The effectiveness of specialist roles in mental health metabolic monitoring: a retrospective cross-sectional comparison study

Abstract

BackgroundPeople with serious mental illness (SMI) exhibit a high prevalence of cardiovascular diseases. Mental health services have a responsibility to address poor physical health in their consumers. One way of doing this is to conduct metabolic monitoring (MM) of risk factors for cardiovascular diseases. This study compares two models of MM among consumers with SMI and describes referral pathways for those at high risk of cardiovascular diseases.MethodsA retrospective cross-sectional comparison design was used. The two models were: (1) MM integrated with case managers, and (2) MM integrated with case managers and specialist roles. Retrospective data were collected for all new episodes at two community mental health services (CMHS) over a 12-month period (September 2012 – August 2013).ResultsA total of 432 consumers with SMI across the two community mental health services were included in the analysis. At the service with the specialist roles, MM was undertaken for 78% of all new episode consumers, compared with 3% at the mental health service with case managers undertaking the role. Incomplete MM was systemic to both CMHS, although all consumers identified with high risk of cardiovascular diseases were referred to a general practitioner or other community based health services. The specialist roles enabled more varied referral options.ConclusionsThe results of this study support incorporating specialist roles over case manager only roles for more effective MM among new episode consumers with SMI.

Providing physical health care for people accessing mental health services: Clinicians’ perceptions of their role

“…There is a growing body of evidence supporting the role of specialist physical health clinicians in mental health services to address some physical health needs of people accessing services, especially metabolic screening and monitoring (Brown et al 2018;Druss et al 2010;Fehily et al 2017;McKenna et al 2014;Osborn et al 2010;Rogers et al 2016). There is a growing body of evidence supporting the role of specialist physical health clinicians in mental health services to address some physical health needs of people accessing services, especially metabolic screening and monitoring (Brown et al 2018;Druss et al 2010;Fehily et al 2017;McKenna et al 2014;Osborn et al 2010;Rogers et al 2016).…”

Enhancing metabolic monitoring for children and adolescents using second‐generation antipsychotics

“…Unfortunately, this study did not evaluate the economic impact of implementing this advanced practice role (McKenna et al 2014). registered psychiatric nurses, occupational therapists, and social workers) were responsible for metabolic monitoring of their patients, and one where a specialized nursing role was dedicated to the metabolic monitoring on behalf of the case managers.…”

The chasm of care: Where does the mental health nursing responsibility lie for the physical health care of people with severe mental illness?

“…Those taking antipsychotic medication should receive regular monitoring of parameters including blood pressure, blood sugar, weight, electrocardiogram, lipids, urea, full blood count, and serum electrolytes, prolactin and liver function tests depending upon the psychotropic agent being used (Vasudev & Martindale ). However, research suggests that the level of routine health screening and monitoring by health professionals is varied with compliance rates ranging from 0% to 70% depending on the practice at the specific service (McKenna et al ; Ward ). This occurs even though antipsychotic medication is an identified primary risk factor for the development of obesity and metabolic disturbances and the prevalence of these is probably underestimated (Scott & Happell ; Stanley & Laugharne ).…”