Institute of Dentistry, Queen Mary University of London, London, UK.
Royal London Dental Hospital, Barts Health NHS Trust, London, United Kingdom.
Health Expect. 2024 Oct;27(5):e70005. doi: 10.1111/hex.70005.
There is wide variation in premature mortality rates in adults with severe mental illness (SMI) across London, with Tower Hamlets (a highly deprived and ethnically diverse area) scoring the highest.
To identify examples of best practice and co-design recommendations for improving physical health checks and follow-up care amongst people with SMI in Tower Hamlets.
Data were collected through online questionnaires (using SMI physical health best practice checklists), one-on-one interviews (n = 7) and focus groups (n = 3) with general practices, secondary mental health services, commissioners and leads of community services and public health programmes, experts by experience and community, voluntary and social enterprise organisations in Tower Hamlets. Data were analysed using deductive and inductive thematic analysis.
Twenty-two participants representing 15 general practices (out of 32), secondary mental health services, commissioners and public health leads completed the online questionnaires. Twenty-one participants took part in interviews and focus groups. Examples of best practice included cleaning and validating the SMI register regularly by general practices, knowing the number of patients who had been offered and/or received physical health checks, having clear pathways to community and specialist care services, using various communication methods and having a key performance indicator (KPI) for tailored smoking cessation services for people with SMI. Recommendations included adopting evidence-informed frameworks for risk stratification and utilising the wider primary care workforce with specific training to follow up on results, offer interventions and support navigating pathways and taking up follow-up care. Incentivising schemes were needed to deliver additional physical health check components such as oral health, cancer screening, Covid-19 vaccination and sexual health checks. Including KPIs in other community services' specifications with reference to SMI people was warranted. Further engagement with experts by experience and staff training were needed.
The present initiative identified best practice examples and co-designed recommendations for improving physical health checks and follow-up care in deprived and ethnically diverse people with SMI.
This initiative was supported by three experts with experience, and two community organisations, who were involved in data curation and interpretation, development of recommendations and/or dissemination activities including writing this manuscript.
伦敦严重精神疾病（SMI）成年人的过早死亡率差异很大，其中塔哈姆雷特（一个高度贫困和种族多样化的地区）得分最高。
确定改善塔哈姆雷特 SMI 人群身体健康检查和后续护理的最佳实践示例和共同设计建议。
通过在线问卷（使用 SMI 身体健康最佳实践清单）、一对一访谈（n=7）和焦点小组（n=3）收集数据，受访者包括一般实践、二级精神卫生服务、委员会和社区服务以及公共卫生计划的负责人、经验丰富的专家以及社区、志愿和社会企业组织。使用演绎和归纳主题分析方法对数据进行分析。
22 名代表 32 个中的 15 个一般实践、二级精神卫生服务、委员会和公共卫生负责人的参与者完成了在线问卷。21 名参与者参加了访谈和焦点小组。最佳实践的示例包括一般实践定期清洁和验证 SMI 登记、了解提供和/或接受身体健康检查的患者人数、拥有通往社区和专科护理服务的明确途径、使用各种沟通方法以及为 SMI 患者提供量身定制的戒烟服务的关键绩效指标（KPI）。建议包括采用风险分层的循证框架，利用更广泛的初级保健劳动力，并进行特定培训，以跟进结果、提供干预措施、支持导航途径并接受后续护理。需要激励计划来提供额外的身体健康检查内容，如口腔健康、癌症筛查、Covid-19 疫苗接种和性健康检查。在其他社区服务的规范中包含与 SMI 人群相关的 KPI 是合理的。需要进一步与经验丰富的专家和员工培训进行接触。
本倡议确定了改善贫困和种族多样化 SMI 人群身体健康检查和后续护理的最佳实践示例和共同设计建议。
本倡议得到了三位经验丰富的专家和两个社区组织的支持，他们参与了数据管理和解释、建议的制定和/或传播活动，包括撰写本文。
