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AIS Annual Report 2016

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1 Activity

1.1. Summary of activity for year ending March 2016

 

Actual

Planned

Assessments

31

24

Anterior Cingulotomy

4

3-5

Follow-up

4

12

Intensive OCD treatment

3

4-6

 

1.2. Referrals

Sixty-one referrals were received during the reporting period (32 men and 29 women); with a mean age of 49.4 years. There were 54 referrals (88.5%) from Scotland, and 7 referrals (9.8%) from England.

1.3. Assessments

Forty-one assessments were conducted during the 2015/16 financial year for 34 patients. Sixteen men and 18 women were seen, with a mean age of 50.2 years (range 23.2 – 74.7 years). Most (97.1%) assessments were for Scottish patients. No assessments were conducted outwith the SLA. The location for assessments was as follows: Ninewells Hospital (80.5%); Other Hospital in Scotland (17.1%); Patient’s Home (2.4%).

We have continued to see a high number of people with OCD (20.6%), with 26.5% having major depression. A range of other disorders were also represented – these indicate the diagnosis made by the AIS (rather than the referrer) and reflect the nature of complex and comorbid mental disorders reaching tertiary and quaternary services.

1.4. Procedures

Four neurosurgical procedures were performed during 2015/16. The procedures were Anterior Cingulotomy (N=3) and Anterior Capsulotomy (N=1). One DBS procedure was performed as part of a clinical trial but this individual isn’t included here. Two patients were Scottish and two patients were English.

2 Mortality Data & Adverse Effects

There have been no deaths and no post-operative infections during the reporting year. Rates of adverse effects are unchanged from previous years, and are consistent with the published literature on the procedures undertaken. We continue to see no consistent and widespread effects on neuropsychological functioning.

3 Waiting Times

The average (±SD) waiting time (from referral to assessment) for Scottish patients was 8.8 ± 4.0 weeks. This is unchanged from previous years. Overall, 50% of Scottish patients waited less than 8.1 weeks to be seen. Only 11.8% waited longer than 12 weeks and these were for reasons outwith the control of the AIS.

4 Quality of Care

4.1. Formal Complaints

There were no formal complaints.

4.2. Improving the Patient Experience – Patient Satisfaction

Patient satisfaction for outpatient assessment and inpatient admission continues to be high, with the overwhelming majority reporting positive experiences of the service. This high level of patient satisfaction has been maintained over the last six years.

5 Best Value Healthcare – Clinical Audit and Outcomes

5.1. Outcome Data for Cingulotomy

The following table only includes those patients reviewed in 2014-15. It is not possible to generalise to all patients undergoing the procedure.

 

Size of change in symptom scores (categories are exclusive)

Indication for surgery

≤20%

≥20%

≥35%

≥50%

Depression (N=4)

2

0

1

1

 

6 Intensive OCD treatment

Three patients have been treated as part of the intensive OCD treatment programme. Two completed a full course of treatment. Two patients underwent outpatient / home-based treatment as an alternative to inpatient treatment. Of the two patients who completed the treatment programme, one did not meet criteria for response whilst the other had a reduction of 55%; meeting ‘responder’ criteria.

Outcomes from treatment are comparable to other specialist centres.

7 Teaching and Research Activities

Members of the team deliver presentations at a regional, national, and international level and the service continues to publish in peer-reviewed journals. The research output of the service continues to be of a high-standard and is internationally-recognised.

8 Service Developments and Future Plans

The intensive OCD programme has been running for three years. We are currently reviewing fully the structure and elements of the content of the programme and will report on these adjustments in subsequent reports.

The neurosurgical pathways established with NHNN in London are working well and we continue to meet regularly with neurosurgical colleagues.

8 Summary and Conclusions

The service continues to meet a relatively niche but important need in Scottish mental health services. The outcomes from neurosurgical treatment and intensive OCD treatment are comparable to other expert centres worldwide and we enjoy good relationships with teams throughout the UK.

National Services Scotland

Advanced Interventions Service
Area 7, Level 6
South Block
Ninewells Hospital and Medical School
Dundee, DD1 9SY. UK.
Tel: +44 (0)1382 496233

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