592479 research-article2015
APY0010.1177/1039856215592479Australasian PsychiatryJang et al.
Australasian
Psychiatry
General practice
An audit of general practitioner involvement in public community mental health care
Australasian Psychiatry 2015, Vol 23(5) 571–574 © The Royal Australian and New Zealand College of Psychiatrists 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1039856215592479 apy.sagepub.com
Jae Jang School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia Shuli Futeran School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, and; Eastern Suburbs Mental Health Service, South Eastern Sydney Local Health District, Sydney, NSW, Australia
Matthew Large School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, and; Eastern Suburbs Mental Health Service, South Eastern Sydney Local Health District, Sydney, NSW, Australia
Jackie Curtis School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, and; Eastern Suburbs Mental Health Service, South Eastern Sydney Local Health District, Sydney, NSW, Australia
Abstract Objective: Existing guidelines suggest that collaboration between general practitioners and mental health services may improve the physical health of people with serious mental illness. This study investigated the extent of general practitioner involvement in a community mental health centre and examined whether the presence of a documented general practitioner in the patient’s medical records was associated with markers of better health outcomes. Methods: The medical records of current patients were audited, including those receiving medical care and case management and those only receiving medical care. The demographic and diagnostic information, evidence of metabolic screening, blood test results, and medications of patients with a recorded general practitioner were compared with those of patients with no recorded general practitioner. Results: Ninety-eight of 191 (51%) of patients had details of a general practitioner documented in their medical records. There were no significant differences in rates of metabolic screening between the two groups. Those with a general practitioner had more medical diagnoses and were taking a greater number of psychiatric medications. Conclusion: Although the medical comorbidities of serious mental illness are becoming increasingly recognised, our findings suggest the need for ongoing and coordinated efforts by policymakers, general practitioners, mental health services and patients to ensure the health and longevity of people with serious mental illness. Keywords: physical health, general practitioner, metabolic syndrome, community psychiatry
Introduction People with serious mental illness (SMI) experience poor physical health1–3 and have a mortality rate two to three times that of the general population.4–6 People with SMI have a dramatically reduced life expectancy7–9 and an increasing mortality gap.10 SMI is associated with cardiovascular risk factors, particularly obesity, tobacco use and physical inactivity.3,11,12 Further, exposure to antipsychotic medications is associated with metabolic syndrome.3,12,13 People with SMI also have barriers to health care as a result of reduced help-seeking,14 socioeconomic disadvantage and stigma.15 The extent of non-treatment of comorbid medical illnesses were well illustrated by the clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study, which found that patients with schizophrenia had rates of non-treatment of 30.2% for diabetes, 62.4% for hypertension and 88.0% for dyslipidaemia.16
Internationally, the co-location of primary health care and mental health care has been effective in improving the medical care of people with SMI in at least one setting.17 In Australia, metabolic monitoring tools18 and protocols have been introduced into routine clinical care in community mental health centre (CMHC) settings.19 Currently in New South Wales, a guideline mandating the need for physical health care of mental health consumers is in practice. This guideline promotes the collaboration of mental health services with other health providers, particularly general practitioners (GPs).20 A similar guideline is in practice in the UK.21 Despite the Corresponding author: Shuli Futeran, Maroubra Community Mental Health, Maroubra, NSW 2035, Australia. Email: [email protected] 571
Downloaded from apy.sagepub.com at TULANE UNIV on November 17, 2015
Australasian Psychiatry 23(5)
international policies, a recent Cochrane review found no studies that assessed the efficacy of physical health monitoring in SMI.22 The aims of this study were to investigate the extent of GP involvement in community mental health care and to examine whether the presence of a documented GP in medical records is associated with markers of better health outcomes.
Methods The study was conducted in a public CMHC in Eastern Sydney that provides two levels of care: i) medical care and ii) medical care with case management. One author conducted a cross-sectional audit of active files of all medical care only and all case-managed clients managed by one of two outpatient teams between March and May 2014. De-identified data (Box 1) was collected using a pro-forma collection system. Two authors piloted the data extraction method and the final data points were reconfirmed. Partially completed metabolic screening forms were defined as those containing waist circumference, BMI and/or blood pressure, but missing other investigative findings. NSW Health standardised Metabolic Monitoring Module forms were utilised to collect anthropometric and pathology measurements which allowed a diagnosis of metabolic syndrome to be determined based on the International Diabetes Federation Consensus:18 - Waist circumference ≥ 94cm (male) ≥ 80cm (female) plus two of - Reduced or treated high-density lipoprotein (HDL) - Raised or treated triglycerides - Raised blood pressure or previously diagnosed hypertension - Raised fasting glucose or previous history of type 2 diabetes. Categorical data was compared using Fisher’s Exact test and dimensional data using an unmatched t-test. All tests were performed in a two-tailed form, with p
APY0010.1177/1039856215592479Australasian PsychiatryJang et al.
Australasian
Psychiatry
General practice
An audit of general practitioner involvement in public community mental health care
Australasian Psychiatry 2015, Vol 23(5) 571–574 © The Royal Australian and New Zealand College of Psychiatrists 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1039856215592479 apy.sagepub.com
Jae Jang School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia Shuli Futeran School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, and; Eastern Suburbs Mental Health Service, South Eastern Sydney Local Health District, Sydney, NSW, Australia
Matthew Large School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, and; Eastern Suburbs Mental Health Service, South Eastern Sydney Local Health District, Sydney, NSW, Australia
Jackie Curtis School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, and; Eastern Suburbs Mental Health Service, South Eastern Sydney Local Health District, Sydney, NSW, Australia
Abstract Objective: Existing guidelines suggest that collaboration between general practitioners and mental health services may improve the physical health of people with serious mental illness. This study investigated the extent of general practitioner involvement in a community mental health centre and examined whether the presence of a documented general practitioner in the patient’s medical records was associated with markers of better health outcomes. Methods: The medical records of current patients were audited, including those receiving medical care and case management and those only receiving medical care. The demographic and diagnostic information, evidence of metabolic screening, blood test results, and medications of patients with a recorded general practitioner were compared with those of patients with no recorded general practitioner. Results: Ninety-eight of 191 (51%) of patients had details of a general practitioner documented in their medical records. There were no significant differences in rates of metabolic screening between the two groups. Those with a general practitioner had more medical diagnoses and were taking a greater number of psychiatric medications. Conclusion: Although the medical comorbidities of serious mental illness are becoming increasingly recognised, our findings suggest the need for ongoing and coordinated efforts by policymakers, general practitioners, mental health services and patients to ensure the health and longevity of people with serious mental illness. Keywords: physical health, general practitioner, metabolic syndrome, community psychiatry
Introduction People with serious mental illness (SMI) experience poor physical health1–3 and have a mortality rate two to three times that of the general population.4–6 People with SMI have a dramatically reduced life expectancy7–9 and an increasing mortality gap.10 SMI is associated with cardiovascular risk factors, particularly obesity, tobacco use and physical inactivity.3,11,12 Further, exposure to antipsychotic medications is associated with metabolic syndrome.3,12,13 People with SMI also have barriers to health care as a result of reduced help-seeking,14 socioeconomic disadvantage and stigma.15 The extent of non-treatment of comorbid medical illnesses were well illustrated by the clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study, which found that patients with schizophrenia had rates of non-treatment of 30.2% for diabetes, 62.4% for hypertension and 88.0% for dyslipidaemia.16
Internationally, the co-location of primary health care and mental health care has been effective in improving the medical care of people with SMI in at least one setting.17 In Australia, metabolic monitoring tools18 and protocols have been introduced into routine clinical care in community mental health centre (CMHC) settings.19 Currently in New South Wales, a guideline mandating the need for physical health care of mental health consumers is in practice. This guideline promotes the collaboration of mental health services with other health providers, particularly general practitioners (GPs).20 A similar guideline is in practice in the UK.21 Despite the Corresponding author: Shuli Futeran, Maroubra Community Mental Health, Maroubra, NSW 2035, Australia. Email: [email protected] 571
Downloaded from apy.sagepub.com at TULANE UNIV on November 17, 2015
Australasian Psychiatry 23(5)
international policies, a recent Cochrane review found no studies that assessed the efficacy of physical health monitoring in SMI.22 The aims of this study were to investigate the extent of GP involvement in community mental health care and to examine whether the presence of a documented GP in medical records is associated with markers of better health outcomes.
Methods The study was conducted in a public CMHC in Eastern Sydney that provides two levels of care: i) medical care and ii) medical care with case management. One author conducted a cross-sectional audit of active files of all medical care only and all case-managed clients managed by one of two outpatient teams between March and May 2014. De-identified data (Box 1) was collected using a pro-forma collection system. Two authors piloted the data extraction method and the final data points were reconfirmed. Partially completed metabolic screening forms were defined as those containing waist circumference, BMI and/or blood pressure, but missing other investigative findings. NSW Health standardised Metabolic Monitoring Module forms were utilised to collect anthropometric and pathology measurements which allowed a diagnosis of metabolic syndrome to be determined based on the International Diabetes Federation Consensus:18 - Waist circumference ≥ 94cm (male) ≥ 80cm (female) plus two of - Reduced or treated high-density lipoprotein (HDL) - Raised or treated triglycerides - Raised blood pressure or previously diagnosed hypertension - Raised fasting glucose or previous history of type 2 diabetes. Categorical data was compared using Fisher’s Exact test and dimensional data using an unmatched t-test. All tests were performed in a two-tailed form, with p
