QOF

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Patients will be included for this indicator if they have:

(They will be rejected if they are solely on Lithium treatment)

Blood Pressure codes (In the previous 12 months)

246% O/E - blood pressure reading

Excluding:

2460 O/E - BP unrecordable
2468. O/E - BP reading:postural drop
246H. O/E - Arterial pressure index normal
246I. O/E - Arterial pressure index abnormal
246K. Target systolic blood pressure
246L. Target diastolic blood pressure
246M. White coat hypertension
246h. Arterial pulse pressure
246i. Diastolic blood pressure centile
246j. Systolic blood pressure centile
246k. Unequal blood pressure in arms

Blood pressure recording exception code

8I3Y. Blood pressure procedure refused
41M.. Blood test declined (v28)

Mental Health Exception reporting codes (in the previous 12 months)

9h9.. Exception reporting: mental health quality indicators
9h91. Excepted from mental health quality indicators: Patient unsuitable
9h92. Excepted from mental health quality indicators: Informed dissent

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Exception codes for in remission from serious mental illness (Added after their latest diagnosis)

E1005 Schizophrenia in remission
E1015 Hebephrenic schizophrenia in remission
E1025 Catatonic schizophrenia in remission
E1035 Paranoid schizophrenia in remission
E1055 Latent schizophrenia in remission
E1075 Schizo-affective schizophrenia in remission
E1106 Single manic episode in full remission
E1116 Recurrent manic episodes, in full remission
E1146 Bipolar affective disorder, currently manic, in full remission
E1156 Bipolar affective disorder, currently depressed, in full remission
Eu317 [X]Bipolar affective disorder, currently in remission
E1166 Mixed bipolar affective disorder, in full remission
E1176 Unspecified bipolar affective disorder, in full remission
Eu329 [X]Single major depressive episode, severe, with psychosis, psychosis in remission
Eu32A [X]Recurrent major depressive episodes, severe, with psychosis, psychosis in remission
Eu26. [X]Nonorganic psychosis in remission
Eu223 [X]Paranoid state in remission

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Psychosis, schizophrenia and bipolar affective disease codes (the earliest code (v15))

E10..% Schizophrenic disorders
E110.% Manic disorder, single episode
E111.% Recurrent manic episodes
E1124 Single major depressive episode, severe, with psychosis
E1134 Recurrent major depressive episode, severe, with psychosis
E114% Bipolar affective disorder, currently manic
E115% Bipolar affective disorder, currently depressed
E116% Mixed bipolar affective disorder
E117% Unspecified bipolar affective disorder
E11y.% Other and unspecified manic-depressive psychoses (excluding E11y2 Atypical depressive disorder)
E11z. Other and unspecified affective psychoses
E11z0 Unspecified affective psychoses NOS
E11zz Other affective psychosis NOS
E12..% Paranoid states (v9)
E13..% Other nonorganic psychoses (excluding E135.. Agitated depression)

E2122 Schizotypal personality
Eu2..% [X]Schizophrenia, schizotypal and delusional disorders
 
Eu30. [X]Manic episode
Eu300 [X]Hypomania
Eu301 [X]Mania without psychotic symptoms
Eu302 [X]Mania with psychotic symptoms
Eu30y [X]Other manic episodes
Eu30z [X]Manic episode, unspecified
Eu31. [X]Bipolar affective disorder
Eu310 [X]Bipolar affective disorder, current episode hypomanic
Eu311 [X]Bipolar affective disorder, current episode manic without psychotic symptoms
Eu312 [X]Bipolar affective disorder, current episode manic with psychotic symptoms
Eu313 [X]Bipolar affective disorder, current episode mild or moderate depression
Eu314 [X]Bipolar affective disorder, current episode severe depression without psychotic symptoms
Eu315 [X]Bipolar affective disorder, current episode severe depression with psychotic symptoms
Eu316 [X]Bipolar affective disorder, current episode mixed
Eu317 [X]Bipolar affective disorder, currently in remission
Eu318 [X]Bipolar affective disorder type I (v21)
Eu319 [X]Bipolar affective disorder type II (v21)

Eu31y [X]Other bipolar affective disorders
Eu31z [X]Bipolar affective disorder, unspecified
Eu323 [X]Severe depressive episode with psychotic symptoms
Eu328 [X]Major depression, severe with psychotic symptoms
Eu329 [X]Single major depressive episode, severe, with psychosis, psychosis in remission
Eu32A [X]Recurrent major depressive episodes, severe, with psychosis, psychosis in remission
Eu333 [X]Recurrent depressive disorder, current episode severe with psychotic symptoms

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Mental health 003.1 Rationale

Patients with schizophrenia have a mortality of between two and three times that of the general population and most of the excess deaths are from diseases that are the major causes of death in the general population. A recent prospective record linkage study of the mortality of acommunity cohort of 370 people with schizophrenia found that the increased mortality risk is probably life-long, and it suggested that the cardiovascular mortality of schizophrenia has increased over the past 25 years relative to the general population. The NICE clinical guideline on bipolar disorder also states that the standardised mortality ratio for cardiovascular death may be twice that of the general population but appears to be reduced if patients adhere to long term medication.

Hypertension in people with schizophrenia is estimated at 19 per cent compared with 15 per cent in the general population. A cross-sectional study of 4310 patients diagnosed with bipolar disorder in 2001 receiving care at veterans’ administration facilities found a prevalence of hypertension of 35 per cent.

There is evidence to suggest that physical conditions such as cardiovascular disorders go unrecognised in psychiatric patients. A direct comparison of cardiovascular screening (blood pressure, lipid levels and smoking status) of people with asthma, people with schizophrenia and other attendees indicated that general practice were less likely to screen people with schizophrenia for cardiovascular risk compared with the other two groups.

Recording (and treating) cardiovascular risk factors are therefore very important for people with a serious mental illness.

Mental health 003.2 Reporting and verification

See indicator wording for requirement criteria

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Prepared By Jean Keenan