title: Promoting physical health in youth mental health services: ensuring routine monitoring of weight and metabolic indices in a first episode psychosis clinic.
abstract: OBJECTIVE
  Clinicians are increasingly being asked to implement guideline recommendations into their practice, but are given little practical guidance on this complex task. In this paper we outline a promising theory-driven approach we took to implementing guideline recommendations about routine monitoring of weight gain and metabolic disturbance in our first-episode psychosis clinic. While there is significant psychological and physical morbidity associated with weight gain and metabolic disturbance, routine monitoring was not being undertaken according to guideline recommendations. We examined the factors that make it difficult to undertake routine monitoring by interviewing psychiatrists. This barrier analysis allowed us to develop and introduce feasible and acceptable strategies to address these barriers, increasing the likelihood that routine monitoring would take place.
  
  
  CONCLUSIONS
  This paper advocates for undertaking an analysis of the barriers clinicians face to undertaking evidence-based practice in order to develop more sophisticated approaches to address areas where clinical practice and evidence are divergent. Such an approach is more likely to ensure that measures to improve practice are successful, are meaningful for the clinicians involved, and become imbedded in the clinical practice of the service.
authors.affiliation: Centre of Excellence, Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia.
authors.forename: Sarah
authors.initials: S
authors.lastname: Hetrick
authors.forename: Mario
authors.initials: M
authors.lastname: Alvarez-Jiménez
authors.forename: Alexandra
authors.initials: A
authors.lastname: Parker
authors.forename: Frank
authors.initials: F
authors.lastname: Hughes
authors.forename: Michaela
authors.initials: M
authors.lastname: Willet
authors.forename: Katherine
authors.initials: K
authors.lastname: Morley
authors.forename: Richard
authors.initials: R
authors.lastname: Fraser
authors.forename: Patrick D
authors.initials: PD
authors.lastname: McGorry
authors.forename: Andrew
authors.initials: A
authors.lastname: Thompson
mesh_terms: D000293:Adolescent; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use; D001835:Body Weight / Q000502:physiology*; D019317:Evidence-Based Medicine; D017408:Guidelines as Topic; D006293:Health Promotion; D006801:Humans; D008605:Mental Health Services / Q000458:organization & administration*; D008660:Metabolism / Q000502:physiology*; D008991:Monitoring, Physiologic; D010809:Physical Fitness / Q000502:physiology*; D011618:Psychotic Disorders / Q000188:drug therapy / Q000534:rehabilitation*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents