Improving the Quality of Physical Health Checks Kate Dale: Mental/Physical Health Project Lead Bradford District Care Trust (BDCT) NB all material copyright BDCT and BAPCT

Research Patients with Severe Mental Illness (SMI) experience health inequalities. The most notable is a shorter lifespan, reduced by around 20 years compared to the general population One of the main causes of early death in people with SMI is cardiovascular disease

Excess mortality People with schizophrenia and bipolar illness are more likely than average to die prematurely from natural causes Harris EC, Barraclough B. Excess mortality of mental disorder. Br J Psych 1998; 173: 11-53 KD Show this slide and talk through causes of early death

KD: Here I will talk through side effects eg sexual dysfunction and other bits!! Car crash – cognitive function

KD Run passed these to support our evidence

Disability Rights Commission People with mental health problems experience ‘diagnostic overshadowing’: that is, reports of physical ill health being viewed as part of the mental health problem or learning disability, and so not investigated or treated. KD Here I have a perfect opportunity to share a real story

Disability Rights Commission Health Inequalities Formal Investigation Found that people with mental health problems have higher rates of obesity, smoking, heart disease, hypertension, respiratory disease, diabetes, stroke and breast cancer… than other citizens KD And again further evidence these slides are quick and easy

Mental/Physical Health QoF Indicators The practice has a (SMI) register. Physical health to be reviewed at 12 monthly 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

Proposal to address health inequalities in the SMI population in Bradford 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. Auditable across the whole city using the SystmOne primary care information system

First round of audit The audit tool used was based on our proposed best practice template To support a proposal for a 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 Smoking – QOF payment BMI – Local incentive payment 12

Audit Findings No patients had been given a cardiovascular risk calculation This would be a good way to identify high risk people for prevention No patients had a blood test for prolactin levels (elevated prolactin is a significant and common adverse effect of antipsychotic treatment)

Findings The quality of the health checks could be improved. Priority should be given to calculating cardiovascular risk.

The SystmOne Physical Health Check Template Screenshots

Physical Health Check Template The template is simply added to the GP system It supports a high quality check It helps predict risk It offers advice on what to do with abnormal findings It is linked to a series of audit reports It supports QOF reporting

Copyright BDCT & BAPCT 2011

Copyright BDCT & BAPCT 2011

Testing of template We piloted the new template in one practice 75 people were on the SMI register Data available for the first 27 people health checked using the new template

Body Mass Index (BMI) 27/27 BMI’s recorded (100%) 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 4 BMI<25 Normal 10 BMI 25–30 Overweight 8 BMI 30-35 Obese 5 BMI >35 V. Obese

BMI 27=100% Cervical Smears 10 of 13 eligible=77% Blood Pressure Cholesterol 21 = 78% Triglyceride 20 = 75% Random Blood Glucose 24 (3 were fasting) = 89% Full Blood Count Liver Function Prolactin 22 = 82% 2 very raised prolactin levels identified 21

Thyroid Function 24 = 89% Smoking Status 27= 100% (18 smokers, 3 ex, 6 non) Smoking Advice 18 = 100% Weekly alcohol intake 27 = 100% Current drug misuse 0 current users On Lithium 2 ECG 23 Requested Q Risk 13 Recorded = 48%

Further Roll out of the physical health check template across 6 GP practices

Use of Physical Health Check Template for the annual Review Practice MH Register Annual Review Baseline Annual Review Q1 Annual Review Q2 A 117 5 14 20 (17%) B 128 3 18 (14%) C 142 4 13 (9%) D 71 18 20 22 (31%) E 38 6 (16%) F 60 9 7 14 (23%)

Blood Pressure Recordings in last 12 months Practice MH Register Baseline Q1 Q2 A 117 84 82 86 (74%) B 128 102 101 107 (84%) C 142 83 87 93 (65%) D 71 54 59 (83%) E 38 24 25 (66%) F 60 45 42 47 (78%)

Opportunities Reduce health inequalities Reduce preventable deaths Improve quality of life, health and wellbeing for patients and families Improve experience of health services for patients and families Tailor interventions to high risk groups (age, ethnicity, substance users)

Further roll out The template is now live in 80 practices across Bradford and Airedale Outcomes are reported on a quarterly basis and demonstrate significant improvement Scope to develop in other clinical systems Regional and National interest Replicated in Learning Disabilities with great success

Future plans Ongoing review Sustain momentum & continue roll out Ongoing support and training Data collection at quarterly intervals

Benefit to patients Early detection of chronic diseases Living longer, living healthier A true holistic approach to care Patient satisfaction & equality Appropriate interventions and provision for support

NB all material copyright BDCT and The End NB all material copyright BDCT and