Inequalities in the primary care of patients with coronary heart disease and serious mental health problems: a cross-sectional study

OBJECTIVE: To determine whether UK patients with coronary heart disease (CHD) who also have schizophrenia or bipolar disorder are less likely to receive primary care in accordance with the agreed national standards of the UK than patients without these mental health problems. DESIGN: Cross-sectional study. SETTING: 485 UK general practices contributing anonymised medical records of over 3.26 million patients to the QRESEARCH database. PARTICIPANTS: 127,932 patients with CHD 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 CHD care indicators defined in the UK General Medical Services 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 in 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, antiplatelets, anticoagulants or beta blockers. CONCLUSIONS: Although the majority of CHD 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.