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Inequalities in the primary care of coronary heart disease patients with serious mental health problems: cross-sectional study
  1. J Hippisley-Cox (julia.hippisley-cox{at}nottingham.ac.uk)
  1. University of Nottingham, United Kingdom
    1. Chris Parker (chris.parker{at}broxtowehucknall-pct.nhs.uk)
    1. Nottingham Primary Care Research Partnership, United Kingdom
      1. Carol A Coupland (carol.coupland{at}nottingham.ac.uk)
      1. University of Nottingham, United Kingdom
        1. Yana Vinogradova (yana.vinogradova{at}nottingham.ac.uk)
        1. University of Nottingham, United Kingdom

          Abstract

          Objective To determine whether UK coronary heart disease patients who also have schizophrenia or bipolar disorder are less likely than patients without these mental health problems to receive primary care in accordance with agreed national standards.

          Design Cross-sectional study

          Setting 485 UK general practices contributing anonymised medical records of over 3.26 million patients to QRESEARCH database

          Participants 127,932 coronary heart disease patients of whom 701 had a diagnosis of schizophrenia or bipolar disorder.

          Main outcome measures The relative risks of receiving statin medication and each of the coronary heart disease care indicators defined in the UK GMS contract, for patients with schizophrenia or bipolar disorder compared with patients with neither condition. The results were adjusted for age, sex, deprivation, diabetes, stroke and smoking status, and allowed for clustering by practice.

          Results Patients with schizophrenia were 15% less likely to have a recent prescription for a statin (95% CI 8% to 20%) and 7% less likely to have a recent record of cholesterol level (95% CI 3% to 11%). There were no significant differences on the adjusted analyses between mental health groups on recording smoking status, advising on smoking cessation, recording blood pressure, achieving target blood pressure or cholesterol values, or prescribing aspirin, anti-platelets, anti-coagulants or beta-blockers.

          Conclusions While the majority of coronary heart disease care indicators are achieved equally for patients who also have a serious mental health problem, there is a shortfall in identifying and treating raised cholesterol among patients with schizophrenia, despite their higher level of risk factors.

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