Characteristics of people with severe mental illness excluded from incentivised physical health checks in the UK: electronic healthcare record study.

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.