Cardiovascular Risk Management in Patients with Severe Mental Illness or Taking Antipsychotics: A Qualitative Study on Barriers and Facilitators Among Dutch General Practitioners

Overview

Journal Eur J Gen Pract

Publisher Informa Healthcare

Specialty Public Health

Date 2022 Jul 7

PMID 35796600

Authors

Kirsti Jakobs

Latoya Lautan

Peter Lucassen

Joost Janzing

Jan van Lieshout

Marion C J Biermans

Erik W M A Bischoff

Affiliations

Soon will be listed here.

Abstract

Background: Patients with severe mental illness (SMI) or receiving treatment with antipsychotics (APs) have an increased risk of cardiovascular disease. Cardiovascular risk management (CVRM) increasingly depends on general practitioners (GPs) because of the shift of mental healthcare from secondary to primary care and the surge of off-label AP prescriptions. Nevertheless, the uptake of patients with SMI/APs in CVRM programmes in Dutch primary care is low.

Objectives: To explore which barriers and facilitators GPs foresee when including and treating patients with SMI or using APs in an existing CVRM programme.

Methods: In 2019, we conducted a qualitative study among 13 Dutch GPs. During individual in-depth, semi-structured interviews a computer-generated list of eligible patients who lacked annual cardiovascular risk (CVR) screening guided the interview. Data was analysed thematically.

Results: The main barriers identified were: (i) underestimation of patient CVR and ambivalence to apply risk-lowering strategies such as smoking cessation, (ii) disproportionate burden on GPs in deprived areas, (iii) poor information exchange between GPs and psychiatrists, and (iv) scepticism about patient compliance, especially those with more complex conditions. The main facilitators included: (i) support of GPs through a computer-generated list of eligible patients and (ii) involvement of family or carers.

Conclusion: This study displays a range of barriers and facilitators anticipated by GPs. These indicate the preconditions required to remove barriers and facilitate GPs, namely adequate recommendations in practice guidelines, improved consultation opportunities with psychiatrists, practical advice to support patient adherence and incentives for practices in deprived areas.

Citing Articles

Transmural collaborative care model for cardiovascular risk management and medication review in patients using antipsychotics in primary care (TACTIC): A study protocol of an incomplete stepped wedge cluster randomized trial.

Jakobs K, van den Brule-Barnhoorn K, van Lieshout J, Janzing J, Cahn W, Kievit W Contemp Clin Trials Commun. 2025; 44:101418.

PMID: 39897941 PMC: 11787019. DOI: 10.1016/j.conctc.2024.101418.

Transmural collaborative care model for the review of antipsychotics: a feasibility study of a complex intervention.

Jakobs K, van den Brule-Barnhoorn K, van Lieshout J, Janzing J, Cahn W, van den Muijsenbergh M Sci Rep. 2024; 14(1):12367.

PMID: 38811680 PMC: 11137011. DOI: 10.1038/s41598-024-62349-9.

Management of antipsychotics in primary care: Insights from healthcare professionals and policy makers in the United Kingdom.

Woodall A, Abuzour A, Wilson S, Mair F, Buchan I, Sheard S PLoS One. 2024; 19(3):e0294974.

PMID: 38427674 PMC: 10906843. DOI: 10.1371/journal.pone.0294974.

Patients with severe mental illness and their carers' expectations for GPs' communication skills: a qualitative approach in Spain.

Ramos-Ruiz J, Perez-Milena A, Noguera-Cuenca C, Rodriguez-Bayon A, Ruiz-Diaz B BJGP Open. 2023; 8(1).

PMID: 37931981 PMC: 11169970. DOI: 10.3399/BJGPO.2023.0124.

Coronary Artery Disease in Patients with Severe Mental Illness.

Tam To B, Roy R, Melikian N, Gaughran F, OGallagher K Interv Cardiol. 2023; 18:e16.

PMID: 37398869 PMC: 10311395. DOI: 10.15420/icr.2022.31.

References

Magnee T, de Beurs D, Boxem R, de Bakker D, Verhaak P . Potential for substitution of mental health care towards family practices: an observational study. BMC Fam Pract. 2017; 18(1):10. PMC: 5282718. DOI: 10.1186/s12875-017-0586-4. View

Barnett K, Mercer S, Norbury M, Watt G, Wyke S, Guthrie B . Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet. 2012; 380(9836):37-43. DOI: 10.1016/S0140-6736(12)60240-2. View

Correll C, Solmi M, Veronese N, Bortolato B, Rosson S, Santonastaso P . Prevalence, incidence and mortality from cardiovascular disease in patients with pooled and specific severe mental illness: a large-scale meta-analysis of 3,211,768 patients and 113,383,368 controls. World Psychiatry. 2017; 16(2):163-180. PMC: 5428179. DOI: 10.1002/wps.20420. View

Vancampfort D, Firth J, Schuch F, Rosenbaum S, Mugisha J, Hallgren M . Sedentary behavior and physical activity levels in people with schizophrenia, bipolar disorder and major depressive disorder: a global systematic review and meta-analysis. World Psychiatry. 2017; 16(3):308-315. PMC: 5608847. DOI: 10.1002/wps.20458. View

Damschroder L, Aron D, Keith R, Kirsh S, Alexander J, Lowery J . Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009; 4:50. PMC: 2736161. DOI: 10.1186/1748-5908-4-50. View

Maranzan K . Interprofessional education in mental health: An opportunity to reduce mental illness stigma. J Interprof Care. 2016; 30(3):370-7. DOI: 10.3109/13561820.2016.1146878. View

Dantas L, Fleck J, Cyrino Oliveira F, Hamacher S . No-shows in appointment scheduling - a systematic literature review. Health Policy. 2018; 122(4):412-421. DOI: 10.1016/j.healthpol.2018.02.002. View

Tong A, Sainsbury P, Craig J . Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007; 19(6):349-57. DOI: 10.1093/intqhc/mzm042. View

Yeomans D, Dale K, Beedle K . Systematic computerised cardiovascular health screening for people with severe mental illness. Psychiatr Bull (2014). 2014; 38(6):280-4. PMC: 4248164. DOI: 10.1192/pb.bp.113.045955. View

10.

McDonell M, Kaufman E, Srebnik D, Ciechanowski P, Ries R . Barriers to metabolic care for adults with serious mental illness: provider perspectives. Int J Psychiatry Med. 2012; 41(4):379-87. DOI: 10.2190/PM.41.4.g. View

11.

Corrigan P, Mittal D, Reaves C, Haynes T, Han X, Morris S . Mental health stigma and primary health care decisions. Psychiatry Res. 2014; 218(1-2):35-8. PMC: 4363991. DOI: 10.1016/j.psychres.2014.04.028. View

12.

Jakobs K, Posthuma A, de Grauw W, Schalk B, Akkermans R, Lucassen P . Cardiovascular risk screening of patients with serious mental illness or use of antipsychotics in family practice. BMC Fam Pract. 2020; 21(1):153. PMC: 7391510. DOI: 10.1186/s12875-020-01225-7. View

13.

Visseren F, Mach F, Smulders Y, Carballo D, Koskinas K, Back M . 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J. 2021; 42(34):3227-3337. DOI: 10.1093/eurheartj/ehab484. View

14.

Cramm J, Adams S, Hipple Walters B, Tsiachristas A, Bal R, Huijsman R . The role of disease management programs in the health behavior of chronically ill patients. Patient Educ Couns. 2014; 95(1):137-42. DOI: 10.1016/j.pec.2013.12.017. View

15.

Halfdanarson O, Zoega H, Aagaard L, Bernardo M, Brandt L, Fuste A . International trends in antipsychotic use: A study in 16 countries, 2005-2014. Eur Neuropsychopharmacol. 2017; 27(10):1064-1076. DOI: 10.1016/j.euroneuro.2017.07.001. View

16.

Ross L, Vigod S, Wishart J, Waese M, Spence J, Oliver J . Barriers and facilitators to primary care for people with mental health and/or substance use issues: a qualitative study. BMC Fam Pract. 2015; 16:135. PMC: 4604001. DOI: 10.1186/s12875-015-0353-3. View

17.

Hippisley-Cox J, Coupland C, Brindle P . Development and validation of QRISK3 risk prediction algorithms to estimate future risk of cardiovascular disease: prospective cohort study. BMJ. 2017; 357:j2099. PMC: 5441081. DOI: 10.1136/bmj.j2099. View

18.

De Hert M, Cohen D, Bobes J, Cetkovich-Bakmas M, Leucht S, Ndetei D . Physical illness in patients with severe mental disorders. II. Barriers to care, monitoring and treatment guidelines, plus recommendations at the system and individual level. World Psychiatry. 2011; 10(2):138-51. PMC: 3104888. DOI: 10.1002/j.2051-5545.2011.tb00036.x. View

19.

van Hasselt F, Oud M, Loonen A . Practical recommendations for improvement of the physical health care of patients with severe mental illness. Acta Psychiatr Scand. 2014; 131(5):387-96. DOI: 10.1111/acps.12372. View

20.

Reilly S, Planner C, Hann M, Reeves D, Nazareth I, Lester H . The role of primary care in service provision for people with severe mental illness in the United Kingdom. PLoS One. 2012; 7(5):e36468. PMC: 3352919. DOI: 10.1371/journal.pone.0036468. View