Why are NICE guidelines and standards important and relevant to us?

Transcription

1 Why are NICE guidelines and standards important and relevant to us? Dr Liz England GP, Laurie Pike health centre RCGP Mental Health Clinical and Commissioning Lead SWB CCG Mental Health Lead NIHR Clinical Lecturer

2 Lipid modification Before starting lipid modification therapy for the primary prevention of CVD, take at least 1 lipid sample to measure a full lipid profile. This should include measurement of total cholesterol, high-density lipoprotein (HDL) cholesterol, non-hdl cholesterol, and triglyceride concentrations. A fasting sample is not needed. [new 2014] Offer atorvastatin 20 mg for the primary prevention of CVD to people who have a 10% or greater 10-year risk of developing CVD. Estimate the level of risk using the QRISK2 assessment tool.

3 Diabetes Annually, regardless of presence of nephropathy: arrange ACR estimation on first-pass urine sample (or spot sample if necessary) measure serum creatinine estimate GFR. If diabetic nephropathy confirmed, offer ACE inhibitor with dose titration to maximum dose (unless not tolerated). Substitute an A2RB if ACE inhibitors are poorly tolerated. Maintain BP < 130/80 mmhg if abnormal ACR. For more information see the managing blood pressure section of this pathway.

4 Schizophrenia and Psychosis: NICE clinical guideline 178 Physical health People with psychosis or schizophrenia, especially those taking antipsychotics, should be offered a combined healthy eating and physical activity programme by their mental healthcare provider. [new 2014] If a person has rapid or excessive weight gain, abnormal lipid levels or problems with blood glucose management, offer interventions in line with relevant NICE guidance (see Obesity [NICE clinical guideline 43], Lipid modification [NICE clinical guideline 67] and Preventing type 2 diabetes [NICE public health guidance 38]). [new 2014] Offer people with psychosis or schizophrenia who smoke help to stop smoking, even if previous attempts have been unsuccessful. Be aware of the potential significant impact of reducing cigarette smoking on the metabolism of other drugs, particularly clozapine and olanzapine. [new 2014] Psychosis and schizophrenia in adults: treatment and management

5 Monitoring physical health in primary care Develop and use practice case registers to monitor the physical and mental health of people with psychosis or schizophrenia in primary care. [2009] GPs and other primary healthcare professionals should monitor the physical health of people with psychosis or schizophrenia when responsibility for monitoring is transferred from secondary care, and then at least annually. The health check should be comprehensive, focusing on physical health problems that are common in people with psychosis and schizophrenia. Include all the checks recommended in and refer to relevant NICE guidance on monitoring for cardiovascular disease, diabetes, obesity and respiratory disease. A copy of the results should be sent to the care coordinator and psychiatrist, and put in the secondary care notes. [new 2014] Identify people with psychosis or schizophrenia who have high blood pressure, have abnormal lipid levels, are obese or at risk of obesity, have diabetes or are at risk of diabetes (as indicated by abnormal blood glucose levels), or are physically inactive, at the earliest opportunity following relevant NICE guidance (see Lipid modification [NICE clinical guideline 67], Preventing type 2 diabetes [NICE public health guidance 38], Obesity [NICE clinical guideline 43], Hypertension [NICE clinical guideline 127], Prevention of cardiovascular disease [NICE public health guidance 25] and Physical activity [NICE public health guidance 44]). [new 2014] Healthcare professionals in secondary care should ensure, as part of the care programme approach, that people with psychosis or schizophrenia receive physical healthcare from primary care as described in recommendations [2009]

6 Standard 4 The NICE Guideline (2009) recommends that monitoring of various physical health parameters in service users with schizophrenia should be carried out regularly and at least once per year in primary care, with a focus on cardiovascular disease risk assessment. i. Body mass index, waist hip ratio or waist circumference. ii. Blood levels of glucose, lipids (total cholesterol and HDL). iii. Blood pressure. iv. Use of tobacco. v. Excessive use of alcohol. vi. Substance misuse. vii. Prolactin (if indicated). viii. History of cardiovascular disease, diabetes, hypertension or hyperlipidaemia in members of the service user s family.

7 NAS People with schizophrenia have increased risks for development of physical health problems, particularly heart disease and diabetes. However, only 29% of this population received a fully comprehensive assessment of important cardiometabolic risk factors. In particular, only 56% of service users were reported to have been weighed during the previous 12 months. For those service users with evidence of physical health problems, for example high blood pressure and high cholesterol levels, there is frequently no evidence that they have had further appropriate investigation or treatment for these problems. At even a simple level, for those with elevated BMI there was only evidence of advice being given about diet and exercise in 76% of cases. The most serious deficits to emerge were in the monitoring and management of physical health problems. Those with schizophrenia have increased risks of premature death from coronary heart disease. Monitoring of cardiometabolic risk factors for this, particularly weight gain, is extremely poor. It is clear that a major initiative is required to address this issue.

8 JAMES MACKENZIE LECTURE 22 November 2012 Don t just screen, intervene top GP calls for better care for mental health patients -People with serious mental illnesses are still getting an unfair deal from their healthcare -Subtle changes in the attitudes and actions of health professionals could significantly improve the quality, and even the length, of their lives. The late Professor Helen Lester James Mackenzie Lecture to the Royal College of General Practitioners AGM. Youtube

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10 So.?? DON T JUST SCREEN, INTERVENE THIS IS PARITY OF ESTEEM