Bailey Jacqueline M, Bartlem Kate M, Wiggers John H, Wye Paula M, Stockings Emily A L, Hodder Rebecca K, Metse Alexandra P, Regan Tim W, Clancy Richard, Dray Julia A, Tremain Danika L, Bradley Tegan, Bowman Jenny A
School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, NSW, Australia.
Hunter Medical Research Institute, Clinical Research Centre, NSW, Australia.
Prev Med Rep. 2019 Aug 14;16:100969. doi: 10.1016/j.pmedr.2019.100969. eCollection 2019 Dec.
People with mental illness experience increased chronic disease burden, contributed to by a greater prevalence of modifiable chronic disease risk behaviours. Policies recommend mental health services provide preventive care for such risk behaviours. Provision of such care has not previously been synthesised. This review assessed the provision of preventive care for modifiable chronic disease risk behaviours by mental health services. Four databases were searched from 2006 to 2017. Eligible studies were observational quantitative study designs conducted in mental health services, where preventive care was provided to clients for tobacco smoking, harmful alcohol consumption, inadequate nutrition, or inadequate physical activity. Two reviewers independently screened studies, conducted data extraction and critical appraisal. Results were pooled as proportions of clients receiving or clinicians providing preventive care using random effects meta-analyses, by risk behaviour and preventive care element (ask/assess, advise, assist, arrange). Subgroup analyses were conducted by mental health service type (inpatient, outpatient, other/multiple). Narrative synthesis was used where meta-analysis was not possible. Thirty-eight studies were included with 26 amenable to meta-analyses. Analyses revealed that rates of assessment were highest for smoking (78%, 95% confidence interval [CI]:59%-96%) and lowest for nutrition (17%, 95% CI:1%-35%); with variable rates of care provision for all behaviours, care elements, and across service types, with substantial heterogeneity across analyses. Findings indicated suboptimal and variable provision of preventive care for modifiable chronic disease risk behaviours in mental health services, but should be considered with caution due to the very low quality of cumulative evidence. PROSPERO registration: CRD42016049889.
患有精神疾病的人慢性病负担增加，这是由可改变的慢性病风险行为的更高患病率所致。政策建议精神卫生服务机构针对此类风险行为提供预防性护理。此前尚未对这种护理的提供情况进行综合分析。本综述评估了精神卫生服务机构针对可改变的慢性病风险行为提供预防性护理的情况。检索了2006年至2017年的四个数据库。纳入的合格研究为在精神卫生服务机构开展的观察性定量研究设计，其中针对吸烟、有害饮酒、营养不足或身体活动不足为服务对象提供了预防性护理。两名评审员独立筛选研究、进行数据提取和批判性评价。通过随机效应荟萃分析，按风险行为和预防性护理要素（询问/评估、建议、协助、安排）汇总结果，得出接受预防性护理的服务对象比例或提供预防性护理的临床医生比例。按精神卫生服务类型（住院、门诊、其他/多种）进行亚组分析。在无法进行荟萃分析时采用叙述性综合分析。纳入了38项研究，其中26项适合进行荟萃分析。分析显示，吸烟的评估率最高（78%，95%置信区间[CI]：59%-96%），营养的评估率最低（17%，95%CI：1%-35%）；所有行为、护理要素以及不同服务类型的护理提供率各不相同，各分析之间存在很大异质性。研究结果表明，精神卫生服务机构针对可改变的慢性病风险行为提供的预防性护理未达最佳水平且存在差异，但由于累积证据质量极低，应谨慎看待这些结果。PROSPERO注册号：CRD42016049889。
