Nurse-Facilitated Health Checks for Persons With Severe Mental Illness: A Cluster-Randomized Controlled Trial

White, Jacquie; Lucas, Joanne; Swift, Louise; Barton, Garry; Johnson, Harriet M.; Irvine, Lisa; Abotsie, Gabriel; Jones, Martin; Gray, Richard

doi:10.1176/appi.ps.201700258

“…This is in line with findings from Wheeler et al (2010) that case managers' prioritized access to services and the treatment of mental illness over other areas. A HIP cluster-randomized controlled trial (White et al, 2018) found that nurses who voluntarily participated in their trial only administered the HIP to a small group of the service users assigned to them resulting in the study concluding that the HIP was not feasible as part of routine care. Although this was similarly found here with the community group, this was not the case with the inpatient group.…”

Section: Discussionmentioning

confidence: 99%

The adaptation and implementation of the Health Improvement Profile to Australian standards in public mental health settings

Brown

¹

,

May

²

,

Beverley-Stone

³

2020

Psychiatric Ment Health Nurs

2

1

0

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Accessible Summary What is known on the subject? The Health Improvement Profile (HIP) is a one‐page form developed in the United Kingdom as a tool for mental health nurses to assess service user's physical health needs. The HIP screens service users’ physical health and provides recommendations that clinicians can provide service users with in order to improve their physical health. There was evidence supporting the effectiveness of the HIP; however, the majority of HIP studies to date involve the screening tool being completed by nurses. In Australia, a large proportion of mental health clinicians providing case management to service users in community settings are not nurses. What the paper adds to existing knowledge? This paper shows that the HIP can be adjusted to suit the needs of Australian service users and can be utilized by clinicians from a variety of disciplines. It also shows that both clinicians and Australian service users find the HIP helpful and argues for it being made available for all service users. It has clearly shown a need to target flu vaccine programmes at service users. What are the implications for practice? The HIP has been shown to be a suitable and acceptable screening tool for different clinicians to assess multiple lifestyle risk factors at once, which can be used across different diagnoses and settings. This study, for example, demonstrated a need to focus on promoting the flu vaccine and smoking cessation, as well as encouraging service users to visit eye and dental health services. Abstract IntroductionHealth Improvement Profile (HIP) studies to date primarily focused on the screening tool being completed by nurses. This paper explores the HIP in two different settings, with an emphasis on expanding physical health roles for all mental health clinicians. AimThe aim of the present study was to adapt the HIP to Australian standards and implement it at a large mental health service. MethodThis is an evaluation of the implementation of the HIP over a two‐month pilot period. Clinicians and service users were surveyed on their experience of the HIP. ResultsThe community team completed the HIP with 34 (15%) service users. The inpatient unit completed the HIP with 137 (54%) service users. Results from the HIP clearly show priority areas for health interventions. Feedback from clinicians and service users was predominately positive. DiscussionWe found the HIP to be an acceptable screening tool that encompasses multiple lifestyle risk factors. Implications for practiceThis study clearly demonstrates the utility of the HIP as a workable and acceptable screening tool with real world applicability. In our pilot, for example, we identified the need for the promotion of influenza vaccinations amongst service users, as well as the ongoing need to target smoking cessation and substance use.

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“…Interventions such as the HIP RCT have also highlighted challenges in incorporating physical health management into mental health care. 186 There has also been recent consideration of other service models. The research evidence suggests that high-intensity interventions incorporating specialists in diet and exercise are most effective, 187,205 although, in the UK, service providers may be hesitant owing to the cost of such initiatives.…”

Section: Discussionmentioning

confidence: 99%

“…185 It is also consistent with the findings of the Health Improvement Profile (HIP) RCT, which trained community mental health nurses to administer health checks to their patients and found that the volunteer nurses administered health checks to only a minority of participating patients. 186 However, given that the subset who received > 180 minutes of additional time devoted to IMPaCT therapy had a clinically significant reduction of -4.2 cm (95% CI -7.2 to -1.2 cm) in their waist circumference, a focus on implementation strategies in future work may be important.…”

Section: Limitations Of the Trialmentioning

confidence: 99%

“…The search for effective evidence-based approaches to reduce the excess cardiometabolic risk experienced by people with SMI is proving a challenge for many research groups, following the negative results in all recent large European RCTs on the topic, namely IMPaCT, STEPWISE, PRIMROSE, HIP and CHANGE. 176,186,[220][221][222] Although the interventions in all these studies were intuitively sensible and it was reasonable to believe that they should have been helpful, researchers are struggling to demonstrate evidence of additional effectiveness in the context of structured health-care systems. It may be that the effectiveness of more individualised long-term approaches to reverse cardiometabolic risk in this population needs to be evaluated, bearing in mind that reversing established cardiometabolic risk in the general population is also a challenge.…”

Section: Recommendations For Researchmentioning

confidence: 99%

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A health promotion intervention to improve lifestyle choices and health outcomes in people with psychosis: a research programme including the IMPaCT RCT

Gaughran

¹

,

Ståhl

²

,

Patel

³

et al. 2020

Programme Grants Appl Res

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Background People with psychotic disorders have reduced life expectancy largely because of physical health problems, especially cardiovascular disease, that are complicated by the use of tobacco and cannabis. Objectives We set out to (1) chart lifestyle and substance use choices and the emergence of cardiometabolic risk from the earliest presentation with psychosis, (2) develop a pragmatic health promotion intervention integrated within the clinical teams to improve the lifestyle choices and health outcomes of people with psychosis and (3) evaluate the clinical effectiveness and cost-effectiveness of that health promotion intervention. Design We performed a longitudinal cohort study of people presenting with their first episode of psychosis in three mental health trusts and followed up participants for 1 year [work package 1, physical health and substance use measures in first episode of psychosis (PUMP)]. We used an iterative Delphi methodology to develop and refine a modular health promotion intervention, improving physical health and reducing substance use in psychosis (IMPaCT) therapy, which was to be delivered by the patient’s usual care co-ordinator and used motivational interviewing techniques and cognitive–behavioural therapy to improve health choices of people with psychosis (work package 2). We then conducted a multicentre, two-arm, parallel-cluster, randomised controlled trial to determine the clinical effectiveness and cost-effectiveness of using the intervention with people with established psychosis (work package 3: IMPaCT randomised controlled trial) in five UK mental health trusts. The work took place between 2008 and 2014. Participants All people aged between 16 and 65 years within 6 months of their first presentation with a non-organic psychosis and who were proficient in English were eligible for inclusion in the PUMP study. Participants in the work package 2 training development were staff selected from a range of settings, working with psychosis. Participants in the phase 3 Delphi consensus and manual development comprised three expert groups of (1) therapists/researchers recruited from the local and national community, (2) clinicians and (3) service users, each of whom took part in two iterative review and feedback sessions. For work package 3, IMPaCT randomised controlled trial, care co-ordinators in participating community mental health teams who were permanently employed and had a minimum of four eligible patients (i.e. aged between 18 and 65 years with a diagnosis of a psychotic disorder) on their caseload were eligible to participate. In studies 1 and 3, patient participants were ineligible if they were pregnant or had a major illness that would have had an impact on their metabolic status or if they had a significant learning disability. All participants were included in the study only after giving written confirmed consent. Main outcome measures Cardiometabolic risk markers, including rates of obesity and central obesity, and levels of glycated haemoglobin (HbA1c) and lipids, were the main outcomes in work package 1 (PUMP), with descriptive data presented on substance use. Our primary outcome measure for the IMPaCT randomised controlled trial was the physical or mental health component Short Form questionnaire-36 items quality-of-life scores at 12 months. Results Obesity rates rose from 18% at first presentation with psychosis to 24% by 1 year, but cardiometabolic risk was not associated with baseline lifestyle and substance use choices. Patterns of increase in the levels of HbA1c over the year following first presentation showed variation by ethnic group. We recruited 104 care co-ordinators, of whom 52 (with 213 patients) were randomised to deliver IMPaCT therapy and 52 (with 193 patients) were randomised to deliver treatment as usual, in keeping with our power calculations. Of these 406 participants with established psychosis, 318 (78%) and 301 (74%) participants, respectively, attended the 12- and 15-month follow-ups. We found no significant effect of IMPaCT therapy compared with treatment as usual on the physical or mental health component Short Form questionnaire-36 items scores at either time point in an intention-to-treat analysis [physical health score (‘d’) –0.17 at 12 months and –0.09 at 15 months; mental health score (‘d’) 0.03 at 12 months and –0.05 at 15 months] or on costs. Nor did we find an effect on other cardiovascular risk indicators, including diabetes, except in the case of high-density lipoprotein cholesterol, which showed a trend for greater benefit with IMPaCT therapy than with treatment as usual (treatment effect 0.085, 95% confidence interval 0.007 to 0.16; p = 0.034). Limitations Follow-up in work package 1 was challenging, with 127 out of 293 participants attending; however, there was no difference in cardiometabolic measures or demographic factors at baseline between those who attended for follow-up and those who did not. In work package 3, the IMPaCT randomised controlled trial, care co-ordinators struggled to provide additional time to their patients that was devoted to the health promotion intervention on top of their usual clinical care contact with them. Conclusions Cardiometabolic risk is prominent even soon after first presentation with psychosis and increases over time. Lifestyle choices and substance use habits at first presentation do not predict those who will be most cardiometabolically compromised 1 year later. Training and supervising care co-ordinators to deliver a health promotion intervention to their own patients on top of routine care is not effective in the NHS for improving quality of life or reducing cardiometabolic risk. Future work Further work is needed to develop and evaluate effective, cost-effective and affordable ways of preventing the emergence of and reversing existing cardiometabolic risk indicators in people with psychosis. Trial registration Current Controlled Trials ISRCTN58667926. Funding This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 8, No. 1. See the NIHR Journals Library website for further project information.

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“…I hope to share the incredible experience of being a part of this project in the hope it will inspire others to have innovative ideas that can result in a contemporary way to educate consumers and the public about mental illness, available treatments and help to reduce stigma. (White et al, 2018). There is evidence from controlled trials that the HIP may enhance physical wellbeing in consumers with SMI.…”

Section: Fentanyl Diversion In Australia and The Impact On Human Rightsmentioning

confidence: 99%

Abstracts

Lerbæk

¹

,

Jørgensen

²

,

Aagaard

³

et al. 2018

Int J Mental Health Nurs

0

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Nurse-Facilitated Health Checks for Persons With Severe Mental Illness: A Cluster-Randomized Controlled Trial

Abstract: Nurses who had volunteered for a clinical trial administered health checks only to a minority of participating patients, suggesting that it may not be feasible to undertake such lengthy structured health checks in routine practice.

Cited by 10 publications

References 10 publications

The adaptation and implementation of the Health Improvement Profile to Australian standards in public mental health settings

The adaptation and implementation of the Health Improvement Profile to Australian standards in public mental health settings

A health promotion intervention to improve lifestyle choices and health outcomes in people with psychosis: a research programme including the IMPaCT RCT

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