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The limited value of the annual physical health examination in long-term secure care

Division of Forensic Psychiatry, ScHARR, Regent Court, 30 Regent Street, Sheffield S1 4DA

Sir: We were concerned that psychiatric patients have increased physical morbidity and mortality (Santhouse & Holloway, 1999), yet their general health care may be neglected. Prisoners also end up with reduced access to health care (Smith, 1999). Thus, we wondered how effective the annual physical examination is for our long-stay psychiatric patients at Rampton high security hospital. We felt this was particularly needed as general practice services have extended in recent years.

An SPSS computer program (weighted to ensure case balance for gender, age and ward) randomly selected 120 cases for a sample of 447 patients at Rampton 1995-1998, 72 (16%) of which were women. We examined the notes consecutively over 3 years, which resulted in 360 records. These were examined for documentation of the annual physical health check.

Results showed that 302 (84%) had recorded evidence of the annual physical, and 11 patients (3%) had declined examination. Few clinically significant abnormalities were detected (6 of 360, 1.7%), though these included cases of previously undiagnosed asthma, diabetes and anaemia. Wider review indicated that physical disease management was variable and non-systematic.

We concluded that the traditional annual physical health check is of limited value. We felt that psychiatrists should review their current care and consider systematic primary care based services for long-term psychiatric in-patients and those on long-term follow-up.

References

SANTHOUSE, A. & HOLLOWAY, F. (1999) Physical health of patients in continuing care. Advances in Psychiatric Treatment, 5, 455-462.

SMITH, R. (1999) Prisoners: an end to second class health care? British Medical Journal, 318, 954-955.[Free Full Text]

This Article A corrigendum has been published Submit an eLetter Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Ness, G. Search for Related Content PubMed Articles by Ness, G.