Abstract
BackgroundSuboptimal treatment of cardiovascular diseases (CVD) among patients with severe mental illness (SMI) may contribute to physical health disparities.AimTo identify SMI characteristics associated with meeting CVD treatment and prevention guidelines.Design and settingPopulation-based electronic health record database linkage between primary care and the sole provider of secondary mental health care services in south east London, UK.MethodCardiovascular disease prevalence, risk factor recording, and Quality and Outcomes Framework (QOF) clinical target achievement were compared among 4056 primary care patients with SMI whose records were linked to secondary healthcare records and 270 669 patients without SMI who were not known to secondary care psychiatric services, using multivariate logistic regression modelling. Data available from secondary care records were then used to identify SMI characteristics associated with QOF clinical target achievement.ResultsPatients with SMI and with coronary heart disease and heart failure experienced reduced prescribing of beta blockers and angiotensin-converting enzyme inhibitor/angiotensin receptor blockers (ACEI/ARB). A diagnosis of schizophrenia, being identified with any indicator of risk or illness severity, and being prescribed with depot injectable antipsychotic medication was associated with the lowest likelihood of prescribing.ConclusionLinking primary and secondary care data allows the identification of patients with SMI most at risk of undertreatment for physical health problems.
Highlights
Linking primary and secondary care data allows the identification of patients with severe mental illness (SMI) most at risk of undertreatment for physical health problems
Secondary care data came from the Case Register Interactive Search (CRIS),[18] an application allowing researchers access to pseudonymised electronic health record (EHR) data from the South London and Maudsley NHS Foundation Trust (SLaM)
Among those with linked records, n = 4056 (16.9%) were recorded with SMI by their GP in Lambeth DataNet (LDN). Analyses compared those with recorded SMI in primary care with linked secondary care records (n = 4056) to those not recorded with SMI in primary care or linked to secondary care (n = 270 669)
Summary
Patients with severe mental illness (SMI), including schizophrenia, bipolar affective disorder, and schizoaffective disorder or other non-organic psychoses, experience lower life expectancy than the general population.[1,2,3,4] This is largely attributed to common physical disorders, cardiovascular diseases (CVDs).[2,3,5,6]Excess mortality linked to CVDs is attributed to several factors, including elevated risk factors such as smoking; side effects of pharmacological treatment; diagnostic overshadowing; and, suboptimal management of comorbid physical conditions.[7,8,9,10,11,12,13,14] Previous studies have been unable to investigate associations for varying SMI-related characteristics as data on physical health and clinical management sit mainly within primary care, whereas mental health condition and management records are mainly stored in secondary care.This study uses London borough population-based data from a linkage of primary and secondary mental healthcare records to: compare CVD prevalence, risk factor recording and treatment for established CVD, and primary care consultation frequency by SMI status; examine whether SMI characteristics are differentially associated with CVD prevalence and treatment; and assess the impact of adjustments for consultation frequency. Patients with severe mental illness (SMI), including schizophrenia, bipolar affective disorder, and schizoaffective disorder or other non-organic psychoses, experience lower life expectancy than the general population.[1,2,3,4] This is largely attributed to common physical disorders, cardiovascular diseases (CVDs).[2,3,5,6]. Excess mortality linked to CVDs is attributed to several factors, including elevated risk factors such as smoking; side effects of pharmacological treatment; diagnostic overshadowing; and, suboptimal management of comorbid physical conditions.[7,8,9,10,11,12,13,14] Previous studies have been unable to investigate associations for varying SMI-related characteristics as data on physical health and clinical management sit mainly within primary care, whereas mental health condition and management records are mainly stored in secondary care. Suboptimal treatment of cardiovascular diseases (CVD) among patients with severe mental illness (SMI) may contribute to physical health disparities
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