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Current guidance on monitoring the physical health of people with serious mental illness is not supported by any evidence from randomized controlled trials, indicates a review in The Cochrane Collaboration.
“It is possible clinicians are expending much effort, time, and financial expenditure on monitoring the physical health of people with serious mental illnesses, which is unnecessary, intrusive, and costly,” says the group, led by Graeme Tosh, from East Midlands Workforce Deanery in Nottingham, UK.
“Clinicians should, therefore, take a much more critical view of current guidance and attempt to initiate or get involved with any studies which could provide an evidence-base for this practice.”
Increasing focus on physical health problems in people with serious mental illness has led to a number of different guidelines (eg, National Institute of Clinical Evidence and The Maudsley Prescribing Guidelines) advising clinicians to monitor the physical health of their patients to prevent deterioration of physical health and maintain quality of life.
Tosh and team set out to review the medical literature to determine the effectiveness of physical health monitoring.
Their selection criteria consisted of all randomized clinical trials comparing physical health monitoring with standard care, or those comparing self-monitoring with monitoring by a healthcare professional; simple versus complex monitoring; specific versus non-specific checks; once only versus regular checks; or comparison of different guidance.
The reviewers failed to find any randomized trials which assessed the effectiveness of physical health monitoring in people with serious mental health problems.
They therefore conclude that “guidance and practice are based on expert consensus, clinical experience, and good intentions rather than high quality evidence.”
Tosh and colleagues acknowledge that the lack of evidence does not necessarily mean that health monitoring has no effect on the physical health of people with severe mental illness.
But they remark that “history is littered with treatments and policies, which ‘seemed like a good idea at the time’ but which, with the benefit of hindsight, were, at best, ineffective and, at worst, resulted in harm.”
As it is possible to evaluate the effects of physical health monitoring in people with mental illness, they argue that, as part of a duty of care, “what could be known, should be shown.”
MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010
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