- Title
- Translation of chronic disease preventive care guidelines into mental health service delivery
- Creator
- Fehily, Caitlin Mary Claire
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2020
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- Compared to the general population, people with a mental illness experience an inequitable burden of chronic physical disease and a median of 10 years reduced life expectancy. A key contributor to this health inequity is a higher prevalence of four chronic disease risk behaviours: tobacco smoking, poor nutrition, harmful alcohol consumption, and physical inactivity. As acknowledged in clinical practice guidelines and policies, mental health services offer an opportune setting to provide ‘preventive care’ to people with a mental illness, in addition to mental health treatment, to address these four key risk behaviours. Despite this potential, low provision of preventive care by clinicians in routine mental health consultations has been reported internationally, including in Australia. There is a gap in the literature regarding the effectiveness of interventions to increase the provision of preventive care for the four key risk behaviours by mental health services. The numerous clinician-reported barriers to providing preventive care in routine mental health consultations has prompted consideration of an alternative model of care, whereby a ‘specialist preventive care clinician’ is dedicated to the role of providing preventive care in an additional consultation. There is a paucity of research examining the effectiveness of this model in increasing the provision of preventive care to clients of a community mental health service. Research is required to examine not only its effectiveness, but also acceptability, client uptake, and cost-efficiency and affordability in order to determine its appropriateness for translation into policy and practice. To address these evidence gaps, the aims of this thesis were to: 1. Systematically review research regarding the effectiveness of intervention strategies to increase the delivery of preventive care by mental health services. 2. Determine the effectiveness of offering clients of a community mental health service an additional consultation with a ‘specialist preventive care clinician’ in increasing client-reported receipt of preventive care. 3. Explore client acceptability of offering an additional consultation with a specialist preventive care clinician, client uptake of the consultation, and client clinical and sociodemographic characteristics associated with uptake. 4. Determine the incremental costs and cost-effectiveness of the specialist preventive care clinician model in increasing client-reported receipt of referrals to telephone-based chronic disease prevention services, relative to usual service delivery; and undertake a budget impact assessment to determine the financial sustainability of its implementation. A series of studies were undertaken to address these aims. The first was a systematic review and meta-analysis of publications reporting the effectiveness of interventions to increase the provision of preventive care in mental health services. Three other studies were conducted in one community mental health service of regional New South Wales, Australia to address aims 2 to 4: a randomised controlled trial of the effectiveness of allocating a ‘specialist preventive care clinician’ to the dedicated role of offering and providing clients of a community mental health service with an additional preventive care consultation (N = 811); a descriptive study of clients randomised to the intervention condition of the randomised controlled trial, examining client ratings of the acceptability of the specialist clinician model, uptake, and socio-demographic characteristics associated with uptake; and a cost-effectiveness and budget impact analysis of the specialist clinician model undertaken from the perspective of the mental health service. The findings presented in this thesis have contributed to advancing research in this field. Firstly, Chapters 2 & 3 provide a synthesis of the effectiveness of intervention strategies to increase the provision of preventive care in mental health services, providing an evidence-base to inform the selection of effective strategies in future interventions and service initiatives. Chapters 4 & 5 provided evidence to support the effectiveness of offering clients an additional consultation with a specialist preventive care clinician, in increasing client receipt of preventive care for tobacco smoking, poor nutrition, harmful alcohol consumption, and physical inactivity. Findings of Chapter 6 provide the first assessment of client uptake of an additional consultation with the specialist clinician, when such an offer is made universally to all clients, indicating that a considerable proportion of such clients take up this offer, and do so regardless of their clinical and socio-demographic characteristics. Additionally, clients perceive the model of care as acceptable. Lastly, Chapter 7 ascertained the cost-effectiveness of the model of care in encouraging clients to accept referrals to telephone behaviour change services (a key care delivery outcome mandated by the local health district policy of the service), and determined the annual budget required for a community mental health service to implement the model. Overall, this thesis has identified the need to identify effective interventions to increase the provision of preventive care in mental health service settings. Embedding a specialist preventive care clinician in a community mental health service was found to increase client receipt of preventive care, have high client ratings of acceptability and uptake (within the context of a universal offer), and involve a low cost per client. The final chapter of this thesis provides recommendations for future research to identify and address factors that influence client uptake of the additional preventive care consultation and to explore strategies to support the implementation of the model of care.
- Subject
- mental illness; chronic disease; chronic disease risk behaviours; thesis by publication; clinical practice change; preventive care
- Identifier
- http://hdl.handle.net/1959.13/1418357
- Identifier
- uon:37339
- Rights
- Copyright 2020 Caitlin Mary Claire Fehily
- Language
- eng
- Full Text
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| Thumbnail | File | Description | Size | Format | |||
|---|---|---|---|---|---|---|---|
| View Details Download | ATTACHMENT01 | Thesis | 6 MB | Adobe Acrobat PDF | View Details Download | ||
| View Details Download | ATTACHMENT02 | Abstract | 277 KB | Adobe Acrobat PDF | View Details Download |