Transcript A Program Targeting Metabolic Risks in Patients with Mental Illness

A Program Targeting Metabolic Risks in Patients with Mental Illness
Nicole Poellet, MS, PMHNP-BC; Judy Coucouvanis, MS, PMHNP-BC; Iva Grasso, RN, MSW; Jim Smith, RN; Robin Scott, RN; Julie
Kuebler, MS, PMHNP-BC; and Charlene Lindahl, MA, RN
Department of Psychiatry, University of Michigan, Ann Arbor, MI
Purpose
Patients with major mental illnesses have an average lifespan 25 to 30 years
less than individuals in the general population. The primary cause of mortality
in these cases is premature cardiovascular disease. Identified contributors to
this risk include psychotropic medications, psychiatric symptoms, and access
to care.
The University of Michigan Department of Psychiatry observed high levels of
metabolic morbidity in child and adult psychiatry clinics and identified this as a
problem. A department wide committee was developed to increase consistent,
standardized monitoring for metabolic risk factors in the outpatient clinics. In
response to increased monitoring, nursing staff developed an intervention for
patients who were identified as being at risk for developing diabetes and
cardiovascular disease. This poster describes the Metabolic Wellness
Program that resulted.
Methods
Results
Nursing staff in ambulatory psychiatry formed a committee in July 2010 with
the objective of building an intervention aimed at reducing incidence and risk
of metabolic syndrome in an outpatient psychiatric population. High
importance was placed on feasibility for patients by limiting the time and
financial commitment involved. Compared to previous studies, the group
intervention was shortened, however direct care manager support was added.
Specific content was modified as well to incorporate several
psychotherapeutic modalities aimed at behavior change.
Results are pending at this time. Outcomes to measure will include:
• Patient self-monitoring for metabolic syndrome,
• Behavior change in the area of the three primary modifiable risk
factors (diet, exercise, stress management), and
• Maintenance/improvement in clinical indicators of metabolic
syndrome.
• Overall patient satisfaction
• Ability to access the program for majority of ambulatory psychiatric
patients
The Healthy Living, Mental Wellness Program:
Part I:
Patients participate in a 4-session group uses cognitive behavioral, selfmanagement, and motivation interviewing techniques to motivate patients and learn
basic skills for behavior change.
Session 1: Metabolic Risks & Management Strategies
Session 2: Diet & Nutrition Factors
Session 3: Staying Fit: The Role of Exercise
Session 4: Managing Stress
Part II:
At the end of the 4-session group, patients work together with staff guidance, to
develop a goal for the next six months. Monthly phone follow up is provided by RN
care managers who build on skills learned in group and offer problem solving support.
Background
Nursing Roles:
Several research studies have tested interventions addressing modifiable risk
factors of metabolic illness in mentally ill populations. The primary modifiable
risk factors include diet, exercise, and stress management. All of the
interventions demonstrated success, though often only moderate statistical
significance or trends toward significance. Several studies compared a
behavioral intervention to the addition of a medication, usually metformin, to
assess differences in response. While both were effective, lifestyle changes
resulted in greater improvements overall.
Psychiatric RN:
• Fifteen minute support contact (phone or in person) once a month
• Therapeutic listening
• Goal setting/self-management
While the literature reports success with lifestyle change interventions, there
were several limitations regarding feasibility of implementation in a standard
outpatient practice. Several studies had significant attrition, leading to
questions about response bias (i.e., those who complete are also most likely to
be successful with behavior change). This further leads to questions about the
ability to keep patients engaged long enough to achieve behavior change in an
outpatient practice. Length of the intervention was another significant factor.
Research interventions took place over 12 -16 weeks, which is not practical in
an outpatient clinical setting given limitations of insurance coverage for this
type of service.
Psychiatric Nurse Practitioner:
• Facilitate group
• Cognitive-Behavioral interventions
• Motivational Interviewing
• Self-Management
• Didactic as indicated
• Provide support to RN care managers
Conclusions/Implications
Individuals with psychiatric diagnoses are at significant risk of
morbidity and mortality related to cardiovascular disease. While the
exact cause remains unknown, interventions to address the primary
risk factors for metabolic illness are warranted. This program aims
to implement evidence based health behavior change interventions
implemented by a nursing team to reduce risks of co-morbid medical
illness for psychiatric patients. The pending outcomes will determine
the feasibility of these interventions for this patient population and
guide modifications for improved interventions in the future.
References
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Nurse Manager:
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• Procedure development
• Systems facilitation
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