Evaluation of a Physical health plan for people with psychosis: a protocol for a quality improvement study

Abstract

Background: People with serious mental illness (SMI) have poorer physical health and reduced lifespans compared to the general population. Reasons for this are complex, but one important area is the identification and treatment of physical health conditions. In England, services are structured into primary and secondary care; physical and mental secondary health services are separate. This often leads to a lack of co-ordination of care, with people missing the screening and treatment they need. People with SMI may find accessing physical health services more difficult due to the impact of their symptoms and/or a lack of social support. When they do access physical care, there may be 'diagnostic overshadowing' where physical health concerns are put down to a mental health diagnosis. Creating tools to support people with SMI to assume more control of their physical health may help to ameliorate some of these problems. The aim of this study is to evaluate the use of a service user-held Physical health plan (PHP) for secondary mental health service users to determine whether its use increases uptake of physical health services.

Methods: We will undertake a pilot quality improvement (QI) study to test the use of the PHP. The development of the PHP is described. A Theory of Change (ToC) has been developed which we will test to understand how the PHP is used, using focus groups at the beginning of the study. We will then pilot the use of the PHP for 6 months in two community mental health teams to find out how people use it, what actions are taken, and if it increases uptake of physical health care. We will use the RE-AIM implementation framework to guide the evaluation. After the pilot, we will undertake interviews with service users and clinical staff to elicit their views on using the PHP.

Discussion: This study uses QI methodology and an implementation framework to test a novel intervention for people with SMI. If successful, the intervention will support people with SMI to access physical health services. The study will inform the design of a larger-scale definitive RCT.

Trial registration: ClinicalTrials.gov Identifier: NCT03178279. Registered date: 05/06/2017.

Keywords: Mental health services; Physical health; Psychotic disorders; Quality improvement.

Conflict of interest statement

Ethical approval for this study has been given by the Westminster Research Ethics Committee, ref: 17/LO/0831. Participants will be asked to give written informed consent by a researcher after being given time to read the patient information sheet and being given time to ask any questions.Not applicableNS is the director of London Safety and Training Solutions Ltd, which provides training and advisory services to healthcare organisations and training programmes globally. FG has received support or honoraria for CME, has advisory work and lectures from Bristol-Myers Squibb, Janssen, Lundbeck, Otsuka, Roche, and Sunovion, and has a family member with professional links to Lilly and GSK, including shares. FG is in part funded by the National Institute for Health Research’s (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London, by the South London Collaboration for Leadership in Applied Health Research and Care Funding scheme, and by the Maudsley Charity.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1

PHP process

Fig. 2

Theory of Change for the present study

Fig. 3

PHP study schedule of enrolment and assessments