Abstract
There is global interest in the reconfiguration of community mental health services, including primary care, to improve clinical and cost effectiveness. This study seeks to describe patterns of service use, continuity of care, health risks, physical healthcare monitoring and the balance between primary and secondary mental healthcare for people with severe mental illness in receipt of secondary mental healthcare in the UK. We conducted an epidemiological medical records review in three UK sites. We identified 297 cases randomly selected from the three participating mental health services. Data were manually extracted from electronic patient medical records from both secondary and primary care, for a 2-year period (2012-2014). Continuous data were summarised by mean and s.d. or median and interquartile range (IQR). Categorical data were summarised as percentages. The majority of care was from secondary care practitioners: of the 18 210 direct contacts recorded, 76% were from secondary care (median, 36.5; IQR, 14-68) and 24% were from primary care (median, 10; IQR, 5-20). There was evidence of poor longitudinal continuity: in primary care, 31% of people had poor longitudinal continuity (Modified Modified Continuity Index ≤0.5), and 43% had a single named care coordinator in secondary care services over the 2 years. The study indicates scope for improvement in supporting mental health service delivery in primary care. Greater knowledge of how care is organised presents an opportunity to ensure some rebalancing of the care that all people with severe mental illness receive, when they need it. A future publication will examine differences between the three sites that participated in this study.
Highlights
There is global interest in the reconfiguration of community mental health services, including primary care, to improve clinical and cost effectiveness
The number of direct primary care contacts over 24 months in the present study compared with: i) our earlier notes review a longitudinal cohort study reported annual mean face-to-face primary care contacts as 10.9 (s.d. 12)[10]; and iii) another study that reported on cardiovascular disease treatment for SMI recorded a mean of 9.4 primary care consultations (s.d. 8) over 9 months.[20]. These studies are more inclusive, including individuals who were not seen in secondary care, so the lower rates of primary care contacts in our study may be explained by the fact that we have focused only on individuals who are seen in secondary care
The increasing rates of poor continuity of care may be explained by the fact that we have focused only on individuals who are seen in secondary care
Summary
We conducted an epidemiological medical records review in three UK sites. We identified 297 cases randomly selected from the three participating mental health services. Data were manually extracted from electronic patient medical records from both secondary and primary care, for a 2-year period (2012– 2014). This multi-site, cross-sectional epidemiological review of primary and secondary care contacts was conducted in three locations across England. Three host National Health Service (NHS) Trust sites, reflecting a geographical spread across England, were invited to participate in this programme of research. The research team (which includes service user researchers, two of whom are coauthors) worked with these Trusts to select secondary care mental health teams to reflect urban/rural and deprivation-level diversity. The study adheres to the international reporting standards for observational studies,[16] and has public and patient involvement embedded throughout the whole programme.[17]
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