McBain Hayley, Lamontagne-Godwin Frederique, Haddad Mark, Simpson Alan, Chapman Jacqui, Jones Julia, Flood Chris, Mulligan Kathleen
School of Health Sciences, University of London, London, UK.
College of Nursing, Midwifery and Healthcare, University of West London, London, UK.
BMJ Open. 2018 Feb 15;8(2):e019400. doi: 10.1136/bmjopen-2017-019400.
To establish healthcare professionals' (HCPs) views about clinical roles, and the barriers and enablers to delivery of diabetes care for people with severe mental illness (SMI).
Cross-sectional, postal and online survey.
Trusts within the National Health Service, mental health and diabetes charities, and professional bodies.
HCPs who care for people with type 2 diabetes mellitus (T2DM) and/or SMI in the UK.
The barriers, enablers and experiences of delivering T2DM care for people with SMI, informed by the Theoretical Domains Framework.
Respondents were 273 HCPs, primarily mental health nurses (33.7%) and psychiatrists (32.2%). Only 25% of respondents had received training in managing T2DM in people with SMI. Univariate analysis found that mental health professionals felt responsible for significantly fewer recommended diabetes care standards than physical health professionals (P<0.001). For those seeing diabetes care as part of their role, the significant barriers to its delivery in the multiple regression analyses were a lack of knowledge (P=0.003); a need for training in communication and negotiation skills (P=0.04); a lack of optimism about the health of their clients (P=0.04) and their ability to manage T2DM in people with SMI (P=0.003); the threat of being disciplined (P=0.02); fear of working with people with a mental health condition (P=0.01); a lack of service user engagement (P=0.006); and a need for incentives (P=0.04). The significant enablers were an understanding of the need to tailor treatments (P=0.04) and goals (P=0.02) for people with SMI.
This survey indicates that despite current guidelines, diabetes care in mental health settings remains peripheral. Even when diabetes care is perceived as part of an HCP's role, various individual and organisational barriers to delivering recommended T2DM care standards to people with SMI are experienced.
了解医疗保健专业人员（HCPs）对临床角色的看法，以及为重度精神疾病（SMI）患者提供糖尿病护理的障碍和促进因素。
横断面邮政和在线调查。
英国国民健康服务体系内的信托机构、心理健康和糖尿病慈善机构以及专业团体。
在英国为2型糖尿病（T2DM）和/或SMI患者提供护理的HCPs。
依据理论领域框架，了解为SMI患者提供T2DM护理的障碍、促进因素和经验。
273名HCPs参与了调查，主要是心理健康护士（33.7%）和精神科医生（32.2%）。只有25%的受访者接受过为SMI患者管理T2DM的培训。单因素分析发现，心理健康专业人员认为自己对推荐的糖尿病护理标准所负的责任明显少于身体健康专业人员（P<0.001）。在多元回归分析中，对于那些将糖尿病护理视为其职责一部分的人来说，提供护理的重大障碍包括缺乏知识（P=0.003）；需要沟通和谈判技能培训（P=0.04）；对患者健康缺乏乐观态度（P=0.04）以及他们为SMI患者管理T2DM的能力（P=0.003）；受到纪律处分的威胁（P=0.02）；害怕与有心理健康问题的人合作（P=0.01）；缺乏服务使用者参与（P=0.006）；以及需要激励措施（P=0.04）。重要的促进因素是理解需要为SMI患者调整治疗（P=0.04）和目标（P=0.02）。
本次调查表明，尽管有现行指南，但心理健康环境中的糖尿病护理仍然处于边缘地位。即使糖尿病护理被视为HCP职责的一部分，在为SMI患者提供推荐的T2DM护理标准方面，仍存在各种个人和组织障碍。
