Health education and prevention for people with severe mental illness: A cross-sectional study of general practice computer records
De Lusignan S., Chan T., Cohen A., Thana L., Dhoul N., Hague N., Van Vlymen J.
Background: Although UK general practice is highly computerised and data from it have been widely used for quality improvement and research in many diseases areas, most data about the prevalence and quality of management of mental illness come from secondary care-based studies. Many of these studies suggest that people with mental health problems have an excess of cardiovascular and respiratory disease. Objective: We carried out this study to determine whether routinely collected general practice data are of sufficient quality to be used for quality improvement, health service planning and research. Setting: Twelve computerised general practices in West Surrey with a combined list size of 117 000 patients. Method: Audit criteria were developed within a primary care research network. A data set was identified which would enable quality of care to be assessed. MIQUEST (Morbidity Information and Export Syntax - a Department of Health-sponsored data extraction application) was used to extract anonymised data, which was transferred to a relational database and then analysed using a statistical package. Results: The standardised prevalence of cardiovascular and respiratory disease for the population was 1.73%. Respiratory disease was more common in people with severe mental illness (SMI); 22.6% had respiratory illness, compared with 16.4%. Patients with SMI and coronary heart disease (CHD) were much less likely to have their cholesterol measured. Low-density lipoprotein cholesterol (LDL) was measured about half as frequently in both groups, with no significant difference found. There was less use of lipid-lowering therapy where only 61.4% of people with SMI and CHD are taking a statin compared with 74.4% of those without (χ2= 0.01.) Mean systolic blood pressure (BP) in people with SMI was 133.6 mmHg. People with SMI and CHD were no more likely to be ex- or current smokers; the percentages of each group who were likely current or ex-smokers were 43.3% and 43.7% respectively. Across all age groups people with SMI were recoaaed as receiving more health promotion advice than people without SMI - advice about smoking, alcohol, diet and exercise. Women with SMI were no more or less likely to have a cervical smear or mammogram performed than those without SMI. Conclusions: General practice data suggest that there may be higher levels of mental health problems than reported in other studies. People with mental health problems have higher levels of cardiovascular and respiratory disease. Although the levels of prevention and screening are lower, people with mental health problems are being advised more about smoking and lifestyle that other patients. Further studies are needed to explore whether people with mental health problems need new or additional interventions to improve lifestyle, as it appears that standard general practitioner (GP) interventions are failing them. © 2005 Radcliffe Publishing.