Richmond Georgia, Kenny Conor, Ahmed Jabed, Stephenson Lucy, Lindsay Jamie, Earls Patrick, Mullin Donncha, Ryland Howard
South London and the Maudsley NHS Foundation Trust.
BMJ Qual Improv Rep. 2017 Feb 9;6(1). doi: 10.1136/bmjquality.u205156.w3484. eCollection 2017.
Patients suffering from mental health illness have considerably more physical health disease burden than the rest of the population and are more likely to die 10 to 20 years younger compared with their peers. Diabetes, cardiovascular and respiratory disease have been recognised as contributing factors to premature death. Furthermore patients with severe mental illness undertake lower levels of physical activity. The aim of the project was therefore to address the inequalities in physical health that affect patients with mental health illness through designing and implementing a sustainable, transferable, patient-centred education and activity intervention. The objective of the project was to increase patient motivation to change behaviour as a result of physical health interventions by increasing patients' physical health understanding, motivation to change their physical health behaviour, motivation to do exercise and by reducing their anxiety. The method used was a prospective cohort study in four eighteen bed psychosis inpatient units. The units were across two large London hospitals in one Hospital Trust involving male and female inpatients with a range of mental health issues. The intervention was comprised of two components. The first component was a weekly 45 minute teaching group designed in collaboration with patients focusing on the key domains that affect the physical health of mental health patients. Four discussion domains (heart health, diabetes and weight, smoking and lung disease, cancer screening and substance misuse) were undertaken, with each cycle lasting four weeks. The second component was a weekly 45 minute exercise group ('normalisation activity') in collaboration with patients and the multidisciplinary team. The intervention was evaluated at the end of each cycle and four cycles in total took place. Weekly pre and post intervention measures were undertaken comprising of a self reported change in understanding, motivation to change physical health behaviours, confidence to change, anxiety and motivation to exercise. The result was a 26% improvement in self-reported understanding across the four domains following teaching. Furthermore patient anxiety reduced by on average 35%, self-reported motivation to change increased by 20%, motivation to do exercise by 26% and confidence to change by 16% as a result of the intervention. The authors conclude that a collaborative approach to education and activity between the Multidisciplinary Team (MDT) and service user results in sustained improvement in understanding of physical health, motivation to change behaviour and to do exercise. It also results in improved confidence and reduced anxiety.
患有精神疾病的患者所承受的身体健康疾病负担比其他人群要大得多，并且与同龄人相比，他们早逝10至20年的可能性更高。糖尿病、心血管疾病和呼吸系统疾病已被确认为过早死亡的促成因素。此外，患有严重精神疾病的患者进行体育活动的水平较低。因此，该项目的目的是通过设计和实施一项可持续、可推广、以患者为中心的教育及活动干预措施，来解决影响精神疾病患者的身体健康方面的不平等问题。该项目的目标是通过增强患者对身体健康的理解、改变其身体健康行为的动机、锻炼的动机以及减轻其焦虑，来提高患者因身体健康干预而改变行为的动机。所采用的方法是在四个拥有18张床位的精神病住院单元中进行一项前瞻性队列研究。这些单元分布在伦敦一家医院信托机构的两家大型医院中，涉及患有一系列精神健康问题的男性和女性住院患者。干预措施由两个部分组成。第一部分是一个每周45分钟的教学小组，该小组是与患者合作设计的，重点关注影响精神疾病患者身体健康的关键领域。进行了四个讨论领域（心脏健康、糖尿病与体重、吸烟与肺病、癌症筛查与药物滥用）的讨论，每个周期持续四周。第二部分是一个每周45分钟的锻炼小组（“常态化活动”），是与患者及多学科团队合作开展的。在每个周期结束时对干预措施进行评估，总共进行了四个周期。每周在干预前后都进行测量，包括自我报告的在理解、改变身体健康行为的动机、改变的信心、焦虑以及锻炼动机方面的变化。结果是，教学后四个领域的自我报告理解水平提高了26%。此外，由于干预，患者焦虑平均降低了35%，自我报告的改变动机增加了20%，锻炼动机增加了26%，改变的信心增加了16%。作者得出结论，多学科团队（MDT）与服务使用者之间在教育和活动方面采取协作方法，会使对身体健康的理解、改变行为和锻炼的动机持续改善。这也会带来信心的提升和焦虑的减轻。
