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Implementation Science
Published in: Implementation Science 1/2015

Open Access 01-12-2015 | Research

Effectiveness of an intervention in increasing the provision of preventive care by community mental health services: a non-randomized, multiple baseline implementation trial

Authors: Kate M. Bartlem, Jenny Bowman, Megan Freund, Paula M. Wye, Daniel Barker, Kathleen M. McElwaine, Luke Wolfenden, Elizabeth M. Campbell, Patrick McElduff, Karen Gillham, John Wiggers

Published in: Implementation Science | Issue 1/2015

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Abstract

Background

Relative to the general population, people with a mental illness are more likely to have modifiable chronic disease health risk behaviours. Care to reduce such risks is not routinely provided by community mental health clinicians. This study aimed to determine the effectiveness of an intervention in increasing the provision of preventive care by such clinicians addressing four chronic disease risk behaviours.

Methods

A multiple baseline trial was undertaken in two groups of community mental health services in New South Wales, Australia (2011–2014). A 12-month practice change intervention was sequentially implemented in each group. Outcome data were collected continuously via telephone interviews with a random sample of clients over a 3-year period, from 6 months pre-intervention in the first group, to 6 months post intervention in the second group. Outcomes were client-reported receipt of assessment, advice and referral for tobacco smoking, harmful alcohol consumption, inadequate fruit and/or vegetable consumption and inadequate physical activity and for the four behaviours combined. Logistic regression analyses examined change in client-reported receipt of care.

Results

There was an increase in assessment for all risks combined following the intervention (18 to 29 %; OR 3.55, p = 0.002: n = 805 at baseline, 982 at follow-up). No significant change in assessment, advice or referral for each individual risk was found.

Conclusions

The intervention had a limited effect on increasing the provision of preventive care. Further research is required to determine how to increase the provision of preventive care in community mental health services.

Trial registration

Australian and New Zealand Clinical Trials Registry ACTRN12613000693​729
Literature
1.
Chang C, Hayes R, Perera G, Broadbent M, Fernandes A, Lee W, et al. Life expectancy at birth for people with serious mental illness and other major disorders from a secondary mental health care case register in London. PLoS One. 2011;6(5):e19590.CrossRefPubMedPubMedCentral
2.
3.
4.
Lawrence D, Hancock K, Kisely S. The gap in life expectancy from preventable physical illness in psychiatric patients in Western Australia: retrospective analysis of population based registers. Br Med J (Clin Res Ed). 2013;346:f2539.
5.
Amaddeo F, Barbui C, Perini G, Biggeri A, Tansella M. Avoidable mortality of psychiatric patients in an area with a community-based system of mental health care. Acta Psychiatr Scand. 2007;115:320–5.CrossRefPubMed
6.
7.
8.
Reichler H, Baker A, Lewin T, Carr V. Smoking among in-patients with drug-related problems in an Australian psychiatric hospital. Drug Alcohol Rev. 2001;20(2):231–7.CrossRef
9.
10.
11.
Lasser K, Boyd JW, Woolhandler S, Himmelstein DU, McCormick D, Bor DH. Smoking and mental illness: a population-based prevalence study. JAMA. 2000;284(20):2606–10.CrossRefPubMed
12.
13.
Bartlem K, Bowman J, Bailey J, Freund M, Wye P, Lecathelinais C, et al. Chronic disease health risk behaviours amongst people with a mental illness. Aust NZ J Psychiatry. 2015;49(8):731–41.CrossRef
14.
Kilian R, Becker T, Kruger K, Schmid S, Frasch K. Health behavior in psychiatric in-patients compared with a German general population sample. Acta Psychiatr Scand. 2006;114(4):242–8.CrossRefPubMed
15.
McCreadie R. Diet, smoking and cardiovascular risk in people with schizophrenia: descriptive study. Br J Psychiatry. 2003;183:534–9.CrossRefPubMed
16.
17.
Davidson S, Judd F, Jolley D, Hocking B, Thompson M, Hyland B. Cardiovascular risk factors for people with mental illness. Aust NZ J Psychiatry. 2001;35(2):196–202.CrossRef
18.
Gratzer D, Levitan R, Sheldon T, Toneatto T, Rector N, Goering P. Lifetime rates of alcoholism in adults with anxiety, depression, or co-morbid depression/anxiety: a community survey of Ontario. J Affect Disord. 2004;79(1–3):209–15.CrossRefPubMed
19.
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):405–8.CrossRefPubMed
20.
Janney CA, Fagiolini A, Swartz HA, Jakicic JM, Holleman RG, Richardson CR. Are adults with bipolar disorder active? Objectively measured physical activity and sedentary behavior using accelerometry. J Affect Disord. 2014;152–154:498–504. doi:10.​1016/​j.​jad.​2013.​09.​009.CrossRefPubMed
21.
World Health Organisation. 2008–2013 Action plan for the global strategy for the prevention and control of noncommunicable diseases. Geneva: World Health Organisation; 2008.
22.
United States Preventive Services Task Force. The guide to clinical preventive services 2014: recommendations of the US Preventive Services Taskforce. Report No.: 14–05158. Rockville: Agency for Healthcare Research and Quality; 2014.
23.
National Preventive Health Taskforce. Australia: the healthiest country by 2020—National Preventative Health Strategy—the roadmap for action. Canberra, 2010.
24.
Royal Australian College of General Practitioners. Guidelines for preventive activities in general practice (The Red Book). Melbourne: Royal Australian College of General Practitioners; 2009.
25.
Hunter New England Local Health District. Preventive care area policy statement, HNEH Pol 10_01. Hunter New England Health; 2010
26.
Department of Health Victoria. Victorian public health and wellbeing plan 2011–2015. Melbourne: Prevention and Population Health Branch, Victorian Government, Department of Health; 2011.
27.
Queensland Health. The health of Queenslanders 2008: prevention of chronic disease. Second report of the chief health officer Queensland. Brisbane: Queensland Health; 2008.
28.
Stanley S, Laugharne J. Clinical guidelines for the physical care of mental health consumers. Perth: Culture and Mental Health Unit, School of Psychiatry and Clinical Neurosciences, University of Western Australia; 2010.
29.
Department of Health Victoria. Improving the physical health of people with severe mental illness: no mental health without physical health. Ministerial Advisory Committee on Mental Health Report. Melbourne: Victorian Government; 2011.
30.
Queensland Health. Queensland MIND essentials: mental illness nursing documents. Brisbane: Queensland Health; 2010.
31.
New South Wales Health. Physical health care of mental health consumers: guideline. Sydney: New South Wales Department of Health; 2009.
32.
New South Wales Health. Physical health care within mental health services. Sydney: New South Wales Department of Health; 2009.
33.
The Scottish Government. Mental health strategy for Scotland: 2012–2015. Edinburgh: The Scottish Government; 2012.
34.
Welsh Assembly Government. The role of community mental health teams in delivering community mental health services: interim policy implementation guidance and standards. Welsh Assembly Government; 2010.
35.
Royal College of Psychiatrists. Improving physical health for people with a mental illness: what can be done? Faculty Report FR/GAP/01. London: Royal College of Psychiatrists; 2013.
36.
37.
National Institute for Health and Care Excellence. Psychosis and schizophrenia in adults: treatment and management. NICE clinical guideline 178. London: National Institute for Health and Care Excellence; 2014.
38.
National Institute for Health and Care Excellence. Bipolar disorder: the assessment and management of bipolar disorder in adults, children and young people in primary and secondary care. NICE clinical guideline 185. London: National Institute for Health and Care Excellence; 2015.
39.
40.
Schroeder S. What to do with a patient who smokes. J Am Med Assoc. 2005;294(4):482–7.CrossRef
41.
Schroeder S, Morris C. Confronting a neglected epidemic: tobacco cessation for persons with mental illnesses and substance abuse problems. Annu Rev Public Health. 2010;31:297–314.CrossRefPubMed
42.
43.
Greening J. Physical health of patients in rehabilitation and recovery: a survey of case note records. Psychiatric Bulletin. 2005;29(6):210–2.CrossRef
44.
Himelhoch S, Leith J, Goldberg R, Kreyenbuhl J, Medoff D, Dixon L. Care and management of cardiovascular risk factors among individuals with schizophrenia and type 2 diabetes who smoke. Gen Hosp Psychiatry. 2009;31(1):30–2.CrossRefPubMedPubMedCentral
45.
Anderson A, Bowman J, Knight J, Wye P, Terry M, Grimshaw S, et al. Smoking-related care provision within community mental health settings: a cross-sectional survey of Australian service managers. Psychiatr Serv. 2013;64(7):707–10.CrossRefPubMed
46.
Bartlem K, Bowman J, Freund M, Wye P, Lecathelinais C, McElwaine K, et al. Acceptability and receipt of preventive care for chronic-disease health risk behaviours reported by clients of community mental health services. Psychiatr Serv. 2015;66(8):857–64.CrossRefPubMed
47.
Bartlem K, Bowman J, Freund M, Wye P, McElwaine K, Wolfenden L, et al. Care provision to prevent chronic disease by community based mental health clinicians. Am J Prevent Med. 2014;47(6):762–70.CrossRef
48.
49.
Shojania K, Jennings A, Mayhew A, Ramsay C, Eccles M, Grimshaw J. The effects of on-screen, point of care computer reminders on processes and outcomes of care. Cochrane Database Syst Rev. 2009;3:CD001096.PubMed
50.
Arditi C, Rege-Walther M, Wyatt JC, Durieux P, Burnand B. Computer-generated reminders delivered on paper to healthcare professionals; effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2012;12:CD001175. doi:10.​1002/​14651858.​CD001175.​pub3.PubMed
51.
Grimshaw J, Thomas R, MacLennan G, Fraser C, Ramsay C, Vale L, et al. Effectiveness and efficiency of guideline dissemination and implementation strategies. Health Technol Assess. 2004;8(6):1–72.CrossRef
52.
Forsetlund L, Bjorndal A, Rashidian A, Jamtvedt G, O'Brien M, Wolf F, et al. Continuing education meetings and workshops: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2009;2:CD003030.PubMed
53.
Jamtvedt G, Young J, Kristofferson D, O'Brien M, Oxman A. Audit and feedback: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2006;2:CD000259.PubMed
54.
55.
Giguere A, Legare F, Grimshaw J, Turcotte S, Fiander M, Grudniewicz A, et al. Printed educational materials: effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev. 2012;10:CD004398. doi:10.​1002/​14651858.​CD004398.​pub3.PubMed
56.
O'Brien MA, Rogers S, Jamtvedt G, Oxman AD, Odgaard-Jensen J, Kristoffersen DT, et al. Educational outreach visits: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2007;4:CD000409. doi:10.​1002/​14651858.​CD000409.​pub2.PubMed
57.
Bakker M, Mullen P, de Vries H, van Breukelen G. Feasibility of implementation of a Dutch smoking cessation and relapse prevention protocol for pregnant women. Patient Educ Couns. 2003;49:35–43.CrossRefPubMed
58.
Moher M, Yudkin P, Wright L, Turner R, Fuller A, Schofield T, et al. Cluster randomised controlled trial to compare three methods of promoting secondary prevention of coronary heart disease in primary care. Br Med J. 2001;322:1–7.CrossRef
59.
Katz D, Brown R, Muehlenbruch D, Fiore M, Baker T. Implementing guidelines for smoking cessation: comparing the efforts of nurses and medical assistants. Am J Prev Med. 2004;27(5):411–6.PubMed
60.
Papadakis S, McDonald P, Mullen K, Reid R, Skulsky K, Pipe A. Strategies to increase the delivery of smoking cessation treatments in primary care settings: a systematic review and meta-analysis. Prev Med. 2010;51:199–213.CrossRefPubMed
61.
Wolfenden L, Wiggers J, Knight J, Campbell E, Spigelman A, Kerridge R, et al. Increasing smoking cessation care in a preoperative clinic: a randomized controlled trial. Prev Med. 2005;41(1):284–90.CrossRefPubMed
62.
Freund M, Campbell E, Paul C, Sakrouge R, Lecathelinais C, Knight J, et al. Increasing hospital-wide delivery of smoking cessation care for nicotine-dependent inpatients: a multi-strategic intervention trial. Addiction. 2009;104(5):839–49.CrossRefPubMed
63.
Kaner E, Lock C, Heather N, McNamee P, Bond S. Promoting brief alcohol intervention by nurses in primary care: a cluster randomised controlled trial. Patient Educ Couns. 2003;51:277–84.CrossRefPubMed
64.
McElwaine K, Freund M, Campbell E, Knight J, Bowman J, Wolfenden L, et al. Increasing preventive care by primary care nursing and allied health clinicians: a non-randomized, controlled trial. Am J Prev Med. 2014;47(4):424–34.CrossRefPubMed
65.
66.
Hawkins N, Sanson-Fisher R, Shakeshaft A, D'Este C, Green L. The multiple baseline design for evaluating population-based research. Am J Prev Med. 2007;33(2):162–8.CrossRefPubMed
67.
Bartlem K, Bowman J, Freund M, Wye P, McElwaine K, Knight J, et al. Evaluating the effectiveness of a clinical practice change intervention in increasing clinician provision of preventive care in a network of community based mental health services: a study protocol of a non-randomised, multiple baseline trial. Implement Sci. 2013;8:85. doi:10.​1186/​1748-5908-8-85.CrossRefPubMedPubMedCentral
68.
Revell C, Schroeder S. Simplicity matters: using system-level changes to encourage clinician intervention in helping tobacco users quit. Nicotine Tob Res. 2005;7(S1):S67–9.CrossRefPubMed
69.
Ministry of Health. New Zealand Smoking Cessation Guidelines. Wellington: Ministry of Health; 2007.
70.
Ministerial Council on Drug Strategy. National Tobacco Strategy, 2004–2009: the strategy. Canberra: Commonwealth of Australia; 2004.
71.
National Health and Medical Research Council. Australian guidelines to reduce health risks from drinking alcohol. Canberra: Commonwealth of Australia; 2009.
72.
National Health and Medical Research Council. Dietary guidelines for Australian adults. Canberra: Commonwealth Department of Health and Ageing; 2003.
73.
Department of Health and Aged Care. An active way to better health. Canberra: Australian Government; 1999.
74.
Grimshaw J, Eccles M, Lavis J, Hill S, Squires J. Knowledge translation of research findings. Implement Sci. 2012;7(50):7–50.
75.
Heatherton TF, Kozlowski LT, Frecker RC, Fagerstrom KO. The Fagerstrom test for nicotine dependence: a revision of the Fagerstrom Tolerance Questionnaire. Br J Addict. 1991;86(9):1119–27.CrossRefPubMed
76.
Australian Bureau of Statistics. National Nutrition Survey selected highlights Australia 1995. Canberra: Australian Bureau of Statistics; 1997.
77.
Babor T, Higgins-Biddle J, Saunders J, Monteiro M. AUDIT. The alcohol use disorders identification test: guidelines for use in primary care. Geneva: World Health Organisation; 2001.
78.
Marshall AL, Hunt J, Jenkins D. Knowledge of and preferred sources of assistance for physical activity in a sample of urban Indigenous Australians. Int J Behav Nutr Phys Activ. 2008;5:22. doi:10.​1186/​1479-5868-5-22.CrossRef
79.
McElwaine K, Freund M, Campbell E, Knight J, Bowman J, Doherty E, et al. The delivery of preventive care to clients of community health services. BioMed Central Health Serv Res. 2013;13:167.CrossRef
80.
Department of Health and Aged Care. Measuring remoteness: Accessibility/Remoteness Index of Australia (ARIA), Occasional Papers: New Series Number 14. Canberra: Commonwealth of Australia; 2001.
81.
Australian Bureau of Statistics. SEIFA: socio-economic indexes for areas. Canberra: Australian Bureau of Statistics; 2008.
82.
Pagano M, Gauvreau K. Multiple comparisons procedures. Principles of biostatistics. Belmount: Duxbury; 2000.
83.
Grol R, Wensing M, Eccles M. Improving patient care: the implementation of change in clinical practice. London: Elsevier; 2005.
84.
Organ B, Nicholson E, Castle D. Implementing a physical health strategy in a mental health service. Australas Psychiatry. 2010;18(5):456–9.CrossRefPubMed
85.
Ehrlich C, Kendall E, Frey N, Denton M, Kisely S. Consensus building to improve the physical health of people with severe mental illness: a qualitative outcome mapping study. BioMed Central Health Serv Res. 2015;15:83. doi:10.​1186/​s12913-015-0744-0.CrossRef
86.
87.
Vidrine J, Shete S, Cao Y, Greisinger A, Harmonson P, Sharp B, et al. Ask advise connect: a new approach to smoking treatment delivery in healthcare settings. JAMA. 2013;173(6):458–64.
88.
89.
90.
Rose SA, Poynter PS, Anderson JW, Noar SM, Conigliaro J. Physician weight loss advice and patient weight loss behavior change: a literature review and meta-analysis of survey data. Int J Obes (Lond). 2013;37(1):118–28. doi:10.​1038/​ijo.​2012.​24.CrossRef
91.
Harris SK, Louis-Jacques J, Knight JR. Screening and brief intervention for alcohol and other abuse. Adolesc Med. 2014;25(1):126–56.
92.
Stead L, Perera R, Lancaster T. Telephone counselling for smoking cessation. Cochrane Database Syst Rev. 2006;3:CD002850.PubMed
93.
Eakin E, Lawler S, Vandelanotte C, Owen N. Telephone interventions for physical activity and dietary behavior change: a systematic review. Am J Prev Med. 2007;32(5):419–34.CrossRefPubMed
94.
95.
Ossip-Klein D, McIntosh S. Quitlines in North America: evidence base and applications. Am J Med Sci. 2003;326(4):201–5.CrossRefPubMed
96.
Newman V, Flatt S, Pierce J. Telephone counseling promotes dietary change in healthy adults: results of a pilot trial. J Am Diet Assoc. 2008;108(8):1350–4.CrossRefPubMed
97.
Robson D, Hadded M, Gray R, Gournay K. Mental health nursing and physical health care: a cross sectional study of nurses’ attitudes, practice and perceived training needs for the physical health care of people with severe mental illness. Int J Ment Health Nurs. 2013;22(5):409–17.CrossRefPubMed
98.
Johnson J, Malchy L, Ratner P, Hossain S, Procyshyn R, Bottorff J, et al. Community mental healthcare providers’ attitudes and practices related to smoking cessation interventions for people living with severe mental illness. Patient Educ Couns. 2009;77(2):289–95.CrossRefPubMed
99.
100.
Bartlem K, Bowman J, Ross K, Freund M, Wye P, McElwaine K et al. Mental health clinician attitudes to the provision of preventive care for chronic disease risk behaviours and association with care provision. BMC Psychiatry. Accepted for publication.
101.
Lawrence C, Bluhm J, Foldes S, Alesci N, Klatt C, Center B, et al. A randomized trial of a pay-for-performance program targeting clinician referral to a state tobacco quitline. Arch Intern Med. 2008;168(18):1993–9.CrossRef
102.
Krist A, Woolf S, Frazier C, Johnson R, Rothemich S, Wilson D, et al. An electronic linkage system for health behavior counseling: Effect on delivery of the 5A’s. Am J Prev Med. 2008;35(5S):S350–8.CrossRefPubMed
103.
104.
Conroy M, Majchrzak N, Silverman C, Chang Y, Regan S, Schneider L, et al. Measuring provider adherence to tobacco treatment guidelines: a comparison of electronic medical record review, patient survey, and provider survey. Nicotine Tob Res. 2005;7(Supp1):S35–43.CrossRefPubMed
105.
Durlak JA, DuPre EP. Implementation matters: a review of research on the influence of implementation on program outcomes and the factors affecting implementation. Am J Community Psychol. 2008;41(3–4):327–50. doi:10.​1007/​s10464-008-9165-0.CrossRefPubMed
Metadata
Title
Effectiveness of an intervention in increasing the provision of preventive care by community mental health services: a non-randomized, multiple baseline implementation trial
Authors
Kate M. Bartlem
Jenny Bowman
Megan Freund
Paula M. Wye
Daniel Barker
Kathleen M. McElwaine
Luke Wolfenden
Elizabeth M. Campbell
Patrick McElduff
Karen Gillham
John Wiggers
Publication date
01-12-2015
Publisher
BioMed Central
Published in
Implementation Science / Issue 1/2015
Electronic ISSN: 1748-5908
DOI
https://doi.org/10.1186/s13012-016-0408-4

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