Abstract
BACKGROUND: Physical health checks in primary care for people with severe mental illness ((SMI) defined as schizophrenia, bipolar disorders and non-organic psychosis) aim to reduce health inequalities. Patients who decline or are deemed unsuitable for screening are removed from the denominator used to calculate incentivisation, termed exception reporting. AIMS: To describe the prevalence of, and patient characteristics associated with, exception reporting in patients with SMI. METHOD: We identified adult patients with SMI from the UK Clinical Practice Research Datalink (CPRD), registered with a general practice between 2004 and 2018. We calculated the annual prevalence of exception reporting and investigated patient characteristics associated with exception reporting, using logistic regression. RESULTS: Of 193 850 patients with SMI, 27.7% were exception reported from physical health checks at least once. Exception reporting owing to non-response or declining screening increased over the study period. Patients of Asian or Black ethnicity (Asian: odds ratio 0.72, 95% CI 0.65-0.80; Black: odds ratio 0.86, 95% CI 0.76-0.97; compared with White) and women (odds ratio 0.90, 95% CI 0.88-0.92) had a reduced odds of being exception reported, whereas patients diagnosed with 'other psychoses' (odds ratio 1.19, 95% CI 1.15-1.23; compared with bipolar disorder) had increased odds. Younger patients and those diagnosed with schizophrenia were more likely to be exception reported owing to informed dissent. CONCLUSIONS: Exception reporting was common in people with SMI. Interventions are required to improve accessibility and uptake of physical health checks to improve physical health in people with SMI.