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

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.

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

Mental/Physical HealthQoF 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 Findings77% 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

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 BMI23 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 27=100%

Cholesterol 21 = 78%

Triglyceride 20 = 75%

Random Blood Glucose 24 (3 were fasting) = 89%

Full Blood Count 27=100%

Liver Function 27=100%

Prolactin 22 = 82%

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 0 3 18 (14%)

C 142 0 4 13 (9%)

D 71 18 20 22 (31%)

E 38 0 4 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 54 59 (83%)

E 38 24 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

The End

NB all material copyright BDCT and