University of Waikato, Hamilton, New Zealand.
Southern District Health Board, Dunedin, New Zealand.
J Psychiatr Ment Health Nurs. 2021 Dec;28(6):1005-1017. doi: 10.1111/jpm.12729. Epub 2021 Jan 24.
WHAT IS KNOWN ON THIS SUBJECT?: The physical health of people with serious mental illness (SMI) is an issue of growing concern in New Zealand and internationally. Metabolic syndrome is prevalent among people with severe mental illness and increases the likelihood of developing cardiovascular disease and diabetes. No previous international research has investigated rates of metabolic monitoring in specialist mental health services and in primary care. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Rates of metabolic monitoring are low in this specialist mental health service and in primary care. Primary care nurses are positive in their views of their role in providing care for people with mental illness, and would value further education in this area. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Services need to consider ways in which nurses can be supported to improve rates of metabolic monitoring. Guidelines may have a role to play in improved monitoring but need service-level support in order to be effective. ABSTRACT: Introduction People with serious mental illness experience significant disparities in their physical health compared with the general population. One indicator of health impairment is metabolic syndrome, which increases the likelihood of developing cardiovascular disease and diabetes. No international studies have reported both primary care and mental health nurses' rates of metabolic monitoring among people with serious mental illness, and no New Zealand studies have investigated rates of metabolic monitoring. Aim To evaluate metabolic monitoring practices within one of New Zealand's 20 district health board regions. Method An audit of clinical records in primary care (n = 46) and secondary care (n = 47) settings and a survey of practice nurses were conducted. A survey was sent to 127 practice nurses with a response rate of 19% (n = 24). Data were analysed using descriptive statistics. Results Rates of metabolic monitoring were low in both services. Survey participants expressed positive views towards physical health monitoring and confidence in relating to mental health consumers. Rates of treatment of metabolic abnormalities were low, and communication between primary and secondary services was limited. Conclusion Despite existence of guidelines and protocols, metabolic monitoring rates in both primary and secondary health services are low. Incorporating metabolic monitoring systems into service delivery, supported by appropriate tools and resourcing, is essential to achieve better clinical outcomes for people experiencing mental illness.
在新西兰和国际上，严重精神疾病（SMI）患者的身体健康是一个日益受到关注的问题。代谢综合征在严重精神疾病患者中很常见，增加了患心血管疾病和糖尿病的可能性。以前没有国际研究调查过专门的精神卫生服务和初级保健中的代谢监测率。本文增加了哪些新知识：在这个专门的精神卫生服务机构和初级保健中，代谢监测的比例很低。初级保健护士对他们在为精神疾病患者提供护理方面的角色持积极态度，并希望在这一领域接受进一步的教育。这对实践有什么影响：服务机构需要考虑如何支持护士提高代谢监测率。指南在提高监测率方面可能发挥作用，但需要在服务层面上得到支持才能发挥作用。
引言与一般人群相比，严重精神疾病患者的身体健康存在显著差异。健康受损的一个指标是代谢综合征，它增加了患心血管疾病和糖尿病的可能性。没有国际研究报告过严重精神疾病患者的初级保健和精神科护士的代谢监测率，也没有新西兰研究调查过代谢监测率。目的评估新西兰 20 个地区卫生委员会之一的代谢监测实践。方法对初级保健（n=46）和二级保健（n=47）环境中的临床记录进行审计，并对执业护士进行调查。向 127 名执业护士发送了一份调查，回应率为 19%（n=24）。使用描述性统计对数据进行分析。结果两项服务中的代谢监测率均较低。调查参与者对身体健康监测表示出积极的看法，并对与精神卫生消费者建立关系有信心。代谢异常的治疗率较低，初级和二级服务之间的沟通有限。结论尽管存在指南和方案，但初级和二级卫生服务中的代谢监测率都很低。将代谢监测系统纳入服务提供，辅以适当的工具和资源，对于改善精神疾病患者的临床结果至关重要。
