Quality of diabetes care among adults with serious mental illness
ABSTRACT The study compared the quality of care for type 2 diabetes delivered to two groups with type 2 diabetes--adults with serious mental illness and those with no serious mental illness--in a range of community-based clinic settings.
Cross-sectional analyses of medical chart data from 300 patients (201 with serious mental illness and 99 without serious mental illness) were used to examine indicators of the quality of care established by the Diabetes Quality Improvement Project. Recommended services assessed included glycosylated hemoglobin examination, eye and foot examinations, blood pressure check, and urine and lipid profiles. Self-report data were used to compare receipt of provider-delivered diabetes education and receipt of cues regarding self-management of diabetes for the two study groups.
Evidence of lower quality of diabetes care was found for persons with serious mental illness as reflected by their receipt of fewer recommended services and less education about diabetes, compared with those without serious mental illness. Although participants with serious mental illness were less likely to receive cues from providers regarding the need for glucose self-monitoring, they were as likely as those without serious mental illness to receive cues regarding diet and medication adherence.
Although participants with serious mental illness received some services that are indicated in quality-of-care standards for diabetes, they were less likely to receive the full complement of recommended services and care support, suggesting that more effort may be required to provide optimal diabetes care to these vulnerable patients.
SourceAvailable from: Brendon Stubbs[Show abstract] [Hide abstract]
ABSTRACT: Background Prevalence rates of smoking in people with mental illness are high and premature mortality attributed to tobacco related physical comorbidity is a major concern. We conducted a meta-analysis comparing rates of receipt of smoking cessation advice among people with and without mental illness. Method Major electronic databases were searched from inception till August 2014 for studies comparing rates of receipt of smoking cessation advice of people with and without a mental illness. Two independent authors completed methodological appraisal and extracted data. A random effects meta-analysis was utilized. Results Seven studies of satisfactory methodological quality (n mental illness = 68,811, n control = 652,847) were included. Overall there was no significant difference in smoking cessation advice rates between those with and without a mental illness (RR = 1.02, 95% CI: 0.94 – 1.11-, n = 721,658, Q = 1421, p < 0.001). Subgroup analyses demonstrated people with severe mental illness (SMI) received comparable rates of smoking cessation advice to those without SMI (RR = 1.09, 95% CI 0.98-1.2, n = 559,122). This remained true for people with schizophrenia (RR = 1.09, 95% CI 0.68-1.70) and bipolar disorder (RR = 1.14, 95% CI 0.85-1.5). People with non-severe mental illnesses were slightly more likely to receive smoking cessation advice (RR = 1.16, 95% CI = 1.04-1.30, Q = 1364, p < 0.001, n = 580,206). Conclusions People with SMI receive similar smoking cessation advice rates as people without mental illness, whilst those with non-severe mental illness are slightly more likely to receive smoking cessation advice. Whilst progress has been made, offering smoking cessation advice should receive a higher priority in everyday clinical practice for patients with a mental health diagnosis.General Hospital Psychiatry 12/2014; 37(1). DOI:10.1016/j.genhosppsych.2014.11.006 · 2.90 Impact Factor
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ABSTRACT: Mental health condition (MHC) comorbidity is associated with lower intensity care in multiple clinical scenarios. However, little is known about the effect of MHC upon clinicians' decisions about intensifying antiglycemic medications in diabetic patients with poor glycemic control. We examined whether delay in intensification of antiglycemic medications in response to an elevated Hemoglobin A1c (HbA1c) value is longer for patients with MHC than for those without MHC, and whether any such effect varies by specific MHC type.BMC Health Services Research 01/2014; 14(1):458. DOI:10.1186/1472-6963-14-458 · 1.66 Impact Factor
Conference Paper: Why Nursing Leadership is Essential for Integrated Care[Show abstract] [Hide abstract]
ABSTRACT: Why Nursing Leadership is essential for Integrated Care A quickly evolving idea within health care reform is integrated care where a person would have both their medical and behavioral health needs addressed within the primary care structure. Given the prevalence of mental health issues in the general population and common medical co-morbities in the seriously mentally ill population, the federal government, consumers and mental health advocates have rallied significant support for integrated care. While models for system integration and templates for care coordination are rapidly emerging, plans for the work force needed to enact integrated care have not moved forward with the same clarity and vision. Integrated primary care will demand a work force with improved mental health assessment skills and require clinicians capable of matching the intensity of services with the intensity of need around both medical and behavioral issues. Integrated care will also require clinicians with strong interpersonal skills who are capable of resonating with a persons self state and apprehending his/her narrative of illness. Only with this interpersonal connection will the clinician create the compassionate environment that allows conditions of hope to flourish. This presentation discusses the growing interest in situating integrated care in a person-centered health care home, the implications of adopting this framework, and the unique capabilities nurses bring to this model, particularly interpersonal skills and the compassion necessary to stimulate therapeutic optimism. A popular strategy in creating integrated health care services is to bring in a mental health professional to supplement the primary care practitioners skills. But by virtue of their training, NPs have the base for both sets of skills, particularly for the relationship building that is critical to mental health care. It is these interpersonal skills that will create the requisite culture for patient-centered care; yet skills that without nursing leadership will be easily overlooked by health care planners. Strategies for increasing nursing presence in national work force planning are discussed. Discussion will center on what material needs to be added to nurse practitioner training to facilitate interested NPs success in leading culture changes toward patient-centered care and effective integrated care.The National Organization of Nurse Practitioner Faculties 39th Annual Meeting; 04/2013