Preventive Healthcare Interventions Research Articles

GIS-based Social Vulnerability Integration for Robust Flood Response, Disease Prevention and Community Resilience in Chennai Metropolitan Area post-Cyclone Michaung

The present study outlines a comprehensive strategy for flood response, disease prevention and long-term community resilience in the aftermath of a recent Cyclone Michaung, with the proximity of landfall near Chennai and the increased likelihood of flooding in the CMA. Drawing insights from an existing social vulnerability map, the study addresses the unique challenges posed by flooding and aims to mitigate the heightened risk of waterborne and vector-borne diseases. Objectives encompass assessing social vulnerability, formulating a targeted flood response strategy, implementing healthcare interventions for disease prevention, strengthening information dissemination and advocating for long-term resilience planning. The methodology involves reviewing the existing vulnerability map, identifying vulnerable communities, integrating flood impact data and developing a comprehensive response plan. The study utilizes GIS and Remote Sensing technologies for monitoring and assessing the results. Key findings from the social vulnerability assessment inform prioritized intervention areas for both flood response and disease prevention. The discussion interprets results in the context of strategy effectiveness, emphasizing the significance of a nuanced and inclusive approach. This manuscript serves as a guide for stakeholders in implementing a holistic strategy that addresses immediate concerns, prevents disease outbreaks and fosters long-term community resilience.

Double Disparity of Sexual Minority Status and Rurality in Cardiometabolic Hospitalization Risk: A Secondary Analysis Using Linked Population-Based Data

Studies have shown separately that sexual minority populations generally experience poorer chronic health outcomes compared with those who identify as heterosexual, as do rural populations compared with urban dwellers. This Canadian national observational study explored healthcare patterns at the little-understood intersections of lesbian, gay, or bisexual (LGB) identity with residence in rural and remote communities, beyond chronic disease status. The secondary analysis applied logistic regressions on multiple linked datasets from representative health surveys, administrative hospital records, and a geocoded index of community remoteness to examine differences in the risk of potentially avoidable cardiometabolic-related hospitalization among adults of working age. Among those with an underlying cardiometabolic condition and residing in more rural and remote communities, a significantly higher hospitalization risk was found for LGB-identified persons compared with their heterosexual peers (odds ratio: 4.2; 95% confidence interval: 1.5–11.7), adjusting for sociodemographic characteristics, behavioral risk factors, and primary healthcare access. In models stratified by sex, the association remained significant among gay and bisexual men (5.6; CI: 1.3–24.4) but not among lesbian and bisexual women (3.5; CI: 0.9–13.6). More research is needed leveraging linkable datasets to better understand the complex and multiplicative influences of sexual minority status and rurality on cardiometabolic health to inform equity-enhancing preventive healthcare interventions.

The economic burden of mental disorders: results from the Netherlands mental health survey and incidence study-2.

Currently, there is a paucity of up-to-date estimates of the economic burden caused by mental disorders. Such information could provide vital insight into one of the most serious and costly-yet to some extent preventable-health challenges facing the world today. Data from a national psychiatric-epidemiological cohort study (NEMESIS-2, N = 6506) were used to provide reliable, relevant, and up-to-date cost estimates (in 2019 Euro) regarding healthcare costs, productivity losses, and patient and family costs associated with DSM-IV mental disorders both at individual level, but also in the general population and in the workforce of the Netherlands (per 1 million population). In the general population, the costs of mood disorders, specifically depression, are substantial and rank above those from the anxiety disorders, whilst costs of anxiety disorders are more substantial than those stemming from substance use disorders, even when the per-person costs of drug abuse appear highest of all. In the workforce, specific and social phobias are leading causes of excess costs. The workforce has lower healthcare costs but higher productivity costs than general population. The findings suggest that (preventive) healthcare interventions targeting the workforce are likely to become cost-effective and underscore the importance for employers to create healthy work environments. Overall, the results highlight the need to strengthen the role of mental health promotion and prevention of mental disorders in the social domain before people require treatment to reduce the staggering and costly burden caused by mental disorders to individuals and society.

Lung Cancer Screening in People With HIV: A Mixed-Methods Study of Patient and Provider Perspectives

People with HIV are at higher risk of lung cancer; however, there is limited research on attitudes, barriers, and facilitators to lung cancer screening in people with HIV. The objective of this study was to understand the perspectives on lung cancer screening among people with HIV and their providers. Surveys of people with HIV and HIV-care providers were complemented by qualitative focus groups and interviews designed to understand the determinants of lung cancer screening in people with HIV. Participants were recruited through an academic HIV clinic in Seattle, WA. Qualitative guides were developed by integrating the Consolidated Framework for Implementation Research and the Tailored Implementation of Chronic Diseases checklist. Themes that emerged from thematic analyses of qualitative data were compared with surveys in joint displays. All study components were conducted between 2021 and 2022. Sixty-four people with HIV completed surveys, and 43 participated in focus groups. Eleven providers completed surveys, and 10 were interviewed for the study. Themes from joint displays show overall enthusiasm for lung cancer screening among people with HIV and their providers, particularly with a tailored and evidence-based approach. Facilitators in this population may include longstanding engagement with providers and health systems and an emphasis on survivorship through preventive healthcare interventions. People with HIV may also face barriers acknowledged by providers, including a high level of medical comorbidities and competing issues such as substance abuse, mental health concerns, and economic instability. This study reveals that people with HIV and their providers have overall enthusiasm toward screening. However, tailored interventions may be needed to overcome specific barriers, including complex decision making in the setting of medical comorbidity and patient competing issues.

ESTIMATION OF CEREBROVASCULAR INSULT FREQUENCY IN EMERGENCY PATIENTS AT THE CLINICAL HOSPITAL CENTRE RIJEKA

Purpose: Cerebrovascular stroke is defi ned as a sudden focal neurologic defi cit caused by cerebrovascular disease lasting longer than 24 hours. Cerebrovascular insult (CVI) is divided into ischemic and hemorrhagic. Along with heart disease and malignancies, cerebrovascular disease is the most common cause of mortality and disability in the modern world, attributing to this disease being the leading cause of disability across the globe. Diagnosis and identifi cation of the type of stroke requires imaging examination with computed tomography. A detailed history and imaging usually rule out the impersonation of a stroke. Computed tomography (CT) is one of the fi rst diagnostic modalities used to image the brain to identify the diff erence between ischemic and hemorrhagic stroke. The aim of this retrospective analysis was to estimate the incidence of cerebrovascular insult in patients who underwent CT brain examination in the Clinical Department of Radiology at Clinical Hospital Centre (CHC) Rijeka in the period from January 1, 2020, to December 31, 2020. Materials and methods: During this period, 255 data sets from patients' medical records were anonymously collected. The data search included patients who underwent CT of the brain with a clinical question about CVI. Results: The data analysis at CHC Rijeka showed that the incidence of CVI is slightly higher in the male population. It is commonly diagnosed in the population of 81-90 years. About half of the patients with suspected CVI had normal CT fi ndings. Conclusion: These results could serve as a guideline for targeting groups in preventive healthcare interventions and education. Keywords: computed tomography, cerebrovascular insult, ischemic stroke, hemorrhagic stroke

Mothers’ Preventive Health Care Practices and Children’s Survival in Burkina Faso: Findings from Repeated Cross-sectional Household Surveys

The significant reduction in the level of child mortality in both developed and developing countries over recent decades has led to an improvement in children’s health. The implementation, monitoring, and evaluation of the health programs needed to reduce child mortality require determination and an understanding of the factors responsible for this reduction. This study investigated factors that have contributed to the recent improvement in the survival of children under five, focusing on the contribution of preventive health care in improving children’s survival rates in Burkina Faso.
 The data used come from baseline and end-line surveys designed to evaluate the impact of performance-based financing (PBF) on health programs in Burkina Faso. Using time-series for health districts and child-level logistic regression models, we estimated the effect of preventive health care, as summarized by the changes in the composite coverage index (CCI), on under-five child survival of temporal trends and covariates at the household, maternal, and child levels.
 At the health district level, a unit increase in standardized CCI was associated with an improvement in under-five child survival after adjustment for survey period effects. The linear regression analysis showed that a standardized unit increase in CCI was associated with an increase in the percentage of children under five who survive. At the child level, the logistic regression showed that a skilled attendant at birth (SBA), wealth index, and mother’s parity were associated with under-five children’s survival, after adjustment for the survey period effects and a set of household, maternal, and child-level covariates.
 Preventive health care is important in improving under-five children’s survival, whereas the effects of economic growth in Burkina Faso remain weak and inconsistent. Improved coverage of preventive health care interventions are likely to contribute to further reductions in under-five mortality in Burkina Faso.

Virucidal Efficacy of Olanexidine Gluconate as a Hand Antiseptic Against Human Norovirus

Human noroviruses are the major cause of non-bacterial acute gastroenteritis worldwide. Since no therapeutic agent has been proven to prevent human norovirus infection yet, preventive healthcare interventions to block the infection routes play an important role in infection control. One of the possible infection routes of human noroviruses are through contaminated hands, but no hand antiseptics have been proven effective. Olanexidine gluconate is a new biguanide compound that has already been approved for sale as an antiseptic for the surgical field in Japan. A new hand antiseptic was developed using olanexidine gluconate in this study, and its virucidal efficacy against human noroviruses was evaluated using modified RT-qPCR that can account for genome derived from intact viruses using RNase A and photo-reactive intercalators. We tested the virucidal efficacy of five materials; two olanexidine gluconate antiseptics (hand rub formulation and surgical field formulation), two kinds of ethanol solutions at different pH (approx. 3 or 7), and a base component of olanexidine gluconate hand rub formulation against 11 human norovirus genotypes by culture-independent methods. The infectivity of murine norovirus (MNV), a surrogate for human norovirus, was significantly reduced after use of the antiseptics. The olanexidine gluconate hand rub demonstrated the strongest virucidal efficacy against human norovirus among the five tested materials. This study showed that olanexidine gluconate has the potential to become a strong tool for the prevention of human norovirus infection.

Serum levels of nesfatin-1 and irisin in obese children.

Along with the developing technology in the modern age, physical activity had decreased considerably in children and adolescents alike with a concomittant and rapid increase in the prevalence of childhood obsesity. The purpose of the present study is to measure the levels of serum nesfatin-1 and irisin in obese children. The present study was carried out with a total of 62 children, including 32 obese children diagnosed between June 2017 and October 2017 and 30 healthy children. Serum nesfatin-1, irisin, SOD, MDA, fasting blood glucose, total cholesterol (TC), triglyceride (TG), HDL-C, LDL-C, aspartate amino transferase (AST), alanine amino transferase (ALT)), blood urea nitrogen (BUN), C-reactive protein (CRP), calcium (Ca), sodium (Na), potassium (P), chromium (Cr), ferritin, and vitamin B12 data were collected for each patient. In our study, mean nesfatin-1 and SOD values of the obesity group were lower than those of the control group (p <0.05, p <0.001), whereas irisin and MDA values were higher than those of the control group (p <0.001). Childhood obesity is still a significant global problem, despite increased social awareness and numerous preventive healthcare interventions. We believe that all the prospective studies to be carried out to evaluate the relationship between obesity-irisin-nesfatin-1 triad, will make positive contributions to treatment of obesity.

A Review of Epidemic Forecasting Using Artificial Neural Networks

Background and aims: Since accurate forecasts help inform decisions for preventive health-care intervention and epidemic control, this goal can only be achieved by making use of appropriate techniques and methodologies. As much as forecast precision is important, methods and model selection procedures are critical to forecast precision. This study aimed at providing an overview of the selection of the right artificial neural network (ANN) methodology for the epidemic forecasts. It is necessary for forecasters to apply the right tools for the epidemic forecasts with high precision. Methods: It involved sampling and survey of epidemic forecasts based on ANN. A comparison of performance using ANN forecast and other methods was reviewed. Hybrids of a neural network with other classical methods or meta-heuristics that improved performance of epidemic forecasts were analysed. Results: Implementing hybrid ANN using data transformation techniques based on improved algorithms, combining forecast models, and using technological platforms enhance the learning and generalization of ANN in forecasting epidemics. Conclusion: The selection of forecasting tool is critical to the precision of epidemic forecast; hence, a working guide for the choice of appropriate tools will help reduce inconsistency and imprecision in forecasting epidemic size in populations. ANN hybrids that combined other algorithms and models, data transformation and technology should be used for an epidemic forecast.

Report on WHO meeting on immunization in older adults: Geneva, Switzerland, 22–23 March 2017

Many industrialized countries have implemented routine immunization policies for older adults, but similar strategies have not been widely implemented in low- and middle-income countries (LMICs). In March 2017, the World Health Organization (WHO) convened a meeting to identify policies and activities to promote access to vaccination of older adults, specifically in LMICs. Participants included academic and industry researchers, funders, civil society organizations, implementers of global health interventions, and stakeholders from developing countries with adult immunization needs. These experts reviewed vaccine performance in older adults, the anticipated impact of adult vaccination programs, and the challenges and opportunities of building or strengthening an adult and older adult immunization platforms. Key conclusions of the meeting were that there is a need for discussion of new opportunities for vaccination of all adults as well as for vaccination of older adults, as reflected in the recent shift by WHO to a life-course approach to immunization; that immunization in adults should be viewed in the context of a much broader model based on an individual’s abilities rather than chronological age; and that immunization beyond infancy is a global priority that can be successfully integrated with other interventions to promote healthy ageing. As WHO is looking ahead to a global Decade of Healthy Ageing starting in 2020, it will seek to define a roadmap for interdisciplinary collaborations to integrate immunization with improving access to preventive and other healthcare interventions for adults worldwide.

Settling Ulysses: An Adapted Research Agenda for Refugee Mental Health.

Refugees and asylum seekers arriving in Europe during the 2015/2016 wave of migration have been exposed to war conditions in their country of origin, survived a dangerous journey, and often struggled with negative reception in transit and host countries. The mental health consequence of such forced migration experiences is named the Ulysses syndrome. Policies regarding the right to residency can play an important role in reducing mental health symptoms. We propose that facilitating a sense of belonging should be seen as one important preventive mental healthcare intervention. A refugee mental health agenda needs to take into account the interplay between refugees’ and asylum seekers’ mental health, feeling of belonging, and access to healthcare. We urge for policies to restore individuals’ dignity, and recognize the right for homecoming to parallel the mythology of Ulysses.

The role of doctors in smoking cessation: evidence from the Cochrane Library

This article examines the role of doctors in assisting patients who smoke to quit, using evidence from Cochrane systematic reviews of randomised trials. Doctors may help such patients by providing advice, referring patients for counselling and support and by offering pharmacological therapy. Complementary therapies used for smoking cessation include hypnotherapy and acupuncture, but there is a lack of evidence that these interventions have a specific effect in aiding cessation. The number needed to treat (NNT) for simple advice to unselected smokers is 50 - 120. Based on a median no-treatment clinical trial quit rate of 7.5%, the NNT for nicotine replacement therapy is 23 (95% CI 20 to 27), for the antidepressant Bupropion 18 (95% CI 14 to 23), and for the nicotinic partial agonist Varenicline 10 (95% CI 7 to 14). These numbers compare favourably with other preventive healthcare interventions. There remains wide variations in the extent to which these interventions are available in different healthcare systems.

Opportunities for Pharmacists and Student Pharmacists to Provide Clinical Preventive Services

Pharmacists and student pharmacists can play an important role in providing clinical preventive services as specified by the United States Preventive Services Task Force (USPSTF). The USPSTF guidelines provide evidence-based recommendations about clinical preventive services for the general population. The purpose of this paper is to provide information to pharmacists and student pharmacists developing and implementing preventive health care services. Examples of successful pharmacy-based programs are also provided. Pharmacists and student pharmacists can provide preventive health care interventions by conducting screenings, providing education, and making referrals.&#x0D; Conflict of Interest&#x0D; We declare no conflicts of interest or financial interests that the authors or members of their immediate families have in any product or service discussed in the manuscript, including grants (pending or received), employment, gifts, stock holdings or options, honoraria, consultancies, expert testimony, patents and royalties&#x0D; &#x0D; Type: Idea Paper

Opportunities for Pharmacists and Student Pharmacists to Provide Clinical Preventive Services

Pharmacists and student pharmacists can play an important role in providing clinical preventive services as specified by the United States Preventive Services Task Force (USPSTF). The USPSTF guidelines provide evidence-based recommendations about clinical preventive services for the general population. The purpose of this paper is to provide information to pharmacists and student pharmacists developing and implementing preventive health care services. Examples of successful pharmacy-based programs are also provided. Pharmacists and student pharmacists can provide preventive health care interventions by conducting screenings, providing education, and making referrals. Conflict of Interest We declare no conflicts of interest or financial interests that the authors or members of their immediate families have in any product or service discussed in the manuscript, including grants (pending or received), employment, gifts, stock holdings or options, honoraria, consultancies, expert testimony, patents and royalties Type: Idea Paper

Preventive health care of Pony Club horses in rural New South Wales, Australia

To describe preventive health care provided to a cohort of Pony Club horses in rural New South Wales, Australia, and the associated veterinary involvement. Prospective longitudinal study Observational data collected for 48 Pony Club horses using daily owner-kept diaries and monthly veterinary visits for 9-12 months. Frequency of healthcare events varied markedly between the horses; 54% of horses received 5 or more foot-care treatments, 69% received 1-3 anthelmintic treatments, 40% received dental care, 21% received chiropractic care; only 8% were vaccinated. Farriers and owners administered most of the health care. Veterinarians were infrequently involved, administering 2 of the 111 anthelmintic administrations and 2 of the 244 foot-care treatments. No annual health checks or prepurchase examinations were recorded. All dental care was provided by non-veterinary dentists. Horse turnover appeared quick, with 54% of horses acquired within the previous 12 months. The majority of preventive health care was provided by farriers and the owners themselves. The type and frequency of healthcare events varied markedly and most commonly involved foot care and anthelmintic administration. The reasons for the lack of veterinary involvement are unclear. Veterinarians engaging with Pony Club families in a preventive context would likely bring health benefits to this population of horses. This may require adaptation of existing veterinary services to meet the demands of this unique population of horses and young riders. Furthermore, epidemiological studies are required to describe the effects of various preventive healthcare interventions on subsequent and long-term horse health.

From integrated care towards DIY Health – Combining person-centered health care delivery, mobile technology and entrepreneurship

Conference Abstract. Introduction and objectives: To achieve the level of impact necessary to reverse current trends of rising incidence and costs of multimorbidity and enabling healthy ageing will require new health care policy and practices. Notwithstanding integrated care receiving worldwide attention in improving healthcare delivery, the value of data driven and mobile technology for integration of health and care services remains unclear. Nevertheless, person-centered and data driven mobile health (mHealth) has the potential to evolve integrated care from business process re-design towards a new digital health ecosystem that is truly centered around a person facing health challenges. The objective of our study was to identify the opportunities and barriers of mHealth to do this. Highlights: MHealth applications attack the underlying causes of the multimorbidity and ageing challenge in various ways. First, mHealth lifestyle apps promise to help in the prevention of chronic disease and multimorbidity by attacking high risk conditions such as obesity and diabetes. Secondly, personalised care promised by participative mHealth apps will reduce reliance on expensive, institutionalised care by augmenting the effectiveness of treatments. Finally, mHealth apps could empower patients by facilitating remote care, self-medication, independent living and more. One of the major developments in mHealth for integrated care is that (new) entrants in the mHealth market focus more on patients and consumers than on medical professionals. This development has several benefits: First the emphasis on intuitive user interfaces, usability and immediate feedback by these parties seems more effective in nudging people to change towards desired behaviors than traditional (preventive) healthcare interventions. Furthermore, mHealth applications encourage self-monitoring and self-diagnosis, potentially reducing the number of hospital visits for purposes of monitoring and simple diagnoses. However, we see certain challenges. First and foremost, attention should be paid to manage sensitivity of health information by allowing more control over data-driven solutions by end-users and other stakeholders. Secure and dedicated data platforms for the health sector should govern the secure interconnection of health data components. Secondly, to create an effective learning ecosystem, new cross-disciplinary and collaborative research and innovation approaches are needed. These will help tackle technological, behavioral and institutional challenges. Finally, to stimulate the emergence and participation of mHealth entrepreneurs, any health data exchange initiative will need to prioritize access by startups and SMEs to fast track the required fundamental innovations in a traditional health sector. Conclusions: Our analysis shows that new, consumer-focused entrants have a high potential to stimulate person-centered coordinated care. Nevertheless, research and policy should find solutions for potential ‘showstoppers’, such as challenges in privacy, accountability and security. A learning ecosystem, which has to include new research and innovation models, may facilitate this. Another important aspect is to find ways to grant new entrants, in particular start-ups and SMEs, access to core health infrastructure and key data-sets.

Quantifying the impact of accessibility on preventive healthcare in sub-Saharan Africa using mobile phone data.

Poor physical access to health facilities has been identified as an important contributor to reduced uptake of preventive health services and is likely to be most critical in low-income settings. However, the relation among physical access, travel behavior, and the uptake of healthcare is difficult to quantify. Using anonymized mobile phone data from 2008 to 2009, we analyze individual and spatially aggregated travel patterns of 14,816,521 subscribers across Kenya and compare these measures to (1) estimated travel times to health facilities and (2) data on the uptake of 2 preventive healthcare interventions in an area of western Kenya: childhood immunizations and antenatal care. We document that long travel times to health facilities are strongly correlated with increased mobility in geographically isolated areas. Furthermore, we found that in areas with equal physical access to healthcare, mobile phone-derived measures of mobility predict which regions are lacking preventive care. Routinely collected mobile phone data provide a simple and low-cost approach to mapping the uptake of preventive healthcare in low-income settings.

Beneficial effects of treatment with sensory isolation in flotation-tank as a preventive health-care intervention - a randomized controlled pilot trial.

BackgroundSensory isolation in a flotation tank is a method known for inducing deep relaxation and subsequent positive health effects for patients suffering from e.g. stress or muscle tensions pains. Very few studies have investigated this method as a preventive health-care intervention. The purpose of this study was to evaluate the effects in healthy participants after receiving a series of flotation tank treatment.MethodsSixty-five participants (14 men and 51 women) who were all part of a cooperative-health project initiated by their individual companies, were randomized to either a wait-list control group or a flotation tank treatment group where they participated in a seven weeks flotation program with a total of twelve flotation sessions. Questionnaires measuring psychological and physiological variables such as stress and energy, depression and anxiety, optimism, pain, stress, sleep quality, mindfulness, and degree of altered states of consciousness were used. Data were analysed by two-way mixed MANOVA and repeated measures ANOVA.ResultsStress, depression, anxiety, and worst pain were significantly decreased whereas optimism and sleep quality significantly increased for the flotation-REST group. No significant results for the control group were seen. There was also a significant correlation between mindfulness in daily life and degree of altered states of consciousness during the relaxation in the flotation tank.ConclusionsIt was concluded that flotation-REST has beneficial effects on relatively healthy participants.Trial registrationAustralian New Zealand Clinical Trials Registry: ACTRN12613000483752.

The Peru Cervical Cancer Screening Study (PERCAPS): The Design and Implementation of a Mother/Daughter Screen, Treat, and Vaccinate Program in the Peruvian Jungle

Peru struggles to prevent cervical cancer (CC). In the jungle, prevention programs suffer from significant barriers although technology exists to detect CC precursors. This study used community based participatory research (CBPR) methods to overcome barriers. The objective was to evaluate the utility of CBPR techniques in a mother-child screen/treat and vaccinate program for CC prevention in the Peruvian jungle. The CC prevention program used self-sampling for human papillomavirus (HPV) for screening, cryotherapy for treatment and the HPV vaccine Gardasil for vaccination. Community health leaders (HL) from around Iquitos participated in a two half day educational course. The HLs then decided how to implement interventions in their villages or urban sectors. The success of the program was measured by: (1) ability of the HLs to determine an implementation plan, (2) proper use of research forms, (3) participation and retention rates, and (4) participants' satisfaction. HLs successfully registered 320 women at soup kitchens, schools, and health posts. Screening, treatment, and vaccination were successfully carried out using forms for registration, consent, and results with minimum error. In the screen/treat intervention 100% of participants gave an HPV sample and 99.7% reported high satisfaction; 81% of HPV + women were treated, and 57% returned for 6-month followup. Vaccine intervention: 98% of girls received the 1st vaccine, 88% of those received the 2nd, and 65% the 3rd. CBPR techniques successfully helped implement a screen/treat and vaccinate CC prevention program around Iquitos, Peru. These techniques may be appropriate for large-scale preventive health-care interventions.

Long-Term Outcomes of a Randomized Trial of Integrated Skills Training and Preventive Healthcare for Older Adults with Serious Mental Illness

This report describes 1-, 2-, and 3-year outcomes of a combined psychosocial skills training and preventive healthcare intervention (Helping Older People Experience Success [HOPES]) for older persons with serious mental illness. A randomized controlled trial compared HOPES with treatment as usual (TAU) for 183 older adults (age≥ 50 years [mean age: 60.2]) with serious mental illness (28% schizophrenia, 28% schizoaffective disorder, 20% bipolar disorder, 24% major depression) from two community mental health centers in Boston, Massachusetts, and one in Nashua, New Hampshire. HOPES comprised 12 months of weekly skills training classes, twice-monthly community practice trips, and monthly nurse preventive healthcare visits, followed by a 1-year maintenance phase of monthly sessions. Blinded evaluations of functioning, symptoms, and service use were conducted at baseline and at a 1-year (end of the intensive phase), 2-year (end of the maintenance phase), and 3-year (12 months after the intervention) follow-up. HOPES compared with TAU was associated with improved community living skills and functioning, greater self-efficacy, lower overall psychiatric and negative symptoms, greater acquisition of preventive healthcare (more frequent eye exams, visual acuity, hearing tests, mammograms, and Pap smears), and nearly twice the rate of completed advance directives. No differences were found for medical severity, number of medical conditions, subjective health status, or acute service use at the 3-year follow-up. Skills training and nurse facilitated preventive healthcare for older adults with serious mental illness was associated with sustained long-term improvement in functioning, symptoms, self-efficacy, preventive healthcare screening, and advance care planning.