Feasibility and acceptability of patient partnership to improve access to primary care for the physical health of patients with severe mental illnesses: an interactive guide

International Journal for Equity in Health

Steve Kisely⁴  Jean-Pierre Bonin³  Frédéric Denis⁵  Christine Boisvert¹  Alain Lesage²  Jean-François Pelletier¹ 

[1] International Program for Participatory Action Research, Montréal, Canada;Department of Psychiatry, University of Montreal, Centre de recherche de l’Institut universitaire en santé mentale de Montréal, 7401, Hochelaga Street, Montreal H1N 3M5, QC, Canada;Faculty of Nursing, University of Montreal, Montreal, Canada;School of Medicine, The University of Queensland, Brisbane, Australia;University of Franche-Comte, Besançon, France

关键词: Patient partnership;    Small group learning;    Participation;    Personalization;    Global health;    User-led research;    Interactivity;    Strategy for patient-oriented research;   

Others  :  1231448
DOI  :  10.1186/s12939-015-0200-0

 received in 2015-02-04, accepted in 2015-08-11,  发布年份 2015

【 摘 要 】

Introduction

Even in countries with universal healthcare systems, excess mortality rates due to physical chronic diseases in patients also suffering from serious mental illness like schizophrenia is such that their life expectancy could be lessened by up to 20 years. The possible explanations for this disparity include: unhealthy habits (i.e. smoking; lack of exercise); side-effects of psychotropic medication; delays in the detection or initial presentation leading to a more advanced disease at diagnosis; and inequity of access to services. The main objective of this paper is to explore the feasibility and acceptability of patient partnership for developing an interactive guide to improve access to primary care providers for chronic diseases management and health promotion among patients with severe mental illnesses.

Methods

A participatory action research design was used to engage patients with mental illness as full research partners for a strategy for patient-oriented research in primary care for persons with schizophrenia who also have chronic physical illnesses. This strategy was also developed in partnership with a health and social services centre responsible for the health of the population of a territory with about 100,000 inhabitants in East-end Montreal, Canada. A new interactive guide was developed by patient research partners and used by 146 participating patients with serious mental illness who live on this territory, for them to be better prepared for their medical appointment with a General Practitioner by becoming more aware of their own physical condition.

Results

Patient research partners produced a series of 33 short videos depicting signs and symptoms of common chronic diseases and risk factors for the leading causes of mortality and study participants were able to complete the corresponding 33-item questionnaire on an electronic touch screen tablet. What proved to be most relevant in terms of interactivity was the dynamic that has developed among the study participants during the small group learning sessions, a training technique designed for healthcare professionals that was adapted for this project for, and with patient partners.

Conclusion

This research has shown the feasibility and acceptability of patient partnership and patient-oriented research approaches to the R&D process of a new medical tool and intervention for patients with serious mental illness, and its acceptability for addressing inequity of this disadvantaged population in terms of access to primary care providers.

【 授权许可】

   
2015 Pelletier et al.

【 参考文献 】

• [1]Saha S, Chant D, McGrath J. A systematic review of mortality in schizophrenia: is the differential mortality gap worsening over time? Arch Gen Psychiatry. 2007;64:1123–31.
• [2]Giddings G. Sense and sensitivity. CMAJ. 2013; 185(18):1555.
• [3]Kisely S, Smith M, Lawrence D. Inequitable access for mentally ill patients to some medically necessary procedures. CMAJ. 2007; 176:779-784.
• [4]Harris EC, Barraclough B. Excess mortality in mental disorder. Br J Psychiatry. 1998; 173:11-53.
• [5]Hennekens CH, Hennekens AR, Hollar D, Casey DE. Schizophrenia and increased risks of cardiovascular disease. Am Heart J. 2005; 150(6):1115-1121.
• [6]Brown S, Kim M, Mitchell C. Twenty-five year mortality of a community cohort with schizophrenia. Br J Psychiatry. 2010; 196:116-121.
• [7]Hoang U, Stewart R, Goldacre MJ. Mortality after hospital discharge for people with schizophrenia or bipolar disorder: retrospective study of linked English hospital episode statistics, 1999–2006. BMJ. 2011; 343:d542.
• [8]Brown S, Inskip H, Barraclough B. Causes of the excess mortality of schizophrenia. Br J Psychiatry. 2000; 177:212-217.
• [9]Roberts L, Roalfe A, Wilson S. Physical health care of patients with schizophrenia in primary care: a comparative study. Fam Pract. 2007; 24:34-40.
• [10]Carney CP, Jones L, Woolson RF. Medical comorbidity in women and men with schizophrenia. A population-based controlled study. J Gen Intern Med. 2006; 21:1133-1137.
• [11]De Hert M, Correll C, Bobes J, Cetkovich-Bakmas M, Cohen D et al.. Physical illness in patients with severe mental disorders. World Psychiatry. 2011; 10(1):52-77.
• [12]Browne AJ, Varcoe CM, Wong ST, Smye VL, Lavoie J, Littlejohn D et al.. Closing the health equity gap: evidence-based strategies for primary health care organizations. Int J Equity Health. 2012; 11:59. BioMed Central Full Text
• [13]Thammasitboon K, Sukotjo C, Howell H, Karimbux N. Problem-based learning at the Harvard School of Dental Medicine: self-assessment of performance in postdoctoral training. J Dent Educ. 2007; 71(8):1080-1089.
• [14]Loignon C, Hudon C, Goulet É, Boyer S, De Laat M, Fournier N et al.. Perceived barriers to healthcare for persons living in poverty in Quebec, Canada: the EQUIhealThY project. Int J Equity Health. 2015; 14(1):4. BioMed Central Full Text
• [15]Willems S, De Maesschalck S, Deveugele M, Derese A, De Maeseneer J. Socio-economic status of the patient and doctor-patient communication: does it make a difference? Patient Educ Couns. 2005; 56:139-146.
• [16]Israel B, Eng E, Schulz A, Parker E. Methods in community-based participatory research for health. Josey-Bass, San Francisco; 2005.
• [17]Wallerstein NB, Duran B. Using community-based participatory research to address health disparities. Health Promot Pract. 2006; 7(3):312-323.
• [18]Activate: mind & body guidelines: for the physical and oral health management of people with severe mental illness. 2011.
• [19]Pelletier JF. The role of consumers in participatory action research - A Canadian experience. Health Issues. 2014; 113:30-33.
• [20]van Os J, Kapur S. Schizophrenia. Lancet. 2009; 374(9690):635-645.
• [21]Mojtabai R, Cullen B, Everett A, Nugent KL, Sawa A, Sharifi V et al.. Reasons for not seeking general medical care among individuals with serious mental illness. Psychiatr Serv. 2014; 65(6):818-821.
• [22]Saha S, Chant D, Welham J, McGrath J. A systematic review of the prevalence of schizophrenia. PLoS Med. 2005; 2:413-433.
• [23]Bickley LS. Bates’ Guide to Physical Exam and History Taking. 1st ed. Lippincott Williams & Wilkins, Riverwoods, IL; 2012.
• [24]Swartz MH. Textbook of Physical Diagnosis: History and Examination. 7th ed. Saunders, Philadelphia, PA; 2014.
• [25]Minsky S, Etz RS, Gara M, Escobar JI. Service use among patients with serious mental illnesses who presented with physical symptoms at intake. Psychiatr Serv. 2011; 62(10):1146-1151.
• [26]Quan H, Li B, Couris CM et al.. Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries. Am J Epidemiol. 2011; 173(6):676-682.
• [27]Sundararajan V, Henderson T, Perry C, Muggivan A, Quan H, Ghali WA. New ICD-10 version of the Charlson comorbidity index predicted in-hospital mortality. J Clin Epidemiol. 2004; 57(12):1288-1294.
• [28]Grimes DA, Schultz KF. Compared to what? Finding controls in a case control study. Lancet. 2005; 365:1429-1433.
• [29]Seo M, Kim S, Rhee M. Coercion in psychiatric care: Can paternalism justify coercion? Int J Soc Psychiatry. 2011; 59(3):217-223.
• [30]Ministère de la santé et des services sociaux du Québec. Nombre de cas et taux de prévalence du diabète selon l’âge et le sexe au Québec, chez les personnes de 20 ans et plus, 2008–2009. Gouvernement du Québec:. http://sante. gouv.qc.ca/problemes-de-sante/diabete webcite
• [31]Thomas A, Lavrentzou E, Karouzos C, Kontis C. Factors which influence the oral condition of chronic schizophrenia patients. Spec Care Dentist. 1996; 16(2):84-86.
• [32]Velsen L, Beaujean D, Gemert-Pijnen J. Why mobile health app overload drives us crazy, and how to restore the sanity. BMC Med Innform Decis Mak. 2013; 13:23. BioMed Central Full Text
• [33]Abroms LC, Padmanabhan N, Thaweethai L, Phillips T. iPhones Apps for smoking cessation: A content analysis. Am J Prev Med. 2011; 40(3):279-285.
• [34]Breton ER, Fuemmeler BF, Abroms LC. Weight loss–there is an app for that! But does it adhere to evidence-informed practices? Trans Behav Med. 2011; 1(4):523-529.
• [35]Becker J, Fliege H, Kocalevent RD, Bjorner JB, Rose M, Walter OB et al.. Functioning and validity of a Computerized Adaptive Test to measure anxiety (CAT). Depress Anxiety. 2008; 25(12):182-194.
• [36]Bloch G, Rozmovits L, Giambrone B. Barriers to primary care responsiveness to poverty as a risk factor for health. BMC Fam Pract. 2011; 12:62. BioMed Central Full Text
• [37]Price JH, Desmond SM, Snyder FF, Kimmel SR. Perceptions of family practice residents regarding health care and poor patients. J Fam Pract. 1988; 27:615-621.
• [38]Kruse RL, Koopman RJ, Wakefield BJ, Wakefield DS, Keplinger LE, Mehr DR. Internet use by primary care patients: where is the digital divide? Fam Med. 2012; 44:342-347.
• [39]Pelletier JF, Rowe M, Francois N, Bordeleau J, Lupien S. No personalization without participation: on the active contribution of psychiatric patients to the development of a mobile application for mental health. BMC Med Inform Decis Mak. 2013; 13:78. BioMed Central Full Text
• [40]Pelletier JF, Davidson L, Lesage A, Delorme A, Macaulay A, Salsberg J et al.. User-led Research: A Global and Person-centered Initiative. Int J Ment Health Promot. 2011; 13(1):4-12.
• [41]Oliver S. How can health service users contribute to the NHS research and development programme? BMJ. 1995; 310:1318-1320.
• [42]Thornton H. Patient and public involvement in clinical trials. BMJ. 2008; 336(7650):903-904.
• [43]Strategic plan 2009–2013 - NIH Publication No. 08–6439. 2008.
• [44]UK Clinical Research Collaboration progress report, 2006–2008. 2008.
• [45]European roadmap for research infrastructures: Roadmap 2008. Office for Official Publications of the European Communities, Luxembourg; 2008.
• [46]Australian Government - Strategic roadmap for Australian research infrastructure. 2008.
• [47]Richards T, Montori V, Godlee F, Lapsley P, Paul D. Let the patient revolution begin. BMJ. 2013; 346:f2614.
• [48]Pelletier JF. Let the patient-user-citizen revolution continue. Sante Ment au Que. 2015; 40(1):11-17.
• [49]Obiodu V, Obiodu E. An Empirical Review of the Top 500 Medical Apps in a European Android Market. J Mob Technol Med. 2012; 1(4):22-37.
• [50]Mahmud A, Olander E, Eriksén S, Haglund B. Health communication in primary health care -A case study of ICT development for health promotion. BMC Med Inform Decis Mak. 2013; 13:17. BioMed Central Full Text
• [51]Schrank B, Sibitz I, Unger A, Amering M. How Patients With Schizophrenia Use the Internet: Qualitative Study. J Med Internet Res. 2012; 12(5):e-70.
• [52]Lecomte T, Wilde J, Wallace C. Mental Health Consumers as Peer Interviewers. Psychiatr Serv. 1999; 50(5):693-695.
• [53]Rosenheck R, Leslie D, Keefe R, McEvoy J, Swartz M, Perkins D et al.. Barriers to employment for people with schizophrenia. Am J Psychiatry. 2006; 163(3):411-417.
• [54]Alfonsson S, Maathz P, Hursti T. Interformat Reliability of Digital Psychiatric Self-Report Questionnaires: A Systematic Review. J Med Internet Res. 2014; 16(12):e268.