Prevention of coronary heart disease in people with severe mental illnesses: a qualitative study of patient and professionals' preferences for care.
BACKGROUND
People with severe mental illness (SMI) are at increased risk of developing coronary heart disease (CHD) and there is growing emphasis on the need to monitor their physical health. However, there is little consensus on how services for the primary prevention of CHD should be organised for this patient group. We explored the views of people with SMI and health professionals from primary care and community mental health teams (CMHTs) on how best to provide these services.


METHODS
In-depth interviews were conducted with a purposive sample of patients with SMI (n = 31) and staff from primary care (n = 10) and community mental health teams (n = 25) in North Central London. Transcripts of the qualitative interviews were analysed using a 'framework' approach to identify the main themes in opinions regarding various service models.


RESULTS
Cardiovascular risk factors in people with SMI were of concern to participants. However, there was some disagreement about the best way to deliver appropriate care. Although staff felt that primary care should take responsibility for risk factor screening and management, patients favoured CHD screening in their CMHT. Problems with both approaches were identified. These included a lack of familiarity in general practice with SMI and antipsychotic side effects and poor communication of physical health issues to the CMHT. Lack of knowledge regarding CHD risk factor screening and difficulties in interpreting screening results and implementing appropriate interventions exist in secondary care.


CONCLUSIONS
Management of physical health care for people with SMI requires complex solutions that cross the primary-secondary care interface. The views expressed by our participants suggest that neither primary nor secondary care services on their own can provide a comprehensive service for all patients. The increased risk of CHD associated with SMI and antipsychotic medications requires flexible solutions with clear lines of responsibility for assessing, communicating and managing CHD risks.
Wright
Christine A
CA
UCL Department of Mental Health Sciences, Royal Free and University College Medical School, London, NW3 2PF, UK. c.wright@medsch.ucl.ac.uk
Osborn
David P J
DP
Nazareth
Irwin
I
King
Michael B
MB
D000293:Adolescent; D000328:Adult; D000368:Aged; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use; D001291:Attitude of Health Personnel; D003156:Community Mental Health Services / Q000379:methods; D003191:Comprehensive Health Care / Q000379:methods; D003327:Coronary Disease / Q000175:diagnosis / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008131:London / Q000453:epidemiology; D008297:Male; D008403:Mass Screening / Q000379:methods; D001523:Mental Disorders / Q000188:drug therapy / Q000453:epidemiology* / Q000523:psychology*; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000379:methods; D011322:Primary Prevention / Q000379:methods*; D012307:Risk Factors; D012720:Severity of Illness Index
D014150:Antipsychotic Agents