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Assessment and treatment of physical health problems among people with schizophrenia: national cross-sectional study

  • Mike J. Crawford (a1), Simone Jayakumar (a2), Suzie J. Lemmey (a2), Krysia Zalewska (a2), Maxine X. Patel (a3), Stephen J. Cooper (a2) and David Shiers (a2)...
Abstract
Background

In the UK and other high-income countries, life expectancy in people with schizophrenia is 20% lower than in the general population.

Aims

To examine the quality of assessment and treatment of physical health problems in people with schizophrenia.

Method

Retrospective audit of records of people with schizophrenia or schizoaffective disorder aged ⩾18. We collected data on nine key aspects of physical health for 5091 patients and combined these with a cross-sectional patient survey.

Results

Body mass index was recorded in 2599 (51.1%) patients during the previous 12 months and 1102 (21.6%) had evidence of assessment of all nine key measures. Among those with high blood sugar, there was recorded evidence of 53.5% receiving an appropriate intervention. Among those with dyslipidaemia, this was 19.9%. Despite this, most patients reported that they were satisfied with the physical healthcare they received.

Conclusions

Assessment and treatment of common physical health problems in people with schizophrenia falls well below acceptable standards. Cooperation and communication between primary and secondary care services needs to improve if premature mortality in this group is to be reduced.

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Copyright
Corresponding author
Mike J. Crawford, College Centre for Quality Improvement Royal College of Psychiatrists, 21 Prescot Street, London E1 8BB. Email: m.crawford@imperial.ac.uk
Footnotes
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Declaration of interest

The National Audit of Schizophrenia (NAS) is managed by the Royal College of Psychiatrists' College Centre for Quality Improvement. It is commissioned by the Healthcare Quality Improvement Partnership as part of the National Clinical Audit and Patient Outcomes Programme. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health. M.X.P. has received consultancy fees, lecturing honoraria, and/or research funding from Janssen, Lilly, Endo, Lundbeck, Otsuka and Wyeth and has worked or is currently working on clinical trials and studies for Janssen, Amgen and Lundbeck. S.J.C. has previously been Chair of the Psychiatry Expert Group of the Northern Ireland Pharmaceutical Clinical Excellence Programme and a member of the NI Health & Social Care Board Formulary committee. D.S. received a speakers fee from Janssen-Cilag in 2011.

Footnotes
References
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Assessment and treatment of physical health problems among people with schizophrenia: national cross-sectional study

  • Mike J. Crawford (a1), Simone Jayakumar (a2), Suzie J. Lemmey (a2), Krysia Zalewska (a2), Maxine X. Patel (a3), Stephen J. Cooper (a2) and David Shiers (a2)...
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eLetters

Improving assessment and treatment of physical health problems in people with severe mental illness: the case for a shared IT system

Fredrik Johansson, Speciality Doctor
05 December 2014

The poor assessment and treatment of physical health problems in people with schizophrenia found by Crawford et al is sadly not surprising.

The methodological problems that became evident in the pilot phase mirrors the problems faced in practice - many trusts do not have up-to-date physical health monitoring and these must be requested from primary care. Clinicians in mental health services interested in getting this information and who want to actively take part in physical health assessment and treatment have to, like Crawford et al. write to the GP requesting this information and hope for a timely response.

Out of hours there is no simple way of checking current medication, physical health conditions and allergies which are all readily available on primary care data bases. Many clinicians in mental health spent considerable time contacting GP practices to request investigations and results. Conversely, GPs are often frustrated at not finding out about changes in management plans and psychotropic medication fast enough. This system of care is not conducive to the urgent need to improve physical health care for this group of patients.

A shared IT platform between primary care and mental health services with up-to-date information on physical health monitoring such as blood pressure, smoking, weight, BMI, blood tests, ECGs, physical health conditions and their management, current medication and allergies would surely result in improved efficiency and patient safety, and go some way to reconnect, if not integrate, physical and mental health treatment. If this is beyond our capabilities then certainly electronic access to some version of primary care records is surely not?

I note the authors affiliation with the Centre for Quality Improvement at the Royal College of Psychiatrists and I would hope that such a project is high on the agenda. An improved date system would come as a huge relief to many clinicians, especially trainees, who work with these issues every day and might even encourage them to be more involved in the physical health management of their patients.

Unfortunately, primary care services are not incentivised to monitor physical health assertively in those with schizophrenia and many in this patient group do not regularly attend their primary care service. Patientswho attend secondary care services could be offered monitoring of physicalhealth conditions as well as treatment in this setting, and such services are increasingly being offered. A shared IT would certainly help improve the efficiency of such initiatives and allow for a more integrated approach, to the benefit of all parties.

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Conflict of interest: None declared

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