Improving physical health for people with mental health conditions in primary care

Transcription

1 Improving physical health for people with mental health conditions in primary care 1 Dr Sheila Hardy, Education Fellow, UCLPartners and Honorary Senior Lecturer, UCL

2 Overview What is currently happening in primary care? The role of primary care nurses. Educating and training primary care nurses. 2

3 What is currently happening in primary care? Monitoring - primary care (pre payment incentive) Hardy et al. (2013a) Journal of Mental Health. 3

4 What is currently happening in primary care? Monitoring - primary care (post payment incentive) Diabetes Tested Diabetes % tested Severe mental illness Tested Severe mental illness %Tested Chi 2 Statistic P value Blood Pressure 2,298, % 355, % Chi² = p <.001 BMI 2,329, % 335, % Chi² = p<.001 Cholesterol 2,378, % 218, % Chi² = p <.001 HBA1c or glucose 2,363, % 197, % Chi² = p <.001 Mitchell and Hardy. (2013) Psychiatric Services. 4

5 What is currently happening in primary care? Payment incentives 2014/15 QOF ID Indicator wording Changes MH001 The contractor establishes and maintains a register of patients with schizophrenia, bipolar affective disorder and other psychoses and other patients on lithium therapy - MH002 The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a comprehensive care plan documented in the record, (in the preceding 12 months) agreed between individuals, their family and/or carers as appropriate - MH003 MH004 The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a record of blood pressure in the preceding 12 months The percentage of patients aged 40 or over with schizophrenia, bipolar affective disorder and other psychoses who have a record of total cholesterol:hdl ratio in the preceding 12 months - Retired MH005 The percentage of patients aged 40 or over with schizophrenia, bipolar affective disorder and other psychoses who have a record of blood glucose or HbA1c in the preceding 12 months Retired MH006 MH007 MH008 The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a record of BMI in the preceding 12 months The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a record of alcohol consumption in the preceding 12 months The percentage of women aged 25 or over and who have not attained the age of 65 with schizophrenia, bipolar affective disorder and other psychoses whose notes record that a cervical screening test has been performed in the preceding 5 years Retired - - MH009 MH010 The percentage of patients on lithium therapy with a record of serum creatinine and TSH in the preceding 9 months The percentage of patients on lithium therapy with a record of lithium levels in the therapeutic range in the preceding 4 months - - 5

6 What is currently happening in primary care? Monitoring - primary care (post training) Hardy et al. (2013b) International Journal of Social Psychiatry. 6

7 What is currently happening in primary care? Offering lifestyle advice following training Hardy et al. (2013b) International Journal of Social Psychiatry. 7

8 What is currently happening in primary care? Locally Enhanced Service (LES) Enhanced services plug a gap in essential services or deliver higher than specified standards, with the aim of helping PCTs (now CCGs) reduce demand on secondary care. Enhanced services expand the range of services to meet local need, improve convenience and extend choice (DH 2010). 8

9 The role of the primary care nurse 9 Hardy 2014

10 The role of the primary care nurse Tools to help practice nurses A website has been created specifically for practice nurses. It has a best practice manual the Health Improvement Profile for Primary Care (HIP-PC) and other useful tools. These can all be downloaded free: 10

11 The role of the primary care nurse 23% of practice nurses carrying out physical health checks for people with SMI without having training 38% would like training Hardy

12 Educating and training primary care nurses Hardy and Huber

13 Educating and training primary care nurses 13

14 Educating and training primary care nurses HENCEL and UCLPartners: Practice nurse masterclasses Ten modules: Compulsory Module 1 Mental health awareness (classroom) Optional Module 2 Behaviour change (classroom) Module 3 Physical health of people with mental illness (classroom) Module 4 Wellbeing (classroom) Module 5 - Co-morbidities: using a psychological approach (classroom) Module 6 - Alcohol and drug awareness (e-learning) Module 7 - Medications used in mental illness (e-learning) Module 8 - Your patient s journey (e-learning) Module 9 - Care planning (e-learning) Module 10 - Specific conditions (e-learning) 14

15 References Department of Health. (2010) Enhanced Services. g/dh_ Hardy S. (2014) Mental health and wellbeing survey: A snapshot of practice nurses views regarding responsibility and training. 20%20Jan% pdf Hardy S and Huber J. (2014) Training practice nurses to care for people with severe mental illness. Primary Healthcare. 24 (3) Hardy S, Hinks P and Gray R. (2013a) Screening for cardiovascular risk in patients with severe mental illness in primary care: a comparison with patients with diabetes. Journal of Mental Health. 22 (1) Hardy S, Hinks P and Gray R. (2013b) Does training practice nurses to carry out physical health checks for people with severe mental illness increase the level of screening for cardiovascular risk? International Journal of Social Psychiatry. Apr 22. [Epub ahead of print] Mitchell A and Hardy S. (2013) Surveillance for metabolic risk factors in patients with severe mental illness vs diabetes: National Comparison of Screening Practices. Psychiatric Services. 64 (10)

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