Lesley J. Robertson

A retrospective record review and assessment of cost of quetiapine use in a community psychiatric setting in the Sedibeng district of Gauteng

Background With the revision of the National Essential Medicines List in South Africa, quetiapine is only available at the discretion of individual institutions in the public health sector. However, quetiapine is effective in managing all aspects of bipolar disorder, including preventative treatment of depressive episodes, and may be a cost-effective option in severe illness. Aim To present the first retrospective review of quetiapine use in a peri-urban health district of South Africa, describing the patient profile, clinical response and prescribing patterns. Methods The clinical files of all patients in Sedibeng District who received quetiapine over a defined 3-year period (2011–2013) were reviewed. A positive clinical response was defined as both symptomatic and functional improvement. Demographic and clinical characteristics of responders were compared with that of non-responders. Pre- and post-quetiapine scripts of the responders were audited and costed. Results Patients who received quetiapine (n = 40) had chronic disabling illness, often with multiple medication trials and hospitalisations prior to quetiapine use. Bipolar II disorder (followed by bipolar I disorder) was the most common primary psychiatric diagnosis documented. Other than improvement in functioning (p < 0.0001), responders differed significantly from non-responders in terms of a higher level of polypharmacy and a significant reduction in median number of medications from pre- to post-quetiapine (p = 0.0057). Conclusion Quetiapine use was associated with a highly significant improvement in functioning; however, it came at a 52% increase in medicine cost. Pre-quetiapine treatments, though, did not achieve an optimal level of functioning, and overall costs may be reduced by more rational prescribing habits.

Predictors of quality of life among community psychiatric patients in a peri-urban district of Gauteng province, South Africa

Introduction Few studies on quality of life (QoL) in the mentally ill population of South Africa have been conducted, but none in community-dwelling individuals. This study examined the QoL of psychiatric patients at community mental health clinics in Gauteng province of South Africa. Methods A cross-sectional interview-based study was conducted on 121 adult patients attending community psychiatric clinics. To reduce the impact of acute psychiatric symptoms on subjective QoL, only clinically stable patients were included. Instruments used included the World Health Organization Quality of Life BREF domains (i.e. physical health, psychological health, social relationships and environment), the Brief Psychiatric Rating Scale (BPRS) for severity of illness and a socio-demographic and clinical questionnaire. Results Just under half of the sample rated their overall QoL as good or very good. The strongest predictor of a poor QoL in all four domains was residual psychiatric symptomatology. The most severe BPRS scores were for the symptoms of depression, anxiety and somatic concern. Perceived social support significantly predicted a better QoL in the psychological, social relationships and environmental domains. Conclusion This study highlights the negative impact of residual psychiatric symptoms on subjective QoL, and the importance of social support and enhancing QoL. If better QoL is the goal of care, then our findings highlight the importance of managing residual symptoms and promoting social support.

Community mental health services in Southern Gauteng: An audit using Gauteng District Health Information Systems data

Background Community mental health services (CMHS) are a central objective of the National Mental Health Policy Framework and Strategic Plan. Three core components are described: residential facilities, day care and outpatient services. Primary mental health care with specialist support is required according to an intervention pyramid. Staffing norms provide for a minimum mental health service coverage of 2.7% of the population for adults and 1.5% for children and adolescents. Aim The aim of this study was to describe the existing CMHS in Southern Gauteng in terms of the National Mental Health Policy. Methods The CMHS of the City of Johannesburg, Ekurhuleni, Sedibeng and West Rand districts were studied. Information regarding service organisation and staffing was obtained via the Gauteng Directorate of Mental Health. Routinely collected District Health Information Systems data for the 2014/2015 year were analysed. Results The organisation of services was not consistent with that recommended by the Mental Health Policy, and specialist CMHS were inappropriately situated within primary care. Only 2.23% of clinic visits were for mental health, and 80% of these were at specialist CMHS. Overall mental health coverage was approximately 0.3% of the population for adults and 0.02% for children and adolescents. Staffing, residential facilities and day care were far below the cited norms for minimal cover. Conclusion Our audit revealed that the CMHS in Southern Gauteng did not meet any of the norms cited by the Mental Health Policy. Barriers to implementation of this aspect of the Mental Health Policy need to be explored.

The South African Society of Psychiatrists’ response to the White Paper for National Health Insurance in South Africa

The South African Department of Health (DoH) released its White Paper for National Health Insurance (NHI) in December 2015 for public comment. The South African Society of Psychiatrists (SASOP) submitted a detailed response following discussion amongst both public and private sector members. This has been published as a pdf in the August 2016 edition of South African Psychiatry, available at www.southafricanpsychiatry.co.za. For the most part, our response was concerned with the proposed organisation of health services as they relate to mental health care. However, we also made comment on good governance within the health service and on human rights issues. In this respect, we responded as advocates for our patients, for the public good and for our profession. Essentially, we submitted a response as participants in the proposed transformation of the health system appropriate to our social contract with society.