ISLINGTON PROFILE PUBLIC HEALTH INTELLIGENCE

Transcription

1 Appendix: 5.2a ISLINGTON PROFILE PUBLIC HEALTH INTELLIGENCE MENTAL HEALTH Psychotic Disorders November 2012

2 About this profile PURPOSE This public health intelligence profile describes the trends and patterns in the prevalence of diagnosed psychotic disorders in people aged 18 and over in Islington. This work will support and inform: joint commissioners and public health teams, and Islington s clinical commissioning group; individual general practices in Islington mental health trusts community and voluntary sector This profile can be found on our intranet: CONTENTS 1. Overview and recommendations 2 2. Key messages 2 3. GP PH dataset and case definition 4 4. How to use these analysis 5 5. Psychotic disorder analysis - Prevalence of diagnosed psychotic disorders 6 - Breakdown of psychotic disorder diagnoses by demographic factors 14 - Psychotic disorders and long term conditions 22 - Data recording and risk factor screening 26 - Care plans and review Data sources & methods 37 FURTHER INFORMATION AND FEEDBACK This profile was created by Claire Tiffany (Public Health Information Officer) with input from Baljinder Heer (Public Health Strategist), Jonathan O Sullivan (Assistant Director Public Health), George Howard (Senior Joint Commissioning Manager for Mental Health and Continuing Healthcare) and Sharon Bennett (Mental Health and Medicines Management lead for Islington Clinical Commissioning Group). It was reviewed by Dalina Vekinis (Senior Public Health Information Analyst) and Dr Sarah Dougan (Senior Public Health Manager: Health Intelligence & Needs Assessment). For further information, please contact Dalina Vekinis. publichealth.intelligence@nclondon.nhs.uk Tel: We would also very much welcome your comments on these profiles and how they could better suit your individual or practice requirements, so please do contact us with your ideas. 1

3 Recommendations and key messages OVERVIEW & RECOMMENDATIONS 1. Ensure care pathways related to psychotic disorders, take long term conditions and lifestyle factors in to account. People with psychotic disorders are at higher risk of physical ill-health than the general population. Within Islington higher rates of obesity and smoking are seen in people with psychotic disorders compared to the general population. An unhealthy lifestyle contributes to poorer health outcomes. Developing specific pathways for care that focus on lifestyle changes and preventing and managing long term conditions will help provide better health outcomes. 2. Improve monitoring of lifestyle and risk factors. Up to half of patients who have a psychotic disorder are seen only in a primary care setting. For these patients, it is important that the primary care team takes responsibility for carrying out reviews focussing on lifestyle (e.g. smoking) and risk factors (e.g. blood pressure). People with psychotic disorders in Islington are more likely to have smoking status, alcohol consumption and BMI recorded than the general population. They are also more likely to have a record of blood pressure in the past 15 months. There is, however, still room for improvement, particularly for recording alcohol consumption which is missing for 26% of people with psychotic disorders. 3. Documented care plans. Around 250 (9%) of eligible people with a psychotic disorder in Islington did not have a comprehensive care plan documented. This is slightly more than the national average (7%). KEY MESSAGES Prevalence of diagnosed psychotic disorders in context In 2010/11 there were 3,152 people diagnosed with a psychotic disorder registered with Islington GP practices. Islington s crude prevalence (1.5%) was the highest in England, and significantly higher than the London and England averages. Around 2 of people aged 18 and over diagnosed with a psychotic disorder in Islington have a bipolar disorder. The remaining 8 are diagnosed with psychoses (including schizophrenia). Breakdown of Islington prevalence There were fewer than five people aged under 18 recorded with a diagnosis of a psychotic disorder in Islington. The majority of the analysis in this report therefore focuses on adults aged 18 and over. The number of adults with a psychotic disorder varies by practice, from 12 to over 180 registered with St John s Way Medical Centre. Adjusted for the age structure of the population, the prevalence of psychotic disorders within Islingotn is significantly higher than expected for three practices and significantly lower for eight. Prevalence is significantly higher than expected in the North locality, and significantly lower in the South East, reflecting local patterns of deprivation. The average age of adults living with psychotic disorders in Islington is 47 years, with 34 years the average age at diagnosis. This means, on average, people diagnosed with a psychotic disorder have had the diagnosis for 13 years. Around half of adults have had a diagnosis for more than 10 years, whilst a quarter have been diagnosed for less than 5 years. Psychotic disorders affect a greater proportion of men than women aged 18 and over (1.9% compared to 1.4%). The prevalence of diagnosed psychotic disorders increases in people aged 35 2

4 Recommendations and key messages KEY MESSAGES (cont) years and over, with year olds experiencing the highest prevalence. Some minority ethnic groups have a significantly higher prevalence of psychotic disorders (the highest is 4.1% among the Black Caribbean community). Prevalence is also higher in the most deprived areas (2.2%) and areas with the highest social housing density (3.1%). There were 167 new diagnoses of psychotic disorders in 2010/11, equating to 9 in every 10,000 people aged 18 and over being newly diagnosed. Using these figures, and the 2009/10 QOF prevalence figures, suggests that just over 100 people diagnosed with a psychotic disorder left Islington or died in 2010/11. Long term conditions People diagnosed with a psychotic disorder have a significantly higher prevalence of depression (and chronic depression), hypertension, diabetes, chronic kidney disease, COPD, stroke/tia, chronic liver disease and heart failure, when compared to Islington s general population aged 18 and over. Compared to the general population, people with psychotic disorders are 4 times more likely to have chronic depression (3 times as likely to have depression); 2.4 times more likely to have diabetes and 1.9 times more likely to have strokes/ TIAs. Not surprisingly depression is the most commonly diagnosed long term condition among adults with a psychotic disorder. Of people diagnosed with a psychotic disorder, 34% (1,036) are also diagnosed with depression. This is followed by hypertension, diagnosed in 16% (478) of people with psychotic disorders, chronic depression in 12% (369) and diabetes in 11% (337). A diagnosis of chronic depression is more likely to follow a diagnosis of a psychotic disorder than to precede it. In terms of the number of long term conditions, people with psychotic disorders experience similar comorbidity to the general population with long term conditions. Data recording and risk factor screening People with psychotic disorders are more likely to have their smoking status, alcohol consumption and BMI recorded than the general population. Where recorded, adults with psychotic disorders are significantly more likely to be smokers (42% compared to 25% of the general population) and significantly more likely to be obese (31% compared to 16% of the general population). People with psychoses (including schizophrenia) are significantly less likely to be drinkers (27%) than people with bipolar disorders (43%) and the general population (4). Levels of blood pressure recording are higher in people with psychotic disorders than the general population. There is wide variation in the recording of blood pressure across GP practices (45% to 92%) with nine significantly lower than the Islington average. Care plans and review Just under 1 (approximately 250) of people with a psychotic disorder did not have a comprehensive care plan (QOF indicator MH06). A similar proportion, and number, did not have a record of review in the previous 15 months (QOF indicator MH09). 3

5 GP PH dataset and case definition Islington GP PH Dataset Much of the epidemiological analysis in this profile has been undertaken using an anonymised patient-level dataset from GP practices in Islington, in agreement with local GPs and with governance from our multi disciplinary Health Intelligence Advisory Group. The dataset includes key information on demographics (including language and country of birth), behavioural and clinical risk factors, key conditions, details on the control and management of conditions, key medications, and interventions. This unique resource means that for the first time in Islington, it is possible to undertake in depth epidemiological analysis of primary care data for public health purposes, strengthening evidence based decision making within the borough at all levels. More information on the dataset can be found in the Annual Public Health Report While Dr Desai s practice closed in 2011/12, the practice is still included in this analysis to ensure patients registered with the practice are not excluded from analysis. This ensures consistent use of the data as it stood at 31 March Case definitions for psychotic disorder Specific codes extracted to determine a diagnosis of psychotic disorders aligned with those published under mental health in the Quality and Outcomes Framework (QOF) guidance. These can be found on the Primary Care Commissioning website: The mental health QOF includes read codes for schizophrenia, bipolar affective disorder and other pyschoses (Table 1). Following consultation with the HIAG it was decided to report on (1) psychoses (including schizophrenia) and (2) bipolar disorders as schizophrenia may be underdiagnosed and instead coded as psychosis. Bipolar was well coded. Table 1: QOF mental health read codes for psychoses (including schizophrenia) and bipolar disorders READ CODES DISEASE / DESCRIPTION Psychoses (including schizophrenia) [X] signifies a term from ICD-10 (as opposed to ICD-9) E1124 Single major depressive episode, severe, with psychosis E1134 Recurrent major depressive episodes, severe, with psychosis E11y% exc E11y2 Other and unspecified manic-depressive psychoses E11z Other and unspecified affective psychoses E11z0 Unspecified affective psychoses NOS E11zz Other affective psychosis NOS E12% Paranoid states E13% exc E135 Other nonorganic psychoses Eu323 [X] Severe depressive episode with psychotic symptoms Eu328 [X] Major depression, severe with psychotic symptoms Eu333 [X] Recurrent depressive disorder, current episode severe with psychotic symptoms E1 Schizophrenic disorders E2122 Schizotypal personality Eu2% [X]Schizophrenia, schizotypal and delusional disorders Bipolar E11 Manic disorder, single episode E111% Recurrent manic episodes E114-E117z Bipolar Affective Disorder Eu3 [X] Manic episode Eu31% [X] Bipolar affective disorder 4

6 How to use these analyses It is important to bear in mind the following when looking at this profile (or any other public health intelligence products): It is the variation that is important In this profile, it is the variation between Islington GP practices that should be the main point of reflection rather than average achievement. It is the unexplained variation (defined as: variation in the utilisation of health care services that cannot be explained by differences in patient populations or patient preferences) as this can highlight areas for potential improvements. For example, it may highlight under- or over- use of some interventions and services, or it may identify the use of lower value or less effective activities. The data alone cannot tell us whether or not there are good and valid reasons for the variation. It only highlights areas for further investigation and reflection. A perfectly valid outcome of investigations is that the variation is as expected. However, to improve the quality of care and population health outcomes in Islington, a better understanding of reasons behind the variation at a GP practice level with clear identification of areas for improvement is needed. Reaching 10 achievement The graphs may show 10 on their y-axis (vertical) but there is no expectation that 10 will be (ever be) achieved for the vast majority of indicators. There will always be patients for whom the intervention is unsuitable and/or who do not wish to have the intervention. Again, it is about the variation between different GP practices, not an expectation of 10 achievement. Ideally, there would be benchmarking against the achievements in Islington with other deprived London boroughs (ie. with similar health needs), to give an indication of realistic level of achievement for specific indicators across the whole population and an Islington position, but these data are not currently available. Populations not individuals Epidemiology is about the health of the population, not the individual. In this profile this is either all of Islington s registered population or a GP practice population. It includes everyone registered on GP lists at the end of March/beginning of April 2011, whether they attend the practice regularly or not, or never at all. Beware of small numbers Some of the graphs have small numbers in them. They have been left in so that all GP practices can see what is happening in their practice (according to the data). In these cases, the wide 95% confidence intervals will signify the uncertainty around the percentages, but be careful when interpreting them. Problems with coding and/or data extraction There were some specific problems with data extractions from some GP practices for particular variables and these have been noted on the relevant graphs. If after review of the data, any GP practices think there are other problems with coding or data extraction, we will investigate and will amend publications as appropriate: publichealth.intelligence@nclondon.nhs.uk 5

7 PREVALENCE OF DIAGNOSED PSYCHOTIC DISORDERS This section describes the prevalence of psychotic disorders, split by psychoses (including schizophrenia) and bipolar disorders. With the exception of QOF data the analysis is based on people aged 18 and over. 6 London PCTs: crude prevalence (all ages) Percenta age of population % 1.6% 1.4% 1.2% % 0.6% 0.4% 0.2% 0. Islington Camden Prevalence of people diagnosed with a psychotic disorder, all ages, London PCTs, 2010/2011 Kensington And Chelsea Westminster City And Hackney Haringey Hammersmith & Fulham Lambeth Tower Hamlets Lewisham Southwark Brent Ealing Greenwich Croydon Waltham Forest Enfield Barnet Newham Harrow Wandsworth Richmond & Twickenham Redbridge Hounslow Sutton & Merton Bromley Kingston London England Hillingdon Barking & Dagenham Bexley Havering 3,152 people in Islington were recorded as being diagnosed with a psychotic disorder in the 2010/11 Quality and Outcomes Framework (QOF). Islington has the highest prevalence (1.5%) of people recorded as being diagnosed with a psychotic disorder in England, and is significantly higher than the London and England averages. Source: QOF, 2011 London PCT 7

8 Islington: crude prevalence Percentage of population % 1.6% 1.4% 1.2% % 0.6% 0.4% 0.2% 0. Prevalence of people diagnosed with a psychotic disorder, split by bipolar disorder and psychoses (including schizophrenia), Islington's registered population aged 18 and over, March ,015 All psychotic disorders 2,479 Psychoses (including schizophrenia) Type of psychotic disorder Note: Numbers on bars indicate the number of people diagnosed with a psychotic disorder Bipolar disorders A diagnosis of a psychotic disorder was recorded for 1.6% (3,015) of people aged 18 and over with a GP in Islington. Fewer than 5 people aged under 18 had a diagnosis of a psychotic disorder recorded. The majority, 2,479 (82%), were diagnosed with psychoses (including schizophrenia). The remaining 536 (18%) were diagnosed with a bipolar disorder. More information on these categories is given in the GP PH dataset and case definition section (page 5). Different methods of data extraction resulted in 137 fewer people with a diagnosis of a psychotic disorder in the Islington GP PH dataset compared to the QOF. Islington localities: indirectly standardised ratio tandardised ratio Indirectly st Indirectly standardised ratio of people diagnosed with a psychotic disorder, by GP locality, Islington's registered population aged 18 and over, March 2011 Red bars = higher than average Blue bars = no different to average Green bars = lower than average Islington average North South West Central South East GP locality Notes: Numbers on bars indicate the number of people diagnosed with a psychotic disorder Adjusted for the age structure of the population, prevalence of psychotic disorders in people aged 18 and over varies by GP locality. The North GP locality has a prevalence ratio significantly higher than the Islington average, whilst the prevalence ratio for the South East is significantly lower. Variation between localities may be due to differences in population characteristics, for example deprivation and housing etc., and/ or diagnosis and recording practices. 9

9 Islington GP practices: indirectly standardised ratio (psychotic disorder) Indire ectly standardised ratio The Medical Centre The Northern Medical Centre Dr Moneeb's Surgery The Village Practice Indirectly standardised ratio of people diagnosed with a psychotic disorder, by GP practice, Islington's registered population aged 18 and over, March 2011 Dartmouth Park Practice Roman Way Medical Centre The Rise Group Practice Hanley Primary Care Centre Bingfield Street Surgery Goodinge Group Practice The Miller Practice Highbury Grange Medical Centre Archway Primary Care Team Mitchison Road Surgery St John's Way Medical Centre Killick Street Health Centre Stroud Green Medical Clinic Amwell Group Practice Elizabeth Avenue Group Practice The Family Practice River Place Group Practice Ritchie Street Group Practice GP practice Pine Street Medical Practice Partnership Primary Care Centre Barnsbury Medical Practice City Road Group Practice Clerkenwell Medical Practice Islington Central Medical Centre Red bars = higher than average Blue bars = no different to average Green bars = lower than average Islington average Holloway Medical Clinic Andover Medical Centre Sobell Medical Centre Wedmore Gardens Surgery Mildmay Medical Centre Dr Ko's Surgery Dr Desai's Surgery St Peter's Street Medical Practice New North Health Centre Dr Kateb & Partner Adjusted for the age structure of the population, prevalence of psychotic disorders varies by GP practice. Three practices have a prevalence ratio significantly higher than the Islington average. Eight practices have significantly lower prevalence. Variation between practices may be due to differences in population characteristics and/ or diagnosis and recording practices. 10 Islington GP practices: indirectly standardised ratio (bipolar disorder) Indir rectly standardised ratio Partnership Primary Care Centre The Village Practice The Miller Practice Indirectly standardised ratio of people diagnosed with a bipolar disorder, by GP practice, Islington's registered population aged 18 and over, March 2011 Bingfield Street Surgery Stroud Green Medical Clinic Killick Street Health Centre Roman Way Medical Centre The Medical Centre New North Health Centre Dr Moneeb's Surgery Mitchison Road Surgery Islington Central Medical Centre Highbury Grange Medical Centre St John's Way Medical Centre Amwell Group Practice Red bars = higher than average Blue bars = no different to average Green bars = lower than average Islington average GP practice Note: 5 practices with <5 bipolar disorder diagnoses recorded not included (Barnsbury Medical Practice, Dr Desai's Surgery, Holloway Medical Clinic, Sobell Medical Centre, Wedmore Gardens Surgery) Elizabeth Avenue Group Practice The Northern Medical Centre Pine Street Medical Practice The Family Practice Archway Primary Care Team Goodinge Group Practice Clerkenwell Medical Practice Mildmay Medical Centre Ritchie Street Group Practice River Place Group Practice Dartmouth Park Practice Hanley Primary Care Centre The Rise Group Practice City Road Group Practice Andover Medical Centre Dr Kateb & Partner Dr Ko's Surgery St Peter's Street Medical Practice Adjusted for the age structure of the population, prevalence of bipolar disorders varies by GP practice. Three practices have a prevalence ratio significantly higher than the Islington average. One practice has a significantly lower prevalence. Variation between practices may be due to differences in population characteristics and/ or diagnosis and recording practices. 11

10 Islington GP practices: indirectly standardised ratio (psychoses, including schizophrenia) Indirec ctly standardised ratio The Northern Medical Centre The Medical Centre Dartmouth Park Practice Dr Moneeb's Surgery Indirectly standardised ratio of people diagnosed with psychoses (including schizophrenia), by GP practice, Islington's registered population aged 18 and over, March 2011 Red bars = higher than average Blue bars = no different to average Green bars = lower than average Islington average The Rise Group Practice Hanley Primary Care Centre Goodinge Group Practice Roman Way Medical Centre The Village Practice Highbury Grange Medical Centre Archway Primary Care Team St John's Way Medical Centre Mitchison Road Surgery Bingfield Street Surgery Amwell Group Practice Elizabeth Avenue Group Practice River Place Group Practice Barnsbury Medical Practice The Family Practice Ritchie Street Group Practice Killick Street Health Centre The Miller Practice GP practice Stroud Green Medical Clinic City Road Group Practice Pine Street Medical Practice Clerkenwell Medical Practice Holloway Medical Clinic Islington Central Medical Centre Andover Medical Centre Sobell Medical Centre Partnership Primary Care Centre Wedmore Gardens Surgery Dr Ko's Surgery Dr Desai's Surgery Mildmay Medical Centre St Peter's Street Medical Practice Dr Kateb & Partner New North Health Centre Adjusted for the age structure of the population, prevalence of psychoses (including schizophrenia) varies by GP practice. Five practices have a prevalence ratio significantly higher than the Islington average. Six practices have a significantly lower prevalence. Variation between practices may be due to differences in population characteristics and/ or diagnosis and recording practices. 12 Islington GP practices: numbers recorded Number of people St John's Way Medical Centre Goodinge Group Practice Ritchie Street Group Practice Numbers of people diagnosed with a bipolar disorder or psychoses (including schizophrenia), by GP practice, Islington's registered population aged 18 and over, March 2011 The Miller Practice Islington Central Medical Centre The Northern Medical Centre Highbury Grange Medical Centre Elizabeth Avenue Group Practice River Place Group Practice Killick Street Health Centre The Village Practice Amwell Group Practice The Rise Group Practice Clerkenwell Medical Practice Roman Way Medical Centre Archway Primary Care Team Hanley Primary Care Centre City Road Group Practice Mitchison Road Surgery Stroud Green Medical Clinic The Medical Centre GP practice Bipolar* Psychoses (including schizophrenia) *5 practices (asterisked) have less than 5 people diagnosed with a bipolar disorder. The number displayed for these practices indicates the number of people diagnosed with any psychotic disorder (i.e. the numbers for bipolar and psychoses (including schizophrenia) have been combined). St Peter's Street Medical Practice The Family Practice Mildmay Medical Centre Dartmouth Park Practice Andover Medical Centre Dr Moneeb's Surgery Partnership Primary Care Centre Bingfield Street Surgery Pine Street Medical Practice Barnsbury Medical Practice* Dr Ko's Surgery Sobell Medical Centre* Holloway Medical Clinic* Dr Kateb & Partner Dr Desai's Surgery* New North Health Centre Wedmore Gardens Surgery* The number of patients registered with a psychotic disorder aged 18 and over varies by practice, from 12 to 186 at St John s Way Medical Centre. Of these patients the number registered with psychoses (including schizophrenia) ranges from 8 to 154 (St John s Way Medical Centre), whilst the number registered with a bipolar disorder ranges from less than 5 to 44 (The Miller Practice). 13

11 BREAKDOWN OF PSYCHOTIC DISORDER DIAGNOSES BY DEMOGRAPHIC FACTORS This section describes the demographic characteristics of people with psychotic disorders in terms of age, sex, ethnicity, deprivation, Mosaic TM group and social housing density. 14 Years since diagnosis Percetnage of people with a psychotic disorder 35% 3 25% 2 15% 1 5% Years since diagnosis in people diagnosed with a psychotic disorder, Islington's registered population aged 18 and over, March Around a quarter (28%) of people aged 18 and over with a psychotic disorder were diagnosed 4 years ago or less (from March 2011). Around half (48%) have been diagnosed with a psychotic disorder for 10 years or more. The average number of years since diagnosis across Islington is 13. The average age at diagnosis is 34 years. Years since diagnosis Note: Numbers on bars indicate the number of people diagnosed with a psychotic disorder 15

12 Differences by age and sex Percen ntage of people 5% 4% 3% 2% 1% Prevalence of people diagnosed with a psychotic disorder by age and sex, Islington's registered population aged 18 and over, March Men Women All (18+) Age group Notes: Numbers on bars indicate the number of people diagnosed with a psychotic disorder 1,654 1,361 The prevalence of psychotic disorders increases in people aged 35 years and over, with the highest prevalence (2.8%) seen in people aged years. The average age is 47 years. Overall, psychotic disorders are more prevalent in men (1.9%) than women (1.4%), particularly between the ages of 18 to 44 years. Women have statistically significantly higher prevalence of psychotic disorders between the ages of 45 to 84 (compared to all women), whilst prevalence is statistically significantly higher in men between the ages of 35 to 64. Differences by ethnic group tage of people Percent 5% 4% 3% 2% 1% 200 Black Caribbean Prevalence of people diagnosed with a psychotic disorder by detailed ethnic group, Islington's registered population aged 18 and over, March White & Black Caribbean 42 White & Black African 107 Other Black 168 White Irish 188 Black African 18 White & Asian 1,132 White British 11 Pakistani 32 Other Mixed Ethnic group 41 Bangladeshi 39 Other Asian 416 Other White 26 Indian 24 Chinese 55 Other 456 Unknown 3,015 All* Rates of psychotic disorders are significantly higher in people with their ethnicity recorded by their GP as Black Caribbean (4.1%), White & Black Caribbean (3.8%), White & Black African (3.3%), Other Black (2.9%), White Irish (2.6%) and Black African (2.5%). Rates are significantly lower for Indian (1.1%), Chinese (0.9%) and Other (1.1%) ethnic groups. A higher proportion of people with a psychotic disorder have ethnicity recorded than the general population aged 18 and over (85% compared to 8). * includes those with ethnicity not known Note: Numbers on bars indicate the number of people diagnosed with a psychotic disorder 17

13 Differences by local deprivation Percentage of people with a psychotic disorder 5% 4% 3% 2% 1% Prevalence of people with a psychotic disorder by local deprivation quintile, Islington's registered and resident population aged 18 and over, March Most deprived Least deprived Local deprivation quintile The percentage of people with a psychotic disorder is almost 7 higher in the most deprived quintile (2.2%) compared to the least (1.3%). Note: 257 people living outside Islington, or with no deprivation score, were not included. Numbers on bars indicate the number of people diagnosed with a psychotic disorder. 18 Differences by density of social housing Percentage of people with a psychotic disorder 5% 4% 3% 2% 1% Prevalence of people with a psychotic disorder by social housing density, Islington's registered and resident population aged 18 and over, March Social housing density Note: 320 people either living outside Islington, or without a social housing density category, were not included. Numbers on bars indicate the number of people diagnosed with a psychotic disorder. 19 The prevalence of psychotic disorders increases steadily with the density of social housing. Prevalence in areas with high social housing density (81-10) is four times higher than in areas with no social housing (3.1% compared to 0.8%). However, in terms of numbers most adults with psychotic disorders (1,475) live in mixed tenure areas. It should be noted that supported housing for people with psychotic disorders is all social housing, and this may partly explain some of the difference. Further details regarding social housing density in Islington, and psychotic disorders, are available in the Health Needs and Social Housing profile: el2page.asp?id=1034&l1=1.

14 Differences by Mosaic TM group Percentage ofpeople with a ps sychotic disorder 5% 4% 3% 2% 1% Percentage of people with a psychotic disorder by Mosaic group, Islington's registered and resident population aged 18 and over, March , N - People renting flats in high density social housing G - Well-educated city dwellers Mosaic group Other Prevalence of psychotic disorders is significantly higher (2.1%) in people renting flats in high density social housing compared to well-educated city dwellers (1.3%) and other groups (1.7%). Note: 339 people either living outside Islington, or without a Mosaic code, were not included. Numbers on bars indocate the number of people diagnosed with a psychotic disorder. Source:Experian Mosaic TM, 2011; applied to Islington's GP PH dataset, New diagnoses by sex Crude incidence rate (pe er 10,000 population) Crude incidence of people diagnosed with a psychotic disorder(patient diagnosed in 2010/11), by sex, Islington's registered population aged 18 years and over, March Men Women Men Women Bipolar disorders Type of psychotic disorder Notes: Numbers on bars indicate the number of people diagnosed with a psychotic disorder Psychoses (including schizophrenia) people aged 18 and over were newly diagnosed with a bipolar disorder and 131 with psychoses (including schizophrenia) in 2010/11. Men had a significantly higher incidence rate for psychoses (including schizophrenia) compared to women (10.6 and 4.2 per 10,000 respectively). There was no significant difference between men and women s incidence rate for bipolar disorders (1.6 and 2.3 per 10,000), possibly due to the small numbers. Combining the number of people recorded with a psychotic disorder in the 2009/10 and 2010/11 QOF (3,092 and 3,152 respectively) with the number of new diagnoses (above) we can estimate that around 107 people with a diagnosis of a psychotic disorder either left the area or died during this time period.

15 PSYCHOTIC DISORDERS AND LONG TERM CONDITIONS This section looks at comorbidity, in terms of long term conditions, of people with psychotic disorders. 22 Long term conditions: crude prevalence Perce entage of people Prevalence of long term conditions among people diagnosed with a psychotic disorder compared to Islington's registered population aged 18 and over, March 2011 Depression* Hypertension Chronic depression Diabetes Chronic kidney disease COPD Psychoses(including schizophrenia) Bipolar disorder General population Long term condition * Includes chronic depression Note: People may be counted twice due to comorbidities. Numbers of chronic depression will be underestimated because data were only available for 37/38 Islington practices. Cancer Stroke/TIA Coronary heart disease 23 Chronic liver disease Heart failure Atrial fibrillation The prevalence of 9 of the 12 long term conditions shown in the chart are significantly higher in people with psychotic disorders compared to the general population (cancer, coronary heart disease and atrial fibrillation showed no difference). Not surprisingly depression is the most common long term condition (34%). This is followed by hypertension (16%), chronic depression (12%) and diabetes (11%). Compared to the general population people with psychotic disorders are: 4 times more likely to have chronic depression (3 times as likely to have depression) 2.4 times more likely to have diabetes, and 1.9 times more likely to have strokes/ TIAs.

16 Long term conditions: numbers recorded Number of people 1,200 1, ,036 Number of other long term conditions in people diagnosed with a psychotic disorder, Islington's registered population aged 18 and over, March Bipolar disorder Psychoses(including schizophrenia) ,036 people diagnosed with a psychotic disorder also have a diagnosis of depression. Of these 369 have chronic depression (on an anti-depressant for two or more years). Hypertension has been diagnosed for 478 people with a psychotic disorder and diabetes has been diagnosed for Depression* Hypertension Chronic depression Diabetes Chronic kidney disease COPD Long term condition * Includes chronic depression Note: People may be counted twice due to comorbidities. Numbers of chronic depression will be underestimated because data were only available for 37/38 Islington practices. Cancer Stroke/TIA Coronary heart disease Chronic liver disease Heart failure Atrial fibrillation 24 Comorbidity Percentage e ofpeople 10 75% 5 25% Percentage of people diagnosed with psychotic disorders, by number of long term conditions, compared to Islington's registered population aged 18 and over with a diagnosed long term condition, March , , ,449 When compared to the general population with a long term condition, people with psychotic disorders have similar comorbidity in terms of the number of long term conditions (psychotic disorder is counted as a long term condition). 1, ,539 21,191 All psychotic disorders Bipolar disorder Psychoses (including schizophrenia) 1 condition 2 conditions 3 condition 4+ conditions General population Note: Long term conditions include high blood pressure, chronic kidney disease, diabetes, CHD, Cancer, Stroke/ TIA, COPD, atrial fibrillation, dementia, chronic depression, psychotic disorders and chronic liver disease. Numbers on bars indicate the number of people diagnosed with a psychotic disorder. For people with a psychotic disorder, the psychotic disorder is counted as one condition - i.e. 1,898 people have a psychotic disorder and no other long term condition. 25

17 DATA RECORDING AND RISK FACTOR SCREENING This section compares the smoking status, alcohol consumption, body mass index and blood pressure recording of people with psychotic disorders to the general population. 26 Smoking status of people Percentage Smoking status in people diagnosed with a psychotic disorder and with a smoking status recorded, compared to Islington's registered population, aged 18 and over, March , Smoker Ex-smoker Non-smoker Smoking status Bipolar disorders Psychoses(including schizophrenia) General population Notes: Numbers on bars indicate the number of people diagnosed with a psychotic disorder People diagnosed with psychotic disorders are almost twice as likely to be smokers than the general population aged 18 and over (of those with a smoking status recorded). 42% of people diagnosed with a bipolar disorder and 47% with psychoses (including schizophrenia) are smokers, compared to 25% of the general population aged 18 and over. 2% of people with a psychotic disorder do not have a smoking status recorded, significantly less than the general population (13%). 27

18 Islington GP practices: smokers Pe ercentage of smokers Prevalence of smokers in people diagnosed with a psychotic disorder and with a smoking status recorded, by GP practice, compared to Islington's registered population aged 18 and over, March 2011 General population Islington average (psychotic disorders) Islington average (general population) Hanley Primary Care Centre Andover Medical Centre Dr Desai's Surgery Dr Kateb & Partner Amwell Group Practice The Rise Group Practice Partnership Primary Care Centre Highbury Grange Medical Centre Holloway Medical Clinic New North Health Centre The Medical Centre Killick Street Health Centre Ritchie Street Group Practice Goodinge Group Practice St John's Way Medical Centre City Road Group Practice The Northern Medical Centre Roman Way Medical Centre Sobell Medical Centre Stroud Green Medical Clinic St Peter's Street Medical Practice Dr Moneeb's Surgery Mildmay Medical Centre Mitchison Road Surgery Dartmouth Park Practice Archway Primary Care Team Islington Central Medical Centre River Place Group Practice Elizabeth Avenue Group Practice Dr Ko's Surgery Bingfield Street Surgery The Village Practice Clerkenwell Medical Practice The Miller Practice Barnsbury Medical Practice Wedmore Gardens Surgery Pine Street Medical Practice The Family Practice GP practice Red bars = higher than average Blue bars = no different to average Green bars = lower than average The prevalence of smoking in people diagnosed with a psychotic disorder ranges from 3 to 65% across GP practices, with an average of 46% for Islington. This compares to a range of 16% to 32% and an average of 25% among the general population aged 18 and over. The prevalence is significantly higher than the Islington average for people diagnosed with a psychotic disorder for three practices and significantly lower for two. Only three practices have similar percentages of smokers in people diagnosed with a psychotic disorder and the general population. 28 Alcohol consumption of people Percentage Alcohol consumption in people diagnosed with a psychotic disorder compared to Islington's registered population, aged 18 and over, March 2011 People diagnosed with psychoses (including schizophrenia) are less likely to be drinkers (27%) than people diagnosed with a bipolar disorder (43%) and the general population aged 18 and over (4). 26% of people with a psychotic disorder and 34% of the general population aged 18 and over do not have alcohol consumption recorded , Drinker Non-drinker Not known Alcohol consumption Bipolar disorders Psychoses(including schizophrenia) General population Note: Numbers on bars indicate the number of people diagnosed with a psychotic disorder 29

19 Body Mass Index of people Percentage Percentage of people diagnosed with a psychotic disorder by BMI group, where recorded, compared to Islington's registered population, aged 18 and over, March Underweight Healthy Overweight Obese BMI group Bipolar disorders Psychoses(including schizophrenia) General population Note: Numbers on bars indicate the number of people diagnosed with a psychotic disorder 30 People diagnosed with a psychotic disorder are almost twice as likely to be obese compared to the general population aged 18 and over (31% compared to 16%). 26% (130) of people diagnosed with a bipolar disorder and 32% (727) of people with psychoses (including schizophrenia) are obese compared to 16% of the general population aged 18 and over. People diagnosed with psychoses (including schizophrenia) are significantly more likely to be underweight or overweight than the general population aged 18 and over. 8% of people with a psychotic disorder and 17% of the general population aged 18 and over do not have their BMI recorded. Islington GP practices: Obesity Percentage obese Barnsbury Medical Practice Pine Street Medical Practice Prevalence of obesity in people diagnosed with a psychotic disorder and with a BMI recorded, by GP practice, compared to Islington's registered population aged 18 and over, March 2011 The Medical Centre Mitchison Road Surgery Goodinge Group Practice Roman Way Medical Centre City Road Group Practice Hanley Primary Care Centre Ritchie Street Group Practice Bingfield Street Surgery Partnership Primary Care Centre Killick Street Health Centre Dr Moneeb's Surgery St John's Way Medical Centre The Village Practice Elizabeth Avenue Group Practice Islington Central Medical Centre River Place Group Practice The Family Practice Clerkenwell Medical Practice Stroud Green Medical Clinic Dr Ko's Surgery GP practice General population Islington average (psychotic disorders) Islington average (general population) Red bars = higher than average Blue bars = no different to average Green bars = lower than average Mildmay Medical Centre Andover Medical Centre Amwell Group Practice Highbury Grange Medical Centre The Northern Medical Centre The Rise Group Practice Dartmouth Park Practice Holloway Medical Clinic Sobell Medical Centre St Peter's Street Medical Practice The Miller Practice Archway Primary Care Team The prevalence of obesity in people diagnosed with a psychotic disorder ranges from 22% to 54% across GP practices, with an average of 31% for Islington. This compares to a range from 1 to 28% and an average of 16% among the general population aged 18 and over. Two practices have significantly higher prevalence than the Islington average, whilst one has a significantly lower prevalence. Note: 4 practices with <5 obese people diagnosed with a psychotic disorder not included (Dr Desai's Surgery, Dr Kateb & Brown Surgery, New North Health Centre, Wedmore Gardens Surgery) 31

20 Blood pressure recording of people Percentage Blood pressure recording in people diagnosed with a psychotic disorder, compared to Islington's registered population, aged 18 and over, March , ,681 All psychotic disorders Bipolar disorders Psychoses (including schizophrenia) General population The proportion of people with a psychotic disorder who had their blood pressure recorded during the past 15 months, is significantly higher than the general population aged 18 and over. 67% (323) of people with a bipolar disorder and 73% (1,681) of people with psychoses (including schizophrenia) had their blood pressure recorded over the past 15 months compared to 5 of the general population. Notes: Numbers on bars indicate the number of people diagnosed with a psychotic disorder 32 Islington GP practices: blood pressure recording Percentage of people Holloway Medical Clinic Sobell Medical Centre The Family Practice Blood pressure recording in people diagnosed with a psychotic disorder, by GP practice, compared to Islington's registered population aged 18 and over, March 2011 Dr Desai's Surgery The Medical Centre Bingfield Street Surgery The Northern Medical Centre Roman Way Medical Centre Dr Moneeb's Surgery Islington Central Medical Centre Killick Street Health Centre Stroud Green Medical Clinic Dr Ko's Surgery St John's Way Medical Centre Archway Primary Care Team River Place Group Practice Goodinge Group Practice Clerkenwell Medical Practice The Rise Group Practice GP practice General population Islington average (psychotic disorders) Islington average (general population) Red bars = higher than average Blue bars = no different to average Green bars = lower than average Mitchison Road Surgery Pine Street Medical Practice Dartmouth Park Practice Mildmay Medical Centre City Road Group Practice Ritchie Street Group Practice Elizabeth Avenue Group Practice Highbury Grange Medical Centre Amwell Group Practice Barnsbury Medical Practice Andover Medical Centre The Miller Practice St Peter's Street Medical Practice Wedmore Gardens Surgery Dr Kateb & Partner The percentage of people diagnosed with a psychotic disorder who have had a blood pressure reading in the past 15 months ranges from 45% to 92% across GP practices, with an average of 72% for Islington. This compares to a range from 4 to 71% and an average of 5 among the general population aged 18 and over. Six practices have percentages significantly higher than the Islington average, whilst nine have a significantly lower percentage. 33

21 CARE PLANS AND REVIEW This section presents two mental health QOF indicators at GP practice level. The remaining 2010/11 mental health indicators are available via practice level QOF reports on the intranet: or by ing: 34 Islington GP practices: care plans Perecentage of people e with a psychotic disorder Source: QOF, 2011 QOF MH06: Percentage of people diagnosed with a psychotic disorder who have a comprehensive care plan document recorded, by GP practice, Islington's registered population, all ages, 2010/2011 Islington The Family Practice New North Health Centre Dartmouth Park Practice Killick Street Health Centre Roman Way Medical Centre Dr Ko's Surgery Mitchison Road Surgery St John's Way Medical Centre Ritchie Street Group Practice Hanley Primary Care Centre Pine Street Medical Practice Archway Primary Care Team Highbury Grange Medical Centre River Place Group Practice Clerkenwell Medical Practice Elizabeth Avenue Group Practice Stroud Green Medical Clinic Barnsbury Medical Practice St Peter's Street Medical Practice Bingfield Street Surgery The Miller Practice Andover Medical Centre Dr Kateb & Partner The Medical Centre Goodinge Group Practice The Village Practice Sobell Medical Centre The Amwell Group Practice The Northern Medical Centre Dr Moneeb's Surgery Partnership Primary Care Centre Islington Central Medical Centre Mildmay Medical Centre The Rise Group Practice City Road Group Practice Dr Desai's Surgery Wedmore Gardens Surgery Holloway Medical Clinic GP practice (9%) out of an eligible 2,926 people with a psychotic disorder in Islington did not have a comprehensive care plan documented in the records, agreed between individuals, their family and/or carers as appropriate. The percentage of people with a care plan varies across GP practices in Islington from 69% to 10, with an average of 91% for Islington. Practices with the largest numbers (rather than percentages) of people who did not have a care plan were Ritchie Street Group Practice and St John's Way Medical Centre (22 people each).

22 Islington GP practices: review of care Perecentage of people with a psychotic disorder Source: QOF, 2011 QOF MH09: Percentage of people diagnosed with a psychotic disorder who have a record of review in the past 15 months, by GP practice, Islington's registered population, all ages, 2010/ Islington Roman Way Medical Centre Highbury Grange Medical Centre Barnsbury Medical Practice The Rise Group Practice Stroud Green Medical Clinic The Village Practice Hanley Primary Care Centre The Family Practice The Medical Centre Dr Ko's Surgery Pine Street Medical Practice Elizabeth Avenue Group Practice Clerkenwell Medical Practice Dartmouth Park Practice Wedmore Gardens Surgery The Miller Practice Islington Central Medical Centre St John's Way Medical Centre Ritchie Street Group Practice City Road Group Practice Dr Moneeb's Surgery The Amwell Group Practice Mitchison Road Surgery Andover Medical Centre Dr Desai's Surgery Dr Kateb & Partner Mildmay Medical Centre The Northern Medical Centre River Place Group Practice St Peter's Street Medical Practice Archway Primary Care Team Bingfield Street Surgery Partnership Primary Care Centre Killick Street Health Centre Sobell Medical Centre Goodinge Group Practice New North Health Centre Holloway Medical Clinic GP practice 249 (9%) out of an eligible 2,844 people with a psychotic disorder in Islington did not have their care reviewed in the previous 15 months. The percentage of people with a psychotic disorder who had their care reviewed in the previous 15 months varies across GP practices in Islington from 78% to 10, with an average of 91% for Islington. Practices with the largest numbers (rather than percentages) of people who did not have a care review were Highbury Grange Medical Centre (26 people) and Roman Way Medical Centre (20 people). Please note, this QOF indicator is no longer included (from 2011/12 onwards).

23 Data sources & methods Islington GP Dataset extraction Much of the epidemiological analysis in this profile has been undertaken using an anonymised patient-level dataset from GP practices in Islington, in agreement with local GPs and with governance from our multi disciplinary Health Intelligence Advisory Group. This dataset includes key information on demographics (including age and ethnicity), behavioural and clinical risk factors, key conditions, details on the control and management of conditions. This unique resource means that for the first time in Islington, it is possible to undertake in depth epidemiological analysis of primary care data for public health purposes, strengthening evidence based decision making within the borough at all levels. Population denominators In calculating rates, the registered population was used as of March The practice list sizes were obtained from the Islington GP dataset (see above). 95% confidence intervals Percentages and rates are reported with 95% CI. These give the range of values which quantify the imprecision in the estimate of the percentage or rate. They are used to quantify the imprecision that results from random variation in the estimation of the value because events (e.g. admissions) are influenced by the random occurrences that are inherent in life. They do not include imprecision resulting from systematic error (i.e. bias). By comparing the 95% CIs around estimates or a target, we can say whether statistically, there are differences or not in the estimates we are observing. Indirectly standardised rates The indirectly standardised rate is the observed number of events, relative to the number of events that would be expected, if standard age-specific rates were applied to the particular observed population s age structure. This enables the comparison of a population rate (e.g. that for a GP) with a standard rate, (e.g. that for the borough), taking into account differences in population age structures. 37