People with severe mental illness (SMI) die on average 17-20 years earlier than the general population, the most common cause of death being cardiovascular diseases (CVD). One of the major contributors to premature CVD mortality rates in SMI is the increased prevalence rate of type 2 diabetes (T2D) compared to the general population. T2D requires patients to adopt multiple self-care tasks for prevention of diabetes complications. People with SMI and T2D are less likely to take up these processes, more likely to have worse glycaemic control and develop complications.
Stage 1: In study 1a, we will conduct a systematic review of randomized controlled trials (RCT) and non-RCTs to synthesise, using standardized methods for data extraction, the evidence for key components of integrated SMI and T2D care such as formal social support, joint clinics, joint care plans, SMI specific structured education, economic evaluations and barriers to uptake. In study 1b, we will conduct structured online surveys and targeted semi-structured interviews with medical and nursing directors of mental health and acute trusts and commissioners of diabetes, mental health and integrated services to identify and describe innovative service models in England that are not being evaluated in a research framework. We will conduct a narrative synthesis from both studies to describe the most effective components of integrated care and the most common barriers.
Stage 2: In study 2 we will conduct a stakeholder day event across two sites, Cambridgeshire & Peterborough and Lambeth Clinical Commission Groups (CCG) that represent the geographical, ethnic and social diversity of people with SMI and T2D in England. The stakeholders, experts by experience (EbE), HCP and commissioners will work together to design and refine the key components required for 3 potential models of care: usual care for SMI and T2D; joint clinics with general practitioners (GP), diabetologists and psychiatrists; joint clinics with additional support from link workers.
Stage 3: In study 3, we will evaluate the 3 models in 9 surgeries within Lambeth in a pre-post feasibility study: for their effectiveness in improving glycaemic control and other diabetes outcomes; a cost-effectiveness analysis; a process evaluation to identify ongoing barriers; and calculation of participation, attrition rates and sample size for a full scale RCT.
Papachristou Nadal, I., Cliffton, C., Chamley, M., Winkley, K., Gaughran, F., & Ismail, K. (2020). Exploring healthcare professionals' perspectives of barriers and facilitators to supporting people with severe mental illness and Type 2 diabetes mellitus. Health & Social Care in the Community, 28(2), 690-697.