An audit of the reporting of depression & anxiety in COPD patients.

Anxiety and depression contribute to a substantial burden of Chronic Obstructive Pulmonary Disease-related morbidity by impairing quality of life and by reducing adherence to treatment. The identification of COPD patients with comorbid depression or anxiety symptoms is vital, as it is estimated that only a third of patients with these co-morbidities are receiving appropriate treatment. The aim of this audit was therefore to identify whether current methods of anxiety and depression screening in elderly patients (over the age of 65) with severe COPD (FEV1 <50% at most recent spirometry reading) are adequate by assessing how frequently anxiety and depression is reported as "discussed with patient" in COPD review appointments across two practices. SystmOne was used to identify a total of 83 patients, and the recording of depression and anxiety discussions in this cohort's review appointments was analysed and compared with the incidence of QOF-coded depression and anxiety in the patient notes. The results show that both the rate and the quality of depression and anxiety reporting in these review appointments is highly heterogeneous, and has led to 'missed' patients suffering from comorbid mental health issues. Additionally, this audit identified a number of patients with depression or anxiety directly related to their COPD, and it highlighted a trend among this cohort towards more frequent appointments with their General Practitioner, and towards related presentations at the Emergency Department. The results of this audit suggest there is room for amelioration of the current practice, such as the implementation of a structured screening tool into System One's COPD review appointment template.

Physical Health Checks in Patients on Antipsychotic Medication.

Schizophrenic patients have traditionally suffered from high rates of cardiovascular disease and early mortality. NICE guidelines suggest that several physical health measures be monitored regularly in these patients, and particularly those on antipsychotic medication, which has a wide side-effect profile that may potentiate the risk of cardiovascular disease and other comorbidities. This general practice audit aimed to determine the rates of physical health monitoring in primary care in patients on antipsychotic medication for over a year for psychotic symptoms or schizophrenia. The search was conducted in three different general practices in March 2019, yielding 19, 8 and 30 patients respectively, with a total of 57 patients. This audit aims to record and analyse rates of monitoring of a range of physical health measures recommended by NICE guidelines over the past year. The results demonstrated that physical health monitoring was poor amongst all the practices audited, especially that of prolactin and waist circumference. We recommend that these rates of monitoring be improved, through implementing templates or the delivery of targeted education to general practitioners and nurses.

The Effect of Positive and Negative Poster Messages on Organ Donor Registration.

BACKGROUND: There is a mismatch between the number of people who require transplants and the number of organ donors. Promotional materials have been shown to increase rates of organ donor registration. This study assessed the impact on the intention to join the organ donor registry of a gain-framed message about lives saved through organ donation compared to a loss-framed message about lives lost waiting for a transplant. METHODS: Two posters were designed that were identical other than the slogan. One slogan was gain-framed: "One organ donor can save 9 lives!" and the other loss-framed: "3 people die every day in the UK waiting for an organ transplant." Twenty copies of each were distributed between hospitals in Cambridge and Newcastle, UK, for 20 weeks. After 10 weeks, the gain-framed and loss-framed posters swapped locations. Each poster had a QR code that linked to the online organ donor register sign-up form, and the click-through rate was used to determine registration. Analysis was performed using a 2-tailed sign binomial test. RESULTS: Sixty-eight registrations occurred over a 20-week period. Overall, there was no significant difference in registrations between gain- and loss-framed posters (37 vs 31, P = .54). However, poster location influenced registration, as prior to the location swap there was a significant difference in gain-framed vs loss-framed posters (28 vs 10, P = .005). Additionally, registration was significantly higher in Cambridge vs Newcastle (47 vs 21, P = .01). CONCLUSIONS: Posters can increase organ donor register (ODR) registration independent of gain- or loss-framing. However, poster location, both intra- and inter-hospital, significantly influences effectiveness.