Cardiovascular disease treatment among patients with severe mental illness: a data linkage study between primary and secondary care.
BACKGROUND
Suboptimal treatment of cardiovascular diseases (CVD) among patients with severe mental illness (SMI) may contribute to physical health disparities.


OBJECTIVE
To identify SMI characteristics associated with meeting CVD treatment and prevention guidelines.


METHODS
Population-based electronic health record database linkage between primary care and the sole provider of secondary mental health care services in south east London, UK.


METHODS
Cardiovascular disease prevalence, risk factor recording, and Quality and Outcomes Framework (QOF) clinical target achievement were compared among 4056 primary care patients with SMI whose records were linked to secondary healthcare records and 270 669 patients without SMI who were not known to secondary care psychiatric services, using multivariate logistic regression modelling. Data available from secondary care records were then used to identify SMI characteristics associated with QOF clinical target achievement.


RESULTS
Patients with SMI and with coronary heart disease and heart failure experienced reduced prescribing of beta blockers and angiotensin-converting enzyme inhibitor/angiotensin receptor blockers (ACEI/ARB). A diagnosis of schizophrenia, being identified with any indicator of risk or illness severity, and being prescribed with depot injectable antipsychotic medication was associated with the lowest likelihood of prescribing.


CONCLUSIONS
Linking primary and secondary care data allows the identification of patients with SMI most at risk of undertreatment for physical health problems.
King's College London, Institute of Psychiatry, Psychology and Neuroscience, London.
Charlotte
C
Woodhead
King's College London, Institute of Psychiatry, Psychology and Neuroscience, London.
Mark
M
Ashworth
Head of information governance, South London and Maudsley NHS Foundation Trust, London.
Matthew
M
Broadbent
Reader in social science for medical humanities, Durham University, Centre for Medical Humanities, Durham.
Felicity
F
Callard
King's College London, Institute of Psychiatry, Psychology and Neuroscience, London.
Matthew
M
Hotopf
King's College London, Institute of Psychiatry, Psychology and Neuroscience, London.
Peter
P
Schofield
Head of information governance, South London and Maudsley NHS Foundation Trust, London.
Murat
M
Soncul
King's College London, Institute of Psychiatry, Psychology and Neuroscience, London.
Robert J
RJ
Stewart
King's College London, Institute of Psychiatry, Psychology and Neuroscience, London.
Max J
MJ
Henderson
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D015897:Comorbidity; D003430:Cross-Sectional Studies; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D016247:Information Storage and Retrieval; D008131:London / Q000453:epidemiology; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care / Q000458:organization & administration; D012307:Risk Factors; D063127:Secondary Health Care / Q000458:organization & administration
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D014150:Antipsychotic Agents
cardiovascular diseases; data linkage; health inequalities; primary health care; psychoses