title: Rectal and postmenopausal bleeding: consultation and referral of patients with and without severe mental health problems.
abstract: BACKGROUND
  People with severe mental health problems receive less effective care for some physical conditions. There is concern that this could apply to rectal bleeding or postmenopausal bleeding. Published estimates of consultation rates and outcomes for these symptoms vary widely.
  
  
  OBJECTIVE
  To estimate rates of first-ever consultation for rectal bleeding and postmenopausal bleeding in general practice, together with subsequent referrals and outcomes. To identify inequalities for patients with severe mental health problems.
  
  
  METHODS
  Cohort study.
  
  
  METHODS
  Primary care.
  
  
  METHODS
  Patients with first-ever consultations for rectal or postmenopausal bleeding were identified among more than 3 million patients from 328 practices contributing routine data to the QRESEARCH database. Their records were followed for 2 years.
  
  
  RESULTS
  There were 30 175 first consultations for rectal bleeding (2.6 per thousand patients per year at age 25-29 years, rising to 4.8 over age 85 years) and 10 142 for postmenopausal bleeding (highest at 7.4 per thousand per year aged 55-59 years). Overall, 2.2% of those with rectal bleeding and 1.7% of those with postmenopausal bleeding went on to have a relevant cancer diagnosis within 2 years. Cancer risk was strongly related to age, and was higher for males with rectal bleeding than females with rectal bleeding. Recorded referrals were at similar rates among patients with and without severe mental health problems.
  
  
  CONCLUSIONS
  The rate of first consultations for rectal bleeding or postmenopausal bleeding is relatively low. Less than 2.5% overall have a relevant cancer diagnosis within 2 years. There is no evidence of inequality in referral for patients with severe mental health problems.
authors.affiliation: Nottingham Primary Care Research Partnership, Hucknall, Nottingham. chris.parker@nottinghamshirecounty-tpct.nhs.uk
authors.forename: Chris
authors.initials: C
authors.lastname: Parker
authors.forename: Julia
authors.initials: J
authors.lastname: Hippisley-Cox
authors.forename: Carol
authors.initials: C
authors.lastname: Coupland
authors.forename: Yana
authors.initials: Y
authors.lastname: Vinogradova
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005194:Family Practice / Q000592:standards*; D005240:Feasibility Studies; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000150:complications*; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000175:diagnosis*; D017698:Postmenopause; D011787:Quality of Health Care / Q000592:standards*; D012007:Rectum; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012307:Risk Factors; D012720:Severity of Illness Index; D014592:Uterine Hemorrhage / Q000150:complications / Q000175:diagnosis*