Williams, Sevdalis, Gaughran. (2019) Evaluation of a Physical health plan for people with psychosis: a protocol for a quality improvement study.

https://pilotfeasibilitystudies.biomedcentral.com/articles/10.1186/s40814-019-0396-7

Williams, Julie et al. "Evaluation Of A Physical Health Plan For People With Psychosis: A Protocol For A Quality Improvement Study". Pilot And Feasibility Studies, vol 5, no. 1, 2019. Springer Nature, doi:10.1186/s40814-019-0396-7. Accessed 11 Feb 2019.


Background

People with serious mental illness (SMI) have poorer physical health and reduced lifespans compared to the general population. Reasons for this are complex, but one important area is the identification and treatment of physical health conditions. In England, services are structured into primary and secondary care; physical and mental secondary health services are separate. This often leads to a lack of co-ordination of care, with people missing the screening and treatment they need. People with SMI may find accessing physical health services more difficult due to the impact of their symptoms and/or a lack of social support. When they do access physical care, there may be ‘diagnostic overshadowing’ where physical health concerns are put down to a mental health diagnosis. Creating tools to support people with SMI to assume more control of their physical health may help to ameliorate some of these problems. The aim of this study is to evaluate the use of a service user-held Physical health plan (PHP) for secondary mental health service users to determine whether its use increases uptake of physical health services.
Methods

We will undertake a pilot quality improvement (QI) study to test the use of the PHP. The development of the PHP is described. A Theory of Change (ToC) has been developed which we will test to understand how the PHP is used, using focus groups at the beginning of the study. We will then pilot the use of the PHP for 6 months in two community mental health teams to find out how people use it, what actions are taken, and if it increases uptake of physical health care. We will use the RE-AIM implementation framework to guide the evaluation. After the pilot, we will undertake interviews with service users and clinical staff to elicit their views on using the PHP.
Discussion

This study uses QI methodology and an implementation framework to test a novel intervention for people with SMI. If successful, the intervention will support people with SMI to access physical health services. The study will inform the design of a larger-scale definitive RCT.
Trial registration

ClinicalTrials.gov Identifier: NCT03178279. Registered date: 05/06/2017

 

to counter all that IPAT and somatic symptoms stuff, here's a study on a possible way to counter diagnostic overshadowing and get care for physical conditions even when their healthcare team doesn't care because (in the view of the doc) "it's only depression" (or whatever)

 

One of my sons comes into the above category (in the UK). I noticed a couple of years ago that things had improved at his Community Mental Health team as they were beginning to take note of his physical health needs, encouraging him to go to his GP for blood tests, talking to him about his health, weighing him (the meds and his lifestyle mean he is very overweight), and possibly taking his blood pressure (not sure about that one). I had read that there was a report out on this subject a few years back regarding early death rate for people with psychosis conditions, such as schizophrenia as he has, and I think that the NHS is beginning to take this on board already.

Getting him to go to the GP is another matter though. He is due for a check at the moment, but he hasn't got there yet. In addition to the need for that check, many of his teeth are rotting and he has had an abscess recently and needs to have many extractions. In spite of this and getting antibiotics for his abscess from the dentist, he still hasn't gone for the xrays which have to precede the extractions. In fact I have just written to him again urging him to take action (he is many miles from me).

'People with SMI may find accessing physical health services more difficult due to the impact of their symptoms and/or a lack of social support' - this is the problem - it's not just identifying the problem but supporting people to get there.

 

yeah, that's a good point. Maybe they're still trying to make the patient fix the problem when it's not a patient-caused problem.

 

Historically there have been problems for adults with learning difficulties accessing general health care in the UK.

I don't know if this has been quantified but people working with adults with learning difficulties also had the perception that their clients were given lower priority for such as major surgery on the basis of their quality of life being questioned or say with such as people with Down's on the basis of a lower than average life expectancy.

This reflects the situation a number of years ago, so it is possible things have improved.