Point-of-care testing in serious mental illness

“Patients with schizophrenia and other serious mental health conditions, die 15-20 years earlier than the average – often of unrelated diseases such as cardiovascular disease, obesity or diabetes,” explains consultant psychiatrist, Professor Belinda Lennox who led the initiative. “Patients are often unable to access additional health appointments – and often don’t have the opportunity to look after their physical health. As a result, we see a lot of avoidable illness and early death in this group.”

NICE guidelines recommend annual physical health checks for patients with schizophrenia and early psychosis, but this target is often missed. An NHS South audit revealed that only 38% of patients in early intervention services had received the checks, and figures from other community services are even lower.

But now mental health staff are using simple finger-prick blood tests, given alongside routine appointments, to pick up signs of diabetes and high cholesterol, offer advice on diet, exercise and lifestyle, and signpost patients to specialist services if needed. The tests are for blood glucose and lipids. “The idea is brilliantly simple, and a great way to ensure that patients don’t slip through the net,” says Professor Lennox.

The project started with a 2020 pilot in Oxford, involving 300 patients and 25 staff. The pilot doubled the number of mental health patients receiving physical health tests, and has now been rolled out across the South East NHS Region (since Jan 2020).

“Of course, there were challenges to overcome,” continues Lennox. “We did a lot of research into the best machines to use, and we also needed to overcome the fact that mental and physical health records are held in different systems. We developed a way to get the results instantly to the right system so results are available to the right healthcare teams straight away.”

“There were also different levels of enthusiasm for the approach from different teams. Some mental health practitioners were wary of taking blood tests: they did not feel it was their job and were nervous about offering follow up advice. But we developed training and guidance materials and produced simple protocols for staff to follow depending on the results. Many staff have been really enthusiastic champions of the approach and like the fact it allows them to offer better care to patients.”

Patients themselves have been almost universally positive about the approach. Feedback indicates that they found it easier, quicker, and less painful, and were less anxious, than having tests done by a GP. They also appreciated receiving the results straight away and the opportunity to discuss how to make lifestyle adjustments with a trusted healthcare worker. Evaluation data showed that physical health checks doubled in the teams that adopted point-of-care testing.

“This approach has huge potential,” continues Professor Lennox. “It could be used in many more contexts and test for a variety of other disease indicators. At a time when the NHS is struggling to maximise value-for-money and efficiency, and many patients experience multiple health concerns, it offers a simple but effective solution to improving testing and care.”

Belinda Lennox is Professor of Psychiatry at Oxford University and Honorary Consultant Psychiatrist at Oxford Health NHS FT

Funders:

• National Institute of Health Research
• Research England 

Project partners:

Gail Hayward, Associate Professor and GP, Director NIHR Community Healthcare MIC, Department Primary Care, University of Oxford; Phil Turner, NIHR MIC coordinator, Department Primary Care, University of Oxford; Margaret Glogowska, Qualitative Researcher, Department Primary Care, University of Oxford; Mike Denis, Chief Executive Akrivia Health; Joseph Butler, Simone de Cassan, and Monty Lyman, Clinical Fellows psychiatry, Oxford Health NHS FT.