Introducing Extended Consultations for Patients with Severe Mental Illness in General Practice. Results from the SOFIA Feasibility Study

Abstract

Abstract Background The SOFIA intervention aims to improve life expectancy and quality of life for patients with severe mental illness (SMI). The complex intervention was co-designed with relevant stakeholders and consists of an extended consultation in general practice, focusing on a patient-centred and structured care approach. We tested its feasibility and assessed the clinical content of extended consultations as preparation for a larger randomized pilot study. Methods The study was a one-armed feasibility study. We planned that seven general practices in northern Denmark would introduce extended consultations with their patients with SMI for six months. Patients with SMI were identified using practice medical records and screened for eligibility by the patients’ general practitioner (GP). Data were collected using case report forms filled out by practice personnel and via qualitative methods, including observations of consultations, individual semi-structured interviews, a focus group with GPs, and informal conversations with patients and general practice staff. Results Five general practices employing seven GPs participated in the study, which was terminated 3 ½ month ahead of schedule due to the COVID-19 pandemic. General practices contacted 57 patients with SMI. In total, 38 patients (67%) attended an extended consultation, which led to a change in patients’ somatic health care plan in 82% of consultations. The conduct of the extended consultations varied between GPs and diverged from the SOFIA protocol. Nonetheless, GPs found that the extended consultations were feasible and, in most cases, perceived as beneficial for the patient group. Most patients also perceived an extended consultation as beneficial. Discussion Our findings suggest that extended consultations for patients with SMI in general practice are feasible and perceived as beneficial by GPs and patients. Larger studies with a longer follow-up period could help to assess the long-term effects and the best implementation strategies for introducing extended consultations for patients with SMI in general practice. Conclusion Introducing extended consultations for patients with SMI in the Danish general practice setting was feasible and acceptable to patients and GPs. Extended consultations are well-suited for eliciting patients’ values and preferences and likely lead to changes in most patients’ somatic health care plans.