scholarly journals Clinical audit of cardio-metabolic monitoring in people with intellectual disability (PWID) taking antipsychotic medication

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S87-S88
Author(s):  
Sandar Kyaw ◽  
Fadzlien Bintizahari ◽  
Peter Speight
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Intellectual Disability ◽  
Physical Health ◽  
Antipsychotic Medication ◽  
Clinical Audit ◽  
Successful Implementation ◽  
Close Monitoring ◽  
Metabolic Monitoring ◽  
The Impact

AimsTo ensure close monitoring of physical health parameters when antipsychotics are prescribed and to liaise with primary care to ensure appropriate interventions are implemented.BackgroundAntipsychotics are the most frequently prescribed psychotropic medication for PwID. Treatment with antipsychotic agent is associated with cardio-metabolic risks such as obesity, diabetes, and dyslipidemia. A strong association is well documented between antipsychotic use and the risk of stroke in schizophrenia although the magnitude of this association has yet to be studied in PwID.PwID have an increased risk of premature death. Cardio-metabolic monitoring and appropriate intervention to this vulnerable cohort will improve the preventable cardio-metabolic multi-morbidity. The NICE guideline (CG11) recommends antipsychotic medication should only be initially prescribed and monitored by the secondary care professionals for at least 12 months. They also should work together with primary care to ensure appropriate interventions are arranged where necessary.MethodA retrospective audit was performed for 40 service users, taking antipsychotic medication. Quota sampling was used to identify 10 cases each from the caseload of 4 consultant psychiatrists, within the Intellectual Disability community setting, between September 2019 and October 2019.An audit tool was designed, in accordance with cardio-metabolic measures (smoking status, height, weight, Blood Pressure, HbA1c, Lipid profile), based on physical health CQUIN targets and the Lester adaptation tool. Collection of data was performed from electronic case records and electronic blood results service. The work was performed with the approval of local clinical audit team and analysed by using Microsoft Excel.ResultBaseline cardio-metabolic assessment was observed in over a half of the sample population (50–65%) whilst only less than 15% was noted at 3–6 months. Documentation Evaluation of physical health assessments for new admissions to the Oleaster during the first wave of COVID-19 on body weight and blood pressure was seen only in 15% and 2.5% of population respectively at 3–6 months. Collaboration with GP for annual health check was observed in 78–100% of population.Intriguingly, our finding indicates a significant improvement in all required compliance when nursing team is involved.ConclusionImproving physical healthcare is essential to reduce the cardio metabolic outcome in PwID taking antipsychotic medication. Better involvement of community nurses as well as availability of Sphygmomanometers at every outpatient clinic will determine the successful implementation of cardio metabolic monitoring and effective collaboration with primary care clinicians.Once the action plan is disseminated to the teams, the impact of change will be reassessed by a re-audit in one year's time.

scholarly journals Physical Health in People with Intellectual Disabilities

2020 ◽  
pp. 203-212
Author(s):  
Umesh Chauhan ◽  
Ken Courtenay ◽  
Matthew Hoghton
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Intellectual Disability ◽  
Physical Health ◽  
Health Problems ◽  
History Taking ◽  
Health And Wellbeing ◽  
People With Intellectual Disabilities ◽  
The Impact

The aim of this chapter is to outline the importance of good physical health for a person with intellectual disability (ID) on their mental health and wellbeing; the impact of the choice of psychotropic therapy on their physical health; the presentations of mental disorders in people with ID with health problems; what to include in assessment—good history taking, physical examination, and investigations. Other aspects covered are the management of health problems including health prevention and what to monitor; the role of guidelines; and importance of liaison with GPs and the Primary Care Team.

scholarly journals Examining the effectiveness of telemonitoring with routinely acquired blood pressure data in primary care: challenges in the statistical analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Richard A. Parker ◽  
Paul Padfield ◽  
Janet Hanley ◽  
Hilary Pinnock ◽  
John Kennedy ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Statistical Analysis ◽  
Propensity Score ◽  
Random Coefficient ◽  
White Coat ◽  
White Coat Effect ◽  
Regression Adjustment ◽  
The Impact

Abstract Background Scale-up BP was a quasi-experimental implementation study, following a successful randomised controlled trial of the roll-out of telemonitoring in primary care across Lothian, Scotland. Our primary objective was to assess the effect of telemonitoring on blood pressure (BP) control using routinely collected data. Telemonitored systolic and diastolic BP were compared with surgery BP measurements from patients not using telemonitoring (comparator patients). The statistical analysis and interpretation of findings was challenging due to the broad range of biases potentially influencing the results, including differences in the frequency of readings, ‘white coat effect’, end digit preference, and missing data. Methods Four different statistical methods were employed in order to minimise the impact of these biases on the comparison between telemonitoring and comparator groups. These methods were “standardisation with stratification”, “standardisation with matching”, “regression adjustment for propensity score” and “random coefficient modelling”. The first three methods standardised the groups so that all participants provided exactly two measurements at baseline and 6–12 months follow-up prior to analysis. The fourth analysis used linear mixed modelling based on all available data. Results The standardisation with stratification analysis showed a significantly lower systolic BP in telemonitoring patients at 6–12 months follow-up (-4.06, 95% CI -6.30 to -1.82, p < 0.001) for patients with systolic BP below 135 at baseline. For the standardisation with matching and regression adjustment for propensity score analyses, systolic BP was significantly lower overall (− 5.96, 95% CI -8.36 to − 3.55 , p < 0.001) and (− 3.73, 95% CI− 5.34 to − 2.13, p < 0.001) respectively, even after assuming that − 5 of the difference was due to ‘white coat effect’. For the random coefficient modelling, the improvement in systolic BP was estimated to be -3.37 (95% CI -5.41 to -1.33 , p < 0.001) after 1 year. Conclusions The four analyses provide additional evidence for the effectiveness of telemonitoring in controlling BP in routine primary care. The random coefficient analysis is particularly recommended due to its ability to utilise all available data. However, adjusting for the complex array of biases was difficult. Researchers should appreciate the potential for bias in implementation studies and seek to acquire a detailed understanding of the study context in order to design appropriate analytical approaches.

scholarly journals Do you mind if I take your blood pressure? Physical health monitoring of children and young people on ADHD medication amidst a pandemic

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S183-S184
Author(s):  
Emma Davies ◽  
Maham Khan ◽  
Claire Jones
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Young People ◽  
Physical Health ◽  
Health Monitoring ◽  
Neurodevelopmental Disorder ◽  
Adhd Medication ◽  
Children And Young People ◽  
Nice Guidance ◽  
The Impact

AimsTo establish whether physical health monitoring for CYP on ADHD medication is according to NICE guidance (2018).To determine the impact of COVID-19 pandemic restrictions on physical health monitoring for CYP on ADHD medication.Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder, characterised by a persistent pattern of inattention and/or hyperactivity-impulsivity, directly impacting on academic, occupational, or social functioning. It affects between 1-5% of children and young people (CYP) most often presenting in early-mid childhood.Pharmacological treatment can be considered in CYP if certain criteria are met, where licensed medications include methylphenidate, dexamfetamine, lisdexamfetamine, atomoxetine and guanfacine. Stimulant and non-stimulant medications require frequent physical health monitoring due to their side effects including an increase in blood pressure and/or heart rate, loss of appetite, growth restriction and tics.MethodStandards and criteria were derived from the NICE guidance (2018), whilst local trust policies were reviewed, demonstrating discrepancies. Standards were expected to be met for 100% of patients.Electronic patient records were reviewed retrospectively from a representative cohort of CYP reviewed by clinicians in a community CAMHS service during March-November 2020. Data were entered manually into a spreadsheet for evaluation.ResultA total of 27 CYP records were reviewed, average age 13yo, on a range of stimulant/non-stimulant preparations.5 (19%) had height checked every 6 months, with 4 delayed to 7-8 months.For those >10yo, only 5 (19%) had weight checked every 6 months.Only 2 (7%) had their height and weight plotted on a growth chart and reviewed by the healthcare professional responsible for treatment.Just 4 (15%) had heart rate and blood pressure recorded before and after each dose change, whilst similarly only 4 (not the same) had these parameters recorded every 6 months.17 patients were reviewed by telephone/video call, where 5 patients provided physical health parameters (measured at home).ConclusionAcross all parameters, standards are not being met for the required physical health monitoring for CYP on ADHD medication.The COVID-19 pandemic has significantly changed the working conditions for community teams, impacting face to face reviews, creating challenges for physical health monitoring.Our ongoing implementations for change include the use of a proforma for physical health measurements, improving psychoeducation for families, exploring potential barriers with senior colleagues and collaborating with pharmacy colleagues to update local guidelines in accordance with the latest NICE recommendations. We aim to re-audit in June 2021.

scholarly journals SAT-558 A Dedicated Endocrine Hypertension Service Increases the Timely Diagnosis of Primary Aldosteronism

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Jun Yang ◽  
Yin Y Lim ◽  
Renata Libianto ◽  
Jimmy Shen ◽  
Morag Jennifer Young ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Primary Aldosteronism ◽  
Pressure Control ◽  
Organ Damage ◽  
Antihypertensive Medications ◽  
Endocrine Hypertension ◽  
Treatment Naïve ◽  
Hypertension Diagnosis ◽  
The Impact

Abstract Background: Primary aldosteronism (PA) accounts for 3.2-12.7% of hypertension in primary care but is often diagnosed late, if at all. A delayed or missed diagnosis leads to poor blood pressure control and greater cardiovascular risk that could be averted with targeted treatment. An Endocrine Hypertension Service (EHS), encompassing an education program, streamlined diagnostic tests and dedicated PA clinic, was developed to address this issue. Aims: To analyse the impact of Victoria’s first dedicated EHS on the pattern of PA diagnoses. Methods: Socio-demographic and clinical data from all patients who attended the EHS since July 2016 (N=267) was collected prospectively. Patients were divided into Year 1 (Y1), Year 2 (Y2), and Year 3 (Y3), based on their first visit. Results: The proportion of referrals from primary care increased (20% in Y1 to 52% in Y3) with more referrals being made for treatment-naive hypertension (3% in Y1 to 19% in Y3). Patients with a hypertension diagnosis of 5 years or less at the time of referral to EHS increased from 34% in Y1 to 45% in Y3 whilst the percentage of patients with a hypertension diagnosis of more than 10 years decreased from 50% in Y1 to 35% in Y3. Consistent with an earlier presentation, the proportion of patients with end-organ damage at the time of referral decreased from 44% in Y1 to 29% in Y3. Almost a third of the PA patients had unilateral disease; all of those who underwent adrenalectomy had biochemical cure. Patients with bilateral PA were treated with spironolactone. Their systolic/diastolic blood pressure decreased by 15/12 mmHg in Y1, 17/13 mmHg in Y2 and 23/11 mmHg in Y3; while the mean number of antihypertensive medications decreased from 2.9 to 1.8 in Y1, 2.7 to 2.0 in Y2 and 2.2 to 1.6 in Y3 Conclusion: The EHS has facilitated an increase in referrals for PA screening from primary care, resulting in the earlier diagnosis of PA, when less complications are present, and optimised patient outcomes. A broader uptake of such a clinical service, integrated with education outreach, will bridge the gap between the reported high prevalence of PA and the actual low diagnostic rates.

scholarly journals Effect of the physical activity program on the treatment of resistant hypertension in primary care

2018 ◽  
Vol 19 (6) ◽  
pp. 575-583 ◽  
Author(s):  
Piotr J. Kruk ◽  
Michał Nowicki
Keyword(s):  
Physical Activity ◽  
Blood Pressure ◽  
Primary Care ◽  
Resistant Hypertension ◽  
Lifestyle Modification ◽  
Heart Association ◽  
Pressure Control ◽  
Physical Activity Program ◽  
Activity Program ◽  
The Impact

AbstractBackgroundRegular physical activity is widely recommended for patients with arterial hypertension as an essential component of lifestyle modification. Much less is known about the impact of physical exercise on the management of treatment of resistant hypertension (RH). The aim was to assess the effect of physical activity program intensified by mobile phone text reminders on blood pressure control in subjects with RH managed in the primary care.MethodsIn total, 53 patients with primary hypertension were qualified, including 27 who met the criteria for RH and 26 with well-controlled hypertension (WCH). Ambulatory 24-h blood pressure was monitored and body composition evaluated with bioimpedance and habitual physical activity profile was determined continuously over 72 h with accelerometer. All measurements were performed at baseline and after three and six months. The patients were asked to modify their lifestyle according to American Heart Association Guidelines that included regular aerobic physical activity tailored to individual needs.FindingsPhysical activity in RH increased significantly after six months compared with control subjects (P=0.001). Office systolic blood pressure (SBP) and diastolic blood pressure (DBP) in the RH group decreased significantly after three months but after six months only office DBP remained significantly lower. After three months 24-h SBP decreased by 3.1±11 mmHg (P=0.08) and DBP by 2.0±6 mmHg (P=0.17) in RH, whereas in WCH respective changes were +1.2±10 and −0.3±6 mmHg. After six months 24-h BP changes were similar.ConclusionIndividualized structured physical activity program increases physical activity in the treatment of resistant hypertensives in primary care but the effect on 24-h blood pressure is only transient.

Physical health and well being

2009 ◽  
pp. 139-212
Keyword(s):  
Public Health ◽  
Blood Pressure ◽  
Health Promotion ◽  
Intellectual Disability ◽  
Physical Health ◽  
Oxygen Saturation ◽  
Health Assessment ◽  
Well Being ◽  
Temperature Pulse ◽  
Health And Well Being

Introduction 140 Health inequalities 142 Principles of health promotion 144 Promoting public health 146 Promoting physical well-being of individuals 148 Physical health assessment of people with intellectual disability 150 Blood pressure, temperature, pulse 152 Respiration and oxygen saturation levels 154 Epilepsy 156 Supporting people with epilepsy ...

scholarly journals Impact of Patient Beliefs on Blood Pressure Control in the General Population: Findings from the Population-Based STAAB Cohort Study

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Theresa Tiffe ◽  
Caroline Morbach ◽  
Viktoria Rücker ◽  
Götz Gelbrich ◽  
Martin Wagner ◽  
...  
Keyword(s):  
Blood Pressure ◽  
General Population ◽  
Blood Pressure Control ◽  
Antihypertensive Medication ◽  
Pressure Control ◽  
Population Based ◽  
Blood Pressure Target ◽  
Successful Implementation ◽  
Inverse Association ◽  
The Impact

Background. Effective antihypertensive treatment depends on patient compliance regarding prescribed medications. We assessed the impact of beliefs related towards antihypertensive medication on blood pressure control in a population-based sample treated for hypertension. Methods. We used data from the Characteristics and Course of Heart Failure Stages A-B and Determinants of Progression (STAAB) study investigating 5000 inhabitants aged 30 to 79 years from the general population of Würzburg, Germany. The Beliefs about Medicines Questionnaire German Version (BMQ-D) was provided in a subsample without established cardiovascular diseases (CVD) treated for hypertension. We evaluated the association between inadequately controlled hypertension (systolic RR >140/90 mmHg; >140/85 mmHg in diabetics) and reported concerns about and necessity of antihypertensive medication. Results. Data from 293 participants (49.5% women, median age 64 years [quartiles 56.0; 69.0]) entered the analysis. Despite medication, half of the participants (49.8%) were above the recommended blood pressure target. Stratified for sex, inadequately controlled hypertension was less frequent in women reporting higher levels of concerns (OR 0.36; 95%CI 0.17-0.74), whereas no such association was apparent in men. We found no association for specific-necessity in any model. Conclusion. Beliefs regarding the necessity of prescribed medication did not affect hypertension control. An inverse association between concerns about medication and inappropriately controlled hypertension was found for women only. Our findings highlight that medication-related beliefs constitute a serious barrier of successful implementation of treatment guidelines and underline the role of educational interventions taking into account sex-related differences.

A comparison of physical activity, physical fitness levels, BMI and blood pressure of adults with intellectual disability, who do and do not take part in Special Olympics Ireland programmes: Results from the SOPHIE study

2017 ◽  
Vol 22 (2) ◽  
pp. 154-170 ◽  
Author(s):  
Denise Walsh ◽  
Sarahjane Belton ◽  
Sarah Meegan ◽  
Kirsty Bowers ◽  
Deidre Corby ◽  
...  
Keyword(s):  
Physical Activity ◽  
Blood Pressure ◽  
Intellectual Disability ◽  
Physical Fitness ◽  
Vigorous Physical Activity ◽  
Well Being ◽  
Self Report ◽  
Special Olympics ◽  
The Impact ◽  
Fitness Levels

People with an intellectual disability are less physically active, live more sedentary lives, have lower fitness levels and are more likely to be overweight or obese than the general population. No evidence exists on the impact of participation in Special Olympics Ireland (SOI) on physical activity and physical fitness levels. Adults with intellectual disabilities (16–64 years) were recruited from services and SOI clubs. Physical measures included waist circumference, height, weight, blood pressure, heart rate and 6-min walking test. Self-report questionnaires gathered data on physical activity levels. Actigraph (GT3X) accelerometers were used to gain an objective measure of physical activity. SOI participants accumulated more moderate to vigorous physical activity per day, had higher fitness levels and more positive health profile scores than those not taking part in SOI. SOI has the potential to make a positive difference to people’s physical health and subsequently their overall health and well-being.

scholarly journals Examining the Effectiveness of Telemonitoring with Routinely Acquired Blood Pressure Data in Primary Care: Challenges in the Statistical Analysis

2020 ◽  
Author(s):  
Richard Parker ◽  
Paul Padfield ◽  
Janet Hanley ◽  
Hilary Pinnock ◽  
John Kennedy ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Statistical Analysis ◽  
Cohort Analysis ◽  
Random Coefficient ◽  
White Coat ◽  
White Coat Effect ◽  
The Impact ◽  
Analytical Approaches

Abstract BackgroundScale-up BP was a quasi-experimental implementation study, following a successful randomised controlled trial of the roll-out of telemonitoring in primary care across Lothian, Scotland. Our primary objective was to assess the effect of telemonitoring on blood pressure (BP) control using routinely collected data. Telemonitored systolic and diastolic BP were compared with surgery BP measurements from patients not using telemonitoring (comparator patients). The statistical analysis and interpretation of findings was challenging due to the broad range of biases potentially influencing the results, including differences in the frequency of readings, ‘white coat effect’, end digit preference, and missing data.MethodsThree different statistical methods were employed in order to minimise the impact of these biases on the comparison between telemonitoring and comparator groups. These methods were “standardisation with stratification”, “standardisation with matching”, and “random coefficient modelling”. The first two methods standardised the groups so that all participants provided exactly two measurements at baseline and 6-12 months follow-up before using stratification or matched cohort analysis to compare the groups. The third analysis used linear mixed modelling based on all available data. ResultsThe standardisation with stratification analysis showed a significantly lower systolic BP in telemonitoring patients at 6-12 months follow-up (-3.42, 95% CI -1.72 to -5.11, p<0.001). For the standardisation with matching analysis, systolic BP was also significantly lower (-5.96, 95% CI -3.55 to -8.36, p<0.001), even after assuming that -5 of the difference was due to ‘white coat effect’. For the random coefficient modelling, the improvement in systolic BP was estimated to be -4.68 (95% CI -3.12 to -6.24, p<0.001) after one year. ConclusionsThe three analyses provide additional evidence for the effectiveness of telemonitoring in controlling BP in routine primary care. However, adjusting for the complex array of biases was difficult. Researchers should appreciate the potential for bias in implementation studies and seek to acquire a detailed understanding of the study context in order to design appropriate analytical approaches.

Primary care providers’ attitudes towards individuals with intellectual disability: Associations with experience and demographics

2019 ◽  
pp. 174462951986002
Author(s):  
Genevieve Breau ◽  
Jennifer Baumbusch ◽  
Sally Thorne ◽  
T Greg Hislop ◽  
Arminee Kazanjian
Keyword(s):  
Primary Care ◽  
Intellectual Disability ◽  
Nursing Students ◽  
Primary Care Providers ◽  
Educational Interventions ◽  
Advanced Practice Nursing ◽  
Professional Status ◽  
Care Providers ◽  
Generational Difference ◽  
The Impact

Primary care providers are the main point of contact with the healthcare system for individuals with intellectual disability, and they may have pre-existing attitudes towards this group that impacts care. We examined whether participants’ gender, age, professional status and experience with individuals with intellectual disability were associated with attitudes by surveying 95 family physicians, family medicine trainees and advanced practice nursing students across a Canadian province. Younger participants were more likely to feel that those with intellectual disability are similar to themselves and that individuals with intellectual disability should be empowered to take control of their lives. Older participants were more likely to believe that individuals with intellectual disability are vulnerable. These findings suggest there may be a generational difference in attitudes, and educational interventions may be needed to ameliorate attitudes among older primary care providers to reduce the impact of pre-existing attitudes on the provision of care.

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