Department of Mental Health Sciences, Royal Free Campus, University College London Medical School, Rowland Hill Street, London NW3 2PF, UK.
BMC Health Serv Res. 2010 Mar 10;10:61. doi: 10.1186/1472-6963-10-61.
People with severe mental illnesses (SMI) are at increased risk of cardiovascular disease (CVD). Clinical guidelines recommend regular screening for CVD risk factors. We evaluated a nurse led intervention to improve screening rates across the primary-secondary care interface.
Six community mental health teams (CMHTs) were randomised to receive either the nurse led intervention plus education pack (n = 3) or education pack only (n = 3). Intervention (6 months): The nurse promoted CVD screening in primary care and then in CMHTs. Patients who remained unscreened were offered screening by the nurse. After the intervention participants with SMI were recruited from each CMHT to collect outcome data.
Numbers screened during the six months, confirmed in General Practice notes.
All six CMHTs approached agreed to randomisation. 121 people with SMI participated in outcome interviews during two waves of recruitment (intervention arm n = 59, control arm n = 62). Participants from both arms of the trial had similar demographic profiles and rates of previous CVD screening in the previous year, with less than 20% having been screened for each risk factor. After the trial, CVD screening had increased in both arms but participants from the intervention arm were significantly more likely to have received screening for blood pressure (96% vs 68%; adjusted Odds Ratio (OR) 13.6; 95% CI: 3.5-38.4), cholesterol (66.7% vs 26.9%, OR 6.1; 3.2-11.5), glucose (66.7% vs 36.5% OR 4.4; 2.7-7.1), BMI (92.5% vs 65.2% OR 6.5; 2.1-19.6), and smoking status (88.2% vs 57.8% OR 5.5; 3.2-9.5) and have a 10 year CVD risk score calculated (38.2% vs 10.9%) OR 5.2 1.8-15.3). Within the intervention arm approximately half the screening was performed in general practice and half by the trial nurse.
The nurse-led intervention was superior, resulting in an absolute increase of approximately 30% more people with SMI receiving screening for each CVD risk factor. The feasibility of the trial was confirmed in terms of CMHT recruitment and the intervention, but the response rate for outcome collection was disappointing; possibly a result of the cluster design. The trial was not large or long enough to detect changes in risk factors.
International Standard Randomised Controlled Trial Registration Number (ISRCTRN) 58625025.
患有严重精神疾病（SMI）的人患心血管疾病（CVD）的风险增加。临床指南建议定期筛查 CVD 危险因素。我们评估了一种护士主导的干预措施，以改善初级-二级保健界面的筛查率。
将 6 个社区精神卫生团队（CMHT）随机分为接受护士主导的干预加教育包（n = 3）或仅接受教育包（n = 3）。干预（6 个月）：护士在初级保健中促进 CVD 筛查，然后在 CMHT 中促进 CVD 筛查。未接受筛查的患者由护士提供筛查。干预结束后，从每个 CMHT 招募患有 SMI 的患者以收集结局数据。
在六个月内筛查的人数，并在一般实践记录中得到确认。
所有 6 个 CMHT 均同意随机分组。在两轮招募中，共有 121 名 SMI 患者参加了结局访谈（干预组 n = 59，对照组 n = 62）。试验各臂的参与者具有相似的人口统计学特征和前一年 CVD 筛查率，每个危险因素的筛查率不到 20%。试验后，两臂的 CVD 筛查均有所增加，但干预组的参与者更有可能接受血压（96%对 68%；调整后的优势比（OR）13.6；95%CI：3.5-38.4）、胆固醇（66.7%对 26.9%，OR 6.1；3.2-11.5）、血糖（66.7%对 36.5%，OR 4.4；2.7-7.1）、BMI（92.5%对 65.2%，OR 6.5；2.1-19.6）和吸烟状况（88.2%对 57.8%，OR 5.5；3.2-9.5）的筛查，并且计算了 10 年 CVD 风险评分（38.2%对 10.9%，OR 5.2 1.8-15.3）。在干预组中，大约一半的筛查是在一般实践中进行的，另一半是由试验护士进行的。
护士主导的干预措施更有效，导致大约 30%的 SMI 患者接受每个 CVD 危险因素筛查的人数绝对增加。从 CMHT 招募和干预的角度来看，试验的可行性得到了证实，但结局数据采集的应答率令人失望；可能是由于集群设计的结果。该试验的规模或时间都不足以检测到危险因素的变化。
国际标准随机对照试验注册编号（ISRCTN）58625025。
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