1. Improving the Quality of Physical Health Checks Kate Dale, Mental/Physical Health Lead BDCT

2. 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)

3. 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

4. Main Causes of Premature Death Coronary Heart Disease Respiratory Disease Endocrine Disease These can be preventable and reversible!!!

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.

7. 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.

8. More Comprehensive!!!! Recording Alcohol consumption BMI BP Cholesterol/HDL Blood Glucose Cytology Recordings However it does not specify interventions

9. 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

10. National Institute for Clinical Excellence (NICE) Offers guidance for: bipolar disorder(CG38) Schizophrenia (CG82)

11. 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

12. 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.

13. 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

14. 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

15. Audit Findings 77% Had BMI Recorded79% smoking status recorded 52% eligible patients offered weight loss advice87% 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 recorded74% Had blood pressure recorded

16. Audit Findings No patients had been given a cardiovascular risk calculation No patients had a blood test for prolactin levels

17. Discussion The quality of the health checks is in part very good, but could be improved. Priority should be given to calculating cardiovascular risk.

20. Early Findings!!!! Using the new template 1 practice 75 people on SMI register First 27 people were health checked using new template

21. BMI Data 27/27 BMI’s recorded! 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<2510 BMI 25–308 BMI 30-355 BMI >35

22. BMI27=100% Cervical Smears10 of 13 eligible=76.9% Blood Pressure27=100% Cholesterol21 = 77.8% Triglyceride20 = 74.8% Random Blood Glucose24 (+ 3 Fasting) = 88.9% Full Blood Count27=100% Liver Function27=100% Prolactin22 = 81.9%

23. Thyroid Function24 = 88.9% Smoking Status27= 100% (18 smokers 3 ex 6 non) Smoking Advice18 = 100% Weekly alcohol intake27 = 100% Current drug misuse27 recorded 0 current users On Lithium2 ECG23 Requested Q Risk13 Recorded

24. 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

25. Mental Health Annual Physical Review PracticeMH Register Annual Review Baseline Annual Review Q1 Annual Review Q2 B8300611751420 B830071280318 B830081420413 B8301571182022 B8303238046 B83064609714

26. 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

27. 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?

28. Thank you Any Questions?