Key Worker–Mediated Enhancement of Physical Health in First Episode Psychosis: Protocol For a Feasibility Study in Primary Care

Abstract

Background Studies have demonstrated that, for patients with psychosis, a majority of the decline in health status and functioning emerges during the first few years after the onset of illness. This knowledge led to the development of specialized early intervention services (EISs) targeting patients experiencing their first episode of psychosis. The central component of EISs is often assertive case management delivered by a multidisciplinary team, where an appointed key worker is responsible for coordinating treatment and delivering various psychosocial interventions to service users. Objective This paper outlines the protocol for a feasibility study examining how key workers may enhance physical health by supporting integration between primary and secondary care. Methods Semistructured interviews were conducted with key stakeholder groups (General Practitioners and health care professionals working in mental health services). The interviews informed the development of the complex intervention involving a longitudinal pre-post intervention in 8 general practices in 2 regions in Ireland (one urban and one rural). Patients with first episode psychosis (FEP) will be identified from clinical records at general practices and mental health services. Results Baseline and follow-up data (at 6 months) will be collected, examining measures of feasibility, acceptability, and intervention effect size. Conclusions Study findings will inform future practice by examining feasibility of key workers enhancing physical health through improved interaction between primary and secondary care. By identifying issues involved in enhancing recruitment and retention, as well as the likely effect size, the study will inform a future definitive intervention. International Registered Report Identifier (IRRID) DERR1-10.2196/13115

Minding metabolism: targeted interventions to improve cardio-metabolic monitoring across early and chronic psychosis

“…In our sample, none of the patients identified as having diabetes were on diabetic treatment (Table 3 ), whereas 2.4% of those identified as HTN were prescribed anti-hypertensive treatment. These findings clearly indicate a deficit in the model of shared care between primary and secondary care, which is imperative for improved outcomes for patients across the psychotic disorder spectrum [ 91 , 92 ].…”

Keyworker mediated enhancement of physical health in patients with first episode psychosis: A feasibility/acceptability study

“…The intervention was conducted from February through April 2020. As noted, it was informed by the MRC's Framework (Campbell et al, 2000), as well as our study protocol (McCombe et al, 2019), a scoping review conducted on keyworker involvement in FEP patient care (Lim et al, 2020), 10 semi‐structured interviews with healthcare professionals (general practitioners [GPs] and psychiatrists), steering group meetings, and Ireland's national model of care for FEP (Health Service Executive (HSE), 2019) and making every contact count initiatives (O'Brien & Scott, 2016). The intervention sought to provide keyworker led interventions that; (a) enhance FEP participants' physical health and (b) improve integration between healthcare providers (especially MHSs and GPs) regarding participants' physical health issues requiring follow‐up.…”

“…The intervention was evaluated in terms of its feasibility and acceptability. As outlined in our study protocol (McCombe et al, 2019), feasibility was determined by participant recruitment and retention rates. The recruitment rate was defined as the percentage of patients invited who participated in the intervention, while the retention rate was defined as the percentage of patients participating in the intervention who completed it.…”

“…The intervention was evaluated in terms of its feasibility and acceptability. As outlined in our study protocol (McCombe et al, 2019), feasibility was determined by participant recruitment and retention rates.…”

Physical health interventions for patients who have experienced a first episode of psychosis: a narrative review

“…A noteworthy study of an Irish population is currently underway. It explores the role of key workers to support physical health monitoring and intervention in an Irish FEP population (McCombe et al 2019). Studies have highlighted that the majority of the ill effects on physical health occur in the period shortly after the FEP (Liebermann et al 2001).…”