[Comorbid somatic illnesses in psychiatric inpatients - an analysis of administrative data]

The somatic care of patients with comorbid mental disorders: protocol of a mixed-methods study aiming to identify barriers to and enablers of utilization of somatic healthcare (SoKo)

BACKGROUND

Healthcare for people with somatic and comorbid mental diseases can pose a challenge to the healthcare system. The aim of the SoKo study (the Somatic care of patients with mental Comorbidity) is to assess the current state of care and the facilitators and barriers of somatic care of people with somatic disorders and comorbidity of a mental disorder.

METHODS

The study is conducted as a mixed-methods approach and will include (a) descriptive and inferential analysis of secondary claims data of persons insured by a German statutory health insurance company in North Rhine-Westphalia (Techniker Krankenkasse, TK-NRW), (b) qualitative individual interviews and group discussions, and (c) based on (a) and (b), quantitative surveys of both patients and physicians. We intend to analyse a sample of claims data of about 2.6 million persons insured by TK-NRW (group comparisons between TK-NRW insured persons with a diagnosis of a prevalent somatic disease [ICD-10-GM E01-E07, E11, E66, I10-I15, I20-I25, I60-I64] with and without comorbidity of a mental disorder [F00-F99]), in order to assess the uptake of somatic care by people with mental and somatic comorbidity. In addition, primary data from patients with the aforementioned somatic illnesses and a mental comorbidity as well as primary data from physicians (general practitioners and medical specialists) will be collected. The focus here will be on support factors and barriers in the somatic care of people with mental comorbidity.

DISCUSSION

Up to now, there have been no published results of a systematic collection of both secondary and primary data on the utilisation of different care services of somatically ill patients with mental comorbidity for Germany. The present mixed-methods study aims to address this gap.

TRIAL REGISTRATION

The trial is registered with the German Clinical Trials Register DRKS: DRKS00030513. The trial was registered on 3rd February 2023.

Hospital healthcare utilizers with medical and psychiatric claims in the Netherlands: a nationwide study

Background

Psychiatric and medical multimorbidity is associated with low quality of life, poor functioning and excess mortality. Differences in healthcare utilization between those receiving co-occurring medical and psychiatric healthcare (HUMPCs) and those only receiving medical (HUMCs) or only psychiatric healthcare (HUPCs) may indicate differences in care accessibility, help-seeking behavior and the risk patterns of medical illness. We aimed to assess the occurrence of psychiatric diagnostic groups in HUMPCs compared to HUPCs and to compare their medical and psychiatric claims expenditures.

Methods

Using Dutch claims data covering psychiatric and medical hospital care in 2010–2011, healthcare utilization differences between HUMPCs and HUPCs were expressed as differences and ratios, accounting for differences in age and sex between groups. Median claims expenditures were then compared between HUMPCs and HUPCs.

Results

HUMPCs had 40% higher median medical cost of claims compared to HUMCs and a 10% increased number of psychiatric claims compared to HUPCs. HUMPCs were more often diagnosed with: organic disorders; behavioral syndromes associated with physiological disturbances and physical factors; mood [affective] disorders; neurotic, stress related and somatoform disorders; and disorders of adult personality and behavior. By contrast, disorders of psychological development, schizophrenia, schizotypal and delusional disorders, behavioral and emotional disorders with usual onset occurring in childhood, and mental and behavioral disorders due to psychoactive substance abuse were less often diagnosed in this group.

Conclusions

Both medical and psychiatric disease become more costly where both are present. For HUMPCs the costs of both medical and psychiatric claims for almost all diagnostic groups were higher than for HUPCs and HUMCs.