title: Effectiveness of an intervention in increasing the provision of preventive care by community mental health services: a non-randomized, multiple baseline implementation trial.
abstract: BACKGROUND
  Relative to the general population, people with a mental illness are more likely to have modifiable chronic disease health risk behaviours. Care to reduce such risks is not routinely provided by community mental health clinicians. This study aimed to determine the effectiveness of an intervention in increasing the provision of preventive care by such clinicians addressing four chronic disease risk behaviours.
  
  
  METHODS
  A multiple baseline trial was undertaken in two groups of community mental health services in New South Wales, Australia (2011-2014). A 12-month practice change intervention was sequentially implemented in each group. Outcome data were collected continuously via telephone interviews with a random sample of clients over a 3-year period, from 6 months pre-intervention in the first group, to 6 months post intervention in the second group. Outcomes were client-reported receipt of assessment, advice and referral for tobacco smoking, harmful alcohol consumption, inadequate fruit and/or vegetable consumption and inadequate physical activity and for the four behaviours combined. Logistic regression analyses examined change in client-reported receipt of care.
  
  
  RESULTS
  There was an increase in assessment for all risks combined following the intervention (18 to 29 %; OR 3.55, p = 0.002: n = 805 at baseline, 982 at follow-up). No significant change in assessment, advice or referral for each individual risk was found.
  
  
  CONCLUSIONS
  The intervention had a limited effect on increasing the provision of preventive care. Further research is required to determine how to increase the provision of preventive care in community mental health services.
  
  
  BACKGROUND
  Australian and New Zealand Clinical Trials Registry ACTRN12613000693729.
authors.affiliation: School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia. Kate.bartlem@hnehealth.nsw.gov.au.|Population Health, Hunter New England Local Health District, Booth Building, Wallsend Health Services, Longworth Avenue, Wallsend, NSW, 2287, Australia. Kate.bartlem@hnehealth.nsw.gov.au.|Hunter Medical Research Institute, Clinical Research Centre, Level 3 John Hunter Hospital, Lookout Road, New Lambton Heights, NSW, 2305, Australia. Kate.bartlem@hnehealth.nsw.gov.au.
authors.forename: Kate M
authors.initials: KM
authors.lastname: Bartlem
authors.affiliation: School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.|Hunter Medical Research Institute, Clinical Research Centre, Level 3 John Hunter Hospital, Lookout Road, New Lambton Heights, NSW, 2305, Australia.
authors.forename: Jenny
authors.initials: J
authors.lastname: Bowman
authors.affiliation: Hunter Medical Research Institute, Clinical Research Centre, Level 3 John Hunter Hospital, Lookout Road, New Lambton Heights, NSW, 2305, Australia.|School of Medicine and Public Health, Faculty of Health, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.
authors.forename: Megan
authors.initials: M
authors.lastname: Freund
authors.affiliation: School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.|Population Health, Hunter New England Local Health District, Booth Building, Wallsend Health Services, Longworth Avenue, Wallsend, NSW, 2287, Australia.|Hunter Medical Research Institute, Clinical Research Centre, Level 3 John Hunter Hospital, Lookout Road, New Lambton Heights, NSW, 2305, Australia.|School of Medicine and Public Health, Faculty of Health, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.
authors.forename: Paula M
authors.initials: PM
authors.lastname: Wye
authors.affiliation: School of Medicine and Public Health, Faculty of Health, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.
authors.forename: Daniel
authors.initials: D
authors.lastname: Barker
authors.affiliation: Hunter Medical Research Institute, Clinical Research Centre, Level 3 John Hunter Hospital, Lookout Road, New Lambton Heights, NSW, 2305, Australia.|School of Medicine and Public Health, Faculty of Health, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: McElwaine
authors.affiliation: Population Health, Hunter New England Local Health District, Booth Building, Wallsend Health Services, Longworth Avenue, Wallsend, NSW, 2287, Australia.|Hunter Medical Research Institute, Clinical Research Centre, Level 3 John Hunter Hospital, Lookout Road, New Lambton Heights, NSW, 2305, Australia.|School of Medicine and Public Health, Faculty of Health, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.
authors.forename: Luke
authors.initials: L
authors.lastname: Wolfenden
authors.affiliation: Population Health, Hunter New England Local Health District, Booth Building, Wallsend Health Services, Longworth Avenue, Wallsend, NSW, 2287, Australia.|Hunter Medical Research Institute, Clinical Research Centre, Level 3 John Hunter Hospital, Lookout Road, New Lambton Heights, NSW, 2305, Australia.|School of Medicine and Public Health, Faculty of Health, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Campbell
authors.affiliation: School of Medicine and Public Health, Faculty of Health, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.
authors.forename: Patrick
authors.initials: P
authors.lastname: McElduff
authors.affiliation: Population Health, Hunter New England Local Health District, Booth Building, Wallsend Health Services, Longworth Avenue, Wallsend, NSW, 2287, Australia.|Hunter Medical Research Institute, Clinical Research Centre, Level 3 John Hunter Hospital, Lookout Road, New Lambton Heights, NSW, 2305, Australia.
authors.forename: Karen
authors.initials: K
authors.lastname: Gillham
authors.affiliation: Population Health, Hunter New England Local Health District, Booth Building, Wallsend Health Services, Longworth Avenue, Wallsend, NSW, 2287, Australia.|Hunter Medical Research Institute, Clinical Research Centre, Level 3 John Hunter Hospital, Lookout Road, New Lambton Heights, NSW, 2305, Australia.|School of Medicine and Public Health, Faculty of Health, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Wiggers
mesh_terms: D000328:Adult; D002908:Chronic Disease / Q000517:prevention & control; D003156:Community Mental Health Services; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009517:New South Wales; D017063:Outcome Assessment, Health Care; D011315:Preventive Medicine; D036301:Qualitative Research; D040242:Risk Reduction Behavior