Download Kate Dale, Mental/Physical Health Lead BDCT

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!!!!
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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:
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•
•
•
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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
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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!!!!
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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?