Metabolic monitoring of people with severe mental illness who are homeless: A successful quality improvement initiative

Abstract

Aim: To inform service improvement by describing the process and impact of an initiative designed to enable metabolic monitoring among people with severe mental illness who are homeless and avoid services. Method: A mixed methods observational study; analysis of quantitative and qualitative data from service documents, clinical records and interviews with service providers enabled a detailed account of the intervention and impact. To enhance transferability analysis was informed by a theoretical model of behaviour change. Results: Provision of education, training, a portable monitoring kit and environmental restructuring was associated with substantial, sustained improvement in metabolic monitoring, with measures completed for ~90% of patients at six and 12 months post-implementation. Girth and/or BMI indicate risk of metabolic syndrome for most patients. Clinical Implications: Given opportunity, capable clinicians motivated to improve patient outcomes, can integrate additional practices in routine care. Mobile metabolic monitoring is sensible, effective and acceptable to people who avoid services.