Evaluating the effectiveness of a clinical practice change intervention in increasing clinician provision of preventive care in a network of community-based mental health services: a study protocol of a non-randomized, multiple baseline trial

Abstract

BackgroundPeople with a mental illness experience substantial disparities in health, including increased rates of morbidity and mortality caused by potentially preventable chronic diseases. One contributing factor to such disparity is a higher prevalence of modifiable health risk behaviors, such as smoking, inadequate fruit and vegetable intake, harmful alcohol consumption, and inadequate physical activity. Evidence supports the effectiveness of preventive care in reducing such risks, and guidelines recommend that preventive care addressing such risks be incorporated into routine clinical care. Although community-based mental health services represent an important potential setting for ensuring that people with a mental illness receive such care, research suggests its delivery is currently sub-optimal. A study will be undertaken to evaluate the effectiveness of a clinical practice change intervention in increasing the routine provision of preventive care by clinicians in community mental health settings.Methods/designA two-group multiple baseline design will be utilized to assess the effectiveness of a multi-strategic intervention implemented over 12 months in increasing clinician provision of preventive care. The intervention will be implemented sequentially across the two groups of community mental health services to increase provision of client assessment, brief advice, and referral for four health risk behaviors (smoking, inadequate fruit and vegetable consumption, harmful alcohol consumption, and inadequate physical activity). Outcome measures of interest will be collected via repeated cross-sectional computer-assisted telephone interviews undertaken on a weekly basis for 36 months with community mental health clients.DiscussionThis study is the first to assess the effectiveness of a multi-strategic clinical practice change intervention in increasing routine clinician provision of preventive care for chronic disease behavioral risk factors within a network of community mental health services. The results will inform future policy and practice regarding the ability of clinicians within mental health settings to improve preventive care provision as a result of such interventions.Trial registrationAustralian and New Zealand Clinical Trials Registry (ANZCTR) ACTRN12613000693729.

Preventive care for physical activity and fruit and vegetable consumption: a survey of family carer expectations of health service delivery for people with a mental health condition

“…Carers completed items assessing socio-demographic, clinical and health risk behaviours; which were modified from previous research [82]. Items examining the carer and family member relationship, perceptions regarding the impact of health risk behaviours on mental health, and carer expectations of care provision for health risk behaviours by services were developed with input from mental health staff and carers.…”

Effectiveness of an intervention in increasing the provision of preventive care by community mental health services: a non-randomized, multiple baseline implementation trial

“…Outcome data were collected for both groups from 6 months prior to the implementation of the intervention in the first group of services, and continued until 6 months after the completion of the intervention in the second group of services (36-month study period). Further details of the study design and methods have been reported previously [ 67 ]. The study was undertaken in a single regional health district in New South Wales, Australia.…”

Designing Practical Motivational Interviewing Training for Mental Health Practitioners Implementing Behavioral Lifestyle Interventions: Protocol for 3 Pilot Intervention Studies

“…Patients' CVD risk profiles improved significantly in clinical trials in which the study staff incorporated an MI approach to conduct lifestyle interventions among participants with SMI [8][9][10][11][12]. To lessen the disparity of CVD risk experienced by this population on a wider scale, evidence-based programs to improve cardiovascular health need to be implemented in community mental health settings where patients routinely receive their care [13]. Real-world practitioners in these settings need the training not only to deliver the CVD health intervention itself (the requirements of which will likely differ based on education and prior experience) but also for the specific preparation necessary to incorporate an MI approach.…”