Physical health screening for people with severe mental disorders: a best practice implementation project

Abstract

Objective: To improve physical health screening and assessment practices for individuals with severe and persistent mental disorders treated at a Psychosocial Care Center in Brazil. Method: A best practice implementation project following the JBI Evidence Implementation Framework conducted in the municipality of Itatiba in the state of São Paulo, with users of the Psychosocial Care Center II. The baseline audit (n = 278) and follow-up audit (n = 134) assessed compliance with seven evidence-based criteria. The data collection process occurred in different phases, which included identifying the area of practice to be changed, engaging change agents, assessing the context and readiness for change, auditing current service practices, implementing practice changes, evaluating the implemented strategies, and monitoring changes in practice. Results: Baseline compliance was low, with several indicators below 10%. After implementing standardized documentation tools, integrating nursing assessments at intake, and planning inter-service coordination, key improvements were observed. Documentation of physical examination increased from 9.0% to 47.1% (+38.1 pp), Body Mass Index recording from 0% to 22.4% (+22.4 pp), and scheduling of follow-up appointments from 1.1% to 21.6% (+20.5 pp). However, minimal or no progress occurred in laboratory testing, electrocardiogram requests, and monitoring of antipsychotic side effects. Conclusion: The project strengthened internal routines and demonstrated the feasibility of implementing evidence-based practices. Nevertheless, limited progress in criteria dependent on external factors and the need for stronger professional integration highlight the importance of greater investment to address persistent care gaps.