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Community Mental Health Journal

, Volume 46, Issue 6, pp 531–539 | Cite as

Cardiovascular Risk Assessment and Management in Mental Health Clients: Whose Role is it Anyway?

  • Amanda J. Wheeler
  • Jeff Harrison
  • Priya Mohini
  • Jeshika Nardan
  • Amy Tsai
  • Eve Tsai
Original Paper

Abstract

People with serious mental illness have higher rates of morbidity and mortality from cardiovascular disease. This study describes health practitioners’ views on their role and confidence assessing and managing cardiovascular risk. The key findings were of a widespread acknowledgement of the need to undertake systematic risk assessment and offer structured approaches to risk factor management. Barriers of client engagement, lack of good systems and poor information sharing between primary and secondary care providers were identified. Solutions discussed included a collaborative care model or the integration of physical health services, perhaps a general practitioner-led clinic, within the secondary care setting. Whilst there is a need to identify an optimal care model there is an even greater need to take some rather than no action.

Keywords

Mental illness Cardiovascular risk Risk reduction Qualitative methods 

Notes

Acknowledgments

Thanks to all those who participated in the key informant interviews. We would also like to thank Tamasailau Sualii-Sauni for her input regarding the qualitative analysis and reviewing the presentation of results. Thanks also to Teresa Timo for transcribing assistance, the administration staff at the School of Pharmacy and the library staff at The University of Auckland for their support, knowledge and advice. Declaration of Interests: No author received any financial compensation for the completion of this manuscript. No author is financially involved with any organisation that may benefit financially by this manuscript.

References

  1. Basu, R., Brar, J. S., Chengappa, K. N. R., John, V., Parepally, H., Gershon, S., et al. (2004). The prevalence of the metabolic syndrome in patients with schizoaffective disorder—bipolar subtype. Bipolar Disorders, 6(4), 314–318.CrossRefPubMedGoogle Scholar
  2. Binnendijk, A. (1996). Conducting key informant interviews. Washington, D.C: United States Agency for International Development (USAID) Center for Development Information and Evaluation (Number 2).Google Scholar
  3. Carroll, A., Perez, M., & Toy, P. (2004). UCLA Center for Health Policy Research Health DATA Train the Trainer Project. Retrieved August 14, 2006, from http://www.healthpolicy.ucla.edu/healthdata/ttt_prog19.pdf.
  4. Casey, D. E. (2005). Metabolic issues and cardiovascular disease in patients with psychiatric disorders. American Journal of Medicine, 118(Suppl 2), 15S–22S.PubMedGoogle Scholar
  5. Davidson, S., Judd, F., Jolley, D., Hocking, B., Thompson, S., & Hyland, B. (2001). Cardiovascular risk factors for people with mental illness. Australian and New Zealand Journal of Psychiatry, 35(2), 196–202.CrossRefPubMedGoogle Scholar
  6. Davidson, C., & Tolich, M. (Eds.). (1999). Social science research in New Zealand: Many paths to understanding (1st ed.). Auckland, New Zealand: Longman.Google Scholar
  7. de Lusignan, S., Chan, T., Cohen, A., Thana, L., Dhoul, N., Hague, N., et al. (2005). Health education and prevention for people with severe mental illness: A cross-sectional study of general practice computer records. Primary Care Mental Health, 3(3), 221–233.Google Scholar
  8. Dickerson, F. B., McNary, S. W., Brown, C. H., Kreyenbuhl, J., Goldberg, R. W., & Dixon, L. B. (2003). Somatic healthcare utilization among adults with serious mental illness who are receiving community psychiatric services. Medical Care, 41(4), 560–570.CrossRefPubMedGoogle Scholar
  9. Dickey, B., Normand, S. L., Weiss, R. D., Drake, R. E., & Azeni, H. (2002). Medical morbidity, mental illness, and substance use disorders. Psychiatric Services, 53(7), 861–867.CrossRefPubMedGoogle Scholar
  10. Druss, B. G., & Rosenheck, R. A. (1998). Mental disorders and access to medical care in the United States. American Journal of Psychiatry, 155(12), 1775–1777.PubMedGoogle Scholar
  11. Druss, B. G., Rosenheck, R. A., Desai, M. M., & Perlin, J. B. (2002). Quality of preventive medical care for patients with mental disorders. Medical Care, 40(2), 129–136.CrossRefPubMedGoogle Scholar
  12. Druss, B. G., & von Esenwein, S. A. (2006). Improving general medical care for persons with mental and addictive disorders: Systematic review. General Hospital Psychiatry, 28(2), 145–153.CrossRefPubMedGoogle Scholar
  13. Elley, C. R., Kerse, N., Arroll, B., & Robinson, E. (2003). Effectiveness of counselling patients on physical activity in general practice: Cluster randomised controlled trial. BMJ, 326(7393), 793–798.CrossRefPubMedGoogle Scholar
  14. Goldberg, R. W., Kreyenbuhl, J. A., Medoff, D. R., Dickerson, F. B., Wohlheiter, K., Fang, L. J., et al. (2007). Quality of diabetes care among adults with serious mental illness. Psychiatric Services, 58(4), 536–543.CrossRefPubMedGoogle Scholar
  15. Handcock, P., & Jenkins, C. (2003). The Green Prescription: A field of dreams? New Zealand Medical Journal, 116(1187), U713–U715.PubMedGoogle Scholar
  16. Hannerz, H., Borga, P., & Borritz, M. (2001). Life expectancies for individuals with psychiatric diagnoses. Public Health, 115(5), 328–337.CrossRefPubMedGoogle Scholar
  17. Harris, E. C., & Barraclough, B. (1998). Excess mortality of mental disorder. British Journal of Psychiatry, 173, 11–53.CrossRefPubMedGoogle Scholar
  18. Hennekens, C. H., Hennekens, A. R., Hollar, D., & Casey, D. E. (2005). Schizophrenia and increased risks of cardiovascular disease. American Heart Journal, 150(6), 1115–1121.CrossRefPubMedGoogle Scholar
  19. Horvitz-Lennon, M., Kilbourne, A. M., & Pincus, H. A. (2006). From silos to bridges: Meeting the general health care needs of adults with severe mental illnesses. Health Affairs, 25(3), 659–669.CrossRefPubMedGoogle Scholar
  20. Hyland, B., Judd, F., Davidson, S., Jolley, D., & Hocking, B. (2003). Case managers’ attitudes to the physical health of their patients. Australian and New Zealand Journal of Psychiatry, 37(6), 710–714.PubMedGoogle Scholar
  21. Jennex, A., & Gardner, D. M. (2008). Monitoring and management of metabolic risk factors in outpatients taking antipsychotic drugs: A controlled study. Canadian Journal of Psychiatry—Revue Canadienne de Psychiatrie, 53(1), 34–42.PubMedGoogle Scholar
  22. Jones, D. R., Macias, C., Barreira, P. J., Fisher, W. H., Hargreaves, W. A., & Harding, C. M. (2004). Prevalence, severity, and co-occurrence of chronic physical health problems of persons with serious mental illness. Psychiatric Services, 55(11), 1250–1257.CrossRefPubMedGoogle Scholar
  23. Kilbourne, A. M., Cornelius, J. R., Han, X., Pincus, H. A., Shad, M., Salloum, I., et al. (2004). Burden of general medical conditions among individuals with bipolar disorder. Bipolar Disorders, 6(5), 368–373.CrossRefPubMedGoogle Scholar
  24. Klumpers, U. M. H., Boom, K., Janssen, F. M. G., Tulen, J. H. M., & Loonen, A. J. M. (2004). Cardiovascular risk factors in outpatients with bipolar disorder. Pharmacopsychiatry, 37(5), 211–216.CrossRefPubMedGoogle Scholar
  25. Kreyenbuhl, J., Medoff, D. R., Seliger, S. L., & Dixon, L. B. (2008). Use of medications to reduce cardiovascular risk among individuals with psychotic disorders and type 2 diabetes. Schizophrenia Research, 101(1–3), 256–265.CrossRefPubMedGoogle Scholar
  26. Morriss, R., & Mohammed, F. A. (2005). Metabolism, lifestyle and bipolar affective disorder. Journal of Psychopharmacology, 19(6_suppl), 94–101.CrossRefPubMedGoogle Scholar
  27. National Collaborating Centre for Mental Health. (2002). Schizophrenia: Core interventions in the treatment of schizophrenia in primary and secondary care. Clinical guideline 1. London: National Institute for Clinical Excellence.Google Scholar
  28. Newman, S. C., & Bland, R. C. (1991). Mortality in a cohort of patients with schizophrenia: A record linkage study. Canadian Journal of Psychiatry—Revue Canadienne de Psychiatrie, 36(4), 239–245.PubMedGoogle Scholar
  29. Osby, U., Brandt, L., Correia, N., Ekbom, A., & Sparen, P. (2001). Excess mortality in bipolar and unipolar disorder in Sweden. Archives of General Psychiatry, 58(9), 844–850.CrossRefPubMedGoogle Scholar
  30. Petersen, L. A., Normand, S.-L. T., Druss, B. G., & Rosenheck, R. A. (2003). Process of care and outcome after acute myocardial infarction for patients with mental illness in the VA health care system: Are there disparities? Health Services Research, 38(1 Pt 1), 41–63.CrossRefPubMedGoogle Scholar
  31. Rathore, S. S., Wang, Y., Druss, B. G., Masoudi, F. A., & Krumholz, H. M. (2008). Mental disorders, quality of care, and outcomes among older patients hospitalized with heart failure: An analysis of the national heart failure project. Archives of General Psychiatry, 65(12), 1402–1408.CrossRefPubMedGoogle Scholar
  32. Regenold, W. T., Thapar, R. K., Marano, C., Gavirneni, S., & Kondapavuluru, P. V. (2002). Increased prevalence of type 2 diabetes mellitus among psychiatric inpatients with bipolar I affective and schizoaffective disorders independent of psychotropic drug use. Journal of Affective Disorders, 70(1), 19–26.CrossRefPubMedGoogle Scholar
  33. Royal Australian and New Zealand College of Psychiatrists Clinical Practice Guidelines Team for Schizophrenia and Related Disorders. (2005). Royal Australian and New Zealand College of psychiatrists clinical practice guidelines for the treatment of schizophrenia and related disorders. Australian and New Zealand Journal of Psychiatry, 39(1–2), 1–30.CrossRefGoogle Scholar
  34. Ryan, M. C. M., & Thakore, J. H. (2002). Physical consequences of schizophrenia and its treatment: The metabolic syndrome. Life Sciences, 71(3), 239–257.CrossRefPubMedGoogle Scholar
  35. Scott, K. M., Oakley Browne, M. A., McGee, M. A., & Wells, J. E. (2006). Mental-physical comorbidity in Te Rau Hinengaro: The New Zealand mental health survey. Australian and New Zealand Journal of Psychiatry, 40(10), 882–888.PubMedGoogle Scholar
  36. Smith, S., Yeomans, D., Bushe, C. J. P., Eriksson, C., Harrison, T., Holmes, R., et al. (2007). A well-being programme in severe mental illness. Baseline findings in a UK cohort. International Journal of Clinical Practice, 61(12), 1971–1978.CrossRefPubMedGoogle Scholar
  37. Sokal, J., Messias, E., Dickerson, F. B., Kreyenbuhl, J., Brown, C. H., Goldberg, R. W., et al. (2004). Comorbidity of medical illnesses among adults with serious mental illness who are receiving community psychiatric services. Journal of Nervous and Mental Disease, 192(6), 421–427.CrossRefPubMedGoogle Scholar
  38. The Quit Group. (2006). Quit Me Mutu. Retrieved September 25, 2006, from http://www.quit.org.nz/page/index.php.
  39. Tirupati, S., & Chua, L. E. (2007). Obesity and metabolic syndrome in a psychiatric rehabilitation service. Australian and New Zealand Journal of Psychiatry, 41(7), 606–610.CrossRefPubMedGoogle Scholar
  40. Voruganti, L. P., Punthakee, Z., Van Lieshout, R. J., MacCrimmon, D., Parker, G., Awad, A. G., et al. (2007). Dysglycemia in a community sample of people treated for schizophrenia: The Diabetes in Schizophrenia in Central-South Ontario (DiSCO) study. Schizophrenia Research, 96(1–3), 215–222.CrossRefPubMedGoogle Scholar
  41. Weeke, A., Juel, K., & Vaeth, M. (1987). Cardiovascular death and manic-depressive psychosis. Journal of Affective Disorders, 13(3), 287–292.CrossRefPubMedGoogle Scholar
  42. Wright, C. A., Osborn, D. P. J., Nazareth, I., & King, M. B. (2006). Prevention of coronary heart disease in people with severe mental illnesses: A qualitative study of patient and professionals’ preferences for care. BMC Psychiatry, 6, 16.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Amanda J. Wheeler
    • 1
  • Jeff Harrison
    • 2
  • Priya Mohini
    • 3
  • Jeshika Nardan
    • 3
  • Amy Tsai
    • 3
  • Eve Tsai
    • 3
  1. 1.Clinical Research & Resource Centre, Mental Health and Addictions, Waitemata District Health Board, Faculty of Medical and Health SciencesUniversity of AucklandAucklandNew Zealand
  2. 2.Medicines Management Research Group, School of Pharmacy, Faculty of Medical and Health SciencesUniversity of AucklandAucklandNew Zealand
  3. 3.School of PharmacyUniversity of AucklandAucklandNew Zealand

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