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Development and Rapid Evaluation of Services to Support the Physical Health of People Using Psychiatric Inpatient Units During T

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Development and Rapid Evaluation of Services to Support the Physical Health of People Using Psychiatric Inpatient Units During T Williams et al. Implementation Science Communications (2021) 2:12 Implementation Science https://doi.org/10.1186/s43058-021-00113-0 Communications STUDY PROTOCOL Open Access Development and rapid evaluation of services to support the physical health of people using psychiatric inpatient units during the COVID-19 pandemic: study protocol Julie Williams1* , Elli Fairbairn2,3, Ray McGrath2,3, Amy Clark4, Andy Healey4, Ioannis Bakolis1,5, Fiona Gaughran6,7, Euan Sadler8, Zarnie Khadjesari9, Nick Sevdalis1 and IMPHS group Abstract Background: People diagnosed with a serious mental illness have worse physical health and lower life expectancy than the general population. Integration of mental and physical health services is seen as one service development that could better support this. This protocol describes the evaluation of the provision of a Virtual Physical Health Clinic (VPHC) and Consultant Connect (CC) services to one UK-based mental health Trust. Methods: Prospective, formative, pragmatic evaluation using both quantitative and qualitative techniques and driven by implementation science theoretical frameworks. The VPHC and CC are described along with the methodology being used to rapidly evaluate their implementation, effectiveness and potential economic impact in order to inform future roll out. We will assess the implementation process through quantitative data on uptake and reach and through self-reported data to be collected from interviews and the use of validated implementation outcome assessment measures. We will assess implementation strategies using the Expert Recommendations for Implementing Change (ERIC) strategies as a framework. We will assess the health economic impact of both services using established health economic methods including cost comparison scenarios and health service utilisation analyses. Discussion: Supporting the physical health management of people in psychiatric inpatient units is important in improving the physical health of this population. Integration of mental and physical health can help this to happen effectively. This initiative provides one of the first service evaluation protocols of its kind to be reported in the UK at the time of the COVID-19 pandemic. Keywords: Serious mental illness, Integration, Physical health, Implementation, Effectiveness, Cost-effectiveness, Evaluation * Correspondence: [email protected] 1Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK Full list of author information is available at the end of the article © The Author(s). 2021 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Williams et al. Implementation Science Communications (2021) 2:12 Page 2 of 9 and provide training and research to improve physical Contributions to the literature health outcomes for people with SMI. King’s Health The study advances the literature in understanding how Partners is a partnership between SLaM, King’s College ’ physical and mental health services can be integrated to London university and two local acute trusts: King s Col- lege London NHS Foundation Trust and Guy’s and St improve the physical health of people using mental health Thomas NHS Foundation Trust. services. The IMPHS project was planning services to support Study findings will contribute to our understanding of the the management of physical health in the SLaM adult implementation challenges of providing such an initiative. acute units before the COVID-19 pandemic. This paper This study includes a comprehensive economic evaluation describes the rapid development and introduction of which will demonstrate how this can be done to provide adapted services to assist healthcare staff in SLaM to importance economic data. manage the physical health of patients in inpatient units during the COVID-19 pandemic. Significant change happened across KHP to address Background the COVID-19 pandemic, in the form of service reconfi- People diagnosed with a serious mental illness (SMI) gurations, from March 2020 onwards. This led to collab- such as schizophrenia and bipolar disorder generally oration between the acute Trusts and SLaM designed to have worse physical health and reduced life expectancy support care delivery to SLaM patients and to reduce compared to the general population [1]. International unnecessary pressures on the acute Trusts. These studies have found the mortality gap to be between 10 changes are ongoing due to the changing nature of the and 20 years [2]. Recent literature has attempted to map burden of COVID-19 and the need to provide optimal the scale of this problem and understand its causes [3]. care in a rapidly changing environment. Studies have highlighted risk factors for excess mortality This protocol focuses on the implementation and at the levels of individual, such as the effect of lifestyle evaluation of two distinct but related service develop- factors and medication and the severity of symptoms of ments to inpatient units in SLaM during the COVID-19 mental illness, at the service level, such as lack of coord- pandemic: the Virtual Physical Health Clinic (VPHC) ination of care, and at the society level, such as contin- and Consultant Connect (CC). ued stigma that inhibits access to equitable care [4], and The VPHC was originally designed as a traditional face has made suggestions for strategies to improve processes to face clinic, but this became unviable due to the pan- and outcomes such as better integrating mental health demic. The aims of the VPHC are to firstly improve the physical health systems. In the current global epidemio- management of physical health for patients on SLaM in- logical context, there is emerging evidence that the patient units both for long-term conditions and acute COVID-19 pandemic will exacerbate the treatment gap conditions (including COVID-19 sequelae although not to further disadvantage people with SMI due to disrup- acute COVID-19) by improving access to generalist ad- tions to services and an exacerbation of inequalities in vice and virtual appointments for complex cases and treating physical health problems [5–7]. secondly to reduce inappropriate referrals to, and atten- The National Institute of Health and Care Excellence dances at, general medical services by providing advice (NICE) have developed guidance for the management of and guidance on managing physical health issues. physical health for people with schizophrenia and psych- The Consultant Connect (CC) service was intended as osis [8], but there is evidence that this guidance is not a complementary intervention to the VPHC and aims to always followed [9]. There are few published reports of improve care and treatment for physical health condi- projects to improve physical health management on psy- tions and reduce inappropriate referrals and admissions chiatric units in the UK [10]. of SLaM patients to acute general hospitals by providing telephone-based advice on specific queries. This service The ‘integrating our mental and physical healthcare will now be introduced within SLaM, to offer SLaM cli- systems’ (IMPHS) project nicians working on inpatient units prompt access to a The Integrating our Mental and Physical Healthcare Sys- medical clinical support service, provided by specialist tems (IMPHS) project is funded by the Maudsley Char- colleagues based at local Trusts. ity and is working with the South London and Maudsley NHS Foundation Trust (SLaM) in London, UK, to seek to address risk factors for poor physical health outcomes Study aims for SLaM service users. IMPHS is part of the King’s The primary aim of the evaluation is to understand the Health Partners’ (KHP) Mind and Body programme process of rapidly implementing the VPHC and CC. which seeks to join up mental and physical healthcare This formative evidence on the implementation of both Williams et al. Implementation Science Communications (2021) 2:12 Page 3 of 9 services will ensure that implementation can be rapidly offered initially to all inpatient services and may be ex- optimised and supported in the long-term. tended to Community teams in the future. The secondary aim of the evaluation is to establish the acceptability and feasibility of both the VPHC and CC. Participants The tertiary aims of the evaluation are to: It is expected that the majority of staff using the service will be SLaM trainee doctors (called ‘residents’ in some (1) Undertake an exploratory analysis to inform future systems) and consultants
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