Transcript Rapid review service… - University of South Australia

Effectiveness of health checks to improve the
physical health of patients with severe mental
illness: a single blind cluster randomised controlled
trial of the health improvement profile (HIP)
Jacqueline White [1] Joanne Lucas [2], Louise Swift [3,4],
Garry R Barton [3,4], Harriet Gough [5], Lisa Irvine [3,4],
Gabriel Abotsie [5], Martin Jones [6], Richard Gray [7]
1.
2.
3.
4.
5.
6.
7.
Faculty of Health and Social Care, University of Hull
Nursing Sciences, University of East Anglia
Norwich Medical School, University of East Anglia
Norwich Clinical Trials Unit, University of East Anglia
Norfolk and Suffolk NHS Foundation Trust
University of South Australia
Hamad Medical Corporation, Doha, Qatar
Background
• Reduced Life Expectancy
• Mortality is due to cardiovascular disease
(CVD)
• Health checks are assessments intended to
screen patients for comorbidity (e.g. CVD risk)
Background
• Practice guidelines recommend annual health checks
for people with SMI
• Health checks occur less frequently in SMI and to be
of inferior quality
• Mental health nurses motivated to improve the
physical health of patients with SMI
• Extended Role
The Health Improvement Profile (HIP)
Method
• A single blind cluster randomised controlled
trial
– Treatment as usual plus the HIP (health check)
– Treatment as usual
Inclusion/exclusion criteria
• Nurses
– Registered nurse for a minimum of six months
– Were working clinically in an adult community setting
– At least five SMI patients on their caseload
• Patients
– Over 18 years of age,
– With mental capacity (determined by an appropriately trained
clinician)
– Confirmed primary diagnosis of schizophrenia, schizoaffective or
bipolar disorder
– Additional exclusion criteria
• Serious or unstable medical condition
• Were pregnant or six months post partum
• A senior clinician determined that patient participation in the trial would put
the patient, treating clinical or research team at increased risk
Recruitment of nurses
• Researchers presented the project to generic
and specialist adult community mental health
teams (recovery, rehabilitation, assertive
outreach and forensic teams)
• CMHNs who expressed an interest were
followed up and consent obtained
Recruitment of patients
• Nurses screened their own caseload
• Selected patients invited by their nurse to
participate
• Patients understanding of the study and
obtained written informed consent
• The cycle was repeated until five patients had
been recruited
Randomisation and blinding
• Nurse randomised to receive either the HIP
Programme or treatment as usual (TAU)
• Permuted blocks of random size
• Trial Coordinators were informed by email of the
group allocation
• Research assistants blind to group allocation u
Intervention
• Patients in both group received TAU
• In addition, nurses in the intervention group
received training, and were asked to
implement an annual health check using the
HIP with patient participants on their caseload
Outcome measures
• The primary outcome was the physical
wellbeing of patients at 12 months follow-up
– Measured using the physical component subscale
[PCS] of the Medical Outcome Study (MOS) 36
item Short Form Health Survey version 2 (SF-36v2)
• The SF36v2 and PCS have demonstrated sensitivity to
change in SMI outpatient populations
Data collection
• Outcome measures completed at group
allocation at baseline and 12-month follow up
• Researchers were trained to administer the
outcome measures to patients using
procedures described in the SF-36v2 user
guide
Fewer than half the
health checks were
completed by CMHNs
A quarter of the
health checks were
completed by CMHNs
Characteristics of CMHNs at baseline (Intention to Treat Analysis)
Characteristics of CMHNs at baseline (Intention to Treat Analysis)
Characteristics of CMHNs at baseline (Intention to Treat Analysis)
Characteristics of CMHNs at baseline (Intention to Treat Analysis)
Adverse event reporting
Conclusion
• Health checks delivered by nurses not
effective at improving the physical wellbeing
of SMI patients
• First trial of the effectiveness of health checks
in an SMI population.
• Challenge guideline recommendations
Effectiveness of health checks to improve the
physical health of patients with severe mental
illness: a single blind cluster randomised controlled
trial of the health improvement profile (HIP)
Jacqueline White [1] Joanne Lucas [2], Louise Swift [3,4],
Garry R Barton [3,4], Harriet Gough [5], Lisa Irvine [3,4],
Gabriel Abotsie [5], Martin Jones [6], Richard Gray [7]
1.
2.
3.
4.
5.
6.
7.
Faculty of Health and Social Care, University of Hull
Nursing Sciences, University of East Anglia
Norwich Medical School, University of East Anglia
Norwich Clinical Trials Unit, University of East Anglia
Norfolk and Suffolk NHS Foundation Trust
University of South Australia
Hamad Medical Corporation, Doha, Qatar