PA Program Beneficial to Severe Mental Illness Patients

Chetan Shah, MPharm, MBA

Expanding the use of physician associates (PA) could pay dividends for patients with severe mental health issues.

A team, led by Chetan Shah, MPharm, MBA, Chief Pharmacist, Hertfordshire Partnership University NHS Foundation Trust, evaluated an enhanced physical health clinical led by PA for patients with severe mental illnesses.

The Problem

Patients with a diagnosis of severe mental illnesses are linked to inequalities that contribute to a life expectancy up to 20 years shorter than the general population. This patient population also has higher mortality rates than the general population.

However, the factors that lead to these health burdens include social factors such as unemployment and poverty, higher rates of behaviors that pose a risk to health like smoking and poor diet, and a lack of support to access care.

Other factors include the effects of medications such as weight gain, stigma, discrimination, isolation, and exclusion preventing individuals from seeking help, and diagnostic overshadowing or the misattribution of physical health symptoms to part of an existing mental health diagnosis, rather than a genuine physical health problem requiring treatment.

Data Collection

The investigators developed a new guidance and data collection tool to perform physical health assessments, identify abnormal results, determine when to refer patients to medical staff, provide brief interventions, and record intervention that supports and documents the outcomes of PA-led enhanced physical health clinics that diagnose patients with diabetes, hyperlipidemia, and hematologic abnormalities.

“Patients with mental health problems are likely to be exposed to a combination of different risk factors and therefore have a higher level of metabolic syndrome and comorbidities such as obesity, high BP, raised blood glucose levels, and abnormal cholesterol levels than the general population,” the authors wrote. “In addition to the social determinants of health, another significant risk factor for cardiometabolic adverse reactions is antipsychotic drugs, particularly second-generation antipsychotics.”

The tool was piloted with 5 patients to validate the project.

Results

Patients were evaluated between October and December 2019 and the average patient age was 46 years old for men and 44 years for women.

The investigators conducted an initial discussion between senior medical staff, the chief pharmacist, and human resources professionals to scope the role of physicians associates in a community-based mental health setting.

In the study, PA-led interventions led to 1 patient with diabetes started on metformin, 2 patients starting a prediabetes program with their general practitioner, 1 patient diagnosed with hyperlipidemia and starting simvastatin, 1 patient switched from cigarettes to e-cigarettes, and 1 patient switched from olanzapine to aripiprazole due to metabolic adverse reactions.

In addition, 2 patients intended to contact the National Health Service for cancer screening.

“PAs can be integrated into a community mental health multidisciplinary team and support the physical health of people with severe mental illness,” the authors wrote. “Mental health trusts should consider roles for PAs in their workforce planning.”

Emerging Field

PA is a new profession in the UK, with about 1000 graduates in 2018 and 1200 in training, but only 20 known to be employed in the mental health setting.

There was a recent systematic review that shows the contribution of PAs to secondary care did not affect health outcomes or overall cost.

Another study showed PAs led to improved access to primary care for patients, more timely access to psychiatric appointments, and a longer duration of appointments, reduced wait times, and improved access to tertiary care and screening programs. The study also showed implementation challenges of triage hierarchy and patient understanding of the term PA.

The study, “A physician associate-led clinic for people with severe mental illness in the United Kingdom,” was published online in the Journal of the American Academy of Physician Assistants.