What predetermines the management of patients with severe and enduring mental illness

1
What predetermines the management of patients
with severe and enduring mental illness

• Simon de Lusignan
• http//www.kssnet.org

2
About me

• GP Woodbridge Hill Surgery, Guildford
• Teaching and training practice
• Senior Lecturer, Primary Care Informatics, SGHMS
• Interest in the use of technology to raise the
  quality of care
• www.gpinformatics.org
• Use of computers in the consultation
• Informatics as an enabler of quality
• Director KSSnet
• About which more

3
A diversion about KSSnet

• Local PCRN
• Supporting research through its network
• Working closely with KSS Research facilitators
  based at the University of Surrey
• Membership open to any primary care researcher
• Contact Tom Chan

4
Introduction

• Why this study
• Anecdotal evidence Patients just seeing the
  practice nurse for depots
• Uncertainty, despite NICE guidance, about
  implementing new therapy
• Concern that the physical health may be neglected
  CVS and Resp illness
• Possibly poor prevention
• UNEXPLAINED VARIATION IN CARE

5
A collaborative study

• Surrey and Hampshire Borders NHS Trust
• Mental Health research experience, CMHT
• KSSnet (Kent Surrey and Sussex Primary Care
  Research Network)
• New network establishing its core research skill
• Sainsbury Centre for Mental Health
• Detailed knowledge of literature and research
  methods
• Local PCTs
• Keen to participate
• University of Surrey Postgraduate Medical
  School
• MIQUEST expertise, network of practices
• Primary Care Informatics St. Georges Hospital
  Medical School
• Data extraction and aggregation skills

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Study aim objectives

• To identify the factors that contribute to the
  variation in management of patients with severe
  and enduring mental illness
• Identify patients diagnosed and treated
• Examine medical and preventive interventions
• Link management options to practice, CMHT, and
  consultant
• Cost implications of the modernisation of therapy

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What explains the variation?
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Overview of method

• Literature review
• Reported prevalence 2 per 1000
• Protocol
• Ethical approval
• Recruit practices
• 20 x 10,000 patient practices, across 2 PCTs
• Extract practice data
• The study will be based on data extracted from
  general practice
• Analyse

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What data will be extracted from practices?

• Diagnostic codes
• Medication
• Respiratory and CVS health
• Prevention and lifestyle data
• Which CMHT
• Which consultant(s)
• The PCT

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Data extraction and aggregation

• MIQUEST
• Software from DoH allows data extraction from
  different GP systems
• Template and aggregate in a database
• Move into analysis software
• STATA / SPSS

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Outputs

• Report the degree of variation
• In therapy
• In medical care
• In prevention and screening
• Comment if practice, CMHT, or consultant factors
  appear to account for this variaton

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What next?

• Protocol to be finalised
• Ethics
• Recruitment of practices
• Come back next year to report the findings!

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The end thanks for listening

• Simon de Lusignan
• http//www.kssnet.org