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During the last 20 years there has been increased focus on the problem of premature mortality among people with schizophrenia. This has resulted in a focus on weight gain, the development of metabolic problems, the need to understand the mechanisms behind these and the need to identify strategies to manage these problems. Audit programmes have highlighted the poor quality of monitoring for, and management of, physical health problems in people with all types of mental health disorder but particularly for those with psychotic illnesses. Further, weight gain also reinforces service users’ negative views of themselves and may lead to poor adherence with treatment (Faulkner et al., 2007; Lester et al., 2011; Weiden et al., 2004).
Concerns have repeatedly been expressed about the quality of physical healthcare that people with psychosis receive.
To examine whether the introduction of a financial incentive for secondary care services led to improvements in the quality of physical healthcare for people with psychosis.
Longitudinal data were collected over an 8-year period on the quality of physical healthcare that people with psychosis received from 56 trusts in England before and after the introduction of the financial incentive. Control data were also collected from six health boards in Wales where a financial incentive was not introduced. We calculated the proportion of patients whose clinical records indicated that they had been screened for seven key aspects of physical health and whether they were offered interventions for problems identified during screening.
Data from 17 947 people collected prior to (2011 and 2013) and following (2017) the introduction of the financial incentive in 2014 showed that the proportion of patients who received high-quality physical healthcare in England rose from 12.85% to 31.65% (difference 18.80, 95% CI 17.37–20.21). The proportion of patients who received high-quality physical healthcare in Wales during this period rose from 8.40% to 13.96% (difference 5.56, 95% CI 1.33–10.10).
The results of this study suggest that financial incentives for secondary care mental health services are associated with marked improvements in the quality of care that patients receive. Further research is needed to examine their impact on aspects of care that are not incentivised.
We conducted a secondary analysis of data from the National Audit of Psychosis to identify factors associated with use of community treatment orders (CTOs) and assess the quality of care that people on CTOs receive.
Between 1.1 and 20.2% of patients in each trust were being treated on a CTO. Male gender, younger age, greater use of in-patient services, coexisting substance misuse and problems with cognition predicted use of CTOs. Patients on CTOs were more likely to be screened for physical health, have a current care plan, be given contact details for crisis support, and be offered cognitive–behavioural therapy.
CTOs appear to be used as a framework for delivering higher-quality care to people with more complex needs. High levels of variation in the use of CTOs indicate a need for better evidence about the effects of this approach to patient care.
Users of mental health service are concerned about changes in clinicians providing their care, but little is known about their impact.
To examine associations between changes in staff, and patient satisfaction and quality of care.
A national cross-sectional survey of 3379 people aged 18 or over treated in secondary care for schizophrenia or schizoaffective disorder.
Nearly 41.9% reported at least one change in their key worker during the previous 12 months and 10.5% reported multiple changes. Those reporting multiple changes were less satisfied with their treatment and less likely to report having a care plan, knowing how to obtain help when in a crisis or to have had recommended physical health assessments.
Frequent changes in staff providing care for people with psychosis are associated with poorer quality of care. Greater efforts need to be made to protect relational continuity of care for such patients.
Musicians of Bath and Beyond: Edward Loder (1809-1865) and his Family illuminates three areas that have recently attracted much interest: the musical profession, music in the British provincesand colonies, and English Romantic opera. The Loder family was pre-eminent in Bath's musical world in the early nineteenth century. John David Loder (1788-1846) led the theatre orchestra there from1807, and later the Philharmonic orchestra and Ancient Concerts in London; he also wrote the leading instruction manual on violin playing and taught violin at the Royal Academy of Music. His son Edward James (1809-65) was a brilliant but underrated composer of opera, songs, and piano music. George Loder (1816-68) was a well-known flautist and conductor who made a name in New York and eventuallysettled in Adelaide, where he conducted the Australian premieres of Les Huguenots, Faust, and other important operas. Kate Fanny Loder (1825-1904) became a successful pianist and teacher in early Victorian London, and she is only now getting her due as a composer. This book takes advantage of new and often surprising biographical research on the Loder family as a whole and its four main figures. It uses them to illustrate several aspects of music history: the position of professional musicians in Victorian society; music in the provinces, especially Bath and Manchester;the Victorian opera libretto; orchestra direction; violin teaching; travelling musicians in the US and Australasia; opera singers and companies; and media responses to English opera. The concludingsection is an intense analysis and reassessment of Edward Loder's music, with special emphasis on his greatest work, the opera Raymond and Agnes.
NICHOLAS TEMPERLEY is Professor Emeritus of Musicology at the University of Illinois at Urbana-Champaign and is a leading authority on Victorian music.
CONTRIBUTORS: Stephen Banfield, David Chandler, Andrew Clarke, Liz Cooper,Therese Ellsworth, David J. Golby, Andrew Lamb, Valerie Langfield, Alison Mero, Paul Rodmell, Matthew Spring, Julja Szuster, Nicholas Temperley
In the UK and other high-income countries, life expectancy in people with schizophrenia is 20% lower than in the general population.
To examine the quality of assessment and treatment of physical health problems in people with schizophrenia.
Retrospective audit of records of people with schizophrenia or schizoaffective disorder aged ⩾18. We collected data on nine key aspects of physical health for 5091 patients and combined these with a cross-sectional patient survey.
Body mass index was recorded in 2599 (51.1%) patients during the previous 12 months and 1102 (21.6%) had evidence of assessment of all nine key measures. Among those with high blood sugar, there was recorded evidence of 53.5% receiving an appropriate intervention. Among those with dyslipidaemia, this was 19.9%. Despite this, most patients reported that they were satisfied with the physical healthcare they received.
Assessment and treatment of common physical health problems in people with schizophrenia falls well below acceptable standards. Cooperation and communication between primary and secondary care services needs to improve if premature mortality in this group is to be reduced.