1102 — Implementation of Evidence-Based Weight Practices in Specialty Mental Health
Young AS, Greater Los Angeles VA & UCLA; Cohen AN, Greater Los Angeles VA; Hamilton AB, UCLA & Greater Los Angeles VA; Whelan F, UCLA; McNagny K, Long Beach VA; Teague AB, Durham VA; Reist C, Long Beach VA & UC Irvine;
The population with serious, persistent mental illness has a high rate of obesity and dies many years prematurely, most commonly because of cardiovascular disease. Psychosocial weight control practices are effective in clinical trials, but rarely used in routine care. EQUIP was a partnership with mental health leadership in 4 VISNs that evaluated the implementation and effectiveness of evidence-based weight practices in specialty mental health.
A clinic-level, controlled trial was conducted at 8 VA medical centers. In each VISN, one medical center was assigned to implementation and another to usual care (control). 201 clinicians and 801 patients with schizophrenia were enrolled. Implementation was guided by formative evaluation, and included kiosk-based patient self-assessment, opinion leaders, clinician and patient education, and evidence-based quality improvement teams. Clinicians were trained to deliver a 16-week, group-based weight management program. Patients and clinicians were interviewed at baseline and 15 months. Mixed methods evaluated organizational readiness, implementation acceptability and adoption, patients' use of weight services, and change in weight.
At baseline, staff interviews revealed shortcomings with clinical competencies regarding weight management, and variation by site in readiness to improve care. 80% of patients were overweight and mean Body Mass Index was 30 (obese). Baseline use of evidence-based services was low. With facilitation, clinics engaged in implementation to improve utilization of appropriate services. Overweight individuals at implementation sites were 2.3 times more likely to increase utilization over time compared to control sites (95% CI: 1.5-3.6; Chi-sq = 14.4; p <.01). Controlling for pre-baseline and baseline weight, at control sites patients' final weight was 13.4 +/- 7.6 pounds heavier than at implementation sites (F = 4.83, p = .03).
It is possible to implement weight control practices and reduce weight at mental health clinics, though uptake is limited. Barriers exist to implementing evidence-based psychosocial services. Patients are often ambivalent regarding their need for services and are disadvantaged, with limited transportation options. Clinician competencies are variable and often lacking. Mental health care would benefit from systematic implementation, and from development of psychosocial treatments that focus on motivation, engagement, and feasibility in routine practice.
This partnership between researchers and policymakers resulted in substantial improvements in care and outcomes for people with serious mental illness.