Skip to main content
Top
Published in: BMC Psychiatry 1/2014

Open Access 01-12-2014 | Research article

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

Authors: Brian McKenna, Trentham Furness, Elizabeth Wallace, Brenda Happell, Robert Stanton, Chris Platania-Phung, Karen-leigh Edward, David Castle

Published in: BMC Psychiatry | Issue 1/2014

Login to get access

Abstract

Background

People 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.

Methods

A 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).

Results

A 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.

Conclusions

The results of this study support incorporating specialist roles over case manager only roles for more effective MM among new episode consumers with SMI.
Literature
1.
go back to reference Robson D, Gray R: Serious mental illness and physical problems: a discussion paper. Int J Nurs Stud. 2007, 44: 457-466. 10.1016/j.ijnurstu.2006.07.013.CrossRefPubMed Robson D, Gray R: Serious mental illness and physical problems: a discussion paper. Int J Nurs Stud. 2007, 44: 457-466. 10.1016/j.ijnurstu.2006.07.013.CrossRefPubMed
2.
go back to reference McEvoy J, Meyer J, Goff D, Nasrallah H, Davis S, Sullivan L, Meltzer H, Hsiao J, Scott Stroup T, Lieberman J: Prevalence of the metabolic syndrome in patients with schizophrenia: baseline results from the clinical antipsychotic trials of intervention effectiveness (CATIE) schizophrenia trial and comparison with national estimates from NHANES III. Schizophr Res. 2005, 80 (1): 19-32. 10.1016/j.schres.2005.07.014.CrossRefPubMed McEvoy J, Meyer J, Goff D, Nasrallah H, Davis S, Sullivan L, Meltzer H, Hsiao J, Scott Stroup T, Lieberman J: Prevalence of the metabolic syndrome in patients with schizophrenia: baseline results from the clinical antipsychotic trials of intervention effectiveness (CATIE) schizophrenia trial and comparison with national estimates from NHANES III. Schizophr Res. 2005, 80 (1): 19-32. 10.1016/j.schres.2005.07.014.CrossRefPubMed
3.
go back to reference Pan A, Keum N, Okereke O, Sun Q, Kivimaki M, Rubin R, Hu F: Depression and metabolic syndrome a systematic review and meta-analysis of epidemiological studies. Diabetes Care. 2012, 35: 1171-1180. 10.2337/dc11-2055.CrossRefPubMedPubMedCentral Pan A, Keum N, Okereke O, Sun Q, Kivimaki M, Rubin R, Hu F: Depression and metabolic syndrome a systematic review and meta-analysis of epidemiological studies. Diabetes Care. 2012, 35: 1171-1180. 10.2337/dc11-2055.CrossRefPubMedPubMedCentral
4.
go back to reference Beebe L: Obesity in schizophrenia: screening, monitoring, and health promotion. Perspect Psychiatr Care. 2008, 44 (1): 25-31. 10.1111/j.1744-6163.2008.00144.x.CrossRefPubMed Beebe L: Obesity in schizophrenia: screening, monitoring, and health promotion. Perspect Psychiatr Care. 2008, 44 (1): 25-31. 10.1111/j.1744-6163.2008.00144.x.CrossRefPubMed
5.
go back to reference Improving the Physical Health of People with Severe Mental Illness. No Mental Health without Physical Health. 2011, Department of Health, Melbourne Improving the Physical Health of People with Severe Mental Illness. No Mental Health without Physical Health. 2011, Department of Health, Melbourne
6.
go back to reference Organ B, Nicholson E, Castle D: Implementing a physical health strategy in a mental health service. Australas Psychiatry. 2010, 18 (5): 456-459. 10.3109/10398562.2010.506217.CrossRefPubMed Organ B, Nicholson E, Castle D: Implementing a physical health strategy in a mental health service. Australas Psychiatry. 2010, 18 (5): 456-459. 10.3109/10398562.2010.506217.CrossRefPubMed
7.
go back to reference Alberti K, Eckel R, Grundy S, Zimmet P, Cleeman J, Donato K, Fruchart J, James W, Loria C, Smith S: International Diabetes Federation Task Force on Epidemiology and Prevention, National Heart, Lung, and Blood Institute, American Heart Association, World Heart Foundation, International Atherosclerosis Society, International Association for the Study of Obesity: Harmonizing the metabolic syndrome. Circulation. 2009, 120: 1640-1645. 10.1161/CIRCULATIONAHA.109.192644.CrossRefPubMed Alberti K, Eckel R, Grundy S, Zimmet P, Cleeman J, Donato K, Fruchart J, James W, Loria C, Smith S: International Diabetes Federation Task Force on Epidemiology and Prevention, National Heart, Lung, and Blood Institute, American Heart Association, World Heart Foundation, International Atherosclerosis Society, International Association for the Study of Obesity: Harmonizing the metabolic syndrome. Circulation. 2009, 120: 1640-1645. 10.1161/CIRCULATIONAHA.109.192644.CrossRefPubMed
8.
go back to reference Shor R, Shalev A: Identifying barriers to improving wellness of persons with severe mental illness in community residential mental health facilities. Soc Work Ment Health. 2013, 11 (4): 334-348. 10.1080/15332985.2013.779360.CrossRef Shor R, Shalev A: Identifying barriers to improving wellness of persons with severe mental illness in community residential mental health facilities. Soc Work Ment Health. 2013, 11 (4): 334-348. 10.1080/15332985.2013.779360.CrossRef
9.
go back to reference Happell B, Platania-Phung C, Gray R, Hardy S, Lambert T, McAllister M, Davies C: A role for mental health nursing in the physical health care of consumers with severe mental illness. J Psychiatr Ment Health Nurs. 2011, 18: 706-711. 10.1111/j.1365-2850.2010.01666.x.CrossRefPubMed Happell B, Platania-Phung C, Gray R, Hardy S, Lambert T, McAllister M, Davies C: A role for mental health nursing in the physical health care of consumers with severe mental illness. J Psychiatr Ment Health Nurs. 2011, 18: 706-711. 10.1111/j.1365-2850.2010.01666.x.CrossRefPubMed
10.
go back to reference White J, Gray R, Jones M: The development of the serious mental illness physical health improvement profile. J Psychiatr Ment Health Nurs. 2009, 16: 493-498. 10.1111/j.1365-2850.2009.01375.x.CrossRefPubMed White J, Gray R, Jones M: The development of the serious mental illness physical health improvement profile. J Psychiatr Ment Health Nurs. 2009, 16: 493-498. 10.1111/j.1365-2850.2009.01375.x.CrossRefPubMed
11.
go back to reference Mangurian C, Giwa F, Shumway M, Fuentes-Afflick E, Pérez-Stable E, Dilley J, Schillinger D: Primary care providers’ views on metabolic monitoring of outpatients taking antipsychotic medication. Psychiatr Serv. 2013, 64 (6): 597-599. 10.1176/appi.ps.002542012.CrossRefPubMedPubMedCentral Mangurian C, Giwa F, Shumway M, Fuentes-Afflick E, Pérez-Stable E, Dilley J, Schillinger D: Primary care providers’ views on metabolic monitoring of outpatients taking antipsychotic medication. Psychiatr Serv. 2013, 64 (6): 597-599. 10.1176/appi.ps.002542012.CrossRefPubMedPubMedCentral
12.
go back to reference Tosh G, Clifton A, Xia J, White M: Physical health care monitoring for people with serious mental illness. Cochrane Database Syst Rev. 2014, 1: Tosh G, Clifton A, Xia J, White M: Physical health care monitoring for people with serious mental illness. Cochrane Database Syst Rev. 2014, 1:
13.
go back to reference Wright C, Osborn D, Nazareth I, King M: Prevention of coronary heart disease in people with severe mental illnesses: a qualitative study of patient and professionals’ preferences for care. BMC Psychiatry. 2006, 6: 16-10.1186/1471-244X-6-16.CrossRefPubMedPubMedCentral Wright C, Osborn D, Nazareth I, King M: Prevention of coronary heart disease in people with severe mental illnesses: a qualitative study of patient and professionals’ preferences for care. BMC Psychiatry. 2006, 6: 16-10.1186/1471-244X-6-16.CrossRefPubMedPubMedCentral
14.
go back to reference Wheeler A, Harrison J, Mohini P, Nardan J, Tsai A, Tsai E: Cardiovascular risk assessment and management in mental health clients: whose role is it anyway?. Community Ment Health J. 2010, 46: 531-539. 10.1007/s10597-009-9237-0.CrossRefPubMed Wheeler A, Harrison J, Mohini P, Nardan J, Tsai A, Tsai E: Cardiovascular risk assessment and management in mental health clients: whose role is it anyway?. Community Ment Health J. 2010, 46: 531-539. 10.1007/s10597-009-9237-0.CrossRefPubMed
15.
go back to reference Morrato E, Druss B, Hartung D, Valuck R, Allen R, Campagna E, Newsomer J: Metabolic testing rates in 3 state Medicaid programs after FDA warnings and ADA/APA recommendations for second-generation antipsychotic drugs. Arch Gen Psychiatry. 2010, 67 (1): 17-24. 10.1001/archgenpsychiatry.2009.179.CrossRefPubMed Morrato E, Druss B, Hartung D, Valuck R, Allen R, Campagna E, Newsomer J: Metabolic testing rates in 3 state Medicaid programs after FDA warnings and ADA/APA recommendations for second-generation antipsychotic drugs. Arch Gen Psychiatry. 2010, 67 (1): 17-24. 10.1001/archgenpsychiatry.2009.179.CrossRefPubMed
16.
go back to reference Stanley S, Laugharne J: Clinical guidelines for the physical care of mental health consumers: a comprehensive assessment and monitoring package for mental health and primary care clinicians. Aust N Z J Psychiatry. 2011, 45: 824-829. 10.3109/00048674.2011.614591.CrossRefPubMed Stanley S, Laugharne J: Clinical guidelines for the physical care of mental health consumers: a comprehensive assessment and monitoring package for mental health and primary care clinicians. Aust N Z J Psychiatry. 2011, 45: 824-829. 10.3109/00048674.2011.614591.CrossRefPubMed
17.
go back to reference American Psychiatric Association, American Association of Clinical Endocrinologists, North American Association for the Study of Obesity, North American Association for the Study of Obesity: Consensus development conference on antipsychotic drugs and obesity and diabetes. Diabetes Care. 2004, 27 (2): 596-601. 10.2337/diacare.27.2.596. American Psychiatric Association, American Association of Clinical Endocrinologists, North American Association for the Study of Obesity, North American Association for the Study of Obesity: Consensus development conference on antipsychotic drugs and obesity and diabetes. Diabetes Care. 2004, 27 (2): 596-601. 10.2337/diacare.27.2.596.
18.
go back to reference Burghardt K, Ellingrod V: Detection of metabolic syndrome in schizophrenia and implications for antipsychotic therapy. Mol Diagn Ther. 2013, 17 (1): 21-30. 10.1007/s40291-013-0017-8.CrossRefPubMedPubMedCentral Burghardt K, Ellingrod V: Detection of metabolic syndrome in schizophrenia and implications for antipsychotic therapy. Mol Diagn Ther. 2013, 17 (1): 21-30. 10.1007/s40291-013-0017-8.CrossRefPubMedPubMedCentral
19.
go back to reference Dhamane A, Martin B, Brixner D, Hudson T, Said Q: Metabolic monitoring of patients prescribed second-generation antipsychotics. J Psychiatr Pract. 2013, 19 (5): 360-374. 10.1097/01.pra.0000435035.45308.03.CrossRefPubMed Dhamane A, Martin B, Brixner D, Hudson T, Said Q: Metabolic monitoring of patients prescribed second-generation antipsychotics. J Psychiatr Pract. 2013, 19 (5): 360-374. 10.1097/01.pra.0000435035.45308.03.CrossRefPubMed
20.
go back to reference Gurpegui M, Martínez-Ortega J, Gutiérrez-Rojas L, Rivero J, Rojas C, Jurado D: Overweight and obesity in patients with bipolar disorder or schizophrenia compared with a non-psychiatric sample. Prog Neuropsychopharmacol Biol Psychiatry. 2012, 37 (1): 169-175. 10.1016/j.pnpbp.2012.01.014.CrossRefPubMed Gurpegui M, Martínez-Ortega J, Gutiérrez-Rojas L, Rivero J, Rojas C, Jurado D: Overweight and obesity in patients with bipolar disorder or schizophrenia compared with a non-psychiatric sample. Prog Neuropsychopharmacol Biol Psychiatry. 2012, 37 (1): 169-175. 10.1016/j.pnpbp.2012.01.014.CrossRefPubMed
21.
go back to reference Faulkner G, Cohn T, Remington G: Interventions to reduce weight gain in schizophrenia. Cochrane Database Syst Rev. 2007, 24: Faulkner G, Cohn T, Remington G: Interventions to reduce weight gain in schizophrenia. Cochrane Database Syst Rev. 2007, 24:
22.
go back to reference De Hert M, Cohen D, Bobes J, Cetkovich-Bakmas M, Leucht S, Ndetei D, Newcorner J, Uwakwe R, Asai I, Möller H, Gautam S, Detraux J, Correll C: Physical illness in patients with severe mental disorders. II. Barriers to care, monitoring and treatment guidelines, plus recommendations at the system and individual level. World Psychiatry. 2011, 10: 138-151.CrossRefPubMedPubMedCentral De Hert M, Cohen D, Bobes J, Cetkovich-Bakmas M, Leucht S, Ndetei D, Newcorner J, Uwakwe R, Asai I, Möller H, Gautam S, Detraux J, Correll C: Physical illness in patients with severe mental disorders. II. Barriers to care, monitoring and treatment guidelines, plus recommendations at the system and individual level. World Psychiatry. 2011, 10: 138-151.CrossRefPubMedPubMedCentral
23.
go back to reference Ohlsen R, Peacock G, Smith S: Developing a service to monitor and improve physical health in people with serious mental illness. J Psychiatr Ment Health Nurs. 2005, 12: 614-619. 10.1111/j.1365-2850.2005.00884.x.CrossRefPubMed Ohlsen R, Peacock G, Smith S: Developing a service to monitor and improve physical health in people with serious mental illness. J Psychiatr Ment Health Nurs. 2005, 12: 614-619. 10.1111/j.1365-2850.2005.00884.x.CrossRefPubMed
24.
go back to reference Hyland B, Judd F, Davidson S, Jolley D, Hocking B: Case managers’ attitudes to the physical health of their patients. Aust N Z J Psychiatry. 2003, 37 (6): 710-714. 10.1080/j.1440-1614.2003.01264.x.CrossRefPubMed Hyland B, Judd F, Davidson S, Jolley D, Hocking B: Case managers’ attitudes to the physical health of their patients. Aust N Z J Psychiatry. 2003, 37 (6): 710-714. 10.1080/j.1440-1614.2003.01264.x.CrossRefPubMed
27.
go back to reference Happell B, Scott D, Nankivell J, Platania-Phung C: Screening physical health? Yes! But...: nurses’ views on physical health screening in mental health care. J Clin Nurs. 2013, 22: 2286-2297. 10.1111/j.1365-2702.2012.04325.x.CrossRefPubMed Happell B, Scott D, Nankivell J, Platania-Phung C: Screening physical health? Yes! But...: nurses’ views on physical health screening in mental health care. J Clin Nurs. 2013, 22: 2286-2297. 10.1111/j.1365-2702.2012.04325.x.CrossRefPubMed
28.
go back to reference Horvitz-Lennon M, Kilbourne A, Pincus H: From silos to bridges: meeting the general health care needs of adults with severe mental illnesses. Health Aff. 2006, 25 (3): 659-659. 10.1377/hlthaff.25.3.659.CrossRef Horvitz-Lennon M, Kilbourne A, Pincus H: From silos to bridges: meeting the general health care needs of adults with severe mental illnesses. Health Aff. 2006, 25 (3): 659-659. 10.1377/hlthaff.25.3.659.CrossRef
29.
go back to reference Barber J, Palmese L, Chwastiak L, Ratliff J, Reutenauer E, Jean-Baptiste M, Tek C: Reliability and practicality of measuring waist circumference to monitor cardiovascular risk among community mental health center patients. Community Ment Health J. 2014, 50 (1): 68-74. 10.1007/s10597-012-9590-2.CrossRefPubMed Barber J, Palmese L, Chwastiak L, Ratliff J, Reutenauer E, Jean-Baptiste M, Tek C: Reliability and practicality of measuring waist circumference to monitor cardiovascular risk among community mental health center patients. Community Ment Health J. 2014, 50 (1): 68-74. 10.1007/s10597-012-9590-2.CrossRefPubMed
30.
go back to reference Barnes T, Paton C, Cavanagh M, Hancock E, Taylor D: UK Prescribing Observatory for Mental Health: A UK audit of screening for the metabolic side effects of antipsychotics in community patients. Schizophr Bull. 2007, 33 (6): 1397-1403. 10.1093/schbul/sbm038.CrossRefPubMedPubMedCentral Barnes T, Paton C, Cavanagh M, Hancock E, Taylor D: UK Prescribing Observatory for Mental Health: A UK audit of screening for the metabolic side effects of antipsychotics in community patients. Schizophr Bull. 2007, 33 (6): 1397-1403. 10.1093/schbul/sbm038.CrossRefPubMedPubMedCentral
31.
go back to reference Maki M, Bjorklund P: Improving cardiovascular disease screening in community mental health centers. Perspect Psychiatr Care. 2013, 49 (3): 179-186. 10.1111/j.1744-6163.2012.00348.x.CrossRefPubMed Maki M, Bjorklund P: Improving cardiovascular disease screening in community mental health centers. Perspect Psychiatr Care. 2013, 49 (3): 179-186. 10.1111/j.1744-6163.2012.00348.x.CrossRefPubMed
32.
go back to reference Daumit G, Dickenson F, Wang N-Y, Dalcin A, Jerome G, Anderson C, Young D, Frick K, Yu A, Gennusa J, Oefinger M, Crum R, Charleston J, Casagrande S, Guallar E, Goldberg R, Campbell L, Appel L: A behavioral weight-loss intervention in persons with serious mental illness. N Eng J Med. 2013, 368: 1594-1602. 10.1056/NEJMoa1214530.CrossRef Daumit G, Dickenson F, Wang N-Y, Dalcin A, Jerome G, Anderson C, Young D, Frick K, Yu A, Gennusa J, Oefinger M, Crum R, Charleston J, Casagrande S, Guallar E, Goldberg R, Campbell L, Appel L: A behavioral weight-loss intervention in persons with serious mental illness. N Eng J Med. 2013, 368: 1594-1602. 10.1056/NEJMoa1214530.CrossRef
33.
go back to reference Eldridge D, Dawber N, Gray R: A well-being support program for patients with severe mental illness: a service evaluation. BMC Psychiatry. 2011, 11: 46-10.1186/1471-244X-11-46.CrossRefPubMedPubMedCentral Eldridge D, Dawber N, Gray R: A well-being support program for patients with severe mental illness: a service evaluation. BMC Psychiatry. 2011, 11: 46-10.1186/1471-244X-11-46.CrossRefPubMedPubMedCentral
34.
go back to reference Carless D, Douglas K: The ethos of physical activity delivery in mental health: a narrative study of service user experiences. Issues Ment Health Nurs. 2012, 33: 165-171. 10.3109/01612840.2011.637659.CrossRefPubMed Carless D, Douglas K: The ethos of physical activity delivery in mental health: a narrative study of service user experiences. Issues Ment Health Nurs. 2012, 33: 165-171. 10.3109/01612840.2011.637659.CrossRefPubMed
35.
go back to reference Ussher M, Stanbury L, Cheeseman V, Faulkner G: Physical activity preferences and perceived barriers to activity among persons with severe mental illness in the United Kingdom. Psychiatr Serv. 2007, 58 (3): 405-408. 10.1176/appi.ps.58.3.405.CrossRefPubMed Ussher M, Stanbury L, Cheeseman V, Faulkner G: Physical activity preferences and perceived barriers to activity among persons with severe mental illness in the United Kingdom. Psychiatr Serv. 2007, 58 (3): 405-408. 10.1176/appi.ps.58.3.405.CrossRefPubMed
Metadata
Title
The effectiveness of specialist roles in mental health metabolic monitoring: a retrospective cross-sectional comparison study
Authors
Brian McKenna
Trentham Furness
Elizabeth Wallace
Brenda Happell
Robert Stanton
Chris Platania-Phung
Karen-leigh Edward
David Castle
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Psychiatry / Issue 1/2014
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/s12888-014-0234-7

Other articles of this Issue 1/2014

BMC Psychiatry 1/2014 Go to the issue