Quality statement 7: Assessing physical health

Quality statement

Adults with bipolar disorder have a physical health assessment at least annually.

Rationale

Life expectancy among adults with bipolar disorder is estimated to be 15–20 years lower than for the general population. Causes contributing to high morbidity and premature mortality among adults with bipolar disorder include cardiovascular disease, respiratory disease, diabetes and obesity. Assessing physical health allows healthcare professionals to identify early signs and symptoms of poor health and take action to address them.

Quality measures

Structure

a) Evidence of local arrangements to ensure that adults with bipolar disorder receive a physical health assessment at least annually.

Data source: Local data collection.

b) Evidence of local arrangements to ensure that symptoms of poor physical health identified during the physical health assessment of adults with bipolar disorder are addressed.

Data source: Local data collection.

Process

a) Proportion of adults with bipolar disorder who receive an annual physical health assessment.

Numerator – the number in the denominator who received an annual physical health assessment within the last 12 months.

Denominator – the number of adults with bipolar disorder.

Data source: Local data collection. Some of the information can be collected using NICE Quality and Outcomes Framework menu indicators NM15 (QOF indicator MH007), NM16, NM17 (QOF indicator MH003), NM18 and NM42.

b) Proportion of adults with bipolar disorder who receive treatment or intervention for symptoms of poor physical health identified during the physical health assessment.

Numerator – the number in the denominator who receive treatment or intervention for symptoms of poor physical health identified during the physical health assessment.

Denominator – the number of adults with bipolar disorder who receive an annual physical health assessment that identified symptoms of poor physical health.

Data source: Local data collection.

Outcome

Premature mortality among adults with bipolar disorder.

Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (such as GP practices, community health services and mental health services) ensure that protocols are in place to carry out physical health assessment in adults with bipolar disorder at least annually, and that the assessment results are acted on.

Healthcare professionals carry out a physical health assessment at least annually in adults with bipolar disorder, take appropriate actions based on assessment results and share the results (under shared care arrangements) if the adult is in the care of primary and secondary services.

Commissioners (such as clinical commissioning groups, NHS England local area teams and local authorities) ensure that they commission services that carry out an annual physical health assessment in adults with bipolar disorder at least annually, and take appropriate actions based on assessment results. They include this requirement in continuous training programmes and service specifications.

What the quality statement means for service users and carers

Adults with bipolar disorder have a physical health assessment at least once a year and receive support if any health problems are identified. A copy of the results should be sent to their care coordinator and psychiatrist, and put in their records.

Source guidance

  • Bipolar disorder (2014) NICE guideline CG185, recommendations 1.2.11 and 1.2.12.

Definitions of terms used in this quality statement

Physical health assessment

A physical health assessment for adults with bipolar disorder should include:

  • weight or BMI, diet, nutritional status and level of physical activity

  • cardiovascular status, including pulse and blood pressure

  • metabolic status, including fasting blood glucose, glycosylated haemoglobin (HbA1c) and blood lipid profile

  • liver function

  • renal and thyroid function, and calcium levels, for adults taking long‑term lithium.

Hypertension, abnormal lipid levels, obesity or risk of obesity, diabetes or risk of diabetes, or physical inactivity among adults with bipolar disorder should be identified at the earliest opportunity and treated in line with the NICE guidelines on hypertension, lipid modification, prevention of cardiovascular disease, obesity (prevention, identification, assessment and management, weight management services), physical activity and preventing type 2 diabetes.

[Adapted from Bipolar disorder (NICE guideline CG185) recommendations 1.2.11, 1.2.12, 1.2.13 and 1.2.14]