Fidelity to an evidence-based model for physical healthcare for patients with severe mental illness

BACKGROUND: Individuals with severe mental illness have an elevated risk of developing cardiovascular diseases. This study aimed to examine adherence to an evidence-based model for physical healthcare by using the Physical Health Care Fidelity Scale and to explore whether adherence is associated with risk factors in patients. METHODS: This multicenter study was conducted at clinical sites within specialist mental health services in Norway. Data were collected from 230 patients aged 16 years or older with schizophrenia or bipolar spectrum disorders, or those currently using antipsychotic medications. Using generalized linear mixed models, we explored the relationship between fidelity scores and cardiometabolic risk factors (daily smoking, hypertension, obesity, sedentary behavior, diabetes, lipid disorder, and unhealthy diet). RESULTS: The sites generally demonstrated poor fidelity scores, reflecting a low level of specialist health care implementation of evidence-based practices. All assessed risk factors were highly prevalent, with daily smoking and/or snuff use being the most common (58.1%). Higher fidelity scores were assessed on the Policies subscale than on the Practices subscale, indicating that evidence-based knowledge regarding the identification and treatment of cardiovascular risk factors was more integrated into established policies and procedures than into the actual implementation of the interventions reaching patients. Associations between fidelity and patient clinical outcomes were non-significant after adjustment. CONCLUSION: Specialist healthcare providers demonstrated low adherence to evidence-based practices for cardiovascular risk management. Standardized fidelity measures can pinpoint areas for targeted improvement, and future studies should explore how fidelity levels relate to clinical outcomes. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03271242 (Registration date: 05.09.2017).