Shared guidelines and protocols to achieve better health outcomes for people living with serious mental illness

[Extract]
People living with serious mental illness have poor physical health leading to many years lived with chronic diseases and an average loss of 20 years’ life expectancy. Most of this excess morbidity and mortality is avoidable through the implementation of well accepted preventive measures. Fragmentation of care between hospital, specialist and general practice services was identified as a key barrier to better physical health care by consumers and health experts in the Being Equally Well roadmap. Intersectoral service and care planning with collaborative agreements, clinical information exchange and patient recall systems have been identified as successful components of better care. This article outlines how intersectoral coordinated care could be improved by intercollegiate co-designed clinical guidelines and implementation of formalised shared care protocols that address evidence-to-practice gaps in the care of patients living with serious mental illness.

Clinical guidelines provide an accepted and accessible set of evidence-based recommendations and consensus statements that describe best-practice. The Royal Australian and New Zealand College of Psychiatrists (RANZCP) published clinical guidelines in 2016 to help psychiatrists manage and monitor schizophrenia and related disorders. These guidelines include a recommendation that patients see their general practitioner to manage physical health risks and chronic diseases. There are recommendations about smoking cessation, choice of antipsychotic medication, and frequency of monitoring for cardiometabolic risks. The Royal Australian College of General Practitioners (RACGP) also produces guidelines for preventive activities in general practice including screening interventions, smoking cessation, and the management of diabetes. The Being Equally Well roadmap calls for the RANZCP and RACGP to co-design a single clinical guideline that makes evidence-based recommendations for the management of physical health risks in people living with serious mental illness. The Box describes the current Australian delivery of clinical activities demonstrating both overlap and gaps identified by members of clinician working groups in the Being Equally Well project.