Here - Surrey and Borders Partnership NHS Foundation Trust

More documents

Recommendations

Info

Research and Audit rate of false negatives is consistently low (Twiss J et al, 2008). It is therefore recommended that all patients screening positive for BPD on the MDQ (using a cut off of 9 positive responses as a positive test) should be referred for diagnostic assessment by a professional mental health worker. Additionally a large study in a USA health centre with 1 million adult members identified that by administering one off screening for BPD to patients presenting with depressive symptoms, and following up positive screening results with a referral to a psychiatrist, reduced 5 year health care costs for that health centre by an estimated $1.94 million. This reduction was mostly due the difference in treatment costs between recognized versus unrecognized BPD sufferers (Menzin J et al, 2009). The importance of screening for hypomania/mania is that BPD sufferers are often misdiagnosed as suffering from unipolar depression, frequently leading to incorrect treatment. A single episode of mania constitutes a diagnosis of BPD, whilst an episode of hypomania should increase vigilance in looking out for future episodes of depression. Aims and Objectives of the Audit The purpose of the audit was to assess whether patients presenting to primary care practices within our catchment area were being screened for BPD. Additionally we wanted to establish how effective our service was at correctly identifying both true BPD sufferers, and those suffering from other mental health conditions. We intend to examine this data and consider whether further awareness and screening is required. To summarize, our study aimed to answer 3 questions: Within the context of our service- 1. Do primary care physicians and Mental Health Nurse Practitioners (MHNPs), specialist psychiatric nurses working in both primary and secondary care, screen for BPD? 2. Does screening for BPD increase the likelihood of identifying this condition? 3. Is there a good correlation between the diagnosis proposed by GPs and MHNPs and the final diagnosis made by the psychiatrist? Standard Currently no gold standard or NICE guidelines exist regarding screening for BPD in primary care; therefore we did not stipulate the use of a specific screening tool for our study. There are also no globally agreed cut-off points for what constitutes an acceptable screening test, although most researchers would agree that any good screening measure should have both a low false positive rate and a low false negative rate. The actual values that a researcher may deem acceptable are related to several variables, such as prevalence of condition, cost of screening and burden associated with missing the condition vs. burden associated with over diagnosing the condition (Simon S, 2007). For the purposes of our study, we set 80% sensitivity and 80% specificity as the standard, based upon levels set in other published research (Twiss J et al, 2008). Although these are arbitrary cut-off values, they are in line with generally accepted standards for psychiatric screening tests. Although we did not require the use of a specific screening tool for this study, we previously mentioned that a brief and acceptable screening tool is available, and we may consider using this tool routinely in the future. 10 Surrey and Borders Online Journal www.sabp.nhs.uk/journal
Research Method The study was conducted in our local Primary Mental Health Care Team (PCMHT) which is a community psychiatric service that operates both in GP surgeries and secondary care. A retrospective survey was carried out of all the patients with affective symptoms that were referred to the Tandridge PCMHT over a 6 month period between January and June 2008. It was felt that this would be a sufficiently large sample to accurately and validly assess the efficacy of screening for BPD in our catchment area. Table 1: Proforma used to analyse case records These referrals came from local GP surgeries, through the Crisis Advisory service, the Home Treatment Team and following discharge from the inpatient psychiatric unit at Epsom General Hospital. Some of these referrals also had a further triage assessment by a Mental Health Nurse Practitioner (MHNP) before being referred to the psychiatrist for confirmation of their diagnosis. We examined all patients’ records using an audit proforma that looked at the following parameters: GP assessment MHNP assessment Psychiatrist assessment Did the patient have 2/more episodes of mental illness? Did the GP screen for hypomania? What diagnosis did the GP propose? Did the MHNP screen for hypomania? What diagnosis did the MHNP propose? Final Diagnosis Research and Audit On completion of the proforma’s the data was analysed using the SPSS statistical package. The Psychiatrist’s diagnosis was used as the gold standard next to which the other proposed diagnoses were measured for accuracy. Results Between 01/01/2008 – 30/06/2008 there were 58 patients referred to the Tandridge PCMHT that presented with affective symptoms. Seven records could not be retrieved, subsequently 51 patients were included in the audit. The demographics of our study population were as follows: Table 2: Demographics of study population Gender Age Male, N = 19 Range, 19 – 62 years Female, N = 32 Mean = 37.6 (normal distribution) Out of the 38 patients referred by their GPs, 21 (55.3%) had had two or more episodes of mental illness whilst for 17 patients (44.7%) it was their first episode of mental illness. 13 patients were referred from other sources. In these cases the initial referral letter was analyzed in the same way as a GP referral and if they were also seen by a MHNP, this data was also included. Surrey and Borders Online Journal www.sabp.nhs.uk/journal 11
Page 1 and 2: Issue 1 Summer 2010 Surrey and Bord
Page 3 and 4: Do you ever wonder why you agree to
Page 5 and 6: We are not so aware of the hidden f
Page 7 and 8: esorting too soon to complex statis
Page 9: Bipolar Disorder: how effective is
Page 13 and 14: Screened for Hypomania Yes No Total
Page 15 and 16: In our sample the GPs screening met
Page 17 and 18: Audit of risk assessment documentat
Page 19 and 20: Fig. 2 Re-audit May 2009 - distribu
Page 21 and 22: An evolving service - results of a
Page 23 and 24: having clinical responsibility for
Page 25 and 26: school exposure to psychiatry as an
Page 27 and 28: The measures outlined above will ho
Page 29 and 30: Interview with Fiona Edwards, Chief
Page 31 and 32: Q. Very topical to that is the appo

Here - Surrey and Borders Partnership NHS Foundation Trust

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?