Conference paper
AUDIT TO IDENTIFY THE NUMBER OF PATIENTS WITH MULTIPLE DIAGNOSES IN A COMMUNITY MENTAL HEALTH TEAM IN BEDFORD, ENGLAND
Eva Nora Bongards
; School of Clinical Medicine, University of Cambridge, United Kingdom ; Christ’s College, University of Cambridge, United Kingdom
Rashid Zaman
; South Essex University Partnership Foundation Trust, United Kingdom ; Department of Psychiatry, University of Cambridge, United Kingdom
Mark Agius
; South Essex University Partnership Foundation Trust, United Kingdom ; Department of Psychiatry, University of Cambridge, United Kingdom ; 5Clare College, University of Cambridge, United Kingdom
Abstract
Background: Patients with ‘simple’ mental health problems should be able to be managed exclusively in primary care. It is
therefore anticipated that only the more complex cases would be referred to secondary care. In order to test this hypothesis, the
number of patients registered with a community mental health team (CMHT) in Bedford, United Kingdom, who had received multiple
psychiatric diagnoses in 2010, 2011 and 2013, was determined and analysed.
Method: Using a secure and anonymised Microsoft Excel® database that contains all patient data, the proportions of patients
with more than one diagnosis were audited and thus determined for the months of August 2010, June 2011 and February 2013. The
total number of patients registered was also determined for comprehensiveness. We had established the basic audit standard that
every patient should have only one mental health diagnosis if this was possible.
Results: Many patients were indeed found to have received multiple diagnoses. Furthermore, an increase in the proportion of
patients with multiple diagnoses was observed; from 23.2% in 2010 to 25.2% in 2011 to 34.3% in 2013.
Discussion: Several psychiatric conditions have been shown to be associated with particular psychiatric co-morbidities, which
may be one reason why many of the Bedford CMHT’s patients receive multiple diagnoses. Furthermore, the trend observed may
reflect improving mental healthcare in primary care and therefore fewer referrals of patients with ‘simple’ mental health conditions
to secondary care, thus causing the CMHT’s caseload to become increasingly complex. It may also reflect improving communication
between primary and secondary care, which may also lead to fewer referrals. Finally, the trend may merely reflect better use of the
available database.
Conclusion: We have found that numerous patients received multiple diagnoses. We have also observed an increase in the
proportion of such patients over three years, which may reflect improved management of mental health problems in primary care.
Our results may therefore provide an incentive to establish formal shared care of psychiatric patients between primary and
secondary care to improve patient management even further. Furthermore, our results reflect the complexity of the cases referred to
secondary care, which are far more difficult to treat than those exclusively managed in primary care.
Keywords
CMHT; multiple psychiatric diagnoses; shared care
Hrčak ID:
266618
URI
Publication date:
26.8.2013.
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