Physical health indicators in SMI

We are grateful to Mitchell and Hardy for highlighting their recent publication in Psychiatric Services.¹ We agree that we should have cited this paper in our article in the October BJGP, but we were unaware of it (possibly because it was published around the same time that we were preparing our manuscript for submission). For this omission we unreservedly apologise.

However, we do not entirely agree that our UK-wide comparisons of QOF data were ‘almost identical’ to their work. Although there are obviously some similarities in these papers because both made use of the same publicly-available QOF databases, our paper is different in a number of important regards.

Our analyses were cross-jurisdictional, with data from Scotland, Northern Ireland, Wales and England (Mitchell and Hardy considered only England). We specifically calculated population achievement rates, along with payment and exception rates, and reported differences in rates using a sign test, while Mitchell and Hardy calculated differences in achievement rates before and after exclusions only, using χ² tests at a patient level. Mitchell and Hardy compared screening for BMI, blood pressure (BP), cholesterol and HbA1c/glucose between those with severe mental illness (SMI) and those with diabetes. We compared BMI in diabetes versus BMI in SMI, and also BP in chronic kidney disease versus BP in SMI. We agree wholeheartedly that we need new approaches to addressing health inequalities in SMI. Analysing routine data across the UK in coming years will remain very important.

• © British Journal of General Practice 2015