaptive to individual patient needs. Assistance from their community worker may help engagement. Simple measures may improve participation and reduce potential barriers. CONCLUSION These findings highlighted some of the problems encountered by patients when attempting to participate in a healthy living programme. These results may be useful when implementing future healthy living interventions for patients with serious mental disorders.
Collapse
Affiliation(s)
| | | | - John Geddes
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Anthony Pelosi
- Regional Eating Disorders Unit, St John’s Hospital, Livingston, UK
| |
Collapse
|