People with a severe mental illness (SMI) live 10–25 years shorter, mainly due to cardiovascular disease, partly as a result of antipsychotic use, lifestyle, and limited access to preventive care. This dissertation examines cardiovascular risk management in patients with an SMI in primary care and develops an intervention to reduce vascular risk. The results show that only 8.5% of patients with an SMI without diabetes or cardiovascular disease were screened adequately. General practitioners feel responsible, but lack alertness, knowledge, confidence, and resources to lower the risk. Collaboration with psychiatrists is limited. To improve this, the TACTIC intervention was developed in which general practitioners, psychiatrists, nurses, pharmacists, experts by experience, and patients work together. The feasibility study showed positive effects, such as a lower cardiovascular risk, but challenges remain, including low patient participation. The dissertation emphasizes the importance of collaboration, consistent guidelines, and greater involvement of experts by experience.
Kirsti Jakobs (1969) graduated as a medical doctor in 1996 and completed GP training at Erasmus University Rotterdam in 2001. Since then, she has worked as a GP. In 2014 she finished the NHG cardiovascular specialization in Maastricht, became advisor for the CVRM program in Arnhem, and in 2017 began her PhD at Radboud university medical center.