Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, W1T 7NF, London, United Kingdom.
Department of Applied Health Research, UCL, 1-19 Torrington Place, WC1E 7H, London, United Kingdom.
BMC Health Serv Res. 2024 Feb 28;24(1):255. doi: 10.1186/s12913-024-10628-6.
Cardiovascular disease among patients with severe mental illness in England is a major preventable contributor to premature mortality. To address this, a nurse and peer-coach delivered service (Primrose-A) was implemented in three London general practices from 2019 (implementation continued during COVID-19). This study aimed to conduct interviews with patient and staff to determine the acceptability of, and experiences with, Primrose-A.
Semi-structured audio-recorded interviews with eight patients who had received Primrose-A, and 3 nurses, 1 GP, and 1 peer-coach who had delivered Primrose-A in three London-based GP surgeries were conducted. Reflexive thematic analysis was used to identify themes from the transcribed interviews.
Overall, Primrose-A was viewed positively by patients and staff, with participants describing success in improving patients' mental health, isolation, motivation, and physical health. Therapeutic relationships between staff and patients, and long regular appointments were important facilitators of patient engagement and acceptance of the intervention. Several barriers to the implementation of Primrose-A were identified, including training, administrative and communication issues, burden of time and resources, and COVID-19.
Intervention acceptability could be enhanced by providing longer-term continuity of care paired with more peer-coaching sessions to build positive relationships and facilitate sustained health behaviour change. Future implementation of Primrose-A or similar interventions should consider: (1) training sufficiency (covering physical and mental health, including addiction), (2) adequate staffing to deliver the intervention, (3) facilitation of clear communication pathways between staff, and (4) supporting administrative processes.
在英国，患有严重精神疾病的患者的心血管疾病是导致过早死亡的主要可预防因素。为了解决这个问题，自 2019 年以来，在伦敦的三个全科医生诊所中实施了一项由护士和同伴教练提供的服务（Primrose-A）（在 COVID-19 期间继续实施）。本研究旨在对接受过 Primrose-A 的 8 名患者和 3 名护士、1 名全科医生和 1 名同伴教练进行访谈，以确定 Primrose-A 的可接受性和经验。
对在伦敦的三个全科医生诊所中接受过 Primrose-A 的 8 名患者以及 3 名护士、1 名全科医生和 1 名同伴教练进行了半结构化的音频记录访谈。使用反思性主题分析从转录的访谈中确定主题。
总体而言，Primrose-A 受到患者和工作人员的好评，参与者描述了改善患者心理健康、孤立感、动力和身体健康方面的成功。工作人员与患者之间的治疗关系以及长期定期预约是促进患者参与和接受干预的重要促进因素。确定了实施 Primrose-A 的几个障碍，包括培训、行政和沟通问题、时间和资源的负担以及 COVID-19。
通过提供长期持续的护理并增加更多的同伴辅导课程，可以增强干预措施的可接受性，以建立积极的关系并促进持续的健康行为改变。未来实施 Primrose-A 或类似干预措施时应考虑：（1）培训充足性（涵盖身体和心理健康，包括成瘾），（2）有足够的工作人员提供干预，（3）促进工作人员之间清晰的沟通途径，以及（4）支持行政流程。
