Abstract
BACKGROUND: People living with severe mental illness (SMI) can experience greater risk of premature mortality than the general population with preventable physical ill health a major contributor. Physical health checks are a strategy to improve physical health but uptake is variable. AIM: To collate and assess the published evidence on the effectiveness of interventions to increase access to, and uptake of, physical health reviews for people living with SMI. DESIGN AND SETTING: This was a systematic review. METHOD: Three databases (Medline, CINAHL, and PsycINFO) were searched for studies evaluating interventions aiming to increase access to and uptake of physical health checks for people with SMI. Searches were conducted during October and November 2024 for studies published from 2000 onwards. Studies were included that reported on outcomes of uptake or receipt of physical health checks or screening, including cancer screening. Both randomised controlled trials (RCTs) and comparative non-randomised studies were eligible. Primary, secondary, and tertiary care settings were included. Studies from high-income countries were also included. Risk of bias was assessed using version 2 of the Cochrane risk-of-bias tool for randomised trials (RoB2), an adaptation of the Risk of Bias in Non-randomised Studies of Exposures (ROBINS-E), and Risk of Bias in Non-randomised Studies - of Interventions (ROBINS-I) tools. Data synthesis involved an effect direction plot. RESULTS: Of 4437 identified studies, 12 were eligible. Intervention categories were case management (n = 2), financial incentivisation (n = 3), service change (n = 5), invitation (n = 1), and mixed (n = 1). Two RCTs showed a positive effect of a case-management approach; for one study there was 'high' risk of bias. For other interventions, diverse non-randomised studies were included with either positive or mixed findings and risk of bias ranging from 'moderate' to 'critical'. CONCLUSION: The study identified a scarcity of data and although a case-management approach shows promise there should be further robust and high-quality research.