Butler Joseph, de Cassan Simone, Glogowska Margaret, Fanshawe Thomas R, Turner Phil, Walton Debbie, Lasserson Daniel, Bale Robert, Lennox Belinda, Hayward Gail
Department of Psychiatry, University of Oxford, UK.
Oxford Health NHS Foundation Trust, UK.
BJPsych Open. 2020 Oct 27;6(6):e127. doi: 10.1192/bjo.2020.110.
Physical health outcomes in severe mental illness are worse than in the general population. Routine physical health check completion in this group is poor.
To quantitatively and qualitatively evaluate the impact of point of care (POC) blood testing on physical health check completion in community mental health services.
In a prospective cohort design, we equipped an early intervention service (EIS) and a community mental health team (CMHT) with a POC blood testing device for 6 months. We compared rates of blood test and full physical health check completion in the intervention teams with a matched EIS and CMHT, historically and during the intervention. We explored attitudes to POC testing using thematic analysis of semi-structured interviews with patients and clinicians.
Although the CMHT scarcely used the POC device and saw no change in outcomes, direct comparison of testing rates in the intervention period showed increased physical health check completion in the EIS with the device (rate ratio RR = 5.18; 95% CI 2.54-12.44; P < 0.001) compared with usual care. The rate was consistent with the EIS's increasing rate of testing over time (RR = 0.45; 95% 0.09-2.08; P = 0.32). Similar trends were seen in blood test completion. POC testing was acceptable to patients but clinicians reported usability, provision and impact on the therapeutic relationship as barriers to uptake.
POC testing was beneficial and acceptable to patients and may increase physical health check uptake. Further research, accounting for clinician barriers, is needed to evaluate its clinical and cost-effectiveness.
严重精神疾病患者的身体健康状况比普通人群更差。该群体的常规身体健康检查完成率很低。
定量和定性评估即时检验（POC）血液检测对社区精神卫生服务中身体健康检查完成情况的影响。
在一项前瞻性队列设计中，我们为一个早期干预服务机构（EIS）和一个社区精神卫生团队（CMHT）配备了即时检验血液检测设备，为期6个月。我们将干预组的血液检测率和全面身体健康检查完成率与一个匹配的EIS和CMHT在历史数据以及干预期间的数据进行了比较。我们通过对患者和临床医生的半结构化访谈进行主题分析，探讨了对即时检验的态度。
尽管CMHT几乎未使用即时检验设备，且结果未出现变化，但干预期间检测率的直接比较显示，配备该设备的EIS的身体健康检查完成率相比常规护理有所提高（率比RR = 5.18；95%置信区间2.54 - 12.44；P < 0.001）。该比率与EIS随时间推移不断上升的检测率一致（RR = 0.45；95% 0.09 - 2.08；P = 0.32）。血液检测完成情况也呈现出类似趋势。即时检验对患者来说是可以接受的，但临床医生报告称，可用性、供应情况以及对治疗关系的影响是采用该检验的障碍。
即时检验对患者有益且可接受，可能会提高身体健康检查的接受度。需要进一步研究以评估其临床和成本效益，同时考虑临床医生面临的障碍。
