Cardiovascular health monitoring in patients with psychotic illnesses: A project to investigate and improve performance in primary and secondary care

Abstract

Patients with psychotic illnesses are predicted to die 15 years younger than the national average. The chief cause is cardiovascular disease (1). Evidence-based guidelines including those produced by the National Institute of Health and clinical Excellence and the Quality Outcomes Framework, recommend regular monitoring of their cardiovascular risk (2,3,4).Primary health care audits were undertaken in an urban and a rural setting. These looked at the proportion of patients who had their physical health regularly monitored in line with NICE guidelines. Following an audit in general practice, it became clear that there was a group of patients that were chronic non-attenders. It was not clear whether these patients were the responsibility of the general practices or psychiatric services. An audit in secondary care then looked at the level of cardiovascular health monitoring in that setting, and the communication of results to primary care. These audits demonstrated that monitoring of cardiovascular health did not meet standards as set by NICE. Further to this, communication of findings between primary and secondary care was also poor.Primary care interventions included setting up Alert reminder boxes on the computer system and sending invitations for clinic attendance to ‘at risk’ patients. In secondary care interventions included redesign of the patient lists to include a way of monitoring cardiovascular health and generation of a new discharge summary to facilitate communication of cardiovascular indicators to primary care.These interventions have resulted in marked improvements in cardiovascular health monitoring in primary care, however, there is still room for considerable improvement. Discussions about further intervention strategies, and further audit cycles, are ongoing.

Primary care consultation rates among people with and without severe mental illness: a UK cohort study using the Clinical Practice Research Datalink

“…People with SMI are less likely to receive cardiovascular disease (CVD) screening, compared with people with diabetes, 9 and CVD checks are not always performed in accordance with national guidance. 10 …”

Improving physical health for people taking antipsychotic medication in the Community Learning Disabilities Service

“…Other published studies indicate pharmacy checks on monitoring prior to dispensing the medication 32 and combined projects between primary and secondary care 33 can be effective.…”

Systems for physical health care for mental health patients in the community: different approaches to improve patient care and safety in an Early Intervention in Psychosis Service

“…Repeated studies have demonstrated that the lifespan of people with severe mental illness (SMI) is shorter compared to the general population, equating to a [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] year shortening in life span, mostly due to physical illness. 6 Many physical disorders such as cardiometabolic and nutritional, have been identified as being more prevalent in individuals with serious mental illness compared to the general population.…”

“…Some teams have relied on psychiatric doctors' input and struggled to produce sustained improvements. 14 Common barriers to management of physical illness in patients with severe mental illness are poor engagement and lack of training of mental health professionals. 15 Some suggestions to improve care include using algorithms and monitoring tools, educating and training staff, and bridging the gap between physical and mental health to promote a policy of coordinated and integrated health care for persons with serious mental illness.…”