Transcript Using Information to Span the Physical health/ Mental health Divide

Using Information to Span the
Physical health/ Mental health
Divide
Michael Sharpe
Reader in Psychological Medicine
University of Edinburgh
The Problem
Mind the gap
• Mind and body
• The philosophical, conceptual and
organizational division of services
• This is philosophically, scientifically and
practically outmoded
Some Facts
¼ to ½ of medical outpatients have significant
depression and anxiety.
Such comorbidity is associated with …..
•
Poor quality of life
•
Medically unexplained symptoms
•
Worse medical outcomes
•
Higher use of medical resources
The Opportunity
Limitations of current ISD data
• Psychiatric diagnostic recording LARGELY
ABSENT
• From ISD 0.1% of patients in general hospitals
have recorded diagnoses of depression
Examples from Research
Edinburgh University Psychological
Medicine Research Group
Collecting routine psychiatric
data – Depression in cancer
patients
• Screen all outpatient attenders using
automatic system
• Touch screen computers
• Efficient and acceptable
• But not fully automatic
(funded by Cancer Research UK)
Collecting routine psychiatric
data – the example of cancer
• 20 % have significant psychiatric symptoms.
• 150 consecutive patients with major depression.
• ONLY 5% were receiving appropriate treatment
Collecting routine psychiatric
data – the example of Neurology
• A study of consecutive referral to OPD in
Edinburgh found 50% with psychiatric disorder
and 25 % with medically unexplained symptoms.
• Now conducting a National Neurological
Symptom Study of 5,000 patients to extend study
and observe predictive importance.
(funded by CSO and CRAG)
Using existing ISD activity data to
identify patients with unmet
Psychiatric needs
Identify patients frequently referred to general
hospitals with medically unexplained symptoms
Three stages:
• Identify NUMBER of referrals to hospital
• Review records
• Interview patients to get psychiatric diagnosis.
(funded by CSO and MHDF)
Using existing ISD activity data to
identify patients with unmet
Psychiatric needs
• Most of the patients with frequent referrals
for medically unexplained complaints have
unrecognized/untreated depression.
• Pilot work suggests that recognition and
appropriate management can be effective
What do we need ?
Readily usable integrated
medical/surgical and psychiatric
diagnostic data to quantify and
monitor the size of the problem of
psychiatric problems in nonpsychiatric patients.
How can we get integrated data
• Joined up thinking
• Linking medical and psychiatric databases
• Making and recording of psychiatric
diagnoses in medical patinets
• Better primary care data
Barriers to integrated data
• Major attitudinal blocks
• Failure to recognize the importance of the
problem
• Failures in clinical practice
• The amount of work involved
The way forward…..
1. Improved recording of psychiatric data
2. Recognition of the problem
-
Weight of evidence
Central requirement
3. Improved assessment of patients
-
Training
4. A PILOT STUDY – an “institutional audit”
Further reading
• SNAP report on liaison psychiatry and
psychology (psychological medicine)
• Current BMJ series; ABC of psychological
medicine (and book)