Don’t just screen intervene; a quality improvement initiative to improve physical health screening of young people experiencing severe mental illness

Publication Date14 March 2016
Date14 March 2016
AuthorPaul Jon Greenwood,David Edward Shiers
SubjectHealth & social care,Mental health
Dont just screen intervene; a quality
improvement initiative to improve physical
health screening of young people
experiencing severe mental illness
Paul Jon Greenwood and David Edward Shiers
Paul Jon Greenwood is Project
Manager at the Department
of Mental Health, AQuA,
Salford, UK.
David Edward Shiers is a retired
GP, Leek, UK.
Purpose The purpose of this paper is to improve the quality of monitoring of risk factors that predict the
likelihood of people with severe mental illness (SMI) developing cardiovascular disease (CVD), diabetes and
obesity, major contributors to poor physical health and risk of premature mortality.
Design/methodology/ approach ThefirstphaseoftheAQuADont just screen-intervene
initiative supported five specialised community-based Early Intervention for Psychosis services in
North West England to assess the effectiveness of monitoring of cardiometabolic risk in their patients
using standards derive d from the Lester Positiv e Cardiometabolic Heal th Resource, a national ly
acknowledged framework for people with psychosis receiving antipsychotic medication.
The initial findings for med the basis for a quality i mprovement programme w hich ran from November
2012 until May 2013.
Findings By the end of a six month quality improvement programme the likelihood of a patient receiving a
comprehensive cardiometabolic risk screening (evidenced by recorded measurement of body mass index or
waist circumference, blood pressure, blood glucose and lipid profile, assessment of smoking status and
enquiry of relevant family history) had increased from 10 to between 63 and 80 per cent.
Research limitations/implications Cardiometabolic risk monitoring from the onset of psychosis and its
treatment can be improved utilising quality improvement methodology in real-world specialist mental health
services. Earlier identification and treatment of risk factors that predict higher rates of obesity, diabetes and
SMI may help people with SMI avoid life-restricting and life-shortening physical disorders.
Practical implications Given the National Audit of Schizophrenia findings of inadequate screening
in those with established SMI alongside evidence that CVD risk can emerge early in the course
of psychosis, a group of ea rly intervention in psyc hosis services in Nort h West England decided to
examine this aspect of their routine clinical practice. This service evaluation describes the effectiveness
of a quality improvement programme based on the Lester Positive Cardiometabolic Health
Resource (referred to as Lester resource henceforth) to improve the effectiveness of monitoring of risk
factors that predict the likelihood of people experiencing psychosis and schizophrenia developing CVD
diabetes and obesity.
Social implications A combination of social disadvantage and unhealthy lifestyles,
adverse cardiometabolic impacts of antipsychotic medication and inequitable access to
physical healthcare combine to put people with SMI at particular risk from CVD, the single
biggest cause of premature death, and much more common than suicide (Brown et al., 2010).
Despite higher rates of potentially modifiable CVD risk factors (De Hert et al.,2009) people with SMI appear
to be missing out on opportunities to actively prevent conditions like CVD and diabetes compared to the
general population.
Originality/value People with SMI such as schizophrenia die 15-20 years earlier on average than the
general population. Around 20 per cent of premature deaths can be explained by suicide and injury, but
the remainder arise from a variety of natural causes such as CVD, chronic obstructive pulmonary disorder and
Received 19 January 2015
Revised 3 February 2015
21 April 2015
3 July 2015
Accepted 5 August 2015
AQuA project team, Cheshire and
Wirral Partnership Foundation
Trust Ellesmere Port EIS,
Merseycare NHS Trust Mossley
Hill EIS, Pennine Care NHS
Foundation Trust Tameside EIS,
Five Boroughs Partnership NHS
Foundation Trust Widnes EIS,
Lancashire Care NHS Foundation
Trust Accrington EIS, North West
Young Minds, VIK programme,
Service users from across the
Early Intervention Teams.
Declaration of interests: Dr David
Shiers acknowledges in the paper
that he is a Member of current
NICE quality standard group for
psychosis and schizophrenia in
adults; Board member of the
National Collaborating Centre for
Mental Health; Clinical Advisor
(paid consultancy basis) to
National Audit of Schizophrenia.
PAG E 48
VOL. 21 NO. 1 2016, pp. 48-60, © Emerald Group Publishing Limited, ISSN 1361-9322 DOI 10.1108/MHRJ-01-2015-0003

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