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Fehily C, Jackson B, Hansen V, Stettaford T, Bartlem K, Clancy R, Bowman J. Increasing chronic disease preventive care in community mental health services: clinician-generated strategies. BMC Psychiatry 2023; 23:933. [PMID: 38082423 PMCID: PMC10714530 DOI: 10.1186/s12888-023-05311-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 10/26/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND People with a mental health condition experience a high prevalence of chronic disease risk behaviours e.g., tobacco smoking and physical inactivity. Recommended 'preventive care' to address these risks is infrequently provided by community mental health services. This study aimed to elucidate, among community mental health managers and clinicians, suggestions for strategies to support provision of preventive care. METHODS Three qualitative focus groups (n = 14 clinicians) were undertaken in one regional community mental health service to gather perspectives of barriers to preventive care provision, deductively coded against the domains of the Theoretical Domains Framework (TDF). Drawing on the learnings from the focus groups, individual interviews (n = 15 managers and clinicians) were conducted in two services to identify suggestions for strategies to increase preventive care. Strategies were inductively coded and mapped into TDF domains. RESULTS Barriers were identified across a wide range of TDF domains, most notably knowledge and environmental context and resources. Nine strategies were identified across three themes: training, resources and systems changes; mapping to all 14 TDF domains. CONCLUSION Future research seeking to increase implementation of preventive care may be guided by these findings. There is need for greater recognition and resourcing of preventive care as a priority and integral component of mental health treatment.
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Affiliation(s)
- Caitlin Fehily
- School of Psychological Sciences, College of Engineering, Science and Environment, The University of Newcastle, Callaghan, NSW, Australia.
- Hunter Medical Research Institute, Clinical Research Centre, New Lambton Heights, NSW, Australia.
| | - Belinda Jackson
- School of Psychological Sciences, College of Engineering, Science and Environment, The University of Newcastle, Callaghan, NSW, Australia
| | - Vibeke Hansen
- School of Psychological Sciences, College of Engineering, Science and Environment, The University of Newcastle, Callaghan, NSW, Australia
| | - Tegan Stettaford
- School of Psychological Sciences, College of Engineering, Science and Environment, The University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, Clinical Research Centre, New Lambton Heights, NSW, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia
| | - Kate Bartlem
- School of Psychological Sciences, College of Engineering, Science and Environment, The University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, Clinical Research Centre, New Lambton Heights, NSW, Australia
| | - Richard Clancy
- Hunter Medical Research Institute, Clinical Research Centre, New Lambton Heights, NSW, Australia
- Hunter New England Mental Health, Hunter New England Local Health District, NSW Health, New Lambton, NSW, Australia
- School of Nursing and Midwifery, College of Health, Medicine & Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
| | - Jenny Bowman
- School of Psychological Sciences, College of Engineering, Science and Environment, The University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, Clinical Research Centre, New Lambton Heights, NSW, Australia
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Cole R, Kynn M, Carberry A, Jones R, Parekh S, Whitehead E, Taylor J, Merollini K. Examining service utilisation and impact among consumers of a national mental health stepped care programme in Australia: a protocol using linked administrative data. BMJ Open 2023; 13:e072404. [PMID: 37419645 PMCID: PMC10335474 DOI: 10.1136/bmjopen-2023-072404] [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: 02/01/2023] [Accepted: 06/16/2023] [Indexed: 07/09/2023] Open
Abstract
INTRODUCTION Mental well-being is a global public health priority with increasing mental health conditions having substantial burden on individuals, health systems and society. 'Stepped care', where services are provided at an intensity to meet the changing needs of the consumer, is the chosen approach to mental health service delivery in primary healthcare in Australia for its efficiencies and patient outcomes; yet limited evidence exists on how the programme is being rolled out and its impact in practice. This protocol outlines a data linkage project to characterise and quantify healthcare service utilisation and impacts among a cohort of consumers of a national mental health stepped care programme in one region of Australia. METHODS AND ANALYSIS Data linkage will be used to establish a retrospective cohort of consumers of mental health stepped care services between 1 July 2020 and 31 December 2021 in one primary healthcare region in Australia (n=approx. 12 710). These data will be linked with records from other healthcare service data sets (eg, hospitalisations, emergency department presentations, community-based state government-delivered mental healthcare, hospital costs). Four areas for analysis will include: (1) characterising the nature of mental health stepped care service use; (2) describing the cohort's sociodemographic and health characteristics; (3) quantifying broader service utilisation and associated economic costs; and (4) assessing the impact of mental health stepped care service utilisation on health and service outcomes. ETHICS AND DISSEMINATION Approval from the Darling Downs Health Human Research Ethics Committee (HREA/2020/QTDD/65518) has been granted. All data will be non-identifiable, and research findings will be disseminated through peer-reviewed journals, conference presentations and industry meetings.
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Affiliation(s)
- Rachel Cole
- School of Health, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
- Sunshine Coast Health Network, Maroochydore, Queensland, Australia
| | - Mary Kynn
- School of Electrical Engineering, Computing and Mathematical Sciences, Curtin University, Perth, Western Australia, Australia
| | - Angela Carberry
- Sunshine Coast Health Network, Maroochydore, Queensland, Australia
| | - Rhian Jones
- Sunshine Coast Health Network, Maroochydore, Queensland, Australia
| | | | - Emma Whitehead
- Sunshine Coast Health Network, Maroochydore, Queensland, Australia
| | - Jane Taylor
- School of Health, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
| | - Katharina Merollini
- School of Health, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
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Barriers to the Provision of Preventive Care to People Living with Mental Health Conditions: Self-Report by Staff Working in an Australian Community Managed Organisation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084458. [PMID: 35457326 PMCID: PMC9027436 DOI: 10.3390/ijerph19084458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/02/2022] [Accepted: 04/02/2022] [Indexed: 11/30/2022]
Abstract
People living with mental health conditions experience a reduced life expectancy largely due to a higher prevalence of chronic diseases. Addressing health risk behaviours, including tobacco smoking, inadequate nutrition, harmful alcohol consumption, and physical inactivity (SNAP), through the provision of preventive care, is recommended to reduce this burden. Community Managed Organisations (CMOs) may play an important role in providing preventive care to consumers with mental health conditions, however, few studies have examined preventive care provision in CMO settings; and no studies have comprehensively assessed barriers to the provision of this care using a tool such as the Theoretical Domains Framework (TDF). To fill this research gap, we conducted an online survey among staff (N = 190) from one CMO in Australia to (1) identify barriers to preventive care provision (ask, advise, assist, connect) to address SNAP behaviours among consumers; and (2) explore associations between barriers and preventive care provision. Results demonstrate that while staff reported knowing how to provide preventive care and believed it would positively impact consumers; barriers including confidence in providing this care and consumer uptake of referrals, were identified. Further research among multiple CMOs is needed to identify care provision and associated barriers in the sector more widely.
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The Effectiveness and Cost of an Intervention to Increase the Provision of Preventive Care in Community Mental Health Services: Protocol for a Cluster-Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19053119. [PMID: 35270810 PMCID: PMC8910711 DOI: 10.3390/ijerph19053119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/24/2022] [Accepted: 03/01/2022] [Indexed: 02/04/2023]
Abstract
Preventive care to address chronic disease risk behaviours is infrequently provided by community mental health services. In this cluster-randomised controlled trial, 12 community mental health services in 3 Local Health Districts in New South Wales, Australia, will be randomised to either an intervention group (implementing a new model of providing preventive care) or a control group (usual care). The model of care comprises three components: (1) a dedicated ‘healthy choices’ consultation offered by a ‘healthy choices’ clinician; (2) embedding information regarding risk factors into clients’ care plans; and (3) the continuation of preventive care by mental health clinicians in ongoing consultations. Evidence-based implementation strategies will support the model implementation, which will be tailored by being co-developed with service managers and clinicians. The primary outcomes are client-reported receipt of: (1) an assessment of chronic disease risks (tobacco smoking, inadequate fruit and vegetable consumption, harmful alcohol use and physical inactivity); (2) brief advice regarding relevant risk behaviours; and (3) referral to at least one behaviour change support. Resources to develop and implement the intervention will be captured to enable an assessment of cost effectiveness and affordability. The findings will inform the development of future service delivery initiatives to achieve guideline- and policy-concordant preventive care delivery.
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Gibson L, Clinton-McHarg T, Wilczynska M, Latter J, Bartlem K, Henderson C, Wiggers J, Wilson A, Searles A, Bowman J. Preventive care practices to address health behaviours among people living with mental health conditions: A survey of Community Managed Organisations. Prev Med Rep 2021; 23:101495. [PMID: 34336560 PMCID: PMC8313583 DOI: 10.1016/j.pmedr.2021.101495] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 07/06/2021] [Accepted: 07/10/2021] [Indexed: 12/26/2022] Open
Abstract
People living with mental health conditions have a reduced life expectancy of approximately 10 years compared to the general population, largely due to physical chronic diseases and higher rates of tobacco smoking, poor nutrition, harmful alcohol consumption, physical inactivity and poor sleep behaviours. Community managed organisations (CMOs) may play a valuable role in providing preventive care to people with mental health conditions (consumers) to address these health behaviours. This paper reports the findings of a cross-sectional survey undertaken between November 2018 and February 2019 with leaders of CMOs (n = 76) that support people with mental health conditions in the state of New South Wales, Australia to: 1) measure the provision of preventive care (screening, support, and connections to specialist services) for five health behaviours; 2) identify the presence of key organisational features (e.g., data collection, staff training); and 3) explore if these organisational features were associated with the provision of preventive care. Preventive care provision to a majority of consumers (50% or more) was least frequently reported for tobacco smoking and most frequently reported for physical activity. Staff training and guidelines regarding the provision of preventive care were associated with the provision of such care. The results demonstrate that CMOs are already engaged in providing preventive care to some extent, with certain behaviours and preventive care elements addressed more frequently than others. Further research with additional CMO stakeholders, including staff and consumers, is needed to gain a deeper understanding of factors that may underlie CMOs capacity to routinely provide preventive care.
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Affiliation(s)
- Lauren Gibson
- School of Psychological Sciences, College of Engineering, Science & Environment, University of Newcastle, Callaghan, NSW, Australia
- The Australian Prevention Partnership Centre (TAPPC), Sax Institute, Ultimo, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Tara Clinton-McHarg
- School of Psychological Sciences, College of Engineering, Science & Environment, University of Newcastle, Callaghan, NSW, Australia
- The Australian Prevention Partnership Centre (TAPPC), Sax Institute, Ultimo, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Magdalena Wilczynska
- School of Psychological Sciences, College of Engineering, Science & Environment, University of Newcastle, Callaghan, NSW, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, Australia
| | - Joanna Latter
- School of Psychological Sciences, College of Engineering, Science & Environment, University of Newcastle, Callaghan, NSW, Australia
| | - Kate Bartlem
- School of Psychological Sciences, College of Engineering, Science & Environment, University of Newcastle, Callaghan, NSW, Australia
- The Australian Prevention Partnership Centre (TAPPC), Sax Institute, Ultimo, NSW, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | | | - John Wiggers
- The Australian Prevention Partnership Centre (TAPPC), Sax Institute, Ultimo, NSW, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, Australia
- School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Andrew Wilson
- The Australian Prevention Partnership Centre (TAPPC), Sax Institute, Ultimo, NSW, Australia
- Menzies Centre for Health Policy, School of Public Health, University of Sydney, Australia
| | - Andrew Searles
- The Australian Prevention Partnership Centre (TAPPC), Sax Institute, Ultimo, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Jenny Bowman
- School of Psychological Sciences, College of Engineering, Science & Environment, University of Newcastle, Callaghan, NSW, Australia
- The Australian Prevention Partnership Centre (TAPPC), Sax Institute, Ultimo, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
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6
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Lerbæk B, McCloughen A, Lauritsen MB, Aagaard J, Nordgaard J, Jørgensen R. Barriers and Possible Solutions to Providing Physical Health Care in Mental Health Care: A Qualitative Study of Danish Key Informants' Perspectives. Issues Ment Health Nurs 2021; 42:463-472. [PMID: 32990129 DOI: 10.1080/01612840.2020.1823537] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Provision of physical health care to people diagnosed with severe mental illness is widely reported as inadequate. This interview study explored perspectives of a group of key informants on current practices of providing physical health care within two mental health care settings in Denmark. Thematic analysis of their accounts provided insights into 1) barriers to the provision of physical health care in mental health settings, and 2) possible solutions to overcome existing barriers. Negative attitudes and limited specialist health care knowledge among mental health care professionals constituted serious barriers. To effectively address these barriers, mental health services need to be reoriented towards the prioritisation of physical health alongside mental health. This will require equipping mental health professionals with relevant knowledge and skills and organisational resources, to effectively work with people experiencing or at risk of physical comorbidities.
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Affiliation(s)
- Birgitte Lerbæk
- Clinic for Internal and Emergency Medicine, Aalborg University Hospital, Aalborg, Denmark.,Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark.,Clinic Psychiatry South, Aalborg University Hospital, Psychiatry, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Andrea McCloughen
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Marlene Briciet Lauritsen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Psychiatry, Aalborg University Hospital, Aalborg, Denmark
| | | | - Julie Nordgaard
- Mental Health Center Amager, Copenhagen, Denmark.,University of Copenhagen, Copenhagen, Denmark
| | - Rikke Jørgensen
- Unit for Psychiatric Research, Aalborg University Hospital, Psychiatry, Aalborg, Denmark
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7
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Unmet Need for Medical Care: The Role of Mental Health Status. Community Ment Health J 2021; 57:121-127. [PMID: 32303934 DOI: 10.1007/s10597-020-00613-8] [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: 10/29/2019] [Accepted: 03/28/2020] [Indexed: 12/29/2022]
Abstract
Mental health status is an important factor to consider when exploring correlates of unmet need for medical care and prescription drugs. This paper explores whether self-rated mental health status is associated with unmet need and delays in obtaining medical care and prescription drugs. Descriptive statistics and multivariable logistic regression with 27,305 non-institutionalized adults aged 18 and older from the 2012 Medical Expenditure Panel Survey explore factors associated with self-reported unmet need for medical care and prescriptions, as well as access delays. Patients with lower physical and mental health status had the highest odds of experiencing unmet need for medical care and prescriptions, as well as access delays. These findings highlight the importance of increasing access to a usual source of care among individuals with lower self-rated mental health status as a strategy for addressing unmet need.
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8
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Romain AJ, Trottier A, Karelis AD, Abdel-Baki A. Do Mental Health Professionals Promote a Healthy Lifestyle among Individuals Experiencing Serious Mental Illness? Issues Ment Health Nurs 2020; 41:531-539. [PMID: 32286095 DOI: 10.1080/01612840.2019.1688436] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: While a healthy lifestyle would be an asset to people experiencing psychotic disorders, not all mental health professionals provide counselling regarding healthy behaviours, such as physical activity, healthy nutrition, and tobacco cessation. Therefore, the objective of the present study was to investigate the factors associated with health promotion practice (HPP) among mental health professionals.Methods: Cross-sectional survey including mental health professionals across the Province of Quebec (Canada). The promotion of health behaviour and the "Exercise in Mental Illness Questionnaire - Health Practitioner Version" and its adaptation for nutrition improvement and tobacco cessation were used to evaluate knowledge, beliefs, promotion behaviours, and barriers to HPP.Results: One hundred mental health professionals, most being nurses (29%) and medical doctors/psychiatrists (20%) were recruited throughout the province of Quebec (Canada). The rate of formal training among professionals was 11% for physical activity, 26% for nutrition, and 21% for tobacco cessation. Approximately 60% were promoting physical activity, 49% good nutrition, and 41% tobacco cessation. Professionals promoting healthy behaviours had a higher level of self-efficacy in HPP, were more likely to value physical health, and less likely to endorse barriers to HPP.Conclusion: Rates of formal training in lifestyle habits and health promotion (aiming at improving a healthy lifestyle in patients experiencing psychotic disorders) among mental health professionals are currently low in the Province of Quebec and need to be improved. In addition, the level of confidence and barriers that endorse healthy behaviours appear to be key factors in HPP among mental health professionals.
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Affiliation(s)
- Ahmed Jerome Romain
- Department of Psychiatry, University of Montreal Hospital Research Centre (CRCHUM), Montreal, Quebec, Canada
| | - Alexia Trottier
- Department of Psychiatry, University of Montreal Hospital Research Centre (CRCHUM), Montreal, Quebec, Canada
| | - Antony D Karelis
- Department of Physical Activity Sciences, University of Quebec at Montreal, Montreal, Quebec, Canada
| | - Amal Abdel-Baki
- Department of Psychiatry, University of Montreal Hospital Research Centre (CRCHUM), Montreal, Quebec, Canada.,Department of Psychiatry, University of Montreal, Montreal, Quebec, Canada.,Department of Psychiatry, University Hospital of Montreal (CHUM) - Notre-Dame Hospital, Montreal, Quebec, Canada
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9
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Fehily CMC, Bartlem KM, Wiggers JH, Wye PM, Clancy RV, Castle DJ, Wilson A, Rissel CE, Wutzke S, Hodder RK, Colyvas K, Murphy F, Bowman JA. Effectiveness of embedding a specialist preventive care clinician in a community mental health service in increasing preventive care provision: A randomised controlled trial. Aust N Z J Psychiatry 2020; 54:620-632. [PMID: 32403938 PMCID: PMC7285986 DOI: 10.1177/0004867420914741] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Clinical practice guidelines recommend that community mental health services provide preventive care for clients' chronic disease risk behaviours; however, such care is often not routinely provided. This study aimed to assess the effectiveness of offering clients an additional consultation with a specialist clinician embedded within a community mental health service, in increasing client-reported receipt of, and satisfaction with, preventive care. METHOD A randomised controlled trial was undertaken in one Australian community mental health service. Participants (N = 811) were randomised to receive usual care (preventive care in routine consultations; n = 405) or usual care plus the offer of an additional consultation with a specialist preventive care clinician (n = 406). Blinded interviewers assessed at baseline and 1-month follow-up the client-reported receipt of preventive care (assessment, advice and referral) for four key risk behaviours individually (smoking, poor nutrition, alcohol overconsumption and physical inactivity) and all applicable risks combined, acceptance of referrals and satisfaction with preventive care received. RESULTS Analyses indicated significantly greater increases in 12 of the 18 preventive care delivery outcomes in the intervention compared to the usual care condition from baseline to follow-up, including assessment for all risks combined (risk ratio = 4.00; 95% confidence interval = [1.57, 10.22]), advice for all applicable risks combined (risk ratio = 2.40; 95% confidence interval = [1.89, 6.47]) and offer of referral to applicable telephone services combined (risk ratio = 20.13; 95% confidence interval = [2.56, 158.04]). For each component of care, there was a significant intervention effect for at least one of the individual risk behaviours. Participants reported high levels of satisfaction with preventive care received, ranging from 77% (assessment) to 87% (referral), with no significant differences between conditions. CONCLUSION The intervention had a significant effect on the provision of the majority of recommended elements of preventive care. Further research is needed to maximise its impact, including identifying strategies to increase client uptake.
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Affiliation(s)
- Caitlin MC Fehily
- School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, Callaghan, NSW, Australia
- The Australian Prevention Partnership Centre (TAPPC), Sax Institute, Ultimo, NSW, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, Australia
| | - Kate M Bartlem
- School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, Callaghan, NSW, Australia
- The Australian Prevention Partnership Centre (TAPPC), Sax Institute, Ultimo, NSW, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, Australia
| | - John H Wiggers
- The Australian Prevention Partnership Centre (TAPPC), Sax Institute, Ultimo, NSW, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, Australia
- School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Paula M Wye
- School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Richard V Clancy
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Hunter New England Mental Health, Hunter New England Local Health District, NSW Health, New Lambton, NSW, Australia
- School of Nursing and Midwifery, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia
| | - David J Castle
- Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia
- St Vincent’s Health, Fitzroy, VIC, Australia
| | - Andrew Wilson
- The Australian Prevention Partnership Centre (TAPPC), Sax Institute, Ultimo, NSW, Australia
- Menzies Centre for Health Policy, The University of Sydney, Sydney, NSW, Australia
| | - Chris E Rissel
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- NSW Office of Preventive Health, Liverpool, NSW, Australia
| | - Sonia Wutzke
- The Australian Prevention Partnership Centre (TAPPC), Sax Institute, Ultimo, NSW, Australia
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Rebecca K Hodder
- School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, Callaghan, NSW, Australia
- School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia
| | - Kim Colyvas
- School of Mathematical and Physical Sciences, Faculty of Science and Information Technology, The University of Newcastle, Callaghan, NSW, Australia
| | - Fionna Murphy
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Jenny A Bowman
- School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, Callaghan, NSW, Australia
- The Australian Prevention Partnership Centre (TAPPC), Sax Institute, Ultimo, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
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10
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Fehily CM, Bartlem KM, Wiggers JH, Hodder RK, Gibson LK, Hancox N, Bowman JA. Uptake of a preventive care consultation offered to clients of a community mental health service. Prev Med Rep 2020; 18:101076. [PMID: 32226731 PMCID: PMC7093828 DOI: 10.1016/j.pmedr.2020.101076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 01/31/2020] [Accepted: 03/03/2020] [Indexed: 11/16/2022] Open
Abstract
Preventive care to address client chronic disease risks is not frequently provided in community mental health services. Offering clients an additional preventive care consultation has been shown to increase client receipt of such care. The ability of this approach to have a beneficial impact at the population level is however dependent on its level of acceptability and uptake among clients. No studies have previously reported these outcomes when the additional consultation is universally offered to all clients of a community mental health service. To address this evidence gap, this descriptive study was undertaken to determine community mental health clients' (1) reported acceptability, in principle, of such a model of care, (2) of those who were offered the additional consultation, the level of uptake, and (3) clinical and socio-demographic characteristics associated with uptake. Participants were clients of one community mental health service in Australia. Data were collected in 2017 by telephone interviews and study records. Data from three distinct participant sub-groups are reported. In response to a hypothetical question, 79.3% of participants (n = 157) agreed that an offer of an additional preventive care consultation would be acceptable (Aim 1). Of the participants who were offered such a consultation (n = 264), 37.8% took up the offer (Aim 2); and no clinical or sociodemographic characteristics were significantly associated with uptake (Aim 3). Findings support the feasibility of this model of care. However, further research is needed to identify barriers to uptake, and effective strategies to enhance consultation uptake. Trial registration: ACTRN12616001519448.
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Affiliation(s)
- Caitlin M.C. Fehily
- School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, NSW, Australia
- Hunter Medical Research Institute, Clinical Research Centre, NSW, Australia
- The Australian Preventive Partnership Centre (TAPPC), Sax Institute, Ultimo, NSW, Australia
| | - Kate M. Bartlem
- School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, NSW, Australia
- Hunter Medical Research Institute, Clinical Research Centre, NSW, Australia
- The Australian Preventive Partnership Centre (TAPPC), Sax Institute, Ultimo, NSW, Australia
- Population Health, Hunter New England Local Health District, NSW, Australia
| | - John H. Wiggers
- Hunter Medical Research Institute, Clinical Research Centre, NSW, Australia
- The Australian Preventive Partnership Centre (TAPPC), Sax Institute, Ultimo, NSW, Australia
- Population Health, Hunter New England Local Health District, NSW, Australia
- School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, NSW, Australia
| | - Rebecca K. Hodder
- Hunter Medical Research Institute, Clinical Research Centre, NSW, Australia
- Population Health, Hunter New England Local Health District, NSW, Australia
- School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, NSW, Australia
| | - Lauren K. Gibson
- School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, NSW, Australia
- Hunter Medical Research Institute, Clinical Research Centre, NSW, Australia
- The Australian Preventive Partnership Centre (TAPPC), Sax Institute, Ultimo, NSW, Australia
| | - Natalie Hancox
- School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, NSW, Australia
| | - Jenny A. Bowman
- School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, NSW, Australia
- Hunter Medical Research Institute, Clinical Research Centre, NSW, Australia
- The Australian Preventive Partnership Centre (TAPPC), Sax Institute, Ultimo, NSW, Australia
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11
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Fehily C, Ling R, Searles A, Bartlem K, Wiggers J, Hodder R, Wilson A, Colyvas K, Bowman J. An economic evaluation of a specialist preventive care clinician in a community mental health service: a randomised controlled trial. BMC Health Serv Res 2020; 20:405. [PMID: 32393307 PMCID: PMC7212584 DOI: 10.1186/s12913-020-05204-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 04/12/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Clinical practice guidelines and policies direct community mental health services to provide preventive care to address chronic disease risks, however, such care is infrequently provided in routine consultations. An alternative model of care is to appoint a clinician to the dedicated role of offering and providing preventive care in an additional consultation: the 'specialist clinician' model. Economic evaluations of models of care are needed to determine the cost of adhering to guidelines and policies, and to inform pragmatic service delivery decisions. This study is an economic evaluation of the specialist clinician model; designed to achieve policy concordant preventive care delivery. METHODS A retrospective analysis of the incremental costs, cost-effectiveness, and budget impact of a 'specialist preventive care clinician' (an occupational therapist) was conducted in a randomised controlled trial, where participants were randomised to receive usual care; or usual care plus the offer of an additional preventive care consultation with the specialist clinician. The study outcome was client acceptance of referrals to two free telephone-based chronic disease prevention services. This is a key care delivery outcome mandated by the local health district policy of the service. The base case analysis assumed the mental health service cost perspective. A budget impact analysis determined the annual budget required to implement the model of care for all clients of the community mental health service over 5 years. RESULTS There was a significantly greater increase from baseline to follow-up in the proportion of intervention participants accepting referrals to both telephone services, compared to usual care. The incremental cost-effectiveness ratio was $347 per additional acceptance of a referral (CI: $263-$494). The annual budget required to implement the model of care for all prospective clients was projected to be $711,446 over 5-years; resulting in 2616 accepted referrals. CONCLUSIONS The evaluation provides key information regarding the costs for the mental health service to adhere to policy targets, indicating the model of care involved a low per client cost whilst increasing key preventive care delivery outcomes. Additional modelling is required to further explore its economic benefits. TRIAL REGISTRATION ACTRN12616001519448. Registered 3 November 2016, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371709.
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Affiliation(s)
- Caitlin Fehily
- School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, Callaghan, NSW, Australia.
- Hunter Medical Research Institute, Clinical Research Centre, New Lambton Heights, NSW, Australia.
- The Australian Preventive Partnership Centre (TAPPC), Sax Institute, Ultimo, NSW, Australia.
| | - Rod Ling
- Hunter Medical Research Institute, Clinical Research Centre, New Lambton Heights, NSW, Australia
- School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia
| | - Andrew Searles
- Hunter Medical Research Institute, Clinical Research Centre, New Lambton Heights, NSW, Australia
- School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia
| | - Kate Bartlem
- School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, Clinical Research Centre, New Lambton Heights, NSW, Australia
- The Australian Preventive Partnership Centre (TAPPC), Sax Institute, Ultimo, NSW, Australia
- Population Health, Hunter New England Local Health District, New Lambton, NSW, Australia
| | - John Wiggers
- Hunter Medical Research Institute, Clinical Research Centre, New Lambton Heights, NSW, Australia
- The Australian Preventive Partnership Centre (TAPPC), Sax Institute, Ultimo, NSW, Australia
- School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia
- Population Health, Hunter New England Local Health District, New Lambton, NSW, Australia
| | - Rebecca Hodder
- Hunter Medical Research Institute, Clinical Research Centre, New Lambton Heights, NSW, Australia
- School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia
- Population Health, Hunter New England Local Health District, New Lambton, NSW, Australia
| | - Andrew Wilson
- The Australian Preventive Partnership Centre (TAPPC), Sax Institute, Ultimo, NSW, Australia
| | - Kim Colyvas
- School of Mathematical and Physical Sciences, Faculty of Science and Information Technology, The University of Newcastle, Callaghan, Australia
| | - Jenny Bowman
- School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, Clinical Research Centre, New Lambton Heights, NSW, Australia
- The Australian Preventive Partnership Centre (TAPPC), Sax Institute, Ultimo, NSW, Australia
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12
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Lin SC, Tyus N, Maloney M, Ohri B, Sripipatana A. Mental health status among women of reproductive age from underserved communities in the United States and the associations between depression and physical health. A cross-sectional study. PLoS One 2020; 15:e0231243. [PMID: 32267903 PMCID: PMC7141664 DOI: 10.1371/journal.pone.0231243] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 03/06/2020] [Indexed: 01/19/2023] Open
Abstract
Background In 2017, 46.6 million U.S. adults aged 18 or older self-reported as having mental illness of which 52.0% or 24.2 million are women age 18–49. Perinatal depression and anxiety are linked to adverse outcomes concerning pregnancy, maternal functioning, and healthy child development. Methods and findings Using the 2014 Health Center Patient Survey (HCPS), the objectives of the cross-sectional study are to assess the prevalence of self-reported mental health conditions among female patients of reproductive age and to examine the association between depression and physical health. Physical health conditions of interest included self-rated health, obesity, hypertension, smoking, and diabetes, which all have established associations with potential pregnancy complications and fetal health. The study found 40.8% of patients reported depression; 28.8% reported generalized anxiety; and 15.2% met the criteria for serious psychological distress on the Kessler 6 scale. Furthermore, patients with depression had two to three times higher odds of experiencing co-occurring physical health conditions. Conclusions This study expands the discourse on maternal mental health, throughout the preconception, post-partum, and inter-conception care periods to improve understanding of the inter-correlated physical and mental health issues that could impact pregnancy outcomes and life course trajectory. From 2014 to 2018, the Health Resources and Services Administration (HRSA) has supported investments of nearly $750 million to improve and expand access to mental health and substance use disorder services for prevention, treatment, health education and awareness through comprehensive primary care integration. Moving forward, HRSA will implement strategic training and technical assistance (T/TA) framework that is designed to accelerate the adoption of science driven solutions in primary care in addressing depression for patients with co-occurring chronic conditions and advancing positive maternal outcomes.
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Affiliation(s)
- Sue C. Lin
- U.S. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Primary Health Care, Office of Quality Improvement, Rockville, MD, United States of America
- * E-mail:
| | - Nadra Tyus
- U.S. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Primary Health Care, Office of Quality Improvement, Rockville, MD, United States of America
| | - Maura Maloney
- U.S. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Primary Health Care, Office of Quality Improvement, Rockville, MD, United States of America
| | - Bonnie Ohri
- U.S. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Primary Health Care, Office of Quality Improvement, Rockville, MD, United States of America
| | - Alek Sripipatana
- U.S. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Primary Health Care, Office of Quality Improvement, Rockville, MD, United States of America
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13
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Mazoruk S, Meyrick J, Taousi Z, Huxley A. The effectiveness of health behavior change interventions in managing physical health in people with a psychotic illness: A systematic review. Perspect Psychiatr Care 2020; 56:121-140. [PMID: 31131451 DOI: 10.1111/ppc.12391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 04/02/2019] [Accepted: 04/14/2019] [Indexed: 11/28/2022] Open
Abstract
PURPOSE People living with psychotic illness disproportionately experience more comorbidities and have a markedly shorter life expectancy compared to the general population. This review evaluates the effectiveness of health behavior change interventions in improving health outcomes in this group. DESIGN AND METHODS All studies included objective physical health measures or health behaviors as the main outcome measures and experimental design with baseline and follow-up quantitative data. Only studies of moderate and strong quality were included. Narrative synthesis was undertaken. FINDINGS Included studies utilized a range of methodological designs and outcome measures. The majority reported significant intervention effect on most outcome measures. PRACTICE IMPLICATIONS Health behavior change interventions can be effective in improving health outcomes in people with psychotic illness, with the potential benefit of improved psychiatric outcomes.
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Affiliation(s)
- Sabina Mazoruk
- Department of Health and Social Sciences, University of the West of England, Bristol, UK
| | - Jane Meyrick
- Department of Health and Social Sciences, University of the West of England, Bristol, UK
| | - Zohra Taousi
- Department of Community Psychiatry, Hertfordshire Partnership University NHS Foundation Trust, St Albans, Hertfordshire, UK
| | - Adam Huxley
- Change Grow Live, Department of Psychology, Hatfield, Hertfordshire, UK
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14
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Wang B, Wu Y, Zhang T, Han J, Yu L, Sun W. effect of physical activity on independent living ability among community-dwelling elderly in urban areas of Liaoning Province in China: a population-based study. BMJ Open 2019; 9:e023543. [PMID: 31619410 PMCID: PMC6797253 DOI: 10.1136/bmjopen-2018-023543] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE Independent living ability is crucial for the elderly; however, its assessment performed in China employs various scales and lacks risk factors, especially behavioural and social-psychological factors, which could be improved through health education. This study aimed to assess the independent living ability of community-dwelling elderly in urban areas of China and to identify the association with behavioral and social-psychological factors. DESIGN A population-based study using random cluster sampling method was performed in two core cities in Liaoning Province during March-November 2012. STUDY POPULATION 3686 individuals who were >=65 years old, had no dementia and cognitive impairment, had lived in the sampled communities for >=5 years and could take part in the study were enrolled. MAIN OUTCOME MEASURES Interviews were conducted to collect information of independent living ability, indicated by the instrumental activity of daily living (IADL), behavioural factors, social-psychological factors and confounders (demographic characteristics and health status). The Mini-Mental State Examination was used to screen for cognitive impairment. RESULTS The independence rate was 46.3% in men and 41.1% in women. Structural equation modelling analysis showed that physical activity, drawn from taking a walk and doing exercise, had the strongest association with the IADL in both men (-0.34, SE 0.10) and women (-0.33, SE 0.11). Falling in the last year and worrying about falling were also significantly associated with IADL. The effects of regular drinking, feeling lonely and participating in entertainment were significant in men. CONCLUSION The independent living ability of the elderly in urban areas in Liaoning Province in China was at a low level. Physical activity was one of the important roles in both men and women; whereas the role of social-psychological factors only existed in men. Gender-specific healthcare and education to avoid sedentary life should be advocated for the elderly to maintain/improve their independent living ability.
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Affiliation(s)
- Bowen Wang
- School of Public Health, China Medical University, Shenyang, China
- China First Mandarin Group Northeast International Hospital, Shenyang, China
| | - Yijiao Wu
- School of Public Health, China Medical University, Shenyang, China
| | - Tianjiao Zhang
- School of Public Health, China Medical University, Shenyang, China
| | - Jinsong Han
- School of Public Health, China Medical University, Shenyang, China
| | - Lianzheng Yu
- Department of Noncommunicable Chronic Disease Prevention, Liaoning Provincial Center for Disease Control and Prevention, Shenyang, China
| | - Wei Sun
- School of Public Health, China Medical University, Shenyang, China
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15
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Bailey JM, Bartlem KM, Wiggers JH, Wye PM, Stockings EA, Hodder RK, Metse AP, Regan TW, Clancy R, Dray JA, Tremain DL, Bradley T, Bowman JA. Systematic review and meta-analysis of the provision of preventive care for modifiable chronic disease risk behaviours by mental health services. Prev Med Rep 2019; 16:100969. [PMID: 31497500 PMCID: PMC6718945 DOI: 10.1016/j.pmedr.2019.100969] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 07/05/2019] [Accepted: 08/09/2019] [Indexed: 01/10/2023] Open
Abstract
People with mental illness experience increased chronic disease burden, contributed to by a greater prevalence of modifiable chronic disease risk behaviours. Policies recommend mental health services provide preventive care for such risk behaviours. Provision of such care has not previously been synthesised. This review assessed the provision of preventive care for modifiable chronic disease risk behaviours by mental health services. Four databases were searched from 2006 to 2017. Eligible studies were observational quantitative study designs conducted in mental health services, where preventive care was provided to clients for tobacco smoking, harmful alcohol consumption, inadequate nutrition, or inadequate physical activity. Two reviewers independently screened studies, conducted data extraction and critical appraisal. Results were pooled as proportions of clients receiving or clinicians providing preventive care using random effects meta-analyses, by risk behaviour and preventive care element (ask/assess, advise, assist, arrange). Subgroup analyses were conducted by mental health service type (inpatient, outpatient, other/multiple). Narrative synthesis was used where meta-analysis was not possible. Thirty-eight studies were included with 26 amenable to meta-analyses. Analyses revealed that rates of assessment were highest for smoking (78%, 95% confidence interval [CI]:59%–96%) and lowest for nutrition (17%, 95% CI:1%–35%); with variable rates of care provision for all behaviours, care elements, and across service types, with substantial heterogeneity across analyses. Findings indicated suboptimal and variable provision of preventive care for modifiable chronic disease risk behaviours in mental health services, but should be considered with caution due to the very low quality of cumulative evidence. PROSPERO registration: CRD42016049889. First meta-analysis of chronic disease preventive care provided by mental health service settings Assessed preventive care for smoking, alcohol, nutrition, and physical activity in mental health settings Provision of preventive care varied across risk behaviours, care elements, and service types. Findings indicate suboptimal provision of preventive care for health risk behaviours.
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Affiliation(s)
- Jacqueline M. Bailey
- School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, NSW, Australia
- Hunter Medical Research Institute, Clinical Research Centre, NSW, Australia
- Corresponding author at: School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia.
| | - Kate M. Bartlem
- School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, NSW, Australia
- Hunter Medical Research Institute, Clinical Research Centre, NSW, Australia
- Population Health, Hunter New England Local Health District, NSW, Australia
| | - John H. Wiggers
- Hunter Medical Research Institute, Clinical Research Centre, NSW, Australia
- Population Health, Hunter New England Local Health District, NSW, Australia
- School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, NSW, Australia
| | - Paula M. Wye
- School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, NSW, Australia
| | - Emily A.L. Stockings
- School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, NSW, Australia
- National Drug and Alcohol Research Centre, University of New South Wales, NSW, Australia
| | - Rebecca K. Hodder
- Hunter Medical Research Institute, Clinical Research Centre, NSW, Australia
- Population Health, Hunter New England Local Health District, NSW, Australia
- School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, NSW, Australia
| | - Alexandra P. Metse
- School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, NSW, Australia
- School of Psychology and Exercise Science, Murdoch University, WA, Australia
| | - Tim W. Regan
- School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, NSW, Australia
| | - Richard Clancy
- School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, NSW, Australia
- Hunter Medical Research Institute, Clinical Research Centre, NSW, Australia
- Hunter New England Health, Mental Health and Substance Use Service, NSW, Australia
| | - Julia A. Dray
- School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, NSW, Australia
- Population Health, Hunter New England Local Health District, NSW, Australia
| | - Danika L. Tremain
- Population Health, Hunter New England Local Health District, NSW, Australia
- School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, NSW, Australia
| | - Tegan Bradley
- School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, NSW, Australia
- Hunter Medical Research Institute, Clinical Research Centre, NSW, Australia
| | - Jenny A. Bowman
- School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, NSW, Australia
- Hunter Medical Research Institute, Clinical Research Centre, NSW, Australia
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16
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Lerbæk B, Jørgensen R, Aagaard J, Nordgaard J, Buus N. Mental health care professionals' accounts of actions and responsibilities related to managing physical health among people with severe mental illness. Arch Psychiatr Nurs 2019; 33:174-181. [PMID: 30927987 DOI: 10.1016/j.apnu.2018.11.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 10/11/2018] [Accepted: 11/17/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Life expectancy of people with severe mental illness (SMI) is greatly shortened compared to the general population, and despite extensive research, this issue is unsolved. Although it is widely recognised that people with SMI need support from health care services to manage health related issues, profound health inequalities exist within provision of health care. The aim of this study was to examine how mental health care professionals accounted for their actions and responsibilities related to managing physical health issues among people with SMI. METHODS Three focus groups were conducted with 22 mental health care professionals, employed at three mental health care locations. Participants' situated accounts were subjected to discourse analysis. RESULTS Participants accounted for actions and responsibilities in three typical ways; 1) by positioning people with SMI as difficult to motivate and actively resisting intervention, 2) by positioning people with SMI as so impaired that intervention was futile, and 3) by arguing they are undertreated for physical conditions and might have physical illnesses that staff are not aware of because of prominent mental illness. These discursive strategies seemed to legitimise situations where participants described not responding to physical health issues, and to downplay potential trouble in situations where participants described not succeeding in facilitating lifestyle changes or promoting compliance to treatment of physical conditions. DISCUSSION AND CONCLUSION Mental health care professionals need to increase their awareness of latent discriminating attitudes towards people with SMI. Such attitudes are suggested to reinforce barriers for people with SMI receiving physical health care.
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Affiliation(s)
- Birgitte Lerbæk
- Aalborg University Hospital, Psychiatry, Mølleparkvej 10, 9000 Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Søndre Skovvej 11, 9000 Aalborg, Denmark.
| | - Rikke Jørgensen
- Unit for Psychiatric Research, Aalborg University Hospital, Psychiatry, Mølleparkvej 10, 9000 Aalborg, Denmark.
| | - Jørgen Aagaard
- Aalborg University Hospital, Psychiatry, Mølleparkvej 10, 9000 Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Søndre Skovvej 11, 9000 Aalborg, Denmark.
| | - Julie Nordgaard
- Mental Health Center Amager, Denmark; University of Copenhagen, Copenhagen, Denmark.
| | - Niels Buus
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia; St. Vincent's Private Hospital Sydney, Sydney, Australia; St. Vincent's Hospital Sydney, Sydney, Australia; Institute of Regional Health Research, University of Southern Denmark, Slagelse, Denmark.
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17
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Clancy R, Lewin TJ, Bowman JA, Kelly BJ, Mullen AD, Flanagan K, Hazelton MJ. Providing physical health care for people accessing mental health services: Clinicians' perceptions of their role. Int J Ment Health Nurs 2019; 28:256-267. [PMID: 30152182 DOI: 10.1111/inm.12529] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 07/16/2018] [Indexed: 11/27/2022]
Abstract
The prevalence of health risk behaviours and associated poor physical health is high in people with severe mental illness. Mental health service guidelines and policies stipulate that mental health services should address physical health of people who access services. This study reports results from a large, interdisciplinary, cross-sectional study exploring mental health clinicians' (n = 385) views of role legitimacy in physical health service provision. All disciplines reported that mental health clinicians have a role to play in addressing the physical health of consumers. Among mental health clinicians, psychiatrists and mental health nurses received higher endorsement than allied health clinicians in relation to the provision of physical health care, with primary care providers including general practitioners also ranking highly. As community mental health services routinely appoint allied health staff to case management roles, a challenge for services and a challenge for clinicians are to ensure that physical health and the effects of medication are monitored appropriately and systematically. Online and telephone support services received relatively lower endorsement. As the availability of nonface to face services increases, there is a need to explore their utility in this population and where appropriate promote their uptake.
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Affiliation(s)
- Richard Clancy
- Hunter New England Mental Health, Callaghan, NSW, Australia.,University of Newcastle, Callaghan, NSW, Australia
| | - Terry J Lewin
- Hunter New England Mental Health, Callaghan, NSW, Australia.,University of Newcastle, Callaghan, NSW, Australia
| | | | | | - Antony D Mullen
- Hunter New England Mental Health, Callaghan, NSW, Australia.,University of Newcastle, Callaghan, NSW, Australia
| | - Karen Flanagan
- Hunter New England Mental Health, Callaghan, NSW, Australia.,University of Newcastle, Callaghan, NSW, Australia
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18
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Taylor G, Aveyard P, Bartlem K, Shaw A, Player J, Metcalfe C, Kessler D, Munafò M. IntEgrating Smoking Cessation treatment As part of usual Psychological care for dEpression and anxiety (ESCAPE): protocol for a randomised and controlled, multicentre, acceptability, feasibility and implementation trial. Pilot Feasibility Stud 2019; 5:16. [PMID: 30693096 PMCID: PMC6343330 DOI: 10.1186/s40814-018-0385-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 12/07/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND People with depression/anxiety are twice as likely to smoke and are less responsive to standard tobacco treatments, leading to a reduced life expectancy of up to 13.6 years compared to people without depression/anxiety. However, this group of smokers is motivated to quit, and as a result of quitting smoking, their depression/anxiety is likely to improve. In England, people with depression/anxiety are referred to a primary care-based psychological therapies service known as 'Improving Access to Psychological Therapies' (IAPT), which could offer smoking cessation treatment as part of usual care but currently does not. In this study, we aim (1) to establish the feasibility and acceptability of delivering a smoking cessation treatment alongside IAPT usual care and (2) to establish the feasibility of a multi-centre randomised trial to compare the combined smoking cessation and IAPT treatment to usual IAPT treatment alone. METHODS A randomised and controlled, multi-centre trial to test the acceptability, feasibility and implementation of smoking cessation treatment as offered alongside usual IAPT care, compared to usual care alone, with nested qualitative methods. We will include adult daily smokers with depression/anxiety, who would like help to quit smoking and are about to start IAPT treatment. Follow-up will be conducted at 3-months after baseline. The main outcome will be retention in the smoking cessation treatment. Secondary outcomes are smoking-related (biochemically-verified 7-day point prevalence smoking cessation, number of cigarettes smoked per day, Heaviness of Smoking Index), mental health-related (PHQ-9), service-related (number of 'Did Not Attends', number of planned and completed IAPT sessions), acceptability and feasibility (participant and clinician acceptability and satisfaction of intervention as assessed by questionnaires and qualitative interviews, interviews will also explore acceptability and feasibility of data collection procedures and impact of smoking cessation treatment on usual care and mental health recovery) and implementation-related (intervention delivery checklist, qualitative analysis of intervention delivery). DISCUSSION If the intervention is shown to be acceptable, feasible and suitably implemented, we can conduct a randomised controlled trial. In a future trial, we would examine whether adding smoking cessation treatment increases smoking abstinence and improves depression and anxiety more than usual care, which would lead to long-term health improvement. TRIAL REGISTRATION ISRCTN99531779.
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Affiliation(s)
- Gemma Taylor
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, 10 West, Bath, BA2 7AY UK
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, UK Centre for Tobacco and Alcohol Studies, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter Woodstock Road, Oxford, OX2 6GG UK
| | - Kate Bartlem
- School of Psychology, University of Newcastle, Behavioural Sciences Building, University Drive, Callaghan, 2308 Australia
- Population Health, Hunter New England Local Health District, Wallsend Health Services, Booth Building, Longworth Avenue, Wallsend, NSW 2287 Australia
| | - Alison Shaw
- Centre for Academic Primary Care, Bristol Medical School, Department of Population Health Sciences, Canynge Hall, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Jeremy Player
- Jeremy Player, Solutions 4 Health, 7200 The Quorum, Oxford Business Park, Garsington Road, Oxford, OX4 2JZ UK
| | - Chris Metcalfe
- Bristol Randomised Trials Collaboration, Population Health Sciences, Bristol Medical School, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - David Kessler
- Centre for Academic Primary Care, Bristol Medical School, Department of Population Health Sciences, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN UK
| | - Marcus Munafò
- UK Centre for Tobacco and Alcohol Studies, School of Experimental Psychology, University of Bristol, 12a Priory Road, Bristol, BS8 1TU UK
- MRC Integrative Epidemiology Unit, Oakfield House, Oakfield Grove, Bristol, BS8 2BN UK
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19
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Tremain D, Freund M, Wye P, Bowman J, Wolfenden L, Dunlop A, Bartlem K, Lecathelinais C, Wiggers J. Providing routine chronic disease preventive care in community substance use services: a pilot study of a multistrategic clinical practice change intervention. BMJ Open 2018; 8:e020042. [PMID: 30121589 PMCID: PMC6104796 DOI: 10.1136/bmjopen-2017-020042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To evaluate the potential effectiveness of a practice change intervention in increasing preventive care provision in community-based substance use treatment services. In addition, client and clinician acceptability of care were examined. DESIGN A pre-post trial conducted from May 2012 to May 2014. SETTING Public community-based substance use treatment services (n=15) in one health district in New South Wales (NSW), Australia. PARTICIPANTS Surveys were completed by 226 clients and 54 clinicians at baseline and 189 clients and 46 clinicians at follow-up. INTERVENTIONS A 12-month multistrategic clinician practice change intervention that aimed to increase the provision of preventive care for smoking, insufficient fruit and/or vegetable consumption and insufficient physical activity. PRIMARY AND SECONDARY OUTCOME MEASURES Client and clinician reported provision of assessment, brief advice and referral for three modifiable health risk behaviours: smoking, insufficient fruit and/or vegetable consumption and insufficient physical activity. Clinician-reported optimal care was defined as providing care to 80% of clients or more. Client acceptability and clinician attitudes towards preventive care were assessed at follow-up. RESULTS Increases in client reported care were observed for insufficient fruit and/or vegetable consumption including: assessment (24% vs 54%, p<0.001), brief advice (26% vs 46%, p<0.001), and clinicians speaking about (10% vs 31%, p<0.001) and arranging a referral (1% vs 8%, p=0.006) to telephone helplines. Clinician reported optimal care delivery increased for: assessment of insufficient fruit and/or vegetable consumption (22% vs 63%, p<0.001) and speaking about telephone helplines for each of the three health risk behaviours. Overall, clients and clinicians held favourable views regarding preventive care. CONCLUSION This study reported increases in preventive care for insufficient fruit and/or vegetable consumption; however, minimal increases were observed for smoking or insufficient physical activity. Further investigation of the barriers to preventive care delivery in community substance use settings is needed. TRIALREGISTRATION NUMBER ACTRN12614000469617.
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Affiliation(s)
- Danika Tremain
- Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
- Faculty of Health, The University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Megan Freund
- Faculty of Health, The University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Paula Wye
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
- Faculty of Science and Information Technology, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Jenny Bowman
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
- Faculty of Science and Information Technology, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Luke Wolfenden
- Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
- Faculty of Health, The University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Adrian Dunlop
- Faculty of Health, The University of Newcastle, Callaghan, New South Wales, Australia
- Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, New South Wales, Australia
- Centre for Translational Neuroscience and Mental Health, Waratah, New South Wales, Australia
| | - Kate Bartlem
- Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
- Faculty of Science and Information Technology, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Christophe Lecathelinais
- Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
- Faculty of Health, The University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - John Wiggers
- Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
- Faculty of Health, The University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
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Bartlem K, Bailey J, Metse A, Asara A, Wye P, Clancy R, Wiggers J, Bowman J. Do mental health consumers want to improve their long-term disease risk behaviours? A survey of over 2000 psychiatric inpatients. Int J Ment Health Nurs 2018; 27:1032-1043. [PMID: 29197143 PMCID: PMC6446942 DOI: 10.1111/inm.12411] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/03/2017] [Indexed: 12/13/2022]
Abstract
Policies and clinical guidelines acknowledge the role mental health services have in addressing the physical health of individuals with a mental illness; however, little research has explored interest in reducing health risk behaviours or the acceptability of receiving support to reduce such risks among psychiatric inpatients. This study estimated the prevalence of four long-term disease risk behaviours (tobacco smoking, hazardous alcohol consumption, inadequate fruit and/or vegetable consumption, and inadequate physical activity); patient interest in reducing these risks; and acceptability of being provided care to do so during a psychiatric inpatient stay. A cross-sectional survey was undertaken with 2075 inpatients from four inpatient psychiatric facilities in one health district in Australia (October 2012-April 2014). Prevalence of risk behaviours ranged from 50.2% (inadequate physical activity) to 94.8% (inadequate fruit and/or vegetable consumption). The majority of respondents (88.4%) had more than one risk behaviour, and most were seriously considering improving their risk behaviours (47.6% to 65.3%). The majority (80.4%) agreed that it would be acceptable to be provided support and advice to change such behaviours during their psychiatric inpatient stay. Some diagnoses were associated with smoking and hazardous alcohol consumption, interest in reducing alcohol consumption and increasing fruit and/or vegetable consumption, and acceptability of receiving advice and support. The findings reinforce the need and opportunity for psychiatric inpatient facilities to address the long-term disease risk behaviours of their patients.
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Affiliation(s)
- Kate Bartlem
- School of PsychologyFaculty of Science and Information TechnologyUniversity of NewcastleCallaghanNew South WalesAustralia
- Clinical Research CentreHunter Medical Research InstituteNewcastleNew South WalesAustralia
- Population Health, Hunter New England Local Health DistrictWallsend Health ServicesNewcastleNew South WalesAustralia
| | - Jacqueline Bailey
- School of PsychologyFaculty of Science and Information TechnologyUniversity of NewcastleCallaghanNew South WalesAustralia
- Clinical Research CentreHunter Medical Research InstituteNewcastleNew South WalesAustralia
| | - Alexandra Metse
- School of PsychologyFaculty of Science and Information TechnologyUniversity of NewcastleCallaghanNew South WalesAustralia
- Clinical Research CentreHunter Medical Research InstituteNewcastleNew South WalesAustralia
| | - Ashley Asara
- School of PsychologyFaculty of Science and Information TechnologyUniversity of NewcastleCallaghanNew South WalesAustralia
| | - Paula Wye
- School of PsychologyFaculty of Science and Information TechnologyUniversity of NewcastleCallaghanNew South WalesAustralia
- Clinical Research CentreHunter Medical Research InstituteNewcastleNew South WalesAustralia
- Population Health, Hunter New England Local Health DistrictWallsend Health ServicesNewcastleNew South WalesAustralia
| | - Richard Clancy
- Clinical Research CentreHunter Medical Research InstituteNewcastleNew South WalesAustralia
- School of Nursing and MidwiferyFaculty of Health and MedicineUniversity of NewcastleCallaghanNew South WalesAustralia
- Centre for Translational Neuroscience and Mental HealthHunter New England Mental HealthMater HospitalNewcastleNew South WalesAustralia
| | - John Wiggers
- Clinical Research CentreHunter Medical Research InstituteNewcastleNew South WalesAustralia
- Population Health, Hunter New England Local Health DistrictWallsend Health ServicesNewcastleNew South WalesAustralia
- School of Medicine and Public HealthFaculty of Health and MedicineUniversity of NewcastleCallaghanNew South WalesAustralia
| | - Jenny Bowman
- School of PsychologyFaculty of Science and Information TechnologyUniversity of NewcastleCallaghanNew South WalesAustralia
- Clinical Research CentreHunter Medical Research InstituteNewcastleNew South WalesAustralia
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Fehily C, Bartlem K, Wiggers J, Wolfenden L, Regan T, Dray J, Bailey J, Bowman J. Systematic review of interventions to increase the provision of care for chronic disease risk behaviours in mental health settings: review protocol. Syst Rev 2018; 7:67. [PMID: 29712561 PMCID: PMC5928577 DOI: 10.1186/s13643-018-0735-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 04/20/2018] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND People with a mental illness experience a higher morbidity and mortality from chronic diseases relative to the general population. A higher prevalence of risk behaviours, including tobacco smoking, poor nutrition, harmful alcohol consumption and physical inactivity, is a substantial contributor to this health inequity. Clinical practice guidelines recommend that mental health services routinely provide care to their clients to address these risk behaviours. Such care may include the following elements: ask, assess, advise, assist and arrange (the '5As'), which has been demonstrated to be effective in reducing risk behaviours. Despite this potential, the provision of such care is reported to be low internationally and in Australia, and there is a need to identify effective strategies to increase care provision. The proposed review will examine the effectiveness of interventions which aimed to increase care provision (i.e. increase the proportion of clients receiving or clinicians providing the 5As) for the chronic disease risk behaviours of clients within the context of mental health service delivery. METHODS Eligible studies will be any quantitative study designs with a comparison group and which report on the effectiveness of an intervention strategy (including delivery arrangements, financial arrangements, governance arrangements and implementation strategies) to increase care provision specifically for chronic disease risk behaviours (tobacco smoking, poor nutrition, harmful alcohol consumption and physical inactivity). Screening for studies will be conducted across seven electronic databases: PsycINFO, MEDLINE, Excerpta Medica database (EMBASE), Psychology and Behavioural Sciences Collection, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL) and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Two authors will independently screen studies for eligibility and extract data from included studies. Where studies are sufficiently homogenous, meta-analysis will be performed. Where considerable heterogeneity exists (I 2 ≥ 75), narrative synthesis will be used. DISCUSSION This review will be the first to synthesise evidence for the effectiveness of intervention approaches to facilitate care provision for chronic disease risk behaviours in the context of mental health service delivery. The results have the potential to inform the development of evidenced-based approaches to address the health inequities experienced by this population group. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42017074360 .
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Affiliation(s)
- Caitlin Fehily
- The University of Newcastle, Callaghan, NSW Australia
- The Australian Prevention Partnership Centre (TAPPC), Sax Institute, Ultimo, NSW Australia
- Population Health, Hunter New England Local Health District, Wallsend, NSW Australia
- Hunter Medical Research Institute, Clinical Research Centre, New Lambton Heights, Australia
| | - Kate Bartlem
- The University of Newcastle, Callaghan, NSW Australia
- The Australian Prevention Partnership Centre (TAPPC), Sax Institute, Ultimo, NSW Australia
- Population Health, Hunter New England Local Health District, Wallsend, NSW Australia
- Hunter Medical Research Institute, Clinical Research Centre, New Lambton Heights, Australia
| | - John Wiggers
- The University of Newcastle, Callaghan, NSW Australia
- The Australian Prevention Partnership Centre (TAPPC), Sax Institute, Ultimo, NSW Australia
- Population Health, Hunter New England Local Health District, Wallsend, NSW Australia
- Hunter Medical Research Institute, Clinical Research Centre, New Lambton Heights, Australia
| | - Luke Wolfenden
- The University of Newcastle, Callaghan, NSW Australia
- The Australian Prevention Partnership Centre (TAPPC), Sax Institute, Ultimo, NSW Australia
- Population Health, Hunter New England Local Health District, Wallsend, NSW Australia
- Hunter Medical Research Institute, Clinical Research Centre, New Lambton Heights, Australia
| | - Timothy Regan
- The University of Newcastle, Callaghan, NSW Australia
| | - Julia Dray
- The University of Newcastle, Callaghan, NSW Australia
- Population Health, Hunter New England Local Health District, Wallsend, NSW Australia
- Hunter Medical Research Institute, Clinical Research Centre, New Lambton Heights, Australia
| | - Jacqueline Bailey
- The University of Newcastle, Callaghan, NSW Australia
- Hunter Medical Research Institute, Clinical Research Centre, New Lambton Heights, Australia
| | - Jenny Bowman
- The University of Newcastle, Callaghan, NSW Australia
- The Australian Prevention Partnership Centre (TAPPC), Sax Institute, Ultimo, NSW Australia
- Hunter Medical Research Institute, Clinical Research Centre, New Lambton Heights, Australia
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Bailey JM, Hansen V, Wye PM, Wiggers JH, Bartlem KM, Bowman JA. Supporting change in chronic disease risk behaviours for people with a mental illness: a qualitative study of the experiences of family carers. BMC Public Health 2018; 18:416. [PMID: 29587704 PMCID: PMC5872395 DOI: 10.1186/s12889-018-5314-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 03/14/2018] [Indexed: 11/20/2022] Open
Abstract
Background People with a mental illness experience greater chronic disease morbidity and mortality, and associated reduced life expectancy, compared to those without such an illness. A higher prevalence of chronic disease risk behaviours (inadequate nutrition, inadequate physical activity, tobacco smoking, and harmful alcohol consumption) is experienced by this population. Family carers have the potential to support change in such behaviours among those they care for with a mental illness. This study aimed to explore family carers’: 1) experiences in addressing the chronic disease risk behaviours of their family members; 2) existing barriers to addressing such behaviours; and 3) perceptions of potential strategies to assist them to provide risk behaviour change support. Methods A qualitative study of four focus groups (n = 31), using a semi-structured interview schedule, was conducted with carers of people with a mental illness in New South Wales, Australia from January 2015 to February 2016. An inductive thematic analysis was employed to explore the experience of carers in addressing the chronic disease risk behaviours. Results Two main themes were identified in family carers’ report of their experiences: firstly, that health behaviours were salient concerns for carers and that they were engaged in providing support, and secondly that they perceived a bidirectional relationship between health behaviours and mental well-being. Key barriers to addressing behaviours were: a need to attend to carers’ own well-being; defensiveness on behalf of the family member; and not residing with their family member; with other behaviour-specific barriers also identified. Discussion around strategies which would assist carers in providing support for health risk behaviours identified a need for improved communication and collaboration between carers and health services accessed by their family members. Conclusions Additional support from general and mental health services accessed by family members is desired to assist carers to address the barriers to providing behaviour change support. Carers have the potential to support and extend health service interventions aimed at improving the chronic disease risk behaviours of people with a mental illness but may require additional information, and collaboration from services. Further research is needed to explore these constructs in a large representative sample.
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Affiliation(s)
- Jacqueline M Bailey
- School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia. .,Hunter Medical Research Institute, Clinical Research Centre, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia.
| | - Vibeke Hansen
- University Centre for Rural Health, School of Public Health, University of Sydney, Uralba Street, Lismore, NSW, 2480, Australia
| | - Paula M Wye
- School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, Clinical Research Centre, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
| | - John H Wiggers
- Hunter Medical Research Institute, Clinical Research Centre, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia.,Population Health, Hunter New England Local Health District, Booth Building, Wallsend Health Services, Longworth Avenue, Wallsend, NSW, 2287, Australia.,School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
| | - Kate M Bartlem
- School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, Clinical Research Centre, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia.,Population Health, Hunter New England Local Health District, Booth Building, Wallsend Health Services, Longworth Avenue, Wallsend, NSW, 2287, Australia
| | - Jennifer A Bowman
- School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, Clinical Research Centre, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
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Romain AJ, Marleau J, Baillot A. Impact of obesity and mood disorders on physical comorbidities, psychological well-being, health behaviours and use of health services. J Affect Disord 2018; 225:381-388. [PMID: 28846960 DOI: 10.1016/j.jad.2017.08.065] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 08/06/2017] [Accepted: 08/20/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND Albeit obesity and mood disorders frequently co-occur, few studies examined the impacts of this co-occurrence. The aim was to compare individuals with obesity and mood disorders (ObMD) to those with obesity without mood disorder in terms of physical comorbidities, psychological well-being, health behaviours and use of health services. METHODS Cross-sectional study using the Canadian Community Health Survey including a weighted sample of individuals with obesity (n = 1298) representing inhabitants from the province of Quebec (Canada). RESULTS Adjusted multivariate logistic regressions indicated that ObMD reported more physical conditions with odds ratio (OR) ranging from 1.8 [95%CI: 1.1 - 2.8] (hypertension) to 2.8 [95%CI: 1.3 - 6.0] (stomach ulcer). Also, ObMD reported poorer psychological well-being with OR ranging from 2.1 [95%CI: 1.4 - 3.3] (stress) to 25.6 [95%CI: 14.7 - 45.0] (poor perceived mental health). ObMD also reported more consultations with health professionals with OR ranging from 1.9 [95%CI: 1.0 - 3.5] (physicians) to 7.7 [95%CI: 4.2 - 14.3] (psychologists), and less healthy behaviours with OR ranging from 1.7 [95%CI: 1.1 - 2.6] (fruits and vegetables intake) to 2.1 [95%CI: 1.3 - 3.3] (tobacco). LIMITATIONS Self-reported data so we cannot discard the possibility of a bias in reporting. Also, given the cross-sectional design, no directional conclusion or causality about our results is possible. DISCUSSION The co-occurrence of mood disorder and obesity seems to be an aggravating factor of obesity-related factors because it is associated with poorer health in several areas. Interventions to prevent or manage obesity in mood disorders are necessary.
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Affiliation(s)
- Ahmed Jérôme Romain
- Centre de Recherche de l'Université de Montreal (CRCHUM), Montreal, QC, Canada.
| | - Jacques Marleau
- Centre Intégré de Santé et de Services Sociaux de l'Outaouais, Gatineau, QC, Canada
| | - Aurélie Baillot
- Université du Québec en Outaouais, Gatineau, QC, Canada; Institut du savoir de l'hôpital Montfort-Recherche, Ottawa, ON, Canada; Centre de recherche du Centre Intégré de Santé et Services Sociaux de l'Outaouais, Gatineau, QC, Canada
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Evaluating the effectiveness of a healthy lifestyle clinician in addressing the chronic disease risk behaviours of community mental health clients: study protocol for a randomised controlled trial. Trials 2017; 18:276. [PMID: 28619025 PMCID: PMC5472979 DOI: 10.1186/s13063-017-2017-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 05/10/2017] [Indexed: 12/29/2022] Open
Abstract
Background People with a mental illness experience a greater morbidity and mortality from chronic diseases relative to the general population. A higher prevalence of modifiable health risk behaviours such as smoking, poor nutrition, physical inactivity and harmful alcohol consumption contribute substantially to this disparity. Despite clinical practice guidelines recommending that mental health services routinely provide care to address these risk behaviours, the provision of such care is consistently reported to be low internationally and in Australia. This protocol describes a randomised controlled trial that aims to assess the effectiveness of allocating a clinician within a community mental health service to the specific role of providing assessment, advice and referral for clients’ chronic disease risk behaviours. Methods/design Approximately 540 clients of one community mental health service will be randomised to receive either usual care for chronic disease risks provided in routine consultations or usual care plus an additional face-to-face consultation and follow-up telephone call with a ‘healthy lifestyle clinician’. The clinician will assess clients’ chronic disease risk behaviours, provide advice to change behaviours, and refer at-risk clients to free telephone coaching services (New South Wales (NSW) Quitline and NSW Get Healthy Information and Coaching Service) for specialist behaviour change care. The primary outcomes, regarding referral to and client uptake of the telephone services, will be obtained from the respective services. Telephone interviews of clients at baseline and at 1 and 6 months post baseline follow-ups will assess secondary outcomes: receipt of any assessment, advice and referral from the mental health service; satisfaction with the receipt of such care; satisfaction with the receipt of any care provided by the telephone services; interest and confidence in and perceived importance of changing risk behaviours; and risk behaviour status. Discussion This study will add to the limited literature regarding effective strategies to address chronic disease prevention among the higher risk population of community mental health clients. The results will inform the development of future policies and service delivery initiatives to address the high prevalence of chronic disease risk behaviours among people with a mental illness. Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR), ACTRN12616001519448. Registered on 3 November 2016. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2017-1) contains supplementary material, which is available to authorized users.
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Smoking Cessation Care for People with a Mental Illness: Family Carer Expectations of Health and Community Services. J Smok Cessat 2016. [DOI: 10.1017/jsc.2016.23] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Introduction: Smoking prevalence remains high among people with a mental illness, contributing to higher levels of morbidity and mortality. Health and community services are an opportune setting for the provision of smoking cessation care. Although family carers are acknowledged to play a critical role in supporting the care and assistance provided by such services to people with a mental illness, their expectations regarding the delivery of smoking cessation care have not been examined.Aims: To explore family carer expectations of smoking cessation care provision by four types of health services, to clients with a mental illness, and factors associated with expectations.Methods: A cross-sectional survey was conducted with carers of a person with a mental illness residing in New South Wales, Australia. Carers were surveyed regarding their expectations of smoking cessation care provision from four types of health services. Possible associations between carer expectation of smoking cessation care provision and socio-demographic and attitudinal variables were explored.Results: Of 144 carers, the majority of carers considered that smoking cessation care should be provided by: mental health hospitals (71.4%), community mental health services (78.0%), general practice (82.7%), and non-government organisations (56.6%). The factor most consistently related to expectation of care was a belief that smoking cessation could positively impact mental health.Conclusions: The majority of carers expected smoking cessation treatment to be provided by all services catering for people with a mental illness, reinforcing the appropriateness for such services to provide smoking cessation care for clients in an effective and systematic manner.
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Tremain D, Freund M, Wye P, Wolfenden L, Bowman J, Dunlop A, Gillham K, Bartlem K, McElwaine K, Doherty E, Wiggers J. Provision of Chronic Disease Preventive Care in Community Substance Use Services: Client and Clinician Report. J Subst Abuse Treat 2016; 68:24-30. [PMID: 27431043 DOI: 10.1016/j.jsat.2016.05.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 04/08/2016] [Accepted: 05/23/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION People with substance use problems have a higher prevalence of modifiable health risk behaviors. Routine clinician provision of preventive care may be effective in reducing such health behaviors. This study aimed to examine clinician provision of preventive care to clients of community substance use treatment services. METHODS A cross-sectional survey was undertaken with 386 clients and 54 clinicians of community substance use treatment services in one health district in New South Wales, Australia. Client- and clinician-reported provision of three elements of care (assessment, brief advice and referral) for three health risk behaviors (tobacco smoking, insufficient fruit and/or vegetable consumption and insufficient physical activity) was assessed, with associations with client characteristics examined. RESULTS Provision was highest for tobacco smoking assessment (90% client reported, 87% clinician reported) and brief advice (79% client reported, 80% clinician reported) and lowest for fruit and vegetable consumption (assessment 23%, brief advice 25%). Few clients reported being offered a referral (<10%). Assessment of physical activity and brief advice for all behaviors was higher for clients residing in rural/remote areas. CONCLUSION Assessment and brief advice were provided to the majority of clients for smoking, but sub-optimally for the other behaviors. Further investigation of barriers to the provision of preventive care within substance use treatment settings is required, particularly for referral to ongoing support.
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Affiliation(s)
- Danika Tremain
- Population Health, Hunter New England Local Health District, Wallsend, Australia; Faculty of Health, The University of Newcastle, Callaghan, Australia; Hunter Medical Research Institute, New Lambton Heights, Australia.
| | - Megan Freund
- Population Health, Hunter New England Local Health District, Wallsend, Australia; Faculty of Health, The University of Newcastle, Callaghan, Australia; Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Paula Wye
- Population Health, Hunter New England Local Health District, Wallsend, Australia; Hunter Medical Research Institute, New Lambton Heights, Australia; Faculty of Science and Information Technology, The University of Newcastle, Callaghan, Australia
| | - Luke Wolfenden
- Population Health, Hunter New England Local Health District, Wallsend, Australia; Faculty of Health, The University of Newcastle, Callaghan, Australia; Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Jenny Bowman
- Hunter Medical Research Institute, New Lambton Heights, Australia; Faculty of Science and Information Technology, The University of Newcastle, Callaghan, Australia
| | - Adrian Dunlop
- Faculty of Health, The University of Newcastle, Callaghan, Australia; Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, Australia; Centre for Translational Neuroscience and Mental Health, Waratah, Australia
| | - Karen Gillham
- Population Health, Hunter New England Local Health District, Wallsend, Australia; Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Kate Bartlem
- Population Health, Hunter New England Local Health District, Wallsend, Australia; Hunter Medical Research Institute, New Lambton Heights, Australia; Faculty of Science and Information Technology, The University of Newcastle, Callaghan, Australia
| | - Kathleen McElwaine
- Population Health, Hunter New England Local Health District, Wallsend, Australia; Faculty of Health, The University of Newcastle, Callaghan, Australia; Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Emma Doherty
- Population Health, Hunter New England Local Health District, Wallsend, Australia; Hunter Medical Research Institute, New Lambton Heights, Australia
| | - John Wiggers
- Population Health, Hunter New England Local Health District, Wallsend, Australia; Faculty of Health, The University of Newcastle, Callaghan, Australia; Hunter Medical Research Institute, New Lambton Heights, Australia
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Bartlem KM, Bowman J, Freund M, Wye PM, Barker D, McElwaine KM, Wolfenden L, Campbell EM, McElduff P, Gillham K, Wiggers J. Effectiveness of an intervention in increasing the provision of preventive care by community mental health services: a non-randomized, multiple baseline implementation trial. Implement Sci 2016; 11:46. [PMID: 27039077 PMCID: PMC4818909 DOI: 10.1186/s13012-016-0408-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 03/09/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Relative to the general population, people with a mental illness are more likely to have modifiable chronic disease health risk behaviours. Care to reduce such risks is not routinely provided by community mental health clinicians. This study aimed to determine the effectiveness of an intervention in increasing the provision of preventive care by such clinicians addressing four chronic disease risk behaviours. METHODS A multiple baseline trial was undertaken in two groups of community mental health services in New South Wales, Australia (2011-2014). A 12-month practice change intervention was sequentially implemented in each group. Outcome data were collected continuously via telephone interviews with a random sample of clients over a 3-year period, from 6 months pre-intervention in the first group, to 6 months post intervention in the second group. Outcomes were client-reported receipt of assessment, advice and referral for tobacco smoking, harmful alcohol consumption, inadequate fruit and/or vegetable consumption and inadequate physical activity and for the four behaviours combined. Logistic regression analyses examined change in client-reported receipt of care. RESULTS There was an increase in assessment for all risks combined following the intervention (18 to 29 %; OR 3.55, p = 0.002: n = 805 at baseline, 982 at follow-up). No significant change in assessment, advice or referral for each individual risk was found. CONCLUSIONS The intervention had a limited effect on increasing the provision of preventive care. Further research is required to determine how to increase the provision of preventive care in community mental health services. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry ACTRN12613000693729.
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Affiliation(s)
- Kate M. Bartlem
- School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
- Population Health, Hunter New England Local Health District, Booth Building, Wallsend Health Services, Longworth Avenue, Wallsend, NSW 2287 Australia
- Hunter Medical Research Institute, Clinical Research Centre, Level 3 John Hunter Hospital, Lookout Road, New Lambton Heights, NSW 2305 Australia
| | - Jenny Bowman
- School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
- Hunter Medical Research Institute, Clinical Research Centre, Level 3 John Hunter Hospital, Lookout Road, New Lambton Heights, NSW 2305 Australia
| | - Megan Freund
- Hunter Medical Research Institute, Clinical Research Centre, Level 3 John Hunter Hospital, Lookout Road, New Lambton Heights, NSW 2305 Australia
- School of Medicine and Public Health, Faculty of Health, The University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
| | - Paula M. Wye
- School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
- Population Health, Hunter New England Local Health District, Booth Building, Wallsend Health Services, Longworth Avenue, Wallsend, NSW 2287 Australia
- Hunter Medical Research Institute, Clinical Research Centre, Level 3 John Hunter Hospital, Lookout Road, New Lambton Heights, NSW 2305 Australia
- School of Medicine and Public Health, Faculty of Health, The University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
| | - Daniel Barker
- School of Medicine and Public Health, Faculty of Health, The University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
| | - Kathleen M. McElwaine
- Hunter Medical Research Institute, Clinical Research Centre, Level 3 John Hunter Hospital, Lookout Road, New Lambton Heights, NSW 2305 Australia
- School of Medicine and Public Health, Faculty of Health, The University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
| | - Luke Wolfenden
- Population Health, Hunter New England Local Health District, Booth Building, Wallsend Health Services, Longworth Avenue, Wallsend, NSW 2287 Australia
- Hunter Medical Research Institute, Clinical Research Centre, Level 3 John Hunter Hospital, Lookout Road, New Lambton Heights, NSW 2305 Australia
- School of Medicine and Public Health, Faculty of Health, The University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
| | - Elizabeth M. Campbell
- Population Health, Hunter New England Local Health District, Booth Building, Wallsend Health Services, Longworth Avenue, Wallsend, NSW 2287 Australia
- Hunter Medical Research Institute, Clinical Research Centre, Level 3 John Hunter Hospital, Lookout Road, New Lambton Heights, NSW 2305 Australia
- School of Medicine and Public Health, Faculty of Health, The University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
| | - Patrick McElduff
- School of Medicine and Public Health, Faculty of Health, The University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
| | - Karen Gillham
- Population Health, Hunter New England Local Health District, Booth Building, Wallsend Health Services, Longworth Avenue, Wallsend, NSW 2287 Australia
- Hunter Medical Research Institute, Clinical Research Centre, Level 3 John Hunter Hospital, Lookout Road, New Lambton Heights, NSW 2305 Australia
| | - John Wiggers
- Population Health, Hunter New England Local Health District, Booth Building, Wallsend Health Services, Longworth Avenue, Wallsend, NSW 2287 Australia
- Hunter Medical Research Institute, Clinical Research Centre, Level 3 John Hunter Hospital, Lookout Road, New Lambton Heights, NSW 2305 Australia
- School of Medicine and Public Health, Faculty of Health, The University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
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Bartlem K, Bowman J, Ross K, Freund M, Wye P, McElwaine K, Gillham K, Doherty E, Wolfenden L, Wiggers J. Mental health clinician attitudes to the provision of preventive care for chronic disease risk behaviours and association with care provision. BMC Psychiatry 2016; 16:57. [PMID: 26935328 PMCID: PMC4776348 DOI: 10.1186/s12888-016-0763-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 02/24/2016] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Preventive care for chronic disease risk behaviours by mental health clinicians is sub-optimal. Little research has examined the association between clinician attitudes and such care delivery. This study aimed to explore: i) the attitudes of a multi-disciplinary group of community mental health clinicians regarding their perceived role, perception of client interest, and perceived self-efficacy in the provision of preventive care, ii) whether such attitudes differ by professional discipline, and iii) the association between these attitudes and clinician provision of such care. METHOD A telephone survey was conducted with 151 Australian community mental health clinicians regarding their attitudes towards provision of assessment, advice and referral addressing smoking, nutrition, alcohol, and physical activity, and their reported provision of such care. Logistic regression was used to examine the association between attitudes and care delivery, and attitudinal differences by professional discipline. RESULTS Most clinicians reported that: their manager supported provision of preventive care; such care was part of their role; it would not jeopardise their practitioner-client relationships, clients found preventive care acceptable, and that they had the confidence, knowledge and skills to modify client health behaviours. Half reported that clients were not interested in changing their health behaviours, and one third indicated that the provision of preventive care negatively impacted on time available for delivery of acute care. The following attitudes were positively associated with the provision of preventive care: role congruence, client interest in change, and addressing health risk behaviours will not jeopardise the client-clinician relationship. CONCLUSIONS Strategies are required to translate positive attitudes to improved client care and address attitudes which may hinder the provision of preventive care in community mental health.
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Affiliation(s)
- Kate Bartlem
- Population Health, Hunter New England Local Health District, Booth Building, Wallsend Health Services, Longworth Avenue, Wallsend, NSW, 2287, Australia. .,School of Psychology, Faculty of Science and Information Technology, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia. .,Hunter Medical Research Institute, Clinical Research Centre, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia.
| | - Jenny Bowman
- School of Psychology, Faculty of Science and Information Technology, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia. .,Hunter Medical Research Institute, Clinical Research Centre, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia.
| | - Kate Ross
- School of Psychology, Faculty of Science and Information Technology, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.
| | - Megan Freund
- Hunter Medical Research Institute, Clinical Research Centre, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia. .,School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.
| | - Paula Wye
- Population Health, Hunter New England Local Health District, Booth Building, Wallsend Health Services, Longworth Avenue, Wallsend, NSW, 2287, Australia. .,School of Psychology, Faculty of Science and Information Technology, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia. .,Hunter Medical Research Institute, Clinical Research Centre, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia. .,School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.
| | - Kathleen McElwaine
- Hunter Medical Research Institute, Clinical Research Centre, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia. .,School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.
| | - Karen Gillham
- Population Health, Hunter New England Local Health District, Booth Building, Wallsend Health Services, Longworth Avenue, Wallsend, NSW, 2287, Australia. .,Hunter Medical Research Institute, Clinical Research Centre, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia.
| | - Emma Doherty
- Population Health, Hunter New England Local Health District, Booth Building, Wallsend Health Services, Longworth Avenue, Wallsend, NSW, 2287, Australia. .,Hunter Medical Research Institute, Clinical Research Centre, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia.
| | - Luke Wolfenden
- Population Health, Hunter New England Local Health District, Booth Building, Wallsend Health Services, Longworth Avenue, Wallsend, NSW, 2287, Australia. .,Hunter Medical Research Institute, Clinical Research Centre, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia. .,School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.
| | - John Wiggers
- Population Health, Hunter New England Local Health District, Booth Building, Wallsend Health Services, Longworth Avenue, Wallsend, NSW, 2287, Australia. .,Hunter Medical Research Institute, Clinical Research Centre, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia. .,School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.
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Bartlem KM, Bowman JA, Bailey JM, Freund M, Wye PM, Lecathelinais C, McElwaine KM, Campbell EM, Gillham KE, Wiggers JH. Chronic disease health risk behaviours amongst people with a mental illness. Aust N Z J Psychiatry 2015; 49:731-41. [PMID: 25698807 DOI: 10.1177/0004867415569798] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Amongst people with a mental illness, modifiable health risk behaviours contribute substantially to increased chronic disease morbidity and mortality. This study examined the prevalence of and interest in changing such behaviours amongst community mental health service clients in Australia. METHOD A telephone interview was undertaken with Australian community mental health service clients. Participants reported engagement in four health risk behaviours: tobacco smoking, fruit and vegetable consumption, alcohol consumption, and physical activity. Participants were classified as at risk based upon Australian national guidelines. At-risk participants were asked whether they were considering improving their health risk behaviour within the next month. The association between psychiatric diagnosis and risk, and interest in improving health risk behaviours was examined. RESULTS Risk prevalence was highest for inadequate vegetable consumption (78.3%), followed by inadequate fruit consumption (60%), smoking (50.7%), physical inactivity (46.8%), short-term alcohol risk (40.3%) and chronic alcohol risk (35.3%). A majority of at-risk participants were considering improving their health risk behaviour for smoking, physical inactivity and inadequate fruit and vegetable consumption (65.1%, 71.1%, and 53.3%, respectively). After adjusting for demographic factors, no diagnostic categories were associated with risk for any behaviour. Those with a diagnosis of depression were more likely to be interested in quitting smoking and increasing physical activity. CONCLUSIONS Regardless of diagnosis, a high prevalence of chronic disease health risk behaviours was identified, with many participants expressing an interest in improving these behaviours. Such findings reinforce recommendations that preventive care addressing the chronic disease risks of clients be provided routinely by mental health clinicians. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12613000693729. URL: www.anzctr.org.au/.
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Affiliation(s)
- Kate M Bartlem
- Population Health, Hunter New England Local Health District, Wallsend Health Services, Wallsend, Australia School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, Callaghan, Australia Hunter Medical Research Institute, Clinical Research Centre, New Lambton Heights, Australia
| | - Jennifer A Bowman
- School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, Callaghan, Australia Hunter Medical Research Institute, Clinical Research Centre, New Lambton Heights, Australia
| | - Jacqueline M Bailey
- School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, Callaghan, Australia
| | - Megan Freund
- Population Health, Hunter New England Local Health District, Wallsend Health Services, Wallsend, Australia Hunter Medical Research Institute, Clinical Research Centre, New Lambton Heights, Australia School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Callaghan, Australia
| | - Paula M Wye
- Population Health, Hunter New England Local Health District, Wallsend Health Services, Wallsend, Australia School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, Callaghan, Australia Hunter Medical Research Institute, Clinical Research Centre, New Lambton Heights, Australia
| | - Christophe Lecathelinais
- Population Health, Hunter New England Local Health District, Wallsend Health Services, Wallsend, Australia
| | - Kathleen M McElwaine
- Population Health, Hunter New England Local Health District, Wallsend Health Services, Wallsend, Australia Hunter Medical Research Institute, Clinical Research Centre, New Lambton Heights, Australia School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Callaghan, Australia
| | - Elizabeth M Campbell
- Population Health, Hunter New England Local Health District, Wallsend Health Services, Wallsend, Australia Hunter Medical Research Institute, Clinical Research Centre, New Lambton Heights, Australia School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Callaghan, Australia
| | - Karen E Gillham
- Population Health, Hunter New England Local Health District, Wallsend Health Services, Wallsend, Australia Hunter Medical Research Institute, Clinical Research Centre, New Lambton Heights, Australia
| | - John H Wiggers
- Population Health, Hunter New England Local Health District, Wallsend Health Services, Wallsend, Australia Hunter Medical Research Institute, Clinical Research Centre, New Lambton Heights, Australia School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Callaghan, Australia
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