1. 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

2. 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

3. 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

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

5. KD Run passed these to support our evidence

6. 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

7. 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

8. 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

9. 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

10. First round of audit
The audit tool used was based on our proposed best practice template
To support a proposal for a template locally

11. 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

12. 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

13. 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)

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

15. The SystmOne Physical Health Check Template
Screenshots

16. 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

17. Copyright BDCT & BAPCT 2011

18. Copyright BDCT & BAPCT 2011

19. 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

20. 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

21. 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

22. 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%

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

24. 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%)

25. 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%)

26. 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)

27. 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

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

29. 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

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