AN EVALUATION OF THE NORTHAMPTON PHYSICAL HEALTH AND WELLBEING (PhyHWell) PROJECT
Abstract Background The first study to demonstrate that life expectancy in patients with a severe mental illness (SMI) was reduced was by Farr in 1841. More recently, comparative research has demonstrated a higher level of cardiovascular disease (CVD) than the rest of the population in this group. Despite this knowledge, little has changed in routine practice. One barrier could be that the educational needs of the primary care healthcare professionals in this area are not being met. Aims The aim of this programme of research is to address the physical health needs of people with SMI by improving the practice of healthcare professionals in primary care. Methods The methods employed are the development of a training package and a programme of research divided into eight studies: 1. A retrospective audit to find out whether patients will attend for a health check if they are invited. 2. A prospective audit to see if a tool used for people with physical illnesses to improve their lifestyle (a food diary) is as effective when used with the SMI population. 3. A systematic search to find out what evidence there is for the efficacy of healthcare professional educational outcomes in studies of physical health in SMI. 5 4. The development of a training package for practice nurses to teach them how to carry out physical health checks for people with SMI. 5. A retrospective audit to establish whether as many people with SMI are being screened for cardiovascular disease as people with physical conditions in Northampton. 6. An audit to find out whether as many people with SMI are being screened for cardiovascular disease as people with physical conditions in England. 7. A before and after study to measure the effect of a physical health and SMI training on the practice nurses’ motivation to carry out physical health checks for people with SMI. 8. A before and after study to establish whether training practice nurses to carry out physical health checks for people with SMI increases the level of screening for cardiovascular risk in this group. 9. A qualitative study using interviews with patients with SMI to find out what they think about the physical health checks. Results There were a total of 2,796 patients and eight healthcare professionals included in the programme in Northampton and 2,911,914 patients in the national study. People with SMI will attend for a health check if invited by letter giving them an appointment with a named practitioner (66%). The patients with schizophrenia were all successful in completing food diaries. There were no studies identified as suitable for a systematic review. In the five participating primary care practices in Northampton, the people with SMI received less CVD screening than those with diabetes (21% v 96%, CI=64.53 to 126.55: p<.01). In the 6 national study, patients with diabetes received higher levels of screening in the previous 15 months than those with SMI (97.3% vs 74.7%; p<0.0001). The attitudes of the practice nurses involved in the study towards their role in providing health checks appeared to be modified in a positive direction. Following the training of practice nurses, each individual patient received more CVD screening and lifestyle information (3.85 v 2.69: t=8.22, p<.05). The patients who were interviewed about their physical health check had a good understanding of the importance of a healthy diet and taking regular exercise but did not appear aware of the risk of cardiovascular disease. Conclusion Simple changes in the way patients with SMI are invited to attend a health check increases attendance rates. The quality of primary care health checks for this population is inferior to those provided to patients with diabetes. Training practice nurses improves the quality of the health checks but still not to the levels received by other patient groups.
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