4%). Similar rates of improvement can be seen with renal and thyroid function tests (Tables 2 and ​and33). Table 1. Norfolk database: lithium monitoring tests or measures conducted on all ROCK inhibitor people registered between June 2005 and June 2006 (n = 946) and between June 2011 and June 2012

(n = 1385). Table 2. Norfolk database: creatinine tests conducted on all people registered between June 2005 and June 2006 (n = 946) and between June 2011 and June 2012 (n = 1385). Table 3. Norfolk database: thyroid function tests conducted on Inhibitors,research,lifescience,medical all people registered between June 2005 and June 2006 (n = 946) and between June 2011 and June 2012 (n = 1385). At the time of writing, the only national audit on lithium monitoring occurred in 2009 by the Prescribing Observatory for Mental Health on data Inhibitors,research,lifescience,medical from 38 mental health trusts, excluding Norfolk, who submitted results for a total of 3373 individuals (2976 results for patients who were receiving maintenance treatment,

in that lithium was initiated at least 1 year ago) [Collins et al. 2010] (Table 4). Table 4. POMH-UK data: lithium monitoring Inhibitors,research,lifescience,medical tests or measures conducted during maintenance treatment (n = 2976). One limitation for the generalizability of the data is the lack of variation in the population in Norfolk. Compared with 16.5% of the population in England who were aged 65 or over in 2010, in Norfolk this was 21.4% [ONS, 2011a]. Between 2001 and 2008 in Norfolk, 94.8% of the population were recorded as white British/Irish/Other white background, compared with 87.7% for England as a whole [ONS, 2011b]. Outcomes We believe that by aiding communication between primary and secondary care, the database and shared care policy have facilitated

Inhibitors,research,lifescience,medical good practice and helped to create an environment of partnership working. As well as impacting on rates of testing in the 5 years prior to the NPSA alert, there were no reported incidents relating to lithium therapy in Norfolk compared with the 560 patient safety incidents reported to the NPSA. A key theme in these incidents was a lack of patient monitoring. Inhibitors,research,lifescience,medical This suggests that the database has had a direct impact on improving patient safety [NPSA, 2009; Cree, 2011]. Opportunities for future research In August 2012 the database started to expand into Suffolk. Within this catchment area there are a group of people who had not been on an active management database but who had been subject to guidelines unless and the NPSA alert. This cohort can be analysed to see if there is any further impact of the database in addition to national guidelines on the rates of lithium testing and associated monitoring, as well as the impact the database and resources sent with the registration pack have on patients’ knowledge about and involvement with their lithium therapy. As the database has the potential to expand into other NHS Trusts with more variable patient populations, more specific effects of lithium on these patient groups could be studied.