首页> 外文期刊>International journal of nursing studies >Using the serious mental illness health improvement profile (HIP) to identify physical problems in a cohort of community patients: a pragmatic case series evaluation.
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Using the serious mental illness health improvement profile (HIP) to identify physical problems in a cohort of community patients: a pragmatic case series evaluation.

机译:使用严重的精神疾病健康改善状况(HIP)识别社区患者队列中的身体问题:实用的病例系列评估。

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BACKGROUND AND OBJECTIVES: The physical health of people with serious mental illness is a cause of growing concern to clinicians. Life expectancy in this population may be reduced by up to 25 years and patients often live with considerable physical morbidity that can dramatically reduce quality of life and contribute to social exclusion. This study sought to determine whether the serious mental illness health improvement profile [HIP], facilitated by mental health nurses [MHNs], has the clinical potential to identify physical morbidity and inform future evidence-based care. DESIGN: Retrospective documentation audit and qualitative evaluation of patients' and clinicians' views about the use of the HIP in practice. SETTING: A nurse-led outpatient medication management clinic, for community adult patients with serious mental illness in Scotland. PARTICIPANTS: 31 Community patients with serious mental illness seen in the clinic by 2 MHNs trained to use the HIP. All 31 patients, 9 MHNs, 4 consultant psychiatrists and 12 general practitioners [GPs] (primary care physicians) participated in the qualitative evaluation. METHODS: A retrospective documentation audit of case notes for all patients where the HIP had been implemented. Semi-structured interviews with patients and their secondary care clinicians. Postal survey of GPs. RESULTS: 189 Physical health issues were identified (mean 6.1 per patient). Items most frequently flagged 'red', suggesting that intervention was required, were body mass index [BMI] (n=24), breast self-examination (n=23), waist circumference (n=21), pulse (n=14) and diet (n=13). Some rates of physical health problems observed were broadly similar to those reported in studies of patients receiving antipsychotics in primary care but much lower than those reported in epidemiological studies. Individualised care was planned and delivered with each patient based on the profile. 28 discreet interventions that included providing advice, promoting health behavioural change, performing an electrocardiogram and making a referral to professional colleagues were used. Qualitative feedback was positive. Our observations support the use of the HIP in clinical settings to enhance mental health nursing practice; however, we strongly recommend that training is required to support the use of the HIP.
机译:背景与目的:重度精神疾病患者的身体健康是临床医生日益关注的一个原因。该人群的预期寿命可能会减少多达25岁,并且患者通常会以相当高的身体发病率生活,这可能会大大降低生活质量并导致社会排斥。这项研究试图确定在精神保健护士[MHNs]的帮助下,严重精神疾病的健康改善状况[HIP]是否具有识别身体发病率并为将来基于证据的护理提供临床潜力。设计:对患者和临床医生在实践中使用HIP的观点进行回顾性文件审核和定性评估。地点:由护士领导的门诊药物管理诊所,面向苏格兰严重精神疾病的社区成年患者。参与者:31位社区精神病患者,由2名接受过HIP培训的MHN在诊所诊治。所有31名患者,9名MHN,4名咨询精神病医生和12名全科医生(GPs)(初级保健医师)都参加了定性评估。方法:对所有实施了HIP的患者的病例笔记进行回顾性文件审核。对患者及其二级保健临床医生的半结构式访谈。全科医生的邮政调查。结果:发现了189个身体健康问题(每位患者平均6.1)。经常被标记为“红色”的项目,表明需要干预,它们是体重指数[BMI](n = 24),乳房自我检查(n = 23),腰围(n = 21),脉搏(n = 14) )和饮食(n = 13)。观察到的某些身体健康问题的发生率与基层医疗机构接受抗精神病药治疗的患者的研究报告大致相似,但远低于流行病学研究报告的报告。计划并根据个人资料为每个患者提供个性化护理。使用了28种谨慎的干预措施,包括提供建议,促进健康行为改变,进行心电图检查以及转介给专业同事。定性反馈是积极的。我们的观察结果支持在临床环境中使用HIP来加强心理健康护理实践。但是,我们强烈建议需要进行培训以支持HIP的使用。

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