Physical Health Checks

Transcription

1 Improving the Quality of Physical Health Checks Kate Dale, Mental/Physical Health Project Lead BDCT Kate Beedle, Data Quality Specialist, West & South Yorkshire & Bassetlaw Commissioning Support Unit 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 There is considerable evidence that one of the main causes of early death in people with SMI is cardiovascular disease Other physical causes include cancer

3 The Quality and Outcomes Framework (QOF) Recommends: A physical health check within the last 15 months Until recently did not specify what the health check should include. Recent release of V20 QOF business rules.

4 In future QoF recommends Recording Alcohol consumption BMI BP Cholesterol/HDL Blood Glucose Cytology Recordings However it does not specify interventions

5 Mental/Physical Health QoF Indicators The practice has a (SMI) register. Physical health to be reviewed at 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

6 National Institute for Clinical Excellence (NICE) Offers guidance for: bipolar disorder(cg38) Schizophrenia (CG82)

7 The Bipolar Guide Recommends: Thyroid Function Blood Glucose Lipid profile in the over 40s Blood Pressure Weight/BMI Smoking status t It also recommends prolactin, liver function tests, renal function tests, full blood count and serum drug levels to monitor certain drugs

8 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

9 First round of audits June/July 2009 The audit tool used was based on our proposed best practice template To support a proposal for (mandatory) template locally

10 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

11 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 39% had a cholesterol test and 38% had a triglyceride test 45% had a blood glucose recorded 55% alcohol status recorded 78% of heavy alcohol users were offered advice 3% waist circumference measured 38% had a thyroid function recorded 74% Had blood pressure recorded

12 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)

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

14 The SystmOne Physical Health Check Template Screenshots

15 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 es of audit reports It supports QoF reporting

16 Copyright BDCT & BAPCT 2011

17 Copyright BDCT & BAPCT 2011

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20 Second round of audits Using the new template in our first practice 75 people were on the SMI register Data are available for the first 27 people checked using new template t

21 Body Mass Index (BMI) 27/27 BMI s recorded d (100%) 4 BMI<25 10 BMI BMI BMI >35 Normal Overweight Obese V. Obese 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

22 BMI 27=100% Cervical Smears 10 of 13 eligible=77% Blood Pressure 27=100% Cholesterol 21 = 78% Ti Triglyceride id 20 = 75% Random Blood Glucose 24 (3 were fasting) = 89% Full Blood Count 27=100% Liver Function 27=100% Prolactin 22 = 82%

23 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 27 recorded = 100% 0 current users On Lithium 2 ECG 23 Requested Q Risk 13 Recorded = 48%

24 Quarterly Reports April 2011 July 2011 September 2011 Baseline Total SMI Quarter 1 Total SMI Quarter 2 Total SMI Population:4,608 on Population:4,657 on Population 4,719 CPA 811 CPA 824 on CPA 836

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

26 Use of Physical Health Check Template for the annual al Review Practice MH Annual Annual Annual Register Review Review Q1 Review Q2 Baseline A (4%) (17%) B (14%) C (9%) D (25%) (31%) E (16%) F 60 9 (15%) 7 14 (23%) Average 7% 18%

27 Blood Pressure Recordings in last 12 months Practice MH Register Baseline Q1 Q2 A (74%) B (84%) C (65%) D (83%) E (66%) F (78%) Average (75%)

28 Opportunities Reduce health inequalities Reduce preventable deaths Improve quality of life, health and wellbeing for patients t and families Improve experience of health services for patients and families Tailor interventions to high risk groups (age, ethnicity, substance users)

29 Prevalence of prolactin measurement is low 325 MH Register, No Prolactin Level 4318 MH Register, Prolactin Level in L12m Prolactin elevation occurs in up to 95% of people on antipsychotic medication, depending on medication type, and has risks for sexual dysfunction, osteoporosis and breast cancer

30 Prevalence of Qrisk2 measurement is low 4441 QRisk2 No Qrisk2 219

31 QRisk2 shows high risk in SMI population 28% 72% 0-20% High risk The prevalence of high risk for cardiovascular death is over twice that in the general population

32 The End NB all material copyright BDCT & NB all material copyright BDCT & WSYB CSU