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Regan C, Bartlem K, Fehily C, Campbell E, Lecathelinais C, Doherty E, Wolfenden L, Clancy R, Fogarty M, Conrad A, Bowman J. Evaluation of an implementation support package to increase community mental health clinicians' routine delivery of preventive care for multiple health behaviours: a non-randomised controlled trial. Implement Sci Commun 2023; 4:137. [PMID: 37957727 PMCID: PMC10644601 DOI: 10.1186/s43058-023-00509-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 10/04/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND People with a mental health condition are more likely to engage in risk behaviours compared to people without. Delivery of preventive care to improve such behaviours is recommended for community mental health services, but inadequately implemented. This study assessed the effectiveness of an implementation support package on clinicians' delivery of preventive care (assessment, advice, referral) for four risk behaviours (tobacco smoking, harmful alcohol consumption, physical inactivity, inadequate fruit and vegetable intake) compared to no implementation support. The participatory approach to developing the support package, and fidelity of the implementation strategies, are also described. METHODS A non-randomised controlled trial was undertaken in 2019-2020 with two community mental health services (control and target) in one health district in New South Wales, Australia. A 4-month support package consisting of multiple implementation strategies was delivered to one site following a two-phase participatory design process. Five implementation strategies were proposed to service managers by researchers. After consultation with managers and clinicians, the final implementation support package included four strategies: training and education materials, enabling resources and prompts, client activation material, and audit and feedback. Client-reported receipt of the three elements of preventive care for the four risk behaviours was collected from a cross-sectional sample of clients who had recently attended the service at baseline (6 months) and follow-up (5 months). Logistic regression models examined change in receipt of preventive care to assess effectiveness. RESULTS A total of 860 client surveys were completed (control baseline n = 168; target baseline n = 261; control follow-up n = 164; and target follow-up n = 267). Analyses revealed no significant differential changes in preventive care receipt between the target and control sites from baseline to follow-up, including across the four primary outcomes: assessed for all behaviours (OR = 1.19; 95% CI 0.55, 2.57; p = 0.65); advised for all relevant risk behaviours (OR = 1.18; 95% CI 0.39, 3.61; p = 0.77); referred for any relevant risk behaviour (OR = 0.80; 95% CI 0.40, 1.63; p = 0.55); and complete care (OR = 3.11; 95% CI 0.62, 15.63; p = 0.17). Fidelity of the implementation strategies was limited as one of the four strategies (audit and feedback) was not delivered, components of two strategies (enabling resources and prompts, and client activation material) were not delivered as intended, and one strategy (education and training) was delivered as intended although some components were offered late in the implementation period. CONCLUSIONS The implementation support package was ineffective at increasing preventive care delivery. Further investigation is required to determine optimal participatory design methods to develop effective implementation strategies, including those that support delivery of care in community mental health settings within the ongoing context of uncertain environmental challenges. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry ACTRN12619001379101.
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Affiliation(s)
- Casey Regan
- School of Psychological Sciences, The University of Newcastle, Callaghan, NSW, 2308, Australia.
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia.
- The Australian Preventive Partnership Centre (TAPPC), Sax Institute, Ultimo, NSW, Australia.
- Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia.
| | - Kate Bartlem
- School of Psychological Sciences, The University of Newcastle, Callaghan, NSW, 2308, Australia
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia
- The Australian Preventive Partnership Centre (TAPPC), Sax Institute, Ultimo, NSW, Australia
- Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
| | - Caitlin Fehily
- School of Psychological Sciences, The University of Newcastle, Callaghan, NSW, 2308, Australia
- The Australian Preventive Partnership Centre (TAPPC), Sax Institute, Ultimo, NSW, Australia
- Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
| | - Elizabeth Campbell
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia
- Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, 2308, Australia
| | | | - Emma Doherty
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia
- Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Luke Wolfenden
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Richard Clancy
- Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
- School of Nursing and Midwifery, The University of Newcastle, Callaghan, NSW, 2308, Australia
- Hunter New England Mental Health Services, Po Box 833, Newcastle, NSW, 2300, Australia
| | - Marcia Fogarty
- Hunter New England Mental Health Services, Po Box 833, Newcastle, NSW, 2300, Australia
- Central Adelaide Local Health Network, PO Box 17, Fullarton, SA, 5063, Australia
| | - Agatha Conrad
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, 2308, Australia
- Hunter New England Mental Health Services, Po Box 833, Newcastle, NSW, 2300, Australia
| | - Jenny Bowman
- School of Psychological Sciences, The University of Newcastle, Callaghan, NSW, 2308, Australia
- The Australian Preventive Partnership Centre (TAPPC), Sax Institute, Ultimo, NSW, Australia
- Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
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Bray JW, Thornburg BD, Gebreselassie AW, LaButte CA, Barbosa C, Wittenberg E. Estimating Joint Health State Utility Algorithms Under Partial Information. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:742-749. [PMID: 36307281 PMCID: PMC10126182 DOI: 10.1016/j.jval.2022.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 08/12/2022] [Accepted: 09/26/2022] [Indexed: 05/03/2023]
Abstract
OBJECTIVES We explored the performance of existing joint health state utility estimators when data are not available on utilities that isolate single-condition health states excluding any co-occurring condition. METHODS Using data from the National Epidemiologic Survey on Alcohol and Related Conditions-III, we defined 2 information sets: (1) a full-information set that includes the narrowly defined health state utilities used in most studies that test the performance of joint health state utility estimators, and (2) a limited information set that includes only the more broadly defined health state utilities more commonly available to researchers. We used an example of alcohol use disorder co-occurring with cirrhosis of the liver, depressive disorder, or nicotine use disorder to illustrate our analysis. RESULTS We found that the performance of joint health state utility estimators is appreciably different under limited information than under full information. Full-information estimators typically overestimate the joint state utility, whereas limited-information estimators underestimate the joint state utility, except for the minimum estimator, which is overestimated in all cases. CONCLUSIONS Researchers using joint health state utility estimators should understand the information set available to them and use methodological guidance appropriate for that information set. We recommend the minimum estimator under limited information based on its ease of use, consistency (and therefore a predictable direction of bias), and lower root mean squared error.
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Affiliation(s)
- Jeremy W Bray
- Department of Economics, UNC Greensboro, Greensboro, NC, USA.
| | | | | | | | | | - Eve Wittenberg
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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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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Fehily C, Hodder R, Bartlem K, Wiggers J, Wolfenden L, Dray J, Bailey J, Wilczynska M, Stockings E, Clinton-McHarg T, Regan T, Bowman J. The effectiveness of interventions to increase preventive care provision for chronic disease risk behaviours in mental health settings: A systematic review and meta-analysis. Prev Med Rep 2020; 19:101108. [PMID: 32477852 PMCID: PMC7248238 DOI: 10.1016/j.pmedr.2020.101108] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 03/01/2020] [Accepted: 04/26/2020] [Indexed: 11/25/2022] Open
Abstract
Clinical practice guidelines direct mental health services to provide preventive care to address client chronic disease risk behaviours, however, this care is not routinely provided. The aim of this systematic review was to synthesise evidence regarding the effectiveness of interventions to increase provision of preventive care by mental health services; by care element (ask, assess, advice, assist, arrange) and risk behaviour (tobacco smoking, poor nutrition, harmful alcohol consumption, physical inactivity). Electronic bibliographic databases, Google Scholar, relevant journals, and included study reference lists were searched. Eligible studies were of any design with a comparison group that reported the effectiveness of an intervention to increase the provision of at least one element of preventive care for at least one risk behaviour in a mental health setting. Twenty studies were included, most commonly examining smoking (n = 20) and 'ask' (n = 12). Meta-analysis found interventions involving task shifting were effective in increasing smoking 'advice' (n = 2 RCTs; p = 0.009) and physical activity 'advice' (n = 2 RCTs; p = 0.002). Overall, meta-analysis and narrative synthesis indicated that effective intervention strategies (categorised according to the Effective Practice and Organisation of Care taxonomy) were: task shifting, educational meetings, health information systems, local consensus processes, authority and accountability, and reminders. The most consistent findings across studies were with regard to preventive care for smoking, while conflicting or limited evidence was found regarding other risk behaviours. While further rigorous research examining key risk behaviours is recommended, the findings may inform the selection of strategies for future interventions and service delivery initiatives.
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Affiliation(s)
- Caitlin Fehily
- School of Psychology, Faculty of Science, 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
| | - Rebecca 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
| | - Kate Bartlem
- School of Psychology, Faculty of Science, 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 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
| | - Luke Wolfenden
- 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
| | - Julia Dray
- School of Psychology, Faculty of Science, 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
| | - Jacqueline Bailey
- School of Psychology, Faculty of Science, The University of Newcastle, NSW, Australia
- Hunter Medical Research Institute, Clinical Research Centre, NSW, Australia
| | - Magda Wilczynska
- School of Psychology, Faculty of Science, The University of Newcastle, NSW, Australia
| | - Emily Stockings
- National Drug and Alcohol Research Centre, Randwick, NSW, Australia
| | - Tara Clinton-McHarg
- School of Psychology, Faculty of Science, 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
| | - Timothy Regan
- School of Psychology, Faculty of Science, The University of Newcastle, NSW, Australia
| | - Jenny Bowman
- School of Psychology, Faculty of Science, 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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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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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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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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9
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Obesity prevention and the role of hospital and community-based health services: a scoping review. BMC Health Serv Res 2019; 19:453. [PMID: 31277640 PMCID: PMC6612151 DOI: 10.1186/s12913-019-4262-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 06/14/2019] [Indexed: 11/25/2022] Open
Abstract
Background Control of obesity is an important priority to reduce the burden of chronic disease. Clinical guidelines focus on the role of primary healthcare in obesity prevention. The purpose of this scoping review is to examine what the published literature indicates about the role of hospital and community based health services in adult obesity prevention in order to map the evidence and identify gaps in existing research. Methods Databases were searched for articles published in English between 2006 and 2016 and screened against inclusion and exclusion criteria. Further papers were highlighted through a manual search of the reference lists. Included papers evaluated interventions aimed at preventing overweight and obesity in adults that were implemented within and/or by hospital and community health services; were an empirical description of obesity prevention within a health setting or reported health staff perceptions of obesity and obesity prevention. Results The evidence supports screening for obesity of all healthcare patients, combined with referral to appropriate intervention services but indicates that health professionals do not typically adopt this practice. As well as practical issues such as time and resourcing, implementation is impacted by health professionals’ views about the causes of obesity and doubts about the benefits of the health sector intervening once someone is already obese. As well as lacking confidence or knowledge about how to integrate prevention into clinical care, health professional judgements about who might benefit from prevention and negative views about effectiveness of prevention hinder the implementation of practice guidelines. This is compounded by an often prevailing view that preventing obesity is a matter of personal responsibility and choice. Conclusions This review highlights that whilst a population health approach is important to address the complexity of obesity, it is important that the remit of health services is extended beyond medical treatment to incorporate obesity prevention through screening and referral. Further research into the role of health services in obesity prevention should take a systems approach to examine how health service structures, policy and practice interrelationships, and service delivery boundaries, processes and perspectives impact on changing models of care.
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Twyman L, Cowles C, Walsberger SC, Baker AL, Bonevski B. 'They're Going to Smoke Anyway': A Qualitative Study of Community Mental Health Staff and Consumer Perspectives on the Role of Social and Living Environments in Tobacco Use and Cessation. Front Psychiatry 2019; 10:503. [PMID: 31379622 PMCID: PMC6652148 DOI: 10.3389/fpsyt.2019.00503] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 06/25/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Addressing the high prevalence of tobacco use experienced by people with severe mental illness (SMI) requires consideration of the influence of wider cultural, socioeconomic and environmental factors. This qualitative study aimed to examine the impact of social and living environments on tobacco use and cessation by people with SMI accessing community managed mental health services. The perspectives of both staff and consumers with SMI were explored. Methods: Semi-structured focus groups were undertaken with a purposive sample of community mental health staff and consumers from three sites in three major cities in NSW, Australia. Two sites provided outreach support, and one site provided residential support. Data were collected (2017-2018) until saturation was reached. Focus groups were audio-recorded and transcribed, and thematic analysis was conducted. Results: Thirty-one staff and 17 consumers participated separately in six focus groups. Themes identified by staff included a degree of fatalism, conceptualising tobacco use as choice rather than addiction and tensions between cessation support and broader models of care. Staff viewed smoke-free home and mental health service policies as effective at promoting quitting but contradictory to recovery-oriented models of care. Consumers identified smoking as an integral part of life and social networks, as a way of maintaining control and lack of social support to quit as key themes. While many consumers reported smoking inside the home, others described enforcing smoke-free rules. Conclusion: Social and living environments played an integral role in tobacco use and cessation for both staff and consumers. The role of community managed mental health organisations in addressing tobacco use within social and living environments was not strongly supported by staff and sometimes seen as antithetical to recovery-oriented models of care. Potential ways to address this include education and training for prospective and current community mental health organisation staff highlighting the synergy between the recovery-oriented model and provision of preventive health support.
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Affiliation(s)
- Laura Twyman
- Tabacco Control Unit, Cancer Council NSW, Woolloomooloo, NSW, Australia.,School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
| | - Carla Cowles
- Human Capital Alliance, Potts Point, NSW, Australia
| | | | - Amanda L Baker
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
| | - Billie Bonevski
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
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11
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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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12
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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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13
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Wiggers J, McElwaine K, Freund M, Campbell L, Bowman J, Wye P, Wolfenden L, Tremain D, Barker D, Slattery C, Gillham K, Bartlem K. Increasing the provision of preventive care by community healthcare services: a stepped wedge implementation trial. Implement Sci 2017; 12:105. [PMID: 28830568 PMCID: PMC5567434 DOI: 10.1186/s13012-017-0636-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Accepted: 08/14/2017] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Although clinical guidelines recommend the provision of care to reduce client chronic disease risk behaviours, such care is provided sub-optimally by primary healthcare providers. A study was undertaken to determine the effectiveness of an intervention in increasing community-based clinician implementation of multiple elements of recommended preventive care for four risk behaviours. METHODS A three-group stepped-wedge trial was undertaken with all 56 community-based primary healthcare facilities in one health district in New South Wales, Australia. A 12-month implementation intervention was delivered sequentially in each of three geographically and administratively defined groups of facilities. The intervention consisted of six key strategies: leadership and consensus processes, enabling systems, educational meetings and training, audit and feedback, practice change support, and practice change information and resources. Client-reported receipt of three elements of preventive care: assessment; brief advice; referral for four behavioural risks: smoking, inadequate fruit and/or vegetable consumption, alcohol overconsumption, and physical inactivity, individually, and for all such risks combined were collected for 56 months (October 2009-May 2014). Segmented logistic regression models were developed to assess intervention effectiveness. RESULTS A total of 5369 clients participated in data collection. Significant increases were found for receipt of four of five assessment outcomes (smoking OR 1.53; fruit and/or vegetable intake OR 2.18; alcohol consumption OR 1.69; all risks combined OR 1.78) and two of five brief advice outcomes (fruit and/or vegetable intake OR 2.05 and alcohol consumption OR 2.64). No significant increases in care delivery were observed for referral for any risk behaviour, or for physical inactivity. CONCLUSIONS The implementation intervention was effective in enhancing assessment of client risk status but less so for elements of care that could reduce client risk: provision of brief advice and referral. The intervention was ineffective in increasing care addressing physical inactivity. Further research is required to identify barriers to the provision of preventive care and the effectiveness of practice change interventions in increasing its provision. TRIAL REGISTRATION Australian Clinical Trials Registry ACTRN12611001284954 . Registered 15 December 2011. Retrospectively registered.
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Affiliation(s)
- John Wiggers
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
- Hunter New England Population Health, Wallsend, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Kathleen McElwaine
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Megan Freund
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Libby Campbell
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
- Hunter New England Population Health, Wallsend, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Jenny Bowman
- School of Psychology, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Paula Wye
- School of Psychology, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
- Hunter New England Population Health, Wallsend, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Danika Tremain
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
- Hunter New England Population Health, Wallsend, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Daniel Barker
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
| | | | - Karen Gillham
- Hunter New England Population Health, Wallsend, Australia
| | - Kate Bartlem
- Hunter New England Population Health, Wallsend, Australia
- School of Psychology, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
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14
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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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15
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Wye PM, Stockings EA, Bowman JA, Oldmeadow C, Wiggers JH. Effectiveness of a clinical practice change intervention in increasing the provision of nicotine dependence treatment in inpatient psychiatric facilities: an implementation trial. BMC Psychiatry 2017; 17:56. [PMID: 28173823 PMCID: PMC5297214 DOI: 10.1186/s12888-017-1220-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 01/31/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite clinical practice guidelines recommending the routine provision of nicotine dependence treatment to smokers in inpatient psychiatric facilities, the prevalence of such treatment provision is low. The aim of this study was to examine the effectiveness of a clinical practice change intervention in increasing clinician recorded provision of nicotine dependence treatment to patients in inpatient psychiatric facilities. METHODS We undertook an interrupted time series analysis of nicotine dependence treatment provision before, during and after a clinical practice change intervention to increase clinician recorded provision of nicotine dependence treatment for all hospital discharges (aged >18 years, N = 4175) over a 19 month period in two inpatient adult psychiatric facilities in New South Wales, Australia. The clinical practice change intervention comprised six key strategies: leadership and consensus, enabling systems and procedures, training and education, information and resources, audit and feedback and an on-site practice change support officer. Systematic medical record audit and segmented logistic regression was used to determine differences in proportions for each nicotine dependence treatment outcome measure between the 'pre', 'during' and 'post-intervention' periods. RESULTS The prevalence of all five outcome measures increased significantly between the pre and post-intervention periods, including clinician recorded: assessment of patient smoking status (36.43 to 51.95%; adjusted odds ratio [AOR] = 2.39, 99% Confidence Interval [CI]: 1.23 to 4.66); assessment of patient nicotine dependence status (4.74 to 11.04%; AOR = 109.67, 99% CI: 35.35 to 340.22); provision of brief advice to quit (0.85 to 8.81%; AOR = 97.43, 99% CI: 31.03 to 306.30); provision of nicotine replacement therapy (8.06 to 26.25%; AOR = 19.59, 99% CI: 8.17 to 46.94); and provision of nicotine dependence treatment on discharge (8.82 to 13.45%, AOR = 12.36; 99% CI: 6.08 to 25.14). CONCLUSIONS This is the first study to provide evidence that a clinical practice change intervention may increase clinician recorded provision of nicotine dependence treatment in inpatient psychiatric settings. The intervention offers a mechanism for psychiatric facilities to increase the provision of nicotine dependence treatment in accordance with clinical guidelines.
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Affiliation(s)
- Paula M. Wye
- 0000 0000 8831 109Xgrid.266842.cSchool of Psychology, University of Newcastle, University Drive, Callaghan, New South Wales 2308 Australia ,grid.413648.cHunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, New South Wales 2305 Australia ,Hunter New England Population Health (HNEPH), Longworth Ave, Wallsend, New South Wales 2287 Australia
| | - Emily A. Stockings
- 0000 0004 4902 0432grid.1005.4National Drug and Alcohol Research Centre, University of New South Wales, 22-32 King Street, Randwick, New South Wales 2031 Australia
| | - Jenny A. Bowman
- 0000 0000 8831 109Xgrid.266842.cSchool of Psychology, University of Newcastle, University Drive, Callaghan, New South Wales 2308 Australia ,grid.413648.cHunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, New South Wales 2305 Australia
| | - Chris Oldmeadow
- grid.413648.cHunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, New South Wales 2305 Australia
| | - John H. Wiggers
- grid.413648.cHunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, New South Wales 2305 Australia ,Hunter New England Population Health (HNEPH), Longworth Ave, Wallsend, New South Wales 2287 Australia ,0000 0000 8831 109Xgrid.266842.cSchool of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, New South Wales 2308 Australia
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