Ravikumar Krishnaiah – Equally Well

Ravikumar Krishnaiah MBBS, MRCPsych, MBA, FRANZCP

Dr Krishnaiah is the Medical Director Adult and older persons Community Mental Health Services at the Gold Coast Mental Health and Specialist services. His area is clinical and operational governance of acute and continuing care services and older person mental health services. With an operating budget of $30 Million and provision of highly effective and quality services as per the ACSQHC standards and Service Level Agreement under HHB Act. He has a special interest in innovation, service redesign and service-related research in mental health.

Abstract

Title: Improved physical health assessments and outcomes in case managed mental health consumers

Author(s): Dr Ravikumar Krishnaiah, Dr Tim Shannon

Objective: To provide expert General Practitioner, Psychiatrist and pharmacy led clinical service for physical health care and management for Mental health case managed consumers in mental health community clinic setting. This GP clinic service is commissioned by the GCHHS to provide weekly once clinic at Southport Health Precinct, provided comprehensive physical examination, screening for metabolic monitoring, review of chronic physical conditions, initiating and monitoring medications for obesity. This clinic is also supported by a nurse, psychiatrist, and pharmacist to provide expert care for antipsychotic induced weight and metabolic syndrome.

Method: Case managed consumers were referred for physical health clinic at the time of starting case management to provide baseline evaluation of physical health, review for pre-existing and or current overweight and obesity management, including education on healthy lifestyle and diet and initiation of medications to treat obesity.

Results: In 2020, total of 48 clients attended the clinic, 36 clients were seen more than once (75%.) and 28 clients were seen three times or more (58%). The engagement with consumers provided opportunists to screening of comorbid physical health issues and multidisciplinary intervention in management of chronic physical diseases, such as obesity, hypertension, diabetes, and heart disease including lifestyle modification. Preliminary data suggests that 44% of consumers lost around 2 kg in weight with Metformin and 28% lost weight of average 9.3 kg on Dulaglutide along with comprehensive psychological interventions.

Conclusion: GP led clinic mental health setting is a valuable resource to provide right advice, care and treatment for mental health consumers who otherwise are less likely to engage with primary care GPs. Our engagement with consumers very early in the episode of community care has increased awareness and compliance with the comprehensive treatment plan.