Nick Verhaeghe

Effectiveness and cost-effectiveness of lifestyle interventions on physical activity and eating habits in persons with severe mental disorders: a systematic review.

BackgroundThere is a high prevalence of overweight and obesity in persons with severe mental disorders and this has serious implications on the short and long term health outcomes of these patients. The aim of this review was to evaluate the effectiveness of lifestyle interventions targeting physical activity and eating habits in persons with severe mental disorders. Special attention was given if any of the included studies in the review also examined the cost-effectiveness of these health promotion interventions.MethodsA systematic search through the electronic databases Medline, Web of Science, CINAHL and Cohrane Library was conducted, and by hand-searching the reference lists of the retrieved articles from the electronic databases. Studies were included if they examined effectiveness and/or cost-effectiveness of lifestyle interventions targeting physical activity and eating habits in persons with severe mental disorders, with primary outcome changes in Body Mass Index and body weight.ResultsFourteen studies met the inclusion criteria. Weight loss and Body Mass Index decrease were observed in intervention groups in 11 studies. The difference in weight change between intervention and control groups was statistically significant in nine studies. Differences in mean Body Mass Index between intervention and control groups were statistically significant in eight studies. Five studies reported improvements in quality of life and general health. In none of the studies cost-effectiveness of lifestyle interventions was examined.ConclusionFurther research on both effectiveness and cost-effectiveness of lifestyle interventions targeting physical activity and eating habits in persons with severe mental disorders is required to assist in the development of new health promotion interventions in this population.

Determinants of nonurgent use of the emergency department for pediatric patients in 12 hospitals in Belgium

IntroductionThe nonurgent use of the emergency department (ED) for pediatric patients is an increasing problem facing healthcare systems worldwide. To evaluate the magnitude of the phenomenon and to identify associated factors, an observational prospective survey was performed including all patients (<15xa0years) attending the ED in 12 Belgian hospitals during 2xa0weeks in autumn 2010. Use of ED was considered appropriate if at least one of the following criteria was met: child referred by doctor or police, brought by ambulance, in need for short stay, technical examination or orthopedic treatment, in-patient admission, or death. Among the 3,117 children, attending ED, 39.9xa0% (1,244) of visits were considered inappropriate. Five factors were significantly associated with inappropriate use: age of child, distance to ED, having a registered family doctor, out-of-hours visit, and geographic region. The adjusted odds ratio and 95xa0% confidence intervals are respectively—1.7 (1.3–2.0), 1.7 (1.3–2.2), 1.5 (1.1–2.2), 1.5 (1.2–1.9), and 0.6 (0.5–0.8).ConclusionsAlmost 40xa0% of all paediatric ED attendances did not require hospital expertise. The risk of an inappropriate use of ED by pediatrician patients is predominantly associated with organizational and cultural factors. Access, equity, quality of care, and medical human resources availability have to be taken into account to design financially sustainable model of care for those patients. Furthermore, future research is needed to explain reasons why parents visit ED rather than using of primary-care services.

Perceptions of mental health nurses and patients about health promotion in mental health care: a literature review

The aim of this review was to examine the perceptions of patients with mental disorders and mental health nurses of health promotion targeting physical activity and eating habits in mental health care. An electronic search strategy was conducted. Furthermore, references were searched by hand-searching the reference lists of the retrieved articles from the electronic databases. The literature on perceptions of health promotion and lifestyle interventions in mental health care principally consist of qualitative studies using interviews and focus groups. Positive perceptions of both mental health nurses and patients towards health promotion targeting physical activity and eating habits in mental health care were identified. Contrary, several barriers for integrating healthy lifestyles into the daily life of patients were described. Patients usually want to learn more about healthy lifestyles, but see the ability to change their physical health as beyond their control. In this sense, support from mental health nurses is considered as important. Despite the awareness of the importance of health promotion in mental health care, it appears that visions and attitudes towards the potential of health promotion are in need of change.

Health promotion in mental health care: perceptions from patients and mental health nurses

AIMS AND OBJECTIVESnTo gain insight into the factors influencing the integration of physical activity and healthy eating into the daily care of individuals with mental disorders (MD) living in sheltered housing and to increase the understanding of the relationships between and complexities of these factors.nnnBACKGROUNDnGrowing attention is given to the implementation of health promotion activities in mental health care. By improving the understanding of perceptions of patients and mental health nurses, health promotion programmes targeting physical activity and healthy eating can be developed that better meet the patients needs.nnnDESIGNnA descriptive qualitative study.nnnMETHODSnBased on a purposive sampling strategy, three focus groups including 17 mental health nurses and individual interviews with 15 patients were conducted.nnnRESULTSnAlthough physical and mental health benefits of physical activity and healthy eating were identified, several barriers to integrate healthy lifestyles into the daily life of patients were reported. Important barriers identified by the patients consisted of lack of energy and motivation as a result of the MD, side effects of psychotropic drug use, and hospitalisation. Lack of time and personal views and attitudes towards health promotion were reported by the mental health nurses as important elements influencing the way in which they integrate health promotion in the care provided. Support from the mental health nurse was considered important by the patients in changing their unhealthy lifestyle behaviour.nnnCONCLUSIONSnThe results of the study provide insight into important factors influencing the integration of health promotion activities targeting physical activity and healthy eating in individuals with MD living in sheltered housing.nnnRELEVANCE TO CLINICAL PRACTICEnThe information derived from this study is useful and relevant in the design and implementation of health promotion interventions targeting physical activity and healthy eating in people with MD living in sheltered housing.

Health promotion in individuals with mental disorders: a cluster preference randomized controlled trial

BackgroundThe existing literature on weight management interventions targeting physical activity and healthy eating in mental health care appears to provide only limited evidence. The aim of the study was to examine the effectiveness of a 10-week health promotion intervention, followed by a 6-month follow-up period in individuals with mental disorders living in sheltered housing in the Flanders region (Belgium).MethodsThe study had a cluster preference randomized controlled design. Twenty-five sheltered housing organisations agreed to participate (16 in the intervention group, nine in the control group). In the intervention group, 225 individuals agreed to participate, while in the control group 99 individuals entered into the study. The main outcomes were changes in body weight, Body Mass Index, waist circumference and fat mass. Secondary outcomes consisted of changes in physical activity levels, eating habits, health-related quality of life and psychiatric symptom severity.ResultsA significant difference was found between the intervention group and the control group regarding body weight (−0.35 vs. +0.22 kg; p=0.04), Body Mass Index (−0.12 vs. +0.08 kg/m2; p=0.04), waist circumference (−0.29 vs. + 0.55 cm; p<0.01), and fat mass (−0.99 vs. −0.12%; p<0.01). The decrease in these outcomes in the intervention group disappeared during the follow up period, except for fat mass. Within the intervention group, a larger decrease in the primary outcomes was found in the participants who completed the intervention. No significant differences between the two groups in changes in the secondary outcomes were found, except for the pedometer-determined steps/day. In the intervention group, the mean number of daily steps increased, while it decreased in the control group.ConclusionsThe study demonstrated that small significant improvements in the primary outcomes are possible in individuals with mental disorders. Integration of health promotion activities targeting physical activity and healthy eating into daily care are, however, necessary to maintain the promising results.Trial registrationThis study is registered at ClinicalTrials.gov NCT01336946

Cost Effectiveness of a Pharmacist-Led Information Technology Intervention for Reducing Rates of Clinically Important Errors in Medicines Management in General Practices (PINCER)

Background and ObjectiveWe recently showed that a pharmacist-led information technology-based intervention (PINCER) was significantly more effective in reducing medication errors in general practices than providing simple feedback on errors, with cost per error avoided at £79 (US

Economic Impact of Integrated Care Models for Patients with Chronic Diseases: A Systematic Review

131). We aimed to estimate cost effectiveness of the PINCER intervention by combining effectiveness in error reduction and intervention costs with the effect of the individual errors on patient outcomes and healthcare costs, to estimate the effect on costs and QALYs.MethodsWe developed Markov models for each of six medication errors targeted by PINCER. Clinical event probability, treatment pathway, resource use and costs were extracted from literature and costing tariffs. A composite probabilistic model combined patient-level error models with practice-level error rates and intervention costs from the trial. Cost per extra QALY and cost-effectiveness acceptability curves were generated from the perspective of NHS England, with a 5-year time horizon.ResultsThe PINCER intervention generated £2,679 less cost and 0.81 more QALYs per practice [incremental cost-effectiveness ratio (ICER): −£3,037 per QALY] in the deterministic analysis. In the probabilistic analysis, PINCER generated 0.001 extra QALYs per practice compared with simple feedback, at £4.20 less per practice. Despite this extremely small set of differences in costs and outcomes, PINCER dominated simple feedback with a mean ICER of −£3,936 (standard error £2,970). At a ceiling ‘willingness-to-pay’ of £20,000/QALY, PINCER reaches 59xa0% probability of being cost effective.ConclusionsPINCER produced marginal health gain at slightly reduced overall cost. Results are uncertain due to the poor quality of data to inform the effect of avoiding errors.

Within the triangle of healthcare legacies: comparing the performance of South-Eastern European health systems

OBJECTIVESnTo assess the costs and potential financial benefits of integrated care models for patients with chronic diseases, that is, type 2 diabetes mellitus, schizophrenia, and multiple sclerosis, respectively.nnnMETHODSnA systematic search of the literature was performed using EMBASE, MEDLINE, and Web of Science. Studies that conducted a cost analysis, considered at least two components of the chronic care model, and compared integrated care with standard care were included.nnnRESULTSnOut of 575 articles, 26 were included. Most studies examined integrated care models for type 2 diabetes mellitus (n = 18) and to a lesser extent for schizophrenia (n = 6) and multiple sclerosis (n = 2). Across the three disease groups, the incremental cost per patient per year ranged from - €3860 to + €613.91 (x¯ = - €533.61 ± €902.96). The incremental cost for type 2 diabetes mellitus ranged from - €1507.49 to + €299.20 (x¯ = - €518.22 ± + €604.75), for schizophrenia from - €3860 to + €613.91 (x¯ = - €677.21 ± + €1624.35), and for multiple sclerosis from - €822 to + €339.43 (x¯ = - €241.29 ± + €821.26). Most of the studies (22 of 26 [84.6%]) reported a positive economic impact of integrated care models: for type 2 diabetes mellitus (16 of 18 [88.9%]), schizophrenia (4 of 6 [66.7%]), and multiple sclerosis (1 of 2 [50%]).nnnCONCLUSIONSnIn this systematic literature review, predominantly positive economic impacts of integrated care models for patients with chronic diseases were found.

Cost-effectiveness of health promotion targeting physical activity and healthy eating in mental health care

Abstract Objective: Inter-regional comparison of health-reform outcomes in south-eastern Europe (SEE). Methods: Macro-indicators were obtained from the WHO Health for All Database. Inter-regional comparison among post-Semashko, former Yugoslavia, and prior-1989-free-market SEE economies was conducted. Results: United Nations Development Program Human Development Index growth was strongest among prior-free-market SEE, followed by former Yugoslavia and post-Semashko. Policy cuts to hospital beds and nursing-staff capacities were highest in post-Semashko. Physician density increased the most in prior-free-market SEE. Length of hospital stay was reduced in most countries; frequency of outpatient visits and inpatient discharges doubled in prior-free-market SEE. Fertility rates fell for one third in Post-Semashko and prior-free-market SEE. Crude death rates slightly decreased in prior-free-market-SEE and post-Semashko, while growing in the former Yugoslavia region. Life expectancy increased by 4 years on average in all regions; prior-free-market SEE achieving the highest longevity. Childhood and maternal mortality rates decreased throughout SEE, while post-Semashko countries recorded the most progress. Conclusions: Significant differences in healthcare resources and outcomes were observed among three historical health-policy legacies in south-eastern Europe. These different routes towards common goals created a golden opportunity for these economies to learn from each other.

The potential health and economic effect of a Body Mass Index decrease in the overweight and obese population in Belgium

BackgroundThere is a higher prevalence of obesity in individuals with mental disorders compared to the general population. The results of several studies suggested that weight reduction in this population is possible following psycho-educational and/or behavioural weight management interventions. Evidence of the effectiveness alone is however inadequate for policy making. The aim of the current study was to evaluate the cost-effectiveness of a health promotion intervention targeting physical activity and healthy eating in individuals with mental disorders.MethodsA Markov decision-analytic model using a public payer perspective was applied, projecting the one-year results of a 10-week intervention over a time horizon of 20xa0years, assuming a repeated yearly implementation of the programme. Scenario analysis was applied evaluating the effects on the results of alternative modelling assumptions. One-way sensitivity analysis was performed to assess the effects on the results of varying key input parameters.ResultsAn incremental cost-effectiveness ratio of 27,096€/quality-adjusted life years (QALY) in men, and 40,139€/QALY in women was found in the base case. Scenario analysis assuming an increase in health-related quality of life as a result of the body mass index decrease resulted in much better cost-effectiveness in both men (3,357€/QALY) and women (3,766€/QALY). The uncertainty associated with the intervention effect had the greatest impact on the model.ConclusionsAs far as is known to the authors, this is the first health economic evaluation of a health promotion intervention targeting physical activity and healthy eating in individuals with mental disorders. Such research is important as it provides payers and governments with better insights how to spend the available resources in the most efficient way. Further research examining the cost-effectiveness of health promotion targeting physical activity and healthy eating in individuals with mental disorders is required.