Physical health of patients in rehabilitation and recovery

I read with interest the article by Dr Greening (Psychiatric Bulletin, June 2005, 29, 210-212). I have recently undertaken an audit of the physical healthcare of patients in our rehabilitation and recovery unit in Warwick. Unfortunately, my preliminary results show a similar picture to that reported by Dr Greening.

However, we do have a local general practitioner (GP) who has two sessions allocated per week for the review of any physical health problems: the type of ‘ shared care approach’ suggested by Lester (2005) and Bickle (2005). It must be stressed though that it is not the responsibility of our GP colleagues to trawl through reams of notes (which most rehabilitation patients have) but rather up to the psychiatric team to ensure that patients are having appropriate investigations that can then be discussed with primary care.

For my audit I initially drew up a ‘checklist’ (standards) of the investigations that patients should have depending on what type of medication they are prescribed and how often, if at all, this ought to be repeated. I used the Maudsley Prescribing Guidelines, British National Formulary and consulted pharmaceutical companies in drawing up the standards for each psychotropic agent - one must not forget mood stabilisers and antidepressants that also require monitoring. Although rather time-consuming, it is a more rigorous method than collating the views of colleagues as done by Pitman (2005) prior to audit and is better than a battery of ‘routine tests’ which may be incomplete.

In addition, we have put together a health screen protocol for each patient that not only looks at issues such as diet, smoking, body mass index and exercise but also, among other things, posture/mobility, eyes, ears, teeth/oral hygiene, hair/scalp, immunisation history (although this can be difficult!), menstrual cycle, urinary tract infections and constipation. Each female will also be given appointments for mammograms and cervical smear tests when necessary, as well as leaflets on breast examination. All male patients will be given leaflets on testicular examination, provided by the primary care service. We will review the protocols annually but some areas will need to be addressed more often.

The reasons for regular review of the physical healthcare of psychiatric patients are well documented. I hope that by implementing these protocols using the shared care approach we are promoting a better quality of life that our patients deserve.