Poster from 2010 RCPsych meeting Edinburgh

1. International Congress of the
Royal College of Psychiatrists
21-24 June 2010, EICC, Edinburgh
Quality of Care for Individuals with Mental Ill Health:
Are there Inequalities in Preventive Medical Care & Medical Screening?
Oliver Lord ST in psychiatry, Leicester Partnership Trust, Leicester Alex J Mitchell Consultant in Psychiatry, Department of Cancer &
Molecular Medicine, University Hospitals Leicester (UK) ajm80@le.ac.uk
AIMS Initial hit from search
(n= 429)
We aimed to examine whether the quality of preventive care received by patients with
Not a prevention or screening
study (n= 362)
mental health conditions differs from that received by individuals who have no comparable
Preventive care studies in No quality of care data
mental illness (n= 67) presented (n=4)
Exclusions based on sample
mental disorder. Our hypothesis was that patients with mental illness would be in receipt of
(see text) (n=4)
Preventive care in mental illness No comparison group (n=33)
lower quality or lower frequency of preventive care. vs no mental illess (n=26)
Type of Preventive Clinical groups Summary of findings *
Service
BACKGROUND REVIEW Mammography (n=17) Colonoscopy (n=4) Any mental illness (n=9) Inferior preventive care for
mental illness (n=27)
There has been long standing concern about the delivery of preventive and screening Cervical smear testing
(n=10)
Clinical breast examination
(n=2) Depression / anxiety (n=8) No difference in care or
inconclusive (n=24)
services to patients with mental illness.
vaccinations Care (n=6) Fracture prevention (n=2)
Schizophrenia or bipolar Superior preventive care for
(n=7) mental illness (n=10)
Lifestyle counselling (n=5) Faecal occult blood testing
(n=2)
Distress (n=2)
Blood pressure monitoring Prostate specific antigen
Care (n=4) testing (n=2)
METHODS Studies that examined the quality of care in those with and without comorbid Cholesterol screening Care
(n=4)
General physical/dental
examination (n=2)
HIV testing (n=1)
* = Based on 61
mental illness were reviewed and comparative data extracted from 1980 to December
comparisons (see text)
2009
RESULTS Our preliminary search identified 429 references (fig 1). Of these, Of these, 73 were primary data studies but only 32
specifically examined preventive care in individuals with mental health problems. These were reviewed in detail. We excluded
studies without a defined mental disorder but included distress (table 2). 41 studies were excluded: 33 because they did not include
a comparison group; 4 did not present primary data; 4 studies examined screening in those with comorbid physical and mental
illness that is reviewed elsewhere.
We identified 26 studies that examined preventive care in individuals with vs without psychiatric illness. From these eligible studies,
61 comparisons were documented across 13 health care domains. These included mammography, cervical smears, vaccinations,
cholesterol screening, lifestyle counseling, colonoscopy. 27 comparisons revealed inferior preventive health care in those with
mental illness but 10 suggested superior preventive health care and 24 reached inconclusive findings. Inferior preventive care was
most apparent in those with schizophrenia and in relation to osteoporosis screening, blood pressure monitoring, vaccinations,
mammography and cholesterol monitoring.
CONCLUSIONS We conclude there is strong evidence to suggest that the quality of preventive and screening
services received by patients with mental illness is often lower, but occasionally superior to that received by
individuals who have no comparable mental disorder. More work must be done to improve the quality of medical
and preventive care for individuals with mental illness.