Effects of the SOFIA programme on Needs-based Quality of Life and Self-perceived Inequity in Patients with Severe Mental Illness: Results from a randomised pilot study.

Anne Møller, Maarten Rozing, Kristine Bissenbakker, Alexandra Brandt Ryborg Jønsson, Volkert Siersma, Maria Haahr Nielsen, John Brandt Brodersen

Keywords: quality of life; mental health; psychiatry; patient-reported outcome measures; psychometrics.

Background:

Living with severe mental illness (SMI) negatively affects an individual's quality of life (QoL). The SOFIA program, a coordinated general practice care initiative in Denmark, aimed to reduce mortality and improve QoL for people with SMI. The program included extended GP consultations, training for GPs and staff, and guidance for connecting patients to relevant health and social services.

Research questions:

What is the impact of extended consultations on needs-based QoL in patients with SMI?
What is the impact of extended consultations on self-perceived inequity in patients with SMI?
What is the impact of extended consultations on health-related QoL in people with SMI?

Method:

A cluster-randomised, non-blinded controlled trial across nine general practices in Denmark from November 2020 to March 2021. Participants were adults with SMI defined as patients diagnosed with psychotic, bipolar, or severe depressive disorders. Practices were assigned to either a coordinated care program (CCP), CCP plus a needs-based QoL tool (CCP+), or a control group. Outcomes were measured using the MultiMorbidQuestionnaire, MMQ, and EQ-5D-5L questionnaires.

Results:

Results showed no statistically significant differences in the change in needs-based QoL between intervention and control groups. However, statistically significant differences were revealed between CCP+ and the control group in the change in the two self-perceived inequity scales: not being seen and heard and powerlessness. No statistically significant differences were found in the two other self-perceived inequity scales and the health-related QoL outcome.

Conclusions:

These findings suggest that a comprehensive approach, like that used in the SOFIA consultation, may be essential to prevent individuals with serious mental illness (SMI) from experiencing feelings of inequity. However, a pragmatic randomised controlled trial with an adequate sample size and years of follow-up is needed to validate the SOFIA program's potential impact.

Points for discussion:

How can we use the results in our daily clinical practice: How to improve the patients with severe mental illness from feeling not seen and heard?

Can primary care impact patients with SMI’s feeling of being powerless?

Could we use the results to improve the consultation process when patients have severe mental illness?

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