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Keenan R, Chepulis L, Ly J, Carter S, Lao C, Asim M, Bhat A, Deo S, Lim KP, Mohammed R, Scarlet S, Lawrenson R. Metabolic screening in primary care for patients with schizophrenia or schizoaffective disorder and taking antipsychotic medication. J Prim Health Care 2021; 12:29-34. [PMID: 32223847 DOI: 10.1071/hc19023] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 11/30/2019] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Life expectancy in patients with schizophrenia is 15-20 years less than the general population. A dominant cause of morbidity and mortality in these patients is cardiovascular disease. Adverse consequences of modifiable cardiovascular risk factors can be reduced by regular monitoring of metabolic outcomes and intervention if required. AIM To evaluate the metabolic screening in primary care for patients with schizoaffective disorders managed in primary care. To show the usefulness of combining simple practice audits in evaluating such areas of clinical practice. METHODS An audit was undertaken in eight general practices in the Waikato and Bay of Plenty regions of New Zealand. Specifically, the monitoring of patients with schizophrenia or schizoaffective disorder whose antipsychotic medication was prescribed by primary care doctors was audited. Patient monitoring was compared to the guideline recommendation of the Royal Australian and New Zealand College of Psychiatrists (RANZCP) and the Best Practice Advisory Centre (BPAC). RESULTS In total, 117 patients were included in the audit and none were fully monitored, as recommended by the RANZCP guidelines. Although two-thirds of patients had been evaluated for glycosylated haemoglobin (HbA1c), lipids, blood pressure, complete blood count and weight, <10% of patients had had prolactin, waist circumference or electrocardiogram measurements recorded. The proportion of patients having a HbA1c measured was also significantly higher in younger patients and patients who were non-Māori or enrolled with an urban practice (all P<0.05). When using the simplified BPAC guidelines, half of all patients were correctly monitored. DISCUSSION These findings show there is room for improvement in the monitoring of patients receiving antipsychotic medication in primary care. This may indicate the need for clear guidance and general practitioner education around the monitoring requirements of these patients. Alternatively, a more simplified monitoring protocol may need to be developed. This audit has also shown that there is value in several practices completing the same audit and providing a larger cohort of patients for pooled data analysis.
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Affiliation(s)
- Rawiri Keenan
- Medical Research Centre, University of Waikato, Hamilton, Waikato, New Zealand; and Royal New Zealand College of General Practitioners, Wellington, New Zealand; and Corresponding author.
| | - Lynne Chepulis
- Medical Research Centre, University of Waikato, Hamilton, Waikato, New Zealand
| | - Joanna Ly
- Royal New Zealand College of General Practitioners, Wellington, New Zealand
| | - Sally Carter
- Royal New Zealand College of General Practitioners, Wellington, New Zealand
| | - Chunhuan Lao
- Medical Research Centre, University of Waikato, Hamilton, Waikato, New Zealand
| | - Muhammad Asim
- Royal New Zealand College of General Practitioners, Wellington, New Zealand
| | - Abhijit Bhat
- Royal New Zealand College of General Practitioners, Wellington, New Zealand
| | - Shivam Deo
- Royal New Zealand College of General Practitioners, Wellington, New Zealand
| | - Kee Ping Lim
- Royal New Zealand College of General Practitioners, Wellington, New Zealand
| | - Ruzaimah Mohammed
- Royal New Zealand College of General Practitioners, Wellington, New Zealand
| | - Sophie Scarlet
- Royal New Zealand College of General Practitioners, Wellington, New Zealand
| | - Ross Lawrenson
- Medical Research Centre, University of Waikato, Hamilton, Waikato, New Zealand
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Cabassa LJ, Stefancic A, Lewis-Fernández R, Luchsinger J, Weinstein LC, Guo S, Palinkas L, Bochicchio L, Wang X, O'Hara K, Blady M, Simiriglia C, Medina McCurdy M. Main Outcomes of a Peer-Led Healthy Lifestyle Intervention for People With Serious Mental Illness in Supportive Housing. Psychiatr Serv 2021; 72:555-562. [PMID: 33334158 PMCID: PMC8607694 DOI: 10.1176/appi.ps.202000304] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The effectiveness of the Peer-led Group Lifestyle Balance (PGLB) intervention, a 12-month manualized healthy lifestyle intervention delivered by peer specialists, was investigated in a sample of persons with serious mental illness who were overweight or obese and living in supportive housing. METHODS The authors randomly assigned 314 participants from three supportive housing agencies to PGLB or usual care, with assessments at baseline and 6, 12, and 18 months. Outcomes were clinically significant changes from baseline in weight (≥5% weight loss), cardiorespiratory fitness (CRF; increase of ≥50 meters in the 6-minute walk test), and cardiovascular disease (CVD) risk reduction (clinically significant weight loss or CRF improvement). RESULTS Most participants were from racial-ethnic minority groups (82%, N=255). The mean±SD baseline weight of this sample was 218.8±54.0 pounds, and the body mass index was 33.7±7.2. Compared with the usual care group, a larger proportion of the PGLB group achieved clinically significant changes in study outcomes at 12 and 18 months, but none of these changes was statistically significant. Outcomes differed by site: two sites reported no significant differences between the two groups, and one reported that PGLB significantly outperformed usual care on clinically significant weight loss at 18 months and CVD risk reduction at 6 and 12 months. CONCLUSIONS The null findings indicate that PGLB was not superior to usual care in helping participants achieve clinically significant changes in weight, CRF, and CVD risk reduction at 12 and 18 months. Questions remain regarding how PGLB works, for whom, and in which settings.
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Affiliation(s)
- Leopoldo J Cabassa
- Brown School at Washington University in St. Louis, St. Louis (Cabassa, Guo, Wang); Department of Psychiatry, Columbia University, New York City (Stefancic, Lewis-Fernández); New York State Psychiatric Institute, New York City (Lewis-Fernández); Department of Medicine, Columbia University Medical Center, New York City (Luchsinger); Department of Family and Community Medicine, Jefferson Medical College, Philadelphia (Weinstein); Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles (Palinkas); School of Nursing, Columbia University, New York City (Bochicchio); School of Social Work, Columbia University, New York City (O'Hara); The Bridge, New York City (Blady); Pathways to Housing PA, Philadelphia (Simiriglia); Project Home, Stephen Klein Wellness Center, Philadelphia (McCurdy)
| | - Ana Stefancic
- Brown School at Washington University in St. Louis, St. Louis (Cabassa, Guo, Wang); Department of Psychiatry, Columbia University, New York City (Stefancic, Lewis-Fernández); New York State Psychiatric Institute, New York City (Lewis-Fernández); Department of Medicine, Columbia University Medical Center, New York City (Luchsinger); Department of Family and Community Medicine, Jefferson Medical College, Philadelphia (Weinstein); Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles (Palinkas); School of Nursing, Columbia University, New York City (Bochicchio); School of Social Work, Columbia University, New York City (O'Hara); The Bridge, New York City (Blady); Pathways to Housing PA, Philadelphia (Simiriglia); Project Home, Stephen Klein Wellness Center, Philadelphia (McCurdy)
| | - Roberto Lewis-Fernández
- Brown School at Washington University in St. Louis, St. Louis (Cabassa, Guo, Wang); Department of Psychiatry, Columbia University, New York City (Stefancic, Lewis-Fernández); New York State Psychiatric Institute, New York City (Lewis-Fernández); Department of Medicine, Columbia University Medical Center, New York City (Luchsinger); Department of Family and Community Medicine, Jefferson Medical College, Philadelphia (Weinstein); Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles (Palinkas); School of Nursing, Columbia University, New York City (Bochicchio); School of Social Work, Columbia University, New York City (O'Hara); The Bridge, New York City (Blady); Pathways to Housing PA, Philadelphia (Simiriglia); Project Home, Stephen Klein Wellness Center, Philadelphia (McCurdy)
| | - José Luchsinger
- Brown School at Washington University in St. Louis, St. Louis (Cabassa, Guo, Wang); Department of Psychiatry, Columbia University, New York City (Stefancic, Lewis-Fernández); New York State Psychiatric Institute, New York City (Lewis-Fernández); Department of Medicine, Columbia University Medical Center, New York City (Luchsinger); Department of Family and Community Medicine, Jefferson Medical College, Philadelphia (Weinstein); Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles (Palinkas); School of Nursing, Columbia University, New York City (Bochicchio); School of Social Work, Columbia University, New York City (O'Hara); The Bridge, New York City (Blady); Pathways to Housing PA, Philadelphia (Simiriglia); Project Home, Stephen Klein Wellness Center, Philadelphia (McCurdy)
| | - Lara Carson Weinstein
- Brown School at Washington University in St. Louis, St. Louis (Cabassa, Guo, Wang); Department of Psychiatry, Columbia University, New York City (Stefancic, Lewis-Fernández); New York State Psychiatric Institute, New York City (Lewis-Fernández); Department of Medicine, Columbia University Medical Center, New York City (Luchsinger); Department of Family and Community Medicine, Jefferson Medical College, Philadelphia (Weinstein); Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles (Palinkas); School of Nursing, Columbia University, New York City (Bochicchio); School of Social Work, Columbia University, New York City (O'Hara); The Bridge, New York City (Blady); Pathways to Housing PA, Philadelphia (Simiriglia); Project Home, Stephen Klein Wellness Center, Philadelphia (McCurdy)
| | - Shenyang Guo
- Brown School at Washington University in St. Louis, St. Louis (Cabassa, Guo, Wang); Department of Psychiatry, Columbia University, New York City (Stefancic, Lewis-Fernández); New York State Psychiatric Institute, New York City (Lewis-Fernández); Department of Medicine, Columbia University Medical Center, New York City (Luchsinger); Department of Family and Community Medicine, Jefferson Medical College, Philadelphia (Weinstein); Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles (Palinkas); School of Nursing, Columbia University, New York City (Bochicchio); School of Social Work, Columbia University, New York City (O'Hara); The Bridge, New York City (Blady); Pathways to Housing PA, Philadelphia (Simiriglia); Project Home, Stephen Klein Wellness Center, Philadelphia (McCurdy)
| | - Lawrence Palinkas
- Brown School at Washington University in St. Louis, St. Louis (Cabassa, Guo, Wang); Department of Psychiatry, Columbia University, New York City (Stefancic, Lewis-Fernández); New York State Psychiatric Institute, New York City (Lewis-Fernández); Department of Medicine, Columbia University Medical Center, New York City (Luchsinger); Department of Family and Community Medicine, Jefferson Medical College, Philadelphia (Weinstein); Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles (Palinkas); School of Nursing, Columbia University, New York City (Bochicchio); School of Social Work, Columbia University, New York City (O'Hara); The Bridge, New York City (Blady); Pathways to Housing PA, Philadelphia (Simiriglia); Project Home, Stephen Klein Wellness Center, Philadelphia (McCurdy)
| | - Lauren Bochicchio
- Brown School at Washington University in St. Louis, St. Louis (Cabassa, Guo, Wang); Department of Psychiatry, Columbia University, New York City (Stefancic, Lewis-Fernández); New York State Psychiatric Institute, New York City (Lewis-Fernández); Department of Medicine, Columbia University Medical Center, New York City (Luchsinger); Department of Family and Community Medicine, Jefferson Medical College, Philadelphia (Weinstein); Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles (Palinkas); School of Nursing, Columbia University, New York City (Bochicchio); School of Social Work, Columbia University, New York City (O'Hara); The Bridge, New York City (Blady); Pathways to Housing PA, Philadelphia (Simiriglia); Project Home, Stephen Klein Wellness Center, Philadelphia (McCurdy)
| | - Xiaoyan Wang
- Brown School at Washington University in St. Louis, St. Louis (Cabassa, Guo, Wang); Department of Psychiatry, Columbia University, New York City (Stefancic, Lewis-Fernández); New York State Psychiatric Institute, New York City (Lewis-Fernández); Department of Medicine, Columbia University Medical Center, New York City (Luchsinger); Department of Family and Community Medicine, Jefferson Medical College, Philadelphia (Weinstein); Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles (Palinkas); School of Nursing, Columbia University, New York City (Bochicchio); School of Social Work, Columbia University, New York City (O'Hara); The Bridge, New York City (Blady); Pathways to Housing PA, Philadelphia (Simiriglia); Project Home, Stephen Klein Wellness Center, Philadelphia (McCurdy)
| | - Kathleen O'Hara
- Brown School at Washington University in St. Louis, St. Louis (Cabassa, Guo, Wang); Department of Psychiatry, Columbia University, New York City (Stefancic, Lewis-Fernández); New York State Psychiatric Institute, New York City (Lewis-Fernández); Department of Medicine, Columbia University Medical Center, New York City (Luchsinger); Department of Family and Community Medicine, Jefferson Medical College, Philadelphia (Weinstein); Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles (Palinkas); School of Nursing, Columbia University, New York City (Bochicchio); School of Social Work, Columbia University, New York City (O'Hara); The Bridge, New York City (Blady); Pathways to Housing PA, Philadelphia (Simiriglia); Project Home, Stephen Klein Wellness Center, Philadelphia (McCurdy)
| | - Michael Blady
- Brown School at Washington University in St. Louis, St. Louis (Cabassa, Guo, Wang); Department of Psychiatry, Columbia University, New York City (Stefancic, Lewis-Fernández); New York State Psychiatric Institute, New York City (Lewis-Fernández); Department of Medicine, Columbia University Medical Center, New York City (Luchsinger); Department of Family and Community Medicine, Jefferson Medical College, Philadelphia (Weinstein); Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles (Palinkas); School of Nursing, Columbia University, New York City (Bochicchio); School of Social Work, Columbia University, New York City (O'Hara); The Bridge, New York City (Blady); Pathways to Housing PA, Philadelphia (Simiriglia); Project Home, Stephen Klein Wellness Center, Philadelphia (McCurdy)
| | - Christine Simiriglia
- Brown School at Washington University in St. Louis, St. Louis (Cabassa, Guo, Wang); Department of Psychiatry, Columbia University, New York City (Stefancic, Lewis-Fernández); New York State Psychiatric Institute, New York City (Lewis-Fernández); Department of Medicine, Columbia University Medical Center, New York City (Luchsinger); Department of Family and Community Medicine, Jefferson Medical College, Philadelphia (Weinstein); Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles (Palinkas); School of Nursing, Columbia University, New York City (Bochicchio); School of Social Work, Columbia University, New York City (O'Hara); The Bridge, New York City (Blady); Pathways to Housing PA, Philadelphia (Simiriglia); Project Home, Stephen Klein Wellness Center, Philadelphia (McCurdy)
| | - Monica Medina McCurdy
- Brown School at Washington University in St. Louis, St. Louis (Cabassa, Guo, Wang); Department of Psychiatry, Columbia University, New York City (Stefancic, Lewis-Fernández); New York State Psychiatric Institute, New York City (Lewis-Fernández); Department of Medicine, Columbia University Medical Center, New York City (Luchsinger); Department of Family and Community Medicine, Jefferson Medical College, Philadelphia (Weinstein); Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles (Palinkas); School of Nursing, Columbia University, New York City (Bochicchio); School of Social Work, Columbia University, New York City (O'Hara); The Bridge, New York City (Blady); Pathways to Housing PA, Philadelphia (Simiriglia); Project Home, Stephen Klein Wellness Center, Philadelphia (McCurdy)
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Cabassa LJ, Stefancic A, O'Hara K, El-Bassel N, Lewis-Fernández R, Luchsinger JA, Gates L, Younge R, Wall M, Weinstein L, Palinkas LA. Peer-led healthy lifestyle program in supportive housing: study protocol for a randomized controlled trial. Trials 2015; 16:388. [PMID: 26329472 PMCID: PMC4557630 DOI: 10.1186/s13063-015-0902-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 08/05/2015] [Indexed: 01/28/2023] Open
Abstract
Background The risk for obesity is twice as high in people with serious mental illness (SMI) compared to the general population. Racial and ethnic minority status contribute additional health risks. The aim of this study is to describe the protocol of a Hybrid Trial Type 1 design that will test the effectiveness and examine the implementation of a peer-led healthy lifestyle intervention in supportive housing agencies serving diverse clients with serious mental illness who are overweight or obese. Methods The Hybrid Trial Type 1 design will combine a randomized effectiveness trial with a mixed-methods implementation study. The effectiveness trial will test the health impacts of a peer-led healthy lifestyle intervention versus usual care in supportive housing agencies. The healthy lifestyle intervention is derived from the Group Lifestyle Balanced Program, lasts 12 months, and will be delivered by trained peer specialists. Repeated assessments will be conducted at baseline and at 6, 12, and 18 months post randomization. A mixed-methods (e.g., structured interviews, focus groups, surveys) implementation study will be conducted to examine multi-level implementation factors and processes that can inform the use of the healthy lifestyle intervention in routine practice, using data from agency directors, program managers, staff, and peer specialists before, during, and after the implementation of the effectiveness trial. Discussion This paper describes the use of a hybrid research design that blends effectiveness trial methodologies and implementation science rarely used when studying the physical health of people with SMI and can serve as a model for integrating implementation science and health disparities research. Rigorously testing effectiveness and exploring the implementation process are both necessary steps to establish the evidence for large-scale delivery of peer-led healthy lifestyle intervention to improve the physical health of racial/ethnic minorities with SMI. Trial registration www.clinicaltrials.gov; NCT02175641, registered 24 June 2014
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Affiliation(s)
- Leopoldo J Cabassa
- Columbia University School of Social Work, 1255 Amsterdam Avenue, New York, NY, 10027, USA.
| | - Ana Stefancic
- Columbia University School of Social Work, 1255 Amsterdam Avenue, New York, NY, 10027, USA.
| | - Kathleen O'Hara
- Columbia University School of Social Work, 1255 Amsterdam Avenue, New York, NY, 10027, USA.
| | - Nabila El-Bassel
- Columbia University School of Social Work, 1255 Amsterdam Avenue, New York, NY, 10027, USA.
| | | | - José A Luchsinger
- Columbia University Medical Center, Presbyterian Hospital, 622 West 168th St, New York, NY, 10032, USA.
| | - Lauren Gates
- Columbia University School of Social Work, 1255 Amsterdam Avenue, New York, NY, 10027, USA.
| | - Richard Younge
- New York Presbyterian, Family Medicine, 610 West 158th St, New York, NY, 10032, USA.
| | - Melanie Wall
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA.
| | - Lara Weinstein
- Jefferson University Hospital, 833 Chestnut Street, Philadelphia, PA, 19107, USA.
| | - Lawrence A Palinkas
- University of Southern California School of Social Work, University Park, Los Angeles, CA, 90089, USA.
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