Hypertension Clinical Trial
Official title:
Detection and Treatment of Selected Somatic Chronic Diseases in Patients With Severe Mental Disease: Development and Testing of a Coordinated Interdisciplinary and Intersectoral Intervention
In Denmark, around 2 % of the population live with severe mental disease. People with severe
mental disease live 15-20 years less than the general population. The majority of the years
of life lost are a consequence of the excess mortality due to somatic disease. The high
prevalence of somatic disease among people with severe mental disease can be largely
attributed to physical inactivity, unhealthy diet and side effects from psychopharmacological
drugs. Apart from the impacts of unhealthy lifestyle and medication side effects, research
suggests that individuals with severe mental disease do not receive the same treatment for
their somatic diseases as do the rest of the population. The inequality in diagnostics and
treatment can be attributed to stigmatization from healthcare providers and patients' lacking
awareness of symptoms and reluctance to seek medical care. Further, the increasing
specialization within both somatic and psychiatric care has led to a division between these
two treatment systems (8,9). Patients with severe mental disease who simultaneously have one
or more somatic diseases need their treatment to be coordinated; such treatment should span
general practice, the municipality and the psychiatric and somatic hospital. Accordingly, the
following elements are necessary to create effective and coordinated treatment trajectories:
detailed preparation, qualitative process evaluation as an integrated part of the courses of
treatment, and involvement of all stakeholders from the start.
The overall aim of the project is to optimize the detection of selected chronic somatic
diseases, including cardiovascular disease (ischaemia and heart failure), diabetes,
hypertension and high cholesterol, in individuals with schizophrenia, schizoaffective
disorder or bipolar disorder; to initiate medical treatment; and to ensure treatment
compliance among patients.
Accordingly, the project has the following objectives:
- To develop an intervention targeting individuals with schizophrenia, schizoaffective
disorder or bipolar disorder that can optimize the detection of selected chronic somatic
diseases, including cardiovascular disease (ischaemia and heart failure), diabetes,
hypertension and high cholesterol
- To test whether the developed intervention can optimize the detection of cardiovascular
disease (ischaemia and heart failure), diabetes, hypertension and high cholesterol in
individuals with schizophrenia, schizoaffective disorder or bipolar disorder
The project's hypotheses are that an interdisciplinary and intersectoral intervention
targeting individuals with schizophrenia, schizoaffective disorder or bipolar disorder can
- optimize detection of cardiovascular diseases (ischaemia and cardiac insufficiency),
diabetes, hypertension and high cholesterol by systematic screening in general practice
- lead to initiation and maintenance of relevant medical treatment. Moreover, we
hypothesize that the complete intervention in a long-term perspective will lead to
decreased mortality within the target group.
Design, materials and methods:
The project is divided in two phases. In Phase 1 the project's intervention is developed; in
Phase 2 the intervention is tested. Phase 2 will be conducted as a feasibility study.
Recruitment:
Based on experience from previous studies, we know the target group can be difficult to
recruit and maintain in a course of treatment. We expect that 10-15 patients belonging to
each provider-number will meet the project's inclusion criteria. To obtain sufficient
patients for the project, we aim to include 20 general practitioners (individual
provider-numbers). Accordingly, it is realistic to assume that around 75 patients undergo
screening in general practice.
Recruitment of general practitioners will be done by sending written information about
project participation and an invitation to participate. Only general practitioners who have
one or several practice nurse(s) will be invited. The written invitation will be followed by
a telephone call to all invitees to identify those practitioners wishing to participate.
Intervention:
Phase 1: Development of intervention:
The aim of Phase 1 is to design an intervention based on the experiences and perspectives of
the involved stakeholders regarding how to optimize detection and treatment of somatic
disease among persons with severe mental disease. The project rests on the fundamental idea
that it is crucial to involve all relevant stakeholders as early as in the development phase
if the intervention is to be effective and feasible to implement in practice. This phase
includes 1) meetings with key stakeholders in the field, 2) observations and interviews
within the Mental Health Centre Copenhagen and Copenhagen Municipality, 3) multiple project
meetings involving all sectors in the project as well as on-going monitoring by the project
group.
Phase 2: Testing of the intervention:
The intervention is divided in two parts: a screening intervention and a treatment
intervention. The testing of the interventions is conducted as a feasibility study.
Evaluation:
The evaluation is twofold:
1. Evaluation of the effect of the intervention
2. Evaluation of the implementation process
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