Integrating mental and physical healthcare at King’s Health Partners

IMPARTS is a proactive identification and assessment tool that can be used to collect tailored patient-reported outcomes data. It has been implemented in nearly 70 outpatient clinics across Kings Health Partners’ acute Trusts as part of the Mind and Body programme.

King’s Health Partners (KHP) is an academic health sciences centre based in south east London. It is a partnership made up of three NHS Foundation Trusts (King’s College Hospital, Guy’s and St Thomas’, and South London and Maudsley) working with King’s College London University. KHP serves patients across south London and south east England, with more than 4 million patient contacts each year.

Situation

More than 30% of people with a long-term physical health condition have a mental health condition. However, people living with multiple health conditions often receive care in a reactive and fragmented manner that is artificially split between problems of the mind and problems of the body. This is often the result of disparate payment systems and institutional and cultural barriers between physical and mental health and acute, primary, social and voluntary care. Unfortunately, this can increase the risk of delayed or missed diagnosis of co-morbidities and can therefore lead to exacerbation of the condition and poorer outcomes.

For instance, people with a diagnosis of depression are at increased risk of developing a physical health condition, such as heart disease, stroke or lung disease. Depression is also associated with decreased physical activity and poorer adherence to dietary interventions and smoking cessation programmes.

Also, people with long term conditions, for example rheumatoid arthritis, are at greater risk of having a mental health condition, such as depression or anxiety, but are unable to access appropriate mental health care.

Aspiration

The IMPARTS tool facilitates the provision of holistic, joined-up physical and mental health care by:

• embedding routine collection of patient-reported outcomes as part of clinical care
• allowing clinicians to review patient-reported outcomes prior to an appointment
• supporting clinical teams in providing timely, tailored, evidence-based holistic care to patients
• supporting clinical conversations focusing on what matters to a patient
• improving provision of joined-up mental and physical healthcare and enabling access to integrated care when appropriate

Solution and impact

This screening tool has been developed as part of a wider package of work, which is designed not only to identify need but also to support clinical teams to provide proactive, tailored, evidence-based care to patients. Therefore, the IMPARTS package also:

• works with services to develop care pathways to guide clinicians on possible referral options, depending on the needs of their patients. These include psycho-educational self-help and some signposting to local social prescribing services
• delivers relevant training to support teams to provide psychologically informed care
• includes a research database (NHS research ethics-approved), which allows for the interrogation of pseudonymised datasets of routinely-collected outcomes via IMPARTS and the local clinical record. Patients can opt out of research while still allowing their information to be used for clinical care

For services that are using IMPARTS, patients are asked to answer a series of questions about their health using a tablet-based screening platform, or through a link sent to their smartphone, before their appointment. The questions relate to their wellbeing, smoking, depression and anxiety symptoms, along with others tailored to the patient group. These tailored questions can relate to physical health, mental health, behavioural or social factors.

The results are instantaneously uploaded to the patient’s electronic health record. The clinician can use the data to guide the patient’s consultation and treatment plan. They can refer the patient to other relevant services based on their results, where appropriate, embedding the process in routine clinical care.

Training is provided for all staff who use the IMPARTS package. This covers some key principles and skills for addressing common mental health needs. Clinical teams may also request additional training, including bespoke ways to address the specific needs of their patient population.

IMPARTS data is also available for research and clinical service audit purposes.

Evidence shows that by joining up physical and mental healthcare, it is possible to help someone manage their different conditions, improve their health outcomes, and even prevent unnecessary health problems for some people by identifying risk early. Using IMPARTS helps to tailor patient consultations by equipping clinicians with the full picture of a patient's mental and physical health.

Since its launch, patient-reported outcomes have been captured for more than 40,000 patients, over more than 80,000 screening encounters, across nearly 70 outpatient services.

A recent survey found that 90% of patients felt that IMPARTS had had an effect on how well their healthcare professional understood their needs.

Functionality

• IMPARTS is a web-based system that is hosted within a partner Trust’s servers. It integrates with King’s Health Partners’ acute trusts’ electronic health record (EPR), enabling patient demographic-matching using the hospital number and automatic upload of patient-reported outcomes questionnaire results to EPR documents
• The IMPARTS tool is just one part of the wider IMPARTS package, which includes:
  • clinical conversations and care pathways for patients identified as needing additional support
  • training for clinical teams to support the identification and understanding of the bi-directional impact of physical and wellbeing/mental health difficulties
  • self-help support specifically developed for patients with physical health needs and poorer wellbeing and/or mental health needs
  • research

Capabilities

• Patients can complete tailored questionnaires on a tablet in an outpatient clinic waiting room or ahead of their appointment on their own device through a link sent as part of their appointment reminder
• Integration with the electronic health record, allows results to be uploaded instantaneously and easily viewed by clinicians
• The system summarises patients’ results and makes recommendations for further assessment, onward care and referral, based on pathways agreed with clinical teams
• IMPARTS data is also available for research and clinical service audit purposes

Scope

IMPARTS capability allows for questionnaires to be completed on a tablet in an outpatient clinic waiting room or ahead of a patient’s appointment on their own device through a link sent as part of their appointment reminder.

Key learning points

• Enables delivery of joined-up mind and body care
• Supports identification of patients’ wider bio-psycho-social support needs
• Supports clinicians to deliver care (including remotely) by providing more information about the state of a patient’s health and wellbeing and any support needs
• Integration of IMPARTS with the electronic health record helps to embed it in routine clinical care
• The wider IMPARTS package beyond the tool is key in delivering more joined-up care, in particular mapping and agreeing referral pathways with the clinical team and provision of training
• It is important to have buy-in from the wider organisation and individual clinical and operational teams
• It is important to have involvement of the IT department from an early stage of the project to ensure successful integration between Imparts and the Trust EPR
• Supports self-management for patients by providing tailored self-help resources
• Good value for time, as it allows clinicians to focus on the key findings and recommendations from the IMPARTS questionnaire and therefore to maximise consultation time
• Aligning IMPARTS recommendations with NICE guidance, and suggested referral pathways/signposting is key, but must never replace clinical judgment
• Improves access to care by better identifying unmet need

Key figures/quotes

• More than 86,000 IMPARTS assessments have been completed so far
• IMPARTS is being used in nearly 70 outpatient services

“IMPARTS is a pioneering initiative developed by King’s Health Partners. By treating the whole person, the overall health outcomes for many of these patients can be improved.

So many health risk factors are preventable, but you can only do something about them if you know what needs to change. IMPARTS has helped us develop an integrated approach to patient care.”
Professor Matthew Hotopf, CBE FRCPsych, FMedSci; vice dean of research, Institute of Psychiatry Psychology and Neuroscience, director, NIHR Maudsley Biomedical Research Centre

Find out more

Read more about IMPARTS

Visit the IMPARTS website

Key contact

Jessie McCulloch, programme manager, IMPARTS, King’s Health Partners Mind & Body

Jessie.McCulloch@slam.nhs.uk

Hugh Scott, product manager, Teleologic Ltd

hugh.scott@teleologic.co.uk