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      Quality of diabetes care among patients with schizophrenia. A mixed-methods study

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          Abstract

          Objectives

          Patients with schizophrenia are at high risk of developing diabetes. Our study aimed to determine the prevalence of diabetes in patients with schizophrenia and assess their quality of diabetes care. We further aimed to explore the factors affecting diabetes care in patients with schizophrenia.

          Research design and methods

          We conducted a retrospective review of medical records for patients presenting with schizophrenia from October 2017 to October 2018. Thereafter, we conducted semi-structured interviews based on the Theoretical Domains Framework to explore healthcare providers' attitudes and perspectives toward diabetes care in patients with schizophrenia at a tertiary hospital for mental health services in Saudi Arabia.

          Results

          The prevalence of diabetes in patients with schizophrenia was 3.7%. The rates of annual testing for quality indicators of diabetes were 8.6% for HgbA1c and 31.4% for low-density lipoprotein cholesterol (LDL-C). Screenings for albuminuria and examinations of the eyes and feet were not conducted. Documentation of smoking status was done infrequently (8.6%). The in-depth interviews uncovered issues with managing diabetes in patients with schizophrenia. We identified four themes: the consequences of poor quality diabetic care provided to patients with schizophrenia; problems with the identification of diabetes in patients with schizophrenia; challenges in the management of patients with both diabetes and schizophrenia; and opportunities to improve the quality of diabetes care provided to patients with schizophrenia.

          Conclusions

          This study identified areas that need a considerable amount of work to be undertaken in Saudi Arabia to help patients with schizophrenia. There are numerous opportunities for improving the quality of Type 2 diabetes care such as the involvement of pharmacists to effectively manage diabetes and expanding community-based health services to include mental health, which could accelerate improved care services.

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          Most cited references36

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          A guide to using the Theoretical Domains Framework of behaviour change to investigate implementation problems.

          Lou Atkins, Jill Francis, Rafat Islam … (2017)
          Implementing new practices requires changes in the behaviour of relevant actors, and this is facilitated by understanding of the determinants of current and desired behaviours. The Theoretical Domains Framework (TDF) was developed by a collaboration of behavioural scientists and implementation researchers who identified theories relevant to implementation and grouped constructs from these theories into domains. The collaboration aimed to provide a comprehensive, theory-informed approach to identify determinants of behaviour. The first version was published in 2005, and a subsequent version following a validation exercise was published in 2012. This guide offers practical guidance for those who wish to apply the TDF to assess implementation problems and support intervention design. It presents a brief rationale for using a theoretical approach to investigate and address implementation problems, summarises the TDF and its development, and describes how to apply the TDF to achieve implementation objectives. Examples from the implementation research literature are presented to illustrate relevant methods and practical considerations.
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            New WHO prevalence estimates of mental disorders in conflict settings: a systematic review and meta-analysis

            Fiona J. Charlson, Mark van Ommeren, Abraham Flaxman … (2019)
            Summary Background Existing WHO estimates of the prevalence of mental disorders in emergency settings are more than a decade old and do not reflect modern methods to gather existing data and derive estimates. We sought to update WHO estimates for the prevalence of mental disorders in conflict-affected settings and calculate the burden per 1000 population. Methods In this systematic review and meta-analysis, we updated a previous systematic review by searching MEDLINE (PubMed), PsycINFO, and Embase for studies published between Jan 1, 2000, and Aug 9, 2017, on the prevalence of depression, anxiety disorder, post-traumatic stress disorder, bipolar disorder, and schizophrenia. We also searched the grey literature, such as government reports, conference proceedings, and dissertations, to source additional data, and we searched datasets from existing literature reviews of the global prevalence of depression and anxiety and reference lists from the studies that were identified. We applied the Guidelines for Accurate and Transparent Health Estimates Reporting and used Bayesian meta-regression techniques that adjust for predictors of mental disorders to calculate new point prevalence estimates with 95% uncertainty intervals (UIs) in settings that had experienced conflict less than 10 years previously. Findings We estimated that the prevalence of mental disorders (depression, anxiety, post-traumatic stress disorder, bipolar disorder, and schizophrenia) was 22·1% (95% UI 18·8–25·7) at any point in time in the conflict-affected populations assessed. The mean comorbidity-adjusted, age-standardised point prevalence was 13·0% (95% UI 10·3–16·2) for mild forms of depression, anxiety, and post-traumatic stress disorder and 4·0% (95% UI 2·9–5·5) for moderate forms. The mean comorbidity-adjusted, age-standardised point prevalence for severe disorders (schizophrenia, bipolar disorder, severe depression, severe anxiety, and severe post-traumatic stress disorder) was 5·1% (95% UI 4·0–6·5). As only two studies provided epidemiological data for psychosis in conflict-affected populations, existing Global Burden of Disease Study estimates for schizophrenia and bipolar disorder were applied in these estimates for conflict-affected populations. Interpretation The burden of mental disorders is high in conflict-affected populations. Given the large numbers of people in need and the humanitarian imperative to reduce suffering, there is an urgent need to implement scalable mental health interventions to address this burden. Funding WHO; Queensland Department of Health, Australia; and Bill & Melinda Gates Foundation.
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              Physical illness in patients with severe mental disorders. I. Prevalence, impact of medications and disparities in health care.

              Marc De Hert, Christoph U. Correll, Julio Bobes … (2011)
              The lifespan of people with severe mental illness (SMI) is shorter compared to the general population. This excess mortality is mainly due to physical illness. We report prevalence rates of different physical illnesses as well as important individual lifestyle choices, side effects of psychotropic treatment and disparities in health care access, utilization and provision that contribute to these poor physical health outcomes. We searched MEDLINE (1966 - August 2010) combining the MeSH terms of schizophrenia, bipolar disorder and major depressive disorder with the different MeSH terms of general physical disease categories to select pertinent reviews and additional relevant studies through cross-referencing to identify prevalence figures and factors contributing to the excess morbidity and mortality rates. Nutritional and metabolic diseases, cardiovascular diseases, viral diseases, respiratory tract diseases, musculoskeletal diseases, sexual dysfunction, pregnancy complications, stomatognathic diseases, and possibly obesity-related cancers are, compared to the general population, more prevalent among people with SMI. It seems that lifestyle as well as treatment specific factors account for much of the increased risk for most of these physical diseases. Moreover, there is sufficient evidence that people with SMI are less likely to receive standard levels of care for most of these diseases. Lifestyle factors, relatively easy to measure, are barely considered for screening; baseline testing of numerous important physical parameters is insufficiently performed. Besides modifiable lifestyle factors and side effects of psychotropic medications, access to and quality of health care remains to be improved for individuals with SMI.
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                Author and article information

                Contributors
                Nouf M. Aloudah
                Journal
                Journal ID (nlm-ta): Explor Res Clin Soc Pharm
                Journal ID (iso-abbrev): Explor Res Clin Soc Pharm
                Title: Exploratory Research in Clinical and Social Pharmacy
                Publisher: Elsevier
                ISSN (Electronic): 2667-2766
                Publication date PMC-release: 17 September 2021
                Publication date Collection: December 2021
                Publication date (Electronic): 17 September 2021
                Volume: 4
                Electronic Location Identifier: 100070
                Affiliations
                [a ]Clinical Pharmacy Department, King Saud University, Riyadh, Saudi Arabia
                [b ]University Diabetes Centre, King Saud University, Riyadh, Saudi Arabia
                Author notes
                [* ]Corresponding author. naloudah@ 123456ksu.edu.sa
                Article
                Publisher Item ID: S2667-2766(21)00070-6 Publisher ID: 100070
                DOI: 10.1016/j.rcsop.2021.100070
                PMC ID: 9029903
                PubMed ID: 35479839
                SO-VID: 4b05c9b1-e522-49af-885d-56be447b72c2
                Copyright © © 2021 The Authors
                License:

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Date received : 3 April 2021
                Date revision received : 11 September 2021
                Date accepted : 11 September 2021
                Categories
                Subject: Article

                Keywords: health services research,schizophrenia,diabetes care,implementation research,quality improvement,diabetes,qualitative research,mixed-methods study
                Data availability:
                Keywords: health services research, schizophrenia, diabetes care, implementation research, quality improvement, diabetes, qualitative research, mixed-methods study

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