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Improving the Quality of Physical Health Checks Kate Dale, Mental/Physical Health Lead BDCT Kate Dale Mental/Physical Health Lead To develop and improve existing services for the physical health of those people who experience serious mental illness (SMI) Research • SMI patients receive less health care than average therefore experience health inequalities as a result. • The most notable is a shorter lifespan, reduced by up to 20 years compared to the general population. • Considerable evidence that the main cause of early death in people with SMI is cardiovascular disease Main Causes of Premature Death • Coronary Heart Disease • Respiratory Disease • Endocrine Disease • These can be preventable and reversible!!! The Quality and Outcomes Framework (QOF) • Recommends: • A physical health check within the last 12 months • Historically did not specify what the health check should include. • Recent release of V22 QOF business rules. More Comprehensive!!!! • • • • • • • Recording Alcohol consumption BMI BP Cholesterol/HDL Blood Glucose Cytology Recordings However it does not specify interventions Mental/Physical Health Indicator • The practice has a (SMI) register. • Physical health to be reviewed at 12-15 month intervals. • The review includes a check on accuracy of any prescribed medication • Side effect monitoring Review of physical health Review of co-ordination arrangements with secondary care • Lithium monitoring National Institute for Clinical Excellence (NICE) • Offers guidance for: • bipolar disorder(CG38) • Schizophrenia (CG82) The Bipolar Guide Recommends: • • • • • • • Thyroid Function Blood Glucose Lipid profile in the over 40s Blood Pressure Weight/BMI Smoking status It also recommends prolactin, liver function tests, renal function tests, full blood count and serum drug levels to monitor certain drugs Proposal • A more specific standardised data entry template based on existing mental health QOF indicator • Specific to areas of physical health risks prevalent to those with SMI • More specific tests e.g. blood tests for diabetes, cholesterol, ECG and other appropriate tests. We carried out an audit during June/July 2009 • The audit tool used was based on proposed best practice template • Used as a benchmark for the audit • To gather evidence • To support a proposal for mandatory template locally Audit Outcome • • • • • • • 12 practices audited Using QOF SMI registers 20% of each register Random sample Total of 104 patients included Anonymous 42% female 58% male Audit Findings 77% Had BMI Recorded 79% smoking status recorded 52% eligible patients offered weight loss advice 87% of smokers had been given cessation advice 70% of eligible women had a cervical smear test 55% alcohol status recorded 39% had a cholesterol test and 38% had a triglyceride test 78% of heavy alcohol users were offered advice 45% had a blood glucose recorded 3% waist circumference measured 38% had a thyroid function recorded 74% Had blood pressure recorded Audit Findings No patients had been given a cardiovascular risk calculation No patients had a blood test for prolactin levels Discussion • The quality of the health checks is in part very good, but could be improved. • Priority should be given to calculating cardiovascular risk. Early Findings!!!! • • • • Using the new template 1 practice 75 people on SMI register First 27 people were health checked using new template BMI Data 27/27 BMI’s recorded! 4 BMI<25 10 BMI 25–30 8 BMI 30-35 5 BMI >35 4 out of 27 patients had a Normal BMI 23 out of 27 patients had an Abnormal BMI ALL 23 patients where offered weight loss advice BMI 27=100% Cervical Smears 10 of 13 eligible=76.9% Blood Pressure 27=100% Cholesterol 21 = 77.8% Triglyceride 20 = 74.8% Random Blood Glucose 24 (+ 3 Fasting) = 88.9% Full Blood Count 27=100% Liver Function 27=100% Prolactin 22 = 81.9% Thyroid Function 24 = 88.9% Smoking Status 27= 100% (18 smokers 3 ex 6 non) Smoking Advice 18 = 100% Weekly alcohol intake 27 = 100% Current drug misuse 27 recorded 0 current users On Lithium 2 ECG 23 Requested Q Risk 13 Recorded Quarterly Reports April 2011 Baseline Total SMI Population: 4,608 on CPA 811 July 2011 Quarter 1 Total SMI Population:4,657 on CPA 824 September 2011 Quarter 2 Total SMI Population 4,719 on CPA 836 Mental Health Annual Physical Review Practice MH Register 117 Annual Review Baseline 5 Annual Review Q1 14 Annual Review Q2 20 B83006 B83007 128 0 3 18 B83008 142 0 4 13 B83015 71 18 20 22 B83032 38 0 4 6 B83064 60 9 7 14 Opportunities The register and annual health assessments will be key contributors to: • Reduce health inequalities • Reduce preventable deaths • Improve quality of life, health and wellbeing for patients and families • Improved experience of health services for patients and families Opportunities • To make a real difference to this vulnerable population • Staff to further develop and enhance existing skills • Affect change • Mental Health tailored to local or national incentive scheme? Thank you Any Questions?