Abstract
Aims and method People with severe mental illness (SMI) die relatively young, with mortality rates four times higher than average, mainly from natural causes, including heart disease. We developed a computer-based physical health screening template for use with primary care information systems and evaluated its introduction across a whole city against standards recommended by the National Institute for Health and Care Excellence for physical health and cardiovascular risk screening.Results A significant proportion of SMI patients were excluded from the SMI register and only a third of people on the register had an annual physical health check recorded. The screening template was taken up by 75% of GP practices and was associated with better quality screening than usual care, doubling the rate of cardiovascular risk recording and the early detection of high cardiovascular risk.Clinical implications A computerised annual physical health screening template can be introduced to clinical information systems to improve quality of care.
Highlights
The National Institute for Health and Care Excellence (NICE) has recommended a standard cardiovascular disease risk calculation as part of the annual health check since 2002.16 In this study we focus on the cardiovascular risk assessment element of the computerised physical health check template
32% of people on the severe mental illness (SMI) register received an annual physical health check recorded by a Quality and Outcomes Framework (QOF) code
It is likely that all activity recorded on the system was captured and this accurately reflects the real rate of physical health checks recorded in primary care
Summary
Results were derived from reports written for this evaluation in the SystmOne reports module. 23% (77/335) had a ‘data-rich’ QRiskA2 recorded compared with only 8.5% (120/1296) of patients who had an annual physical review without a template-based health check (P50.01) (Table 1). This difference is broadly in line with the increased proportion of ‘data-rich’ QRiskA2 scores associated with template-based reviews This suggests that use of the template significantly increased the detection of cardiovascular risk, compared with usual practice, and that this may be a feature of screening patients more accurately by using a high standard of QRiskA2 measurement. Three-quarters of patients with a template-based review received the recommended lipid screening and over 90% had the history and physical examination measures This suggests that use of the template had the effect of encouraging primary care teams to collect the data needed to make high-quality cardiovascular risk assessments
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