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Groot L, Schers H, Burgers JS, Smalbrugge M, Uijen AA, Hoogland J, van der Horst HE, Maarsingh OR. Optimising personal continuity for older patients in general practice: a cluster randomised stepped wedge pragmatic trial. BMJ Open 2024; 14:e078169. [PMID: 38772890 PMCID: PMC11110588 DOI: 10.1136/bmjopen-2023-078169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 04/23/2024] [Indexed: 05/23/2024] Open
Abstract
AIM To evaluate the effectiveness, feasibility and acceptability of a multicomponent intervention for improving personal continuity for older patients in general practice. DESIGN A cluster randomised three-wedged, pragmatic trial during 18 months. SETTING 32 general practices in the Netherlands. PARTICIPANTS 221 general practitioners (GPs), practice assistants and other practice staff were included. Practices were instructed to include a random sample of 1050 patients aged 65 or older at baseline and 12-month follow-up. INTERVENTION The intervention took place at practice level and included opTimise persOnal cOntinuity for oLder (TOOL)-kit: a toolbox containing 34 strategies to improve personal continuity. OUTCOMES Data were collected at baseline and at six 3-monthly follow-up measurements. Primary outcome measure was experienced continuity of care at the patient level measured by the Nijmegen Continuity Questionnaire (NCQ) with subscales for personal continuity (GP knows me and GP shows commitment) and team/cross-boundary continuity at 12-month follow-up. Secondary outcomes were measured in GPs, practice assistants and other practice staff and included work stress and satisfaction and perceived level of personal continuity. In addition, a process evaluation was undertaken among GPs, practice assistants and other practice staff to assess the acceptability and feasibility of the intervention. RESULTS No significant effect of the intervention was observed on NCQ subscales GP knows me (adjusted mean difference: 0.05 (95% CI -0.05 to 0.15), p=0.383), GP shows commitment (0.03 (95% CI -0.08 to 0.14), p=0.668) and team/cross-boundary (0.01 (95% CI -0.06 to 0.08), p=0.911). All secondary outcomes did not change significantly during follow-up. Process evaluation among GPs, practice assistants and other practice staff showed adequate acceptability of the intervention and partial implementation due to the COVID-19 pandemic and a high perceived workload. CONCLUSION Although participants viewed TOOL-kit as a practical and accessible toolbox, it did not improve personal continuity as measured with the NCQ. The absence of an effect may be explained by the incomplete implementation of TOOL-kit into practice and the choice of general outcome measures instead of outcomes more specific for the intervention. TRIAL REGISTRATION NUMBER International Clinical Trials registry Platform (ICTRP), trial NL8132 (URL: ICTRP Search Portal (who.int).
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Affiliation(s)
- Lex Groot
- Department of General Practice, Amsterdam UMC Location VUmc, Amsterdam, Netherlands
| | - Henk Schers
- Department of Primary and Community Care, Radboudumc, Nijmegen, Netherlands
| | - J S Burgers
- Guideline Development and Research, Dutch College of General Practitioners, Utrecht, Netherlands
| | - Martin Smalbrugge
- Department of Medicine for Older People, Amsterdam UMC Locatie VUmc, Amsterdam, Netherlands
| | - Annemarie A Uijen
- Department of Primary and Community Care, Radboudumc, Nijmegen, Netherlands
| | - Jeroen Hoogland
- Epidemiology and Data Science, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | | | - Otto R Maarsingh
- Department of General Practice, Amsterdam UMC Location VUmc, Amsterdam, Netherlands
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Hoertel N, Sánchez-Rico M, Kassm SA, Brami B, Olfson M, Rezaei K, Scheer V, Limosin F. Excess mortality and its causes among older adults with schizophrenia versus those with bipolar disorder and major depressive disorder: a 5-year prospective multicenter study. Eur Arch Psychiatry Clin Neurosci 2024:10.1007/s00406-023-01752-1. [PMID: 38294521 DOI: 10.1007/s00406-023-01752-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 12/18/2023] [Indexed: 02/01/2024]
Abstract
Excess mortality observed in people with schizophrenia may persist in later life. The specific causes of increased mortality observed in older adults with schizophrenia and the potential influence of psychotropic medications remain partly unknown. We compared 5-year mortality and its causes of older adults with schizophrenia to bipolar disorder (BD) or major depressive disorder (MDD). We used a 5-year prospective cohort, including 564 older inpatients and outpatients with schizophrenia, BD or MDD (mean age: 67.9 years, SD = 7.2 years). Causes of death were cardiovascular disorder (CVD) mortality, non-CVD disease-related mortality (e.g., infections), suicide, and unintentional injury. The primary analysis was a multivariable logistic model with inverse probability weighting (IPW) to reduce the effects of confounders, including sociodemographic factors, duration and severity of the disorder, and psychiatric and non-psychiatric comorbidity. Five-year all-cause mortality among older participants with schizophrenia and with BD or MDD were 29.4% (n = 89) and 18.4% (n = 45), respectively. Following adjustments, schizophrenia compared to MDD or BD was significantly associated with increased all-cause mortality (AOR = 1.35; 95%CI = 1.04-1.76; p = 0.024) and cardiovascular mortality (AOR = 1.50; 95%CI = 1.13-1.99; p = 0.005). These associations were significantly reduced among patients taking antidepressants [interaction odds ratio (IOR) = 0.42; 95%CI = 0.22-0.79; p = 0.008 and IOR = 0.39: 95%CI = 0.16-0.94; p = 0.035, respectively]. Schizophrenia was associated with higher mortality compared to BD or MDD. Cardiovascular diseases explained most of this excess mortality. Exploratory analyses suggested that psychotropic medications did not influence this excess mortality, except for antidepressants, which were associated with significantly reduced between-group difference in all-cause and cardiovascular mortality.
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Affiliation(s)
- Nicolas Hoertel
- Department of Psychiatry, AP-HP Centre, DMU Psychiatrie et Addictologie, Corentin-Celton Hospital, Parvis Corentin Celton, 92130, Issy-les-Moulineaux, France
- INSERM 1266, Psychiatry and Neurosciences Center, Paris, France
- Université Paris Cité, Paris, France
| | - Marina Sánchez-Rico
- Department of Psychiatry, AP-HP Centre, DMU Psychiatrie et Addictologie, Corentin-Celton Hospital, Parvis Corentin Celton, 92130, Issy-les-Moulineaux, France
| | - Sandra Abou Kassm
- Department of Psychiatry, Lebanese University, Faculty of Medical Sciences, Beirut, Lebanon
- Department of Psychiatry, Centre Hospitalier Guillaume Régnier, Rennes, France
| | - Benjamin Brami
- Department of Psychiatry, AP-HP Centre, DMU Psychiatrie et Addictologie, Corentin-Celton Hospital, Parvis Corentin Celton, 92130, Issy-les-Moulineaux, France
- Department of Adult Psychiatry, Laboratory of Neurosciences, University Hospital of Besançon, UBFC, EA-481, Besançon, France
| | - Mark Olfson
- Department of Psychiatry, Columbia University Medical Center/New York State Psychiatric Institute, New York, USA
| | - Katayoun Rezaei
- Department of Psychiatry, AP-HP Centre, DMU Psychiatrie et Addictologie, Corentin-Celton Hospital, Parvis Corentin Celton, 92130, Issy-les-Moulineaux, France.
| | - Valentin Scheer
- Department of Psychiatry, AP-HP Centre, DMU Psychiatrie et Addictologie, Corentin-Celton Hospital, Parvis Corentin Celton, 92130, Issy-les-Moulineaux, France
- Université Paris Cité, Paris, France
| | - Frédéric Limosin
- Department of Psychiatry, AP-HP Centre, DMU Psychiatrie et Addictologie, Corentin-Celton Hospital, Parvis Corentin Celton, 92130, Issy-les-Moulineaux, France
- INSERM 1266, Psychiatry and Neurosciences Center, Paris, France
- Université Paris Cité, Paris, France
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3
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Engström I, Hansson L, Ali L, Berg J, Ekstedt M, Engström S, Fredriksson MK, Liliemark J, Lytsy P. Relational continuity may give better clinical outcomes in patients with serious mental illness - a systematic review. BMC Psychiatry 2023; 23:952. [PMID: 38110889 PMCID: PMC10729558 DOI: 10.1186/s12888-023-05440-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 12/05/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Continuity of care is considered important for results of treatment of serious mental illness (SMI). Yet, evidence of associations between relational continuity and different medical and social outcomes is sparse. Research approaches differ considerably regarding how to best assess continuity as well as which outcome to study. It has hitherto been difficult to evaluate the importance of relational continuity of care. The aim of this systematic review was to investigate treatment outcomes, including effects on resource use and costs associated with receiving higher relational continuity of care for patients with SMI. METHODS Eleven databases were searched between January 2000 and February 2021 for studies investigating associations between some measure of relational continuity and health outcomes and costs. All eligible studies were assessed for study relevance and risk of bias by at least two independent reviewers. Only studies with acceptable risk of bias were included. Due to study heterogeneity the synthesis was made narratively, without meta-analysis. The certainty of the summarized result was assessed using GRADE. Study registration number in PROSPERO: CRD42020196518. RESULTS We identified 8 916 unique references and included 17 studies comprising around 300 000 patients in the review. The results were described with regard to seven outcomes. The results indicated that higher relational continuity of care for patients with serious mental illness may prevent premature deaths and suicide, may lower the number of emergency department (ED) visits and may contribute to a better quality of life compared to patients receiving lower levels of relational continuity of care. The certainty of the evidence was assessed as low or very low for all outcomes. The certainty of results for the outcomes hospitalization, costs, symptoms and functioning, and adherence to drug treatment was very low with the result that no reliable conclusions could be drawn in these areas. CONCLUSIONS The results of this systematic review indicate that having higher relational continuity of care may have beneficial effects for patients with severe mental illness, and no results have indicated the opposite relationship. There is a need for better studies using clear and distinctive measures of exposure for relational continuity of care.
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Affiliation(s)
- Ingemar Engström
- University Health Care Center, Faculty of Medicine and Health, Örebro University, Örebro, SE-701 82, Sweden.
| | - Lars Hansson
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Lilas Ali
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Jenny Berg
- SBU - Swedish Agency for Health Technology Assessment and Assessment of Social Services, Stockholm, Sweden
| | - Mirjam Ekstedt
- Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden
| | | | - Maja Kärrman Fredriksson
- SBU - Swedish Agency for Health Technology Assessment and Assessment of Social Services, Stockholm, Sweden
| | - Jan Liliemark
- SBU - Swedish Agency for Health Technology Assessment and Assessment of Social Services, Stockholm, Sweden
| | - Per Lytsy
- SBU - Swedish Agency for Health Technology Assessment and Assessment of Social Services, Stockholm, Sweden
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Boyer L, Fernandes S, Brousse Y, Zendjidjian X, Cano D, Riedberger J, Llorca PM, Samalin L, Dassa D, Trichard C, Laprevote V, Sauvaget A, Abbar M, Misdrahi D, Berna F, Lancon C, Coulon N, El-Hage W, Rozier PE, Benoit M, Giordana B, Caqueo-Urizar A, Yon DK, Tran B, Auquier P, Fond G. Development of the PREMIUM computerized adaptive testing for measuring the access and care coordination for patients with severe mental illness. Psychiatry Res 2023; 328:115444. [PMID: 37677894 DOI: 10.1016/j.psychres.2023.115444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 08/24/2023] [Accepted: 08/25/2023] [Indexed: 09/09/2023]
Abstract
Severe mental illness (SMI) patients often have complex health needs, which makes it difficult to access and coordinate their care. This study aimed to develop a computerized adaptive testing (CAT) tool, PREMIUM CAT-ACC, to measure SMI patients' experience with access and care coordination. This multicenter and cross-sectional study included 496 adult in- and out-patients with SMI (i.e., schizophrenia, bipolar disorder, or major depressive disorder). Psychometric analysis of the 13-item bank showed adequate properties, with preliminary evidence of external validity and no substantial differential item functioning for sex, age, care setting, and diagnosis, making it suitable for CAT administration. A post-hoc CAT simulation demonstrated that the tool was efficient and accurate, with an average of seven items, compared to the full item bank administration. Its use by clinicians can contribute to optimizing patient care pathways and transitioning towards more person-centered healthcare.
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Affiliation(s)
- Laurent Boyer
- AP-HM, School of medicine - La Timone Medical Campus, UR3279: Health Service Research and Quality of Life Center (CEReSS), Aix-Marseille University, Marseille, France.
| | - Sara Fernandes
- AP-HM, School of medicine - La Timone Medical Campus, UR3279: Health Service Research and Quality of Life Center (CEReSS), Aix-Marseille University, Marseille, France
| | - Yann Brousse
- AP-HM, School of medicine - La Timone Medical Campus, UR3279: Health Service Research and Quality of Life Center (CEReSS), Aix-Marseille University, Marseille, France
| | - Xavier Zendjidjian
- AP-HM, School of medicine - La Timone Medical Campus, UR3279: Health Service Research and Quality of Life Center (CEReSS), Aix-Marseille University, Marseille, France
| | - Delphine Cano
- AP-HM, School of medicine - La Timone Medical Campus, UR3279: Health Service Research and Quality of Life Center (CEReSS), Aix-Marseille University, Marseille, France
| | - Jeremie Riedberger
- AP-HM, School of medicine - La Timone Medical Campus, UR3279: Health Service Research and Quality of Life Center (CEReSS), Aix-Marseille University, Marseille, France
| | - Pierre-Michel Llorca
- CMP-B CHU, CNRS, Clermont Auvergne INP, Institut Pascal (UMR 6602), University Clermont Auvergne, Clermont-Ferrand, France
| | - Ludovic Samalin
- CMP-B CHU, CNRS, Clermont Auvergne INP, Institut Pascal (UMR 6602), University Clermont Auvergne, Clermont-Ferrand, France
| | - Daniel Dassa
- AP-HM, School of medicine - La Timone Medical Campus, UR3279: Health Service Research and Quality of Life Center (CEReSS), Aix-Marseille University, Marseille, France
| | | | - Vincent Laprevote
- Department of Addictology and Psychiatry, Centre Psychothérapique de Nancy, Laxou, France; INSERM U1114, Fédération de Médecine Translationnelle de Strasbourg, Département de Psychiatrie, Centre Hospitalier Régional Universitaire de Strasbourg, Strasbourg, France
| | - Anne Sauvaget
- CHU Nantes, Movement - Interactions - Performance, Nantes Université, MIP, UR 4334, Nantes F-44000, France
| | - Mocrane Abbar
- Department of Psychiatry, CHU Nîmes, Univ Montpellier, Nîmes, France
| | - David Misdrahi
- National Centre for Scientific Research UMR 5287 - Institut de Neurosciences Cognitives et Intégratives d'Aquitaine, University of Bordeaux, Bordeaux, France; Centre Hospitalier Charles Perrens, Bordeaux, France
| | - Fabrice Berna
- University Hospital of Strasbourg - Department of Psychiatry, INSERM U1114, FMTS, University of Strasbourg, France
| | - Christophe Lancon
- AP-HM, School of medicine - La Timone Medical Campus, UR3279: Health Service Research and Quality of Life Center (CEReSS), Aix-Marseille University, Marseille, France
| | - Nathalie Coulon
- Centre Référent de Réhabilitation Psychosociale, CH Alpes Isère, Grenoble, France
| | - Wissam El-Hage
- CHRU de Tours, Clinique Psychiatrique Universitaire, Tours F-37000, France
| | | | - Michel Benoit
- Department of Psychiatry, Hopital Pasteur, University Hospital of Nice, Nice, France
| | - Bruno Giordana
- Department of Psychiatry, Hopital Pasteur, University Hospital of Nice, Nice, France
| | | | - Dong Keon Yon
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea; Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Bach Tran
- AP-HM, School of medicine - La Timone Medical Campus, UR3279: Health Service Research and Quality of Life Center (CEReSS), Aix-Marseille University, Marseille, France; Institute of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Vietnam
| | - Pascal Auquier
- AP-HM, School of medicine - La Timone Medical Campus, UR3279: Health Service Research and Quality of Life Center (CEReSS), Aix-Marseille University, Marseille, France
| | - Guillaume Fond
- AP-HM, School of medicine - La Timone Medical Campus, UR3279: Health Service Research and Quality of Life Center (CEReSS), Aix-Marseille University, Marseille, France
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Tozzi VD, Banks H, Ferrara L, Barbato A, Corrao G, D'avanzo B, Di Fiandra T, Gaddini A, Compagnoni MM, Sanza M, Saponaro A, Scondotto S, Lora A. Using big data and Population Health Management to assess care and costs for patients with severe mental disorders and move toward a value-based payment system. BMC Health Serv Res 2023; 23:960. [PMID: 37679722 PMCID: PMC10483754 DOI: 10.1186/s12913-023-09655-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 06/06/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND Mental health (MH) care often exhibits uneven quality and poor coordination of physical and MH needs, especially for patients with severe mental disorders. This study tests a Population Health Management (PHM) approach to identify patients with severe mental disorders using administrative health databases in Italy and evaluate, manage and monitor care pathways and costs. A second objective explores the feasibility of changing the payment system from fee-for-service to a value-based system (e.g., increased care integration, bundled payments) to introduce performance measures and guide improvement in outcomes. METHODS Since diagnosis alone may poorly predict condition severity and needs, we conducted a retrospective observational study on a 9,019-patient cohort assessed in 2018 (30.5% of 29,570 patients with SMDs from three Italian regions) using the Mental Health Clustering Tool (MHCT), developed in the United Kingdom, to stratify patients according to severity and needs, providing a basis for payment for episode of care. Patients were linked (blinded) with retrospective (2014-2017) physical and MH databases to map resource use, care pathways, and assess costs globally and by cluster. Two regions (3,525 patients) provided data for generalized linear model regression to explore determinants of cost variation among clusters and regions. RESULTS Substantial heterogeneity was observed in care organization, resource use and costs across and within 3 Italian regions and 20 clusters. Annual mean costs per patient across regions was €3,925, ranging from €3,101 to €6,501 in the three regions. Some 70% of total costs were for MH services and medications, 37% incurred in dedicated mental health facilities, 33% for MH services and medications noted in physical healthcare databases, and 30% for other conditions. Regression analysis showed comorbidities, resident psychiatric services, and consumption noted in physical health databases have considerable impact on total costs. CONCLUSIONS The current MH care system in Italy lacks evidence of coordination of physical and mental health and matching services to patient needs, with high variation between regions. Using available assessment tools and administrative data, implementation of an episodic approach to funding MH could account for differences in disease phase and physical health for patients with SMDs and introduce performance measurement to improve outcomes and provide oversight.
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Affiliation(s)
- Valeria D Tozzi
- Center for Research on Health and Social Care Management, SDA Bocconi School of Management - Bocconi University, Via Sarfatti, 10, Milan, 20136, Italy
| | - Helen Banks
- Center for Research on Health and Social Care Management, SDA Bocconi School of Management - Bocconi University, Via Sarfatti, 10, Milan, 20136, Italy
| | - Lucia Ferrara
- Center for Research on Health and Social Care Management, SDA Bocconi School of Management - Bocconi University, Via Sarfatti, 10, Milan, 20136, Italy.
| | - Angelo Barbato
- Unit for Quality of Care and Rights Promotion in Mental Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Giovanni Corrao
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano- Bicocca, Milan, Italy
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Barbara D'avanzo
- Unit for Quality of Care and Rights Promotion in Mental Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Teresa Di Fiandra
- General Directorate for Health Prevention, Ministry of Health, Rome, Italy
| | | | - Matteo Monzio Compagnoni
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano- Bicocca, Milan, Italy
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Michele Sanza
- Department of Mental Health and Addiction Services, AUSL Romagna, Cesena, Italy
| | - Alessio Saponaro
- General Directorate of Health and Social Policies, Emilia-Romagna Region, Bologna, Italy
| | - Salvatore Scondotto
- Department of Health Services and Epidemiological Observatory, Regional Health Authority, Sicily Region, Palermo, Italy
| | - Antonio Lora
- Department of Mental Health and Addiction Services, ASST Lecco, Lecco, Italy
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Glover‐Wright C, Coupe K, Campbell AC, Keen C, Lawrence P, Kinner SA, Young JT. Health outcomes and service use patterns associated with co-located outpatient mental health care and alcohol and other drug specialist treatment: A systematic review. Drug Alcohol Rev 2023; 42:1195-1219. [PMID: 37015828 PMCID: PMC10946517 DOI: 10.1111/dar.13651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 12/13/2022] [Accepted: 02/24/2023] [Indexed: 04/06/2023]
Abstract
ISSUES Despite long-standing recommendations to integrate mental health care and alcohol and other drug (AOD) treatment, no prior study has synthesised evidence on the impact of physically co-locating these specialist services on health outcomes. APPROACH We searched Medline, PsycINFO, Embase, Web of Science and CINAHL for studies examining health outcomes associated with co-located outpatient mental health care and AOD specialist treatment for adults with a dual diagnosis of substance use disorder and mental illness. Due to diversity in study designs, patient populations and outcome measures among the included studies, we conducted a narrative synthesis. Risk of bias was assessed using the MASTER scale. KEY FINDINGS Twenty-eight studies met our inclusion criteria. We found provisional evidence that integrated care that includes co-located mental health care and AOD specialist treatment is associated with reductions in substance use and related harms and mental health symptom severity, improved quality of life, decreased emergency department presentations/hospital admissions and reduced health system expenditure. Many studies had a relatively high risk of bias and it was not possible to disaggregate the independent effect of physical co-location from other common aspects of integrated care models such as care coordination and the integration of service processes. IMPLICATIONS There are few high-quality, peer-reviewed studies establishing the impact of co-located mental health care and AOD specialist treatment on health outcomes. Further research is required to inform policy, guide implementation and optimise practice. CONCLUSION Integrated care that includes the co-location of mental health care and AOD specialist treatment may yield health and economic benefits.
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Affiliation(s)
- Clare Glover‐Wright
- Centre for Health Equity, Melbourne School of Population and Global HealthThe University of MelbourneMelbourneAustralia
| | - Kym Coupe
- Centre for Health Equity, Melbourne School of Population and Global HealthThe University of MelbourneMelbourneAustralia
| | - Alexander Charles Campbell
- Centre for Health Equity, Melbourne School of Population and Global HealthThe University of MelbourneMelbourneAustralia
| | - Claire Keen
- Centre for Health Equity, Melbourne School of Population and Global HealthThe University of MelbourneMelbourneAustralia
| | | | - Stuart A. Kinner
- Centre for Health Equity, Melbourne School of Population and Global HealthThe University of MelbourneMelbourneAustralia
- Centre for Adolescent Health, Murdoch Children's Research InstituteMelbourneAustralia
- School of Population HealthCurtin UniversityPerthAustralia
- Griffith Criminology InstituteGriffith UniversityBrisbaneAustralia
| | - Jesse T. Young
- Centre for Health Equity, Melbourne School of Population and Global HealthThe University of MelbourneMelbourneAustralia
- Centre for Adolescent Health, Murdoch Children's Research InstituteMelbourneAustralia
- School of Population and Global HealthThe University of Western AustraliaPerthAustralia
- National Drug Research InstituteCurtin UniversityPerthAustralia
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7
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Cheng SH, Chen CC, Lin YY. Longitudinal care continuity and avoidable hospitalization: the application of claims-based measures. BMC Health Serv Res 2023; 23:554. [PMID: 37244982 DOI: 10.1186/s12913-023-09457-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 04/27/2023] [Indexed: 05/29/2023] Open
Abstract
BACKGROUND Longitudinal continuity between a patient and his/her primary care physician is an important aspect in measuring continuity of care (COC). The majority of previous studies employed questionnaire surveys to patients to measure the continual relationship between patients and their physicians. This study aimed to construct a provider duration continuity index (PDCI) by using longitudinal claims data and to examine its agreement with commonly used COC measures. Then, this study investigated the effects of the various types of COC measure on the likelihood of avoidable hospitalization while considering the level of comorbidity. METHODS This study constructed a 4-year panel (from 2014 to 2017) of the nationwide health insurance claims data in Taiwan. In total, 328,044 randomly selected patients with 3 or more physician visits per year were analyzed. Two PDCIs were constructed to measure the duration of interaction between a patient and his/her physicians over time. The agreement between the PDCIs and three commonly used COC indicators, the Usual Provider of Care index, the Continuity of Care Index, and the Sequential Continuity Index, were examined. Generalized estimating equations were conducted to examine the association between COC and avoidable hospitalization by the level of comorbidity. RESULTS The results showed that the correlations among the three commonly used COC indicators were high (γ = 0.787 ~ 0.958) and the correlation between the two longitudinal continuity measures was moderate (γ = 0.577 ~ 0.579), but the correlations between the commonly used COC indicators and the two PDCIs were low (γ = 0.001 ~ 0.257). All COC measures, both the PDCIs and the three commonly used COC indicators, showed independent protective effects on the likelihood of avoidable hospitalization in three comorbidity groups. CONCLUSION The duration of interaction between patients and physicians is an independent domain in measuring COC and has a significant effect on health care outcomes.
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Affiliation(s)
- Shou-Hsia Cheng
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Room 618, 17, Hsu-Chow Road, Taipei, 100, Taiwan.
- Population Health Research Center, National Taiwan University, Taipei, Taiwan.
| | - Chi-Chen Chen
- Department of Public Health, College of Medicine, Fu-Jen Catholic University, Taipei, Taiwan
| | - Yueh-Yun Lin
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Room 618, 17, Hsu-Chow Road, Taipei, 100, Taiwan
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Touhami D, Essig S, Debecker I, Scheel-Sailer A, Gemperli A. The effect of the general practitioner as the first point of contact for care on the satisfaction with health care services in persons living with chronic spinal cord injury: A cross-sectional study. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2023; 177:48-56. [PMID: 36959067 DOI: 10.1016/j.zefq.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 10/15/2022] [Accepted: 12/11/2022] [Indexed: 03/25/2023]
Abstract
OBJECTIVE The primary objective of this study was to investigate the effect of having a general practitioner (GP) as a first point of contact for care on the satisfaction with care services in persons with spinal cord injury (SCI), and how this effect is related to socio-demographic and health-related factors. METHODS This is a cross-sectional survey conducted within the framework of the Swiss Spinal Cord Injury Cohort Study Community Survey 2017. Outcome measures comprised three aspects of care (treatment with respect, understandability of explanations, and involvement in decision-making) and satisfaction with GP care and SCI centres. Information was grouped by first contact of care (GP or SCI specialist) and compared using the Mann-Whitney U test and logistic regression analysis. RESULTS Out of 3,959 invitees, 1,294 participants (33%) completed the survey. No significant association was found between the three aspects of care and the first contact of care. Persons who first contacted a GP and lived within a 10-minute travel distance to the GP practice were significantly less likely to be satisfied with their GP care (-5.7 percentage points, CI 95% = -10.7, -0.7), as compared to those living farther away. Persons who first contacted a GP rather than an SCI specialist were more likely to be satisfied with their GP care if married (7.1 percentage points, CI 95% = 1.4, 12.7), employed (6.6 percentage points, CI 95% = 0.9, 12.3), had a high social status (11.0 percentage points, CI 95% = 2.0, 20.1), or had tetraplegia (10.8 percentage points, CI 95% = 3.6, 18.1). For the same group, satisfaction with SCI centres was significantly higher in persons with good (10.1 percentage points, CI 95% = 0.1, 20.1) or very good health (8.2 percentage points, CI 95% = 1.0, 15.4), as compared to those with poor health. CONCLUSION The majority of participants were satisfied with the services offered by their first contact point for care, with variations due to factors endogenous to the participants. Socio-demographic and health-related factors should be integrated into health care planning strategies and improvement initiatives to ensure equitable access and better quality of health care services.
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Affiliation(s)
- Dima Touhami
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland; Swiss Paraplegic Research, Nottwil, Switzerland.
| | - Stefan Essig
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland; Centre for Primary and Community Care, University of Lucerne, Lucerne, Switzerland
| | | | - Anke Scheel-Sailer
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland; Swiss Paraplegic Centre, Nottwil, Switzerland
| | - Armin Gemperli
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland; Swiss Paraplegic Research, Nottwil, Switzerland; Centre for Primary and Community Care, University of Lucerne, Lucerne, Switzerland
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9
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Groot L, Te Winkel M, Schers H, Burgers J, Smalbrugge M, Uijen A, van der Horst H, Maarsingh O. Optimising personal continuity: a survey of GPs' and older patients' views. BJGP Open 2023:BJGPO.2022.0099. [PMID: 36720564 DOI: 10.3399/bjgpo.2022.0099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 11/16/2022] [Accepted: 12/18/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Personal continuity - having a GP who knows their patients and keeps track of them - is an important dimension of continuity of care and is associated with lower mortality rates, higher quality of life, and reduced healthcare costs. In recent decades it has become more challenging for GPs to provide personal continuity owing to changes in society and health care. AIM To investigate GPs' and older patients' views on personal continuity and how personal continuity can be improved. DESIGN & SETTING Cross sectional survey study in The Netherlands. METHOD A digital and postal survey was sent to 499 GPs and 1599 patients aged 65 years or older. Results were analysed using descriptive statistics for quantitative data and thematic analysis for open questions. RESULTS In total, 249 GPs and 582 patients completed the surveys. A large majority of GPs (92-99%) and patients (91-98%) felt it was important for patients to see their own GP for life events or psychosocial issues. GPs and patients provided suggestions on how personal continuity can be improved. The thematic analysis of these suggestions identified nine themes: 1) personal connection, 2) GP accessibility and availability, 3) communication about (dis)continuity, 4) GP responsibility, 5) triage, 6) time for the patient, 7) actions by third parties, 8) team continuity, and 9) GP vocational training. CONCLUSION Both GPs and older patients still place high value on personal continuity in the context of a changing society. GPs and patients provided a wide range of suggestions for improving personal continuity. The authors will use these suggestions to develop interventions for optimising personal continuity in general practice.
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Affiliation(s)
- Lex Groot
- Department of General Practice, Amsterdam UMC, Vrije Universiteit Amsterdam, Aging and Later Life, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Marije Te Winkel
- Department of General Practice, Amsterdam UMC, Vrije Universiteit Amsterdam, Aging and Later Life, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Henk Schers
- Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Jako Burgers
- Maastricht University Medical Center+, Maastricht University, Department of General Practice, Care and Public Health Research Institute (CAPHRI), Maastricht, The Netherlands
| | - Martin Smalbrugge
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Medicine for Older People, Boelelaan, Amsterdam, The Netherlands
| | - Annemarie Uijen
- Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Henriëtte van der Horst
- Department of General Practice, Amsterdam UMC, Vrije Universiteit Amsterdam, Aging and Later Life, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Otto Maarsingh
- Department of General Practice, Amsterdam UMC, Vrije Universiteit Amsterdam, Aging and Later Life, Amsterdam Public Health, Amsterdam, The Netherlands
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de Cruppé W, Assheuer M, Geraedts M, Beine K. Association between continuity of care and treatment outcomes in psychiatric patients in Germany: a prospective cohort study. BMC Psychiatry 2023; 23:52. [PMID: 36658554 PMCID: PMC9850567 DOI: 10.1186/s12888-023-04545-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 01/11/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Continuity of care is considered an important treatment aspect of psychiatric disorders, as it often involves long-lasting or recurrent episodes with psychosocial treatment aspects. We investigated in two psychiatric hospitals in Germany whether the positive effects of relational continuity of care on symptom severity, social functioning, and quality of life, which have been demonstrated in different countries, can also be achieved in German psychiatric care. METHODS Prospective cohort study with a 20-months observation period comparing 158 patients with higher and 165 Patients with lower degree of continuity of care of two psychiatric hospitals. Patients were surveyed at three points in time (10 and 20 months after baseline) using validated questionnaires (CGI Clinical Global Impression rating scales, GAF Global Assessment of Functioning scale, EQ-VAS Euro Quality of Life) and patient clinical record data. Statistical analyses with analyses of variance with repeated measurements of 162 patients for the association between the patient- (EQ-VAS) or observer-rated (CGI, GAF) outcome measures and continuity of care as between-subject factor controlling for age, sex, migration background, main psychiatric diagnosis group, duration of disease, and hospital as independent variables. RESULTS Higher continuity of care reduced significantly the symptom severity with a medium effect size (p 0.036, eta 0.064) and increased significantly social functioning with a medium effect size (p 0.023, eta 0.076) and quality of life but not significantly and with only a small effect size (p 0.092, eta 0.022). The analyses of variance suggest a time-independent effect of continuity of care. The duration of psychiatric disease, a migration background, and the hospital affected the outcome measures independent of continuity of care. CONCLUSION Our results support continuity of care as a favorable clinical aspect in psychiatric patient treatment and encourage mental health care services to consider health service delivery structures that increase continuity of care in the psychiatric patient treatment course. In psychiatric health care services research patients' motives as well as methodological reasons for non-participation remain considerable potential sources for bias. TRIAL REGISTRATION This prospective cohort study was not registered as a clinical intervention study because no intervention was part of the study, neither on the patient level nor the system level.
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Affiliation(s)
- Werner de Cruppé
- Institute for Health Services Research and Clinical Epidemiology Philipps-Universität Marburg, Karl-Von-Frisch-Strasse 4, 35043 Marburg, Germany
| | - Michaela Assheuer
- Institute for Health Services Research and Clinical Epidemiology Philipps-Universität Marburg, Karl-Von-Frisch-Strasse 4, 35043 Marburg, Germany
| | - Max Geraedts
- Institute for Health Services Research and Clinical Epidemiology Philipps-Universität Marburg, Karl-Von-Frisch-Strasse 4, 35043 Marburg, Germany
| | - Karl Beine
- School of Medicine, Faculty of Health, Institute for Health Systems Research, Herdecke University, Alfred-Herrhausen-Strasse 50, 58448 WittenWitten, Germany
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11
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Medioni J, Scimeca D, Marquez YL, Leray E, Dalichampt M, Hoertel N, Bennani M, Trempat P, Boujedaini N. Benefits of Homeopathic Complementary Treatment in Patients With Breast Cancer: A Retrospective Cohort Study Based on the French Nationwide Healthcare Database. Clin Breast Cancer 2023; 23:60-70. [PMID: 36376237 DOI: 10.1016/j.clbc.2022.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 09/21/2022] [Accepted: 10/01/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND Complementary therapy in oncology aims to help patients better cope with the illness and side effects (SEs) of cancer treatments that affect their quality of life (QOL). This study aimed to assess the benefits of homeopathic treatment on the health-related QOL (HRQOL) of patients with non-metastatic breast cancer (BC) prescribed in postsurgical complementary therapy. PATIENTS AND METHODS An extraction from the French nationwide healthcare database targeted all patients who underwent mastectomy for newly diagnosed BC between 2012 and 2013. HRQOL was proxied by the quantity of medication used to palliate the SEs of cancer treatments. RESULTS A total of 98,009 patients were included (mean age: 61 ± 13 years). Homeopathy was used in 11%, 26%, and 22% of patients respectively during the 7 to 12 months before surgery, the 6 months before, and 6 months after. Thereafter, the use remained stable at 15% for 4 years. Six months after surgery, there was a significant overall decrease (RR = 0.88, confidence interval (CI)95 = 0.87-0.89) in the dispensing of medication associated with SEs in patients treated with ≥ 3 dispensing of homeopathy compared to none. The decrease appeared to be greater for immunostimulants (RR = 0.79, (CI)95 = 0.74-0.84), corticosteroids (RR = 0.82, (CI)95 = 0.79-0.85), and antidiarrheals (RR = 0.83, (CI)95 = 0.77-0.88). CONCLUSION The study showed an increasing use of homeopathy in patients with BC following diagnosis. This use was maintained after surgery and seemed to play a role in helping patients to better tolerate the SEs of cancer treatments.
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Affiliation(s)
- Jacques Medioni
- APHP Hôpital Européen Georges Pompidou, Paris, France; Université Paris Cité, Paris, France
| | | | | | - Emmanuelle Leray
- Univ Rennes, EHESP, CNRS, Inserm, ARENES UMR 6051, RSMS U 1309, F-35000 Rennes, France
| | | | - Nicolas Hoertel
- Université Paris Cité, Paris, France; APHP Corentin Celton, Paris, France
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12
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Park GN, Kim JO, Oh JW, Lee S. Association between anemia and depression: The 2014, 2016, and 2018 Korea National Health and Nutrition Examination Survey. J Affect Disord 2022; 312:86-91. [PMID: 35750091 DOI: 10.1016/j.jad.2022.06.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 05/03/2022] [Accepted: 06/16/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Several studies have reported an association between anemia and depression. However, whether anemia is independently associated with depression remains controversial. The current study aimed to investigate the association between anemia and depression according to sex in a large national sample population. METHODS Data from the 2014, 2016, and 2018 Korean National Health and Nutrition Examination Survey were analyzed, and 15,472 participants were included in this study. Anemia was defined as a hemoglobin level <13 g/dL in men and <12 g/dL in women. We defined a Patient Health Questionnaire-9 score ≥10 as depression and ≥5 as mild depressive symptoms. RESULTS The prevalence of depression was significantly higher in women with anemia than in women without anemia (8.9 % vs. 7.0 %, P = 0.036). In women, anemia was significantly associated with depression after adjusting all covariates in multilevel logistic regression analysis (odds ratio, 1.37; 95 % confidence interval, 1.08-1.75; P = 0.011). However, no significant association was observed in men. LIMITATIONS There is a limit to explaining the causal direction, and several factors may not have been considered as confounders. Also, patients with severe diseases were excluded from data acquisition. A structured diagnostic interview, other than the self-report method, was not conducted. CONCLUSIONS The findings of this study suggest that anemia is associated with depression in women but not in men. A decrease in tissue oxygenation, deterioration of physical performance due to anemia, and altered monoamine synthesis due to malnutrition may have an effect on depression.
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Affiliation(s)
- Gyu Nam Park
- Department of Psychiatry and Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Joo O Kim
- Department of Psychiatry and Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jae Won Oh
- Department of Psychiatry, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea; Mind Health Clinic, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea
| | - San Lee
- Department of Psychiatry and Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Department of Psychiatry, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea; Mind Health Clinic, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea.
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13
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Cochran JM, Fang H, Sonnenberg JG, Cohen EA, Lindenmayer JP, Reuteman-Fowler JC. Healthcare Provider Engagement with a Novel Dashboard for Tracking Medication Ingestion: Impact on Treatment Decisions and Clinical Assessments for Adults with Schizophrenia. Neuropsychiatr Dis Treat 2022; 18:1521-1534. [PMID: 35928793 PMCID: PMC9343256 DOI: 10.2147/ndt.s369123] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 07/02/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Schizophrenia is a severe, chronic condition accounting for disproportionate healthcare utilization. Antipsychotics can reduce relapse rates, but the characteristics of schizophrenia may hinder medication adherence. A phase 3b open-label clinical trial used aripiprazole tablets with sensor (AS; includes pills with ingestible event-marker, wearable sensor patches and smartphone application) in adults with schizophrenia. This post hoc analysis explored how healthcare providers' (HCPs) usage of a dashboard that provided medication ingestion information impacted treatment decisions and clinical assessments. Patients and Methods Participants used AS for 3-6 months. HCPs were instructed to check the dashboard regularly, identify features used, and report impact on treatment decisions. After stratifying HCPs by frequency of dashboard checks and resulting treatment decisions, changes from baseline were calculated for Positive and Negative Syndrome Scale (PANSS), Clinical Global Impression (CGI)-Severity of Illness and CGI-Improvement (CGI-I), and Personal and Social Performance (PSP), and compared using Mann-Whitney U-tests and rank-biserial correlation coefficient (r) effect sizes. Results To ensure sufficient opportunity for AS engagement, 113 participants who completed ≥3 months on study were analyzed. HCPs most often accessed dashboard data regarding medication ingestion and missed doses. HCPs recommended adherence counseling and participant education most often. Participants whose HCPs used the dashboard more and recommended adherence counseling and participant education (n=61) improved significantly more than participants with less dashboard-active HCPs (n=49) in CGI-I mean score (2.9 versus 3.4 [p=0.004]), total PANSS (mean change: -9.2 versus -3.1 [p=0.0002]), PANSS positive subscale (-3.2 versus -1.5 [p=0.003]), PANSS general subscale (-4.3 versus -1.2 [p=0.02]), and Marder factor for negative symptoms (-1.9 versus 0.0 [p=0.03]). Most HCPs found the dashboard easy to use (74%) and helpful for improving conversations with participants about their treatment plan and progress (78%). Conclusion This provider dashboard may facilitate discussions with patients about regular medication-taking, which can improve patient outcomes.
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Affiliation(s)
- Jeffrey M Cochran
- Otsuka Pharmaceutical Development & Commercialization, Inc, Princeton, NJ, USA
| | - Hui Fang
- Otsuka Pharmaceutical Development & Commercialization, Inc, Princeton, NJ, USA
| | - John G Sonnenberg
- Uptown Research Institute, Chicago, IL, USA
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | - Jean-Pierre Lindenmayer
- Department of Psychiatry, New York University Grossman School of Medicine, New York, NY, USA
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14
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Chene M, Sánchez-Rico M, Blanco C, De Raykeer RP, Hanon C, Vandel P, Limosin F, Hoertel N. Psychiatric symptoms and mortality in older adults with major psychiatric disorders: results from a multicenter study. Eur Arch Psychiatry Clin Neurosci 2022; 273:627-638. [PMID: 35723739 DOI: 10.1007/s00406-022-01426-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 05/02/2022] [Indexed: 12/01/2022]
Abstract
Prior research suggests that certain psychiatric symptoms could be associated with increased risk of death. However, it remains unclear whether this association could rely on all or specific symptoms. In this report, we used data from a multicenter 5-year prospective study (N = 641) of older adults with an ICD-10 diagnosis of schizophrenia, bipolar disorder or major depressive disorder, recruited from French community psychiatric departments. We used a latent variable approach to disentangle the effects shared by all psychiatric symptoms (i.e., general psychopathology factor) and those specific to individual psychiatric symptoms, while adjusting for sociodemographic and clinical factors. Psychiatric symptoms were assessed face-to-face by psychiatrists trained to semi-structured interviews using the Brief Psychiatric Rating Scale (BPRS). Among older adults with major psychiatric disorders, we found that all psychiatric symptoms were associated with increased mortality, and that their effect on the 5-year mortality were exerted mostly through a general psychopathology dimension (β = 0.13, SE = 0.05, p < 0.05). No BPRS item or lower order factor had a significant effect on mortality beyond and above the effect of the general psychopathology factor. Greater number of medical conditions, older age, male sex, and being hospitalized or institutionalized at baseline were significantly associated with this risk beyond the effect of the general psychopathology factor. Since psychiatric symptoms may affect mortality mainly through a general psychopathology dimension, biological and psychological mechanisms underlying this dimension should be considered as promising targets for interventions to decrease excess mortality of older individuals with psychiatric disorders.
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Affiliation(s)
- Margaux Chene
- Department of Psychiatry, AP-HP, Western Paris University Hospitals, 92130, Issy-les-Moulineaux, France. .,Department of Psychiatry, Corentin Celton Hospital, Paris Descartes University, 4 parvis Corentin Celton, 92130, Issy-les-Moulineaux, France.
| | - Marina Sánchez-Rico
- Department of Psychiatry, AP-HP, Western Paris University Hospitals, 92130, Issy-les-Moulineaux, France.,Department of Psychobiology and Behavioural Sciences Methods, Faculty of Psychology, Universidad Complutense de Madrid, Campus de Somosaguas, Madrid, Spain
| | - Carlos Blanco
- Division of Epidemiology, Services, and Prevention Research, National Institute On Drug Abuse, Bethesda, MD, USA
| | - Rachel Pascal De Raykeer
- Department of Psychiatry, AP-HP, Western Paris University Hospitals, 92130, Issy-les-Moulineaux, France
| | - Cécile Hanon
- Department of Psychiatry, AP-HP, Western Paris University Hospitals, 92130, Issy-les-Moulineaux, France.,Department of Psychiatry, Corentin Celton Hospital, Paris Descartes University, 4 parvis Corentin Celton, 92130, Issy-les-Moulineaux, France
| | - Pierre Vandel
- Department of Adult Psychiatry, Laboratory of Neurosciences, University Hospital of Besançon, UBFC, EA-481, Besançon, France
| | - Frédéric Limosin
- Department of Psychiatry, AP-HP, Western Paris University Hospitals, 92130, Issy-les-Moulineaux, France.,INSERM UMR 894, Psychiatry and Neurosciences Center, Paris, France.,Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Department of Psychiatry, Corentin Celton Hospital, Paris Descartes University, 4 parvis Corentin Celton, 92130, Issy-les-Moulineaux, France
| | - Nicolas Hoertel
- Department of Psychiatry, AP-HP, Western Paris University Hospitals, 92130, Issy-les-Moulineaux, France.,INSERM UMR 894, Psychiatry and Neurosciences Center, Paris, France.,Paris Descartes University, Sorbonne Paris Cité, Paris, France
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Nicolet A, Al-Gobari M, Perraudin C, Wagner J, Peytremann-Bridevaux I, Marti J. Association between continuity of care (COC), healthcare use and costs: what can we learn from claims data? A rapid review. BMC Health Serv Res 2022; 22:658. [PMID: 35578226 PMCID: PMC9112559 DOI: 10.1186/s12913-022-07953-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 04/08/2022] [Indexed: 01/07/2023] Open
Abstract
Objective To describe how longitudinal continuity of care (COC) is measured using claims-based data and to review its association with healthcare use and costs. Research design Rapid review of the literature. Methods We searched Medline (PubMed), EMBASE and Cochrane Central, manually checked the references of included studies, and hand-searched websites for potentially additional eligible studies. Results We included 46 studies conducted in North America, East Asia and Europe, which used 14 COC indicators. Most reported studies (39/46) showed that higher COC was associated with lower healthcare use and costs. Most studies (37/46) adjusted for possible time bias and discussed causality between the outcomes and COC, or at least acknowledged the lack of it as a limitation. Conclusions Whereas a wide range of indicators is used to measure COC in claims-based data, associations between COC and healthcare use and costs were consistent, showing lower healthcare use and costs with higher COC. Results were observed in various population groups from multiple countries and settings. Further research is needed to make stronger causal claims. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07953-z.
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Affiliation(s)
- Anna Nicolet
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Biopôle 2 SV-A, Route de la Corniche 10, CH-1010, Lausanne, Switzerland.
| | - Muaamar Al-Gobari
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Biopôle 2 SV-A, Route de la Corniche 10, CH-1010, Lausanne, Switzerland
| | - Clémence Perraudin
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Biopôle 2 SV-A, Route de la Corniche 10, CH-1010, Lausanne, Switzerland
| | - Joël Wagner
- Department of Actuarial Science, Faculty of Business and Economics (HEC), and Swiss Finance Institute, University of Lausanne, Lausanne, Switzerland
| | - Isabelle Peytremann-Bridevaux
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Biopôle 2 SV-A, Route de la Corniche 10, CH-1010, Lausanne, Switzerland
| | - Joachim Marti
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Biopôle 2 SV-A, Route de la Corniche 10, CH-1010, Lausanne, Switzerland
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16
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Lavaud P, McMahon K, Sánchez Rico M, Hanon C, Alvarado JM, de Raykeer RP, Limosin F, Hoertel N. Long-term care utilization within older adults with schizophrenia: Associated factors in a multicenter study. Psychiatry Res 2022; 308:114339. [PMID: 34963089 DOI: 10.1016/j.psychres.2021.114339] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 12/08/2021] [Accepted: 12/09/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Data are scarce regarding the clinical factors associated with utilization of long-term care facilities among older adults with schizophrenia. In this multicenter study, we sought to examine potential clinical differences between older adults with schizophrenia who are living in a long-term care facility and their community-dwelling counterparts. METHOD We used data from the French Cohort of individuals with Schizophrenia Aged 55-years or more (CSA) study, a large multicenter sample of older adults with schizophrenia (N = 353). RESULTS The prevalence of long-term care utilization was 35.1% of older patients with schizophrenia. Living in a long term care facility was significantly and independently associated with higher level of depression (Adjusted odds ratio (AOR) [95%CI]=1.97 [1.06-3.64]), lower cognitive (AOR [95%CI]=0.94 [0.88-0.99]) and global functioning (AOR [95%CI]=0.97 [0.95-0.99]), greater lifetime number of hospitalizations in a psychiatric department (AOR [95%CI]=2.30 [1.18-4.50]), not having consulted a general practitioner in the past year (AOR [95%CI]=0.28 [0.0.14-0.56]), urbanicity (AOR [95%CI]=2.81 [1.37-5.80]), and older age (AOR [95%CI]=1.08 [1.03-1.13]). DISCUSSION Older patients with schizophrenia who live in long-term care facilities appear to belong to a distinct group, marked by a more severe course of illness with higher level of depression and more severe cognitive deficits than older patients with schizophrenia living in other settings. Our study highlights the need of early assessment and management of depression and cognitive deficits in this population and the importance of monitoring closely this vulnerable population.
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Affiliation(s)
- Pierre Lavaud
- AP-HP Center, University of Paris, Department of Psychiatry, Regional Resource Center of old age psychiatry, Issy-les-Moulineaux 92130, France.
| | - Kibby McMahon
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 2213 Elba Street, Durham, NC, 27710, United States
| | - Marina Sánchez Rico
- AP-HP Center, University of Paris, Department of Psychiatry, Regional Resource Center of old age psychiatry, Issy-les-Moulineaux 92130, France
| | - Cécile Hanon
- AP-HP Center, University of Paris, Department of Psychiatry, Regional Resource Center of old age psychiatry, Issy-les-Moulineaux 92130, France
| | - Jesús M Alvarado
- Department of Psychobiology & Behavioral Sciences Methods, Faculty of Psychology, Universidad Complutense de Madrid, Campus de Somosaguas S/N, 28223 Pozuelo de Alarcon, Spain
| | - Rachel Pascal de Raykeer
- AP-HP Center, University of Paris, Department of Psychiatry, Regional Resource Center of old age psychiatry, Issy-les-Moulineaux 92130, France; Paris University, Paris, France
| | - Frédéric Limosin
- AP-HP Center, University of Paris, Department of Psychiatry, Regional Resource Center of old age psychiatry, Issy-les-Moulineaux 92130, France; INSERM 1266, Psychiatry and Neurosciences Center, Paris, France; Paris University, Paris, France
| | - Nicolas Hoertel
- AP-HP Center, University of Paris, Department of Psychiatry, Regional Resource Center of old age psychiatry, Issy-les-Moulineaux 92130, France; INSERM 1266, Psychiatry and Neurosciences Center, Paris, France; Paris University, Paris, France
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Variability in the Control of Type 2 Diabetes in Primary Care and Its Association with Hospital Admissions for Vascular Events. The APNA Study. J Clin Med 2021; 10:jcm10245854. [PMID: 34945149 PMCID: PMC8703537 DOI: 10.3390/jcm10245854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/02/2021] [Accepted: 12/08/2021] [Indexed: 01/14/2023] Open
Abstract
Type 2 diabetes (T2D) is associated with increased cardiovascular morbidity, mortality, and hospital admissions. This study aimed to analyze how the differences in delivered care (variability of glycosylated hemoglobin (HbA1c) achieved targets) affect hospital admissions for cardiovascular events (CVEs) in T2D patients. Methods: We analyzed the electronic records in primary care health centers at Navarra (Spain) and hospital admission for CVEs. We followed 26,435 patients with T2D from 2012 to 2016. The variables collected were age, sex, health center, general practitioner practice (GPP), and income. The clinical variables were diagnosis of T2D, weight, height, body mass index (BMI), blood pressure (BP), HbA1c, low-density lipoprotein cholesterol (LDL-C), smoking, and antecedents of CVEs. We calculated, in each GPP practice, the proportion of patients with HbA1c ≥ 9. A non-hierarchical K-means cluster analysis classified GPPs into two clusters according to the level of compliance with HbA1C ≥ 9% control indicators. We used logistic and Cox regressions. Results: T2D patients had a higher probability of admission for CVEs when they belonged to a GPP in the worst control cluster of HbA1C ≥ 9% (HR = 1.151; 95% CI, 1.032–1.284).
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18
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Groot LJJ, Schers HJ, Burgers JS, Schellevis FG, Smalbrugge M, Uijen AA, van de Ven PM, van der Horst HE, Maarsingh OR. Optimising personal continuity for older patients in general practice: a study protocol for a cluster randomised stepped wedge pragmatic trial. BMC FAMILY PRACTICE 2021; 22:207. [PMID: 34666678 PMCID: PMC8526277 DOI: 10.1186/s12875-021-01511-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 07/15/2021] [Indexed: 11/20/2022]
Abstract
Background Continuity of care, in particular personal continuity, is a core principle of general practice and is associated with many benefits such as a better patient-provider relationship and lower mortality. However, personal continuity is under pressure due to changes in society and healthcare. This affects older patients more than younger patients. As the number of older patients will double the coming decades, an intervention to optimise personal continuity for this group is highly warranted. Methods Following the UK Medical Research Council framework for complex Interventions, we will develop and evaluate an intervention to optimise personal continuity for older patients in general practice. In phase 0, we will perform a literature study to provide the theoretical basis for the intervention. In phase I we will define the components of the intervention by performing surveys and focus groups among patients, general practitioners, practice assistants and practice nurses, concluded by a Delphi study among members of our group. In phase II, we will test and finalise the intervention with input from a pilot study in two general practices. In phase III, we will perform a stepped wedge cluster randomised pragmatic trial. The primary outcome measure is continuity of care from the patients’ perspective, measured by the Nijmegen Continuity Questionnaire. Secondary outcome measures are level of implementation, barriers and facilitators for implementation, acceptability and feasibility of the intervention. In phase IV, we will establish the conditions for large-scale implementation. Discussion This is the first study to investigate an intervention for improving personal continuity for older patients in general practice. If proven effective, our intervention will enable General practitioners to improve the quality of care for their increasing population of older patients. The pragmatic design of the study will enable evaluation in real-life conditions, facilitating future implementation. Trial registration number Netherlands Trial Register, trial NL8132. Registered 2 November 2019. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-021-01511-y.
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Affiliation(s)
- Lex J J Groot
- Department of General Practice, Amsterdam University Medical Centre, location VU University Medical Centre, van der Boechorststraat 7, 1081, BT, Amsterdam, the Netherlands.
| | - Henk J Schers
- Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Geert Grooteplein 21, 6525, EZ, Nijmegen, The Netherlands
| | - Jako S Burgers
- MUMC+/ Maastricht University, Department of General Practice, Care and Public Health Research Institute (CAPHRI), Universiteitssingel 40, 6229, ER, Maastricht, the Netherlands
| | - Francois G Schellevis
- Department of General Practice, Amsterdam University Medical Centre, location VU University Medical Centre, van der Boechorststraat 7, 1081, BT, Amsterdam, the Netherlands
| | - Martin Smalbrugge
- Department of Medicine for Older People, Amsterdam University Medical Centre, location VU University Medical Centre, De Boelelaan 1109, 1081, HV, Amsterdam, the Netherlands
| | - Annemarie A Uijen
- Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Geert Grooteplein 21, 6525, EZ, Nijmegen, The Netherlands
| | - Peter M van de Ven
- Department of Epidemiology and Data Science, Vrije Universiteit Amsterdam, De Boelelaan 1089a, 1081, HV, Amsterdam, the Netherlands
| | - Henriëtte E van der Horst
- Department of General Practice, Amsterdam University Medical Centre, location VU University Medical Centre, van der Boechorststraat 7, 1081, BT, Amsterdam, the Netherlands
| | - Otto R Maarsingh
- Department of General Practice, Amsterdam University Medical Centre, location VU University Medical Centre, van der Boechorststraat 7, 1081, BT, Amsterdam, the Netherlands
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19
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Rising co-payments and continuity of healthcare for Dutch patients with bipolar disorder: retrospective longitudinal cohort study. BJPsych Open 2021. [PMCID: PMC8444049 DOI: 10.1192/bjo.2021.994] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background The Netherlands has few financial barriers to access mental healthcare. However, in 2012, a sharp rise in co-payments was introduced. Aims We tested whether these increased co-payments coincided with less guideline-recommended continuous out-patient psychiatric care and more crisis interventions for patients with bipolar disorder. Method A retrospective longitudinal cohort study on a health insurance registry was performed to examine trends, and deviations from these trends, in the healthcare received by patients with bipolar disorder. Deviations of trends were tested by time-series analyses (autoregressive integrated moving average). Subsequently, the relationship between significant deviations of trends and rise in co-payments was examined. Outcome measures were the level of standard out-patient care (out-patient psychiatric care and/or medication), crisis psychiatric care and somatic care. Results The cohort comprised 3210 patients. During follow-up, the use of psychiatric care decreased and somatic care increased. The high rise in co-payments from 2012 onward coincided with decreases in standard out-patient care and increases in medication-only treatment, crisis psychiatric care and somatic care. Crisis intervention was highest when patients received only bipolar disorder medication. Patients receiving continuous standard out-patient care (62%) had less crisis intervention compared with the other patients. Conclusions Our data suggest that the rise of co-payments decreased guideline-recommended continuous out-patient psychiatric care among patients with bipolar disorder, and increased crisis psychiatric care.
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20
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Abou Kassm S, Limosin F, Naja W, Vandel P, Sánchez-Rico M, Alvarado JM, von Gunten A, Hoertel N. Late-onset and nonlate-onset schizophrenia: A comparison of clinical characteristics in a multicenter study. Int J Geriatr Psychiatry 2021; 36:1204-1215. [PMID: 33580724 DOI: 10.1002/gps.5512] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 01/31/2021] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Data are scarce regarding the potential clinical differences between non-late onset schizophrenia (NLOS, i.e., disorder occurring before 40 years of age), late-onset schizophrenia (LOS, occurring between ages 40 and 60 years) and very-late-onset schizophrenia-like psychosis (VLOSLP, occurring after 60 years of age). Furthermore, previous research compared LOS patients with non-age matched NLOS patients. In this study, we sought to examine potential clinical differences between patients of similar age with LOS and NLOS. METHODS/DESIGN This is a cross-sectional multicentre study that recruited in- and outpatients older adults (aged ≥55 years) with an ICD-10 diagnosis of schizophrenia or schizoaffective disorder with NLOS and LOS. Sociodemographic and clinical characteristics, comorbidity, psychotropic medications, quality of life, functioning, and mental health care utilization were drawn for comparison. RESULTS Two hundred seventy-two participants (79.8%) had NLOS, 61 (17.9%) LOS, and 8 (2.3%) VLOSLP. LOS was significantly and independently associated with greater severity of emotional withdrawal and lower severity of depression (all p < 0.05). However, the magnitude of these associations was modest, with significant adjusted odds ratios ranging from 0.71 to 1.24, and there were no significant between-group differences in other characteristics. CONCLUSION In an age-matched multicenter sample of elderly patients with schizophrenia, older adults with LOS were largely similar to older adults with NLOS in terms of clinical characteristics. The few differences observed may be at least partially related to symptom fluctuation with time. Implications of these findings for pharmacological and nonpharmacological management is yet to be determined.
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Affiliation(s)
- Sandra Abou Kassm
- Department of Psychiatry, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Frédéric Limosin
- Département de Psychiatrie, Institut de Psychiatrie et Neurosciences de Paris (IPNP), Université de Paris, AP-HP, Hôpital Corentin-Celton, DMU Psychiatrie et Addictologie, INSERM, Issy-les-Moulineaux, France
| | - Wadih Naja
- Department of Psychiatry, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Pierre Vandel
- Centre d'investigation Clinique-Innovation Technologique CIC-IT 1431, Inserm, CHRU Besançon, Besançon, France.,Neurosciences intégratives et cliniques EA 481, Univ. Franche-Comté, Univ. Bourgogne Franche-Comté, Besançon, France.,Service de psychiatrie de l'adulte, Centre Mémoire de Ressource et de Recherche de Franche-Comté, CHRU Besançon, Besançon, France
| | - Marina Sánchez-Rico
- Département de Psychiatrie, Institut de Psychiatrie et Neurosciences de Paris (IPNP), Université de Paris, AP-HP, Hôpital Corentin-Celton, DMU Psychiatrie et Addictologie, INSERM, Issy-les-Moulineaux, France.,Department of Psychobiology & Behavioral Sciences Methods, Faculty of Psychology, Universidad Complutense de Madrid, Campus de Somosaguas S/N, Pozuelo de Alarcon, Spain
| | - Jesús M Alvarado
- Department of Psychobiology & Behavioral Sciences Methods, Faculty of Psychology, Universidad Complutense de Madrid, Campus de Somosaguas S/N, Pozuelo de Alarcon, Spain
| | - Armin von Gunten
- Department of Psychiatry, Service of Old Age Psychiatry, Lausanne University Hospital, Prilly, Switzerland
| | - Nicolas Hoertel
- Département de Psychiatrie, Institut de Psychiatrie et Neurosciences de Paris (IPNP), Université de Paris, AP-HP, Hôpital Corentin-Celton, DMU Psychiatrie et Addictologie, INSERM, Issy-les-Moulineaux, France
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21
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Hoertel N, Rotenberg L, Blanco C, Camus V, Dubertret C, Charlot V, Schürhoff F, Vandel P, Limosin F. A comprehensive model of predictors of quality of life in older adults with schizophrenia: results from the CSA study. Soc Psychiatry Psychiatr Epidemiol 2021; 56:1411-1425. [PMID: 32415431 DOI: 10.1007/s00127-020-01880-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 05/02/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Numerous factors are known to influence quality of life of adults with schizophrenia. However, little is known regarding the potential predictors of quality of life in the increasing population of older adults with schizophrenia. The main objective of the present study was to propose a comprehensive model of quality of life in this specific population. METHODS Data were derived from the Cohort of individuals with Schizophrenia Aged 55 years or more (CSA) study, a large (N = 353) multicenter sample of older adults with schizophrenia or schizoaffective disorder recruited from French community mental-health teams. We used structural equation modeling to simultaneously examine the effects of six broad groups of clinical factors previously identified as potential predictors of quality of life in this population, including (1) severity of general psychopathology, (2) severity of depression, (3) severity of cognitive impairment, (4) psychotropic medications, (5) general medical conditions and (6) sociodemographic characteristics. RESULTS General psychopathology symptoms, and in particular negative and depressive symptoms, cognitive impairment, reduced overall functioning and low education were significantly and independently associated with diminished quality of life (all p < 0.05). Greater number of medical conditions and greater number of antipsychotics were also independently and negatively associated with quality of life, although these associations did not reach statistical significance in sensitivity analyses, possibly due to limited statistical power. CONCLUSION Several domains are implicated in quality of life among older adults with schizophrenia. Interventions targeting these factors may help improve importantly quality of life of this vulnerable population.
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Affiliation(s)
- Nicolas Hoertel
- DMU Psychiatrie et Addictologie, Service de Psychiatrie et d'Addictologie de l'Adulte et du Sujet Âgé, Centre Ressource Régional de Psychiatrie du Sujet Agé (CRRPSA), Hôpital Corentin Celton, AP-HP.Centre, Université de Paris, Paris, France. .,Inserm U1266, Institut de Psychiatrie et Neurosciences de Paris, Paris, France. .,Faculté de Médecine Paris Descartes, Université de Paris, Paris, France.
| | - Léa Rotenberg
- DMU Psychiatrie et Addictologie, Service de Psychiatrie et d'Addictologie de l'Adulte et du Sujet Âgé, Centre Ressource Régional de Psychiatrie du Sujet Agé (CRRPSA), Hôpital Corentin Celton, AP-HP.Centre, Université de Paris, Paris, France
| | - Carlos Blanco
- Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, Bethesda, MD, USA
| | | | - Caroline Dubertret
- Inserm U1266, Institut de Psychiatrie et Neurosciences de Paris, Paris, France.,Department of Psychiatry, AP-HP, Louis Mourier Hospital, Colombes, France.,Faculté de médecine Paris Diderot, Université de Paris, Paris, France
| | - Véronique Charlot
- Department of Psychiatry, AP-HP, Louis Mourier Hospital, Colombes, France.,Faculté de médecine Paris Diderot, Université de Paris, Paris, France
| | - Franck Schürhoff
- AP-HP, DHU PePSY, Hôpitaux Universitaires Henri-Mondor, Pôle de Psychiatrie, 94000, Créteil, France.,Inserm, U955, Team 15, 94000, Créteil, France.,Fondation FondaMental, 94000, Créteil, France.,Faculté de médecine, UPEC, Université Paris-Est, 94000, Créteil, France
| | - Pierre Vandel
- Centre d'investigation Clinique-Innovation Technologique CIC-IT 1431, Inserm, CHRU Besançon, 25000, Besançon, France.,Neurosciences Intégratives et Cliniques EA 481, Université Franche-Comté, Université Bourgogne Franche-Comté, 25000, Besançon, France.,Service de Psychiatrie de l'adulte, CHRU Besançon, 25000, Besançon, France.,Centre Mémoire de Ressource et de Recherche de Franche-Comté, CHRU Besançon, 25000, Besançon, France
| | - Frédéric Limosin
- DMU Psychiatrie et Addictologie, Service de Psychiatrie et d'Addictologie de l'Adulte et du Sujet Âgé, Centre Ressource Régional de Psychiatrie du Sujet Agé (CRRPSA), Hôpital Corentin Celton, AP-HP.Centre, Université de Paris, Paris, France.,Inserm U1266, Institut de Psychiatrie et Neurosciences de Paris, Paris, France.,Faculté de Médecine Paris Descartes, Université de Paris, Paris, France
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22
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Macdonald A, Adamis D, Broadbent M, Craig T, Stewart R, Murray RM. Continuity of care and mortality in people with schizophrenia. BJPsych Open 2021; 7:e127. [PMID: 36043689 PMCID: PMC8281257 DOI: 10.1192/bjo.2021.965] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 04/22/2021] [Accepted: 06/17/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND People with schizophrenia have shortened lives. This excess mortality seems to be related to physical health conditions that may be amenable to better primary and secondary prevention. Better continuity of care may enhance such interventions as well as help prevent death by self-injury. AIMS We set out to examine the relationship between the continuity of care of patients with schizophrenia, their mortality and cause of death. METHOD Pseudoanonymised community data from 5551 people with schizophrenia presenting over 11 years were examined for changes in continuity of care using the numbers of community teams caring for them and the Modified Modified Continuity Index. These and demographic variables were related to death certifications of physical illness from the Office of National Statistics and mortal self-injury from clinical data. Data were analysed using generalised estimating equations. RESULTS We found no independent relationship between levels of continuity of care and overall mortality. However, lower levels of relationship continuity were significantly and independently related to death by self-injury. CONCLUSIONS We found no evidence that continuity of care is important in the prevention of physical causes of death in schizophrenia. However, there is evidence that declining relationship continuity of care has an independent effect on deaths as a result of self-injury. We suggest that there should be more attention focused on the improvement of continuity of care for these patients.
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Affiliation(s)
- Alastair Macdonald
- National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, UK
| | | | | | - Tom Craig
- (Emeritus) Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Rob Stewart
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Robin M. Murray
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
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23
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Chan KS, Wan EYF, Chin WY, Cheng WHG, Ho MK, Yu EYT, Lam CLK. Effects of continuity of care on health outcomes among patients with diabetes mellitus and/or hypertension: a systematic review. BMC FAMILY PRACTICE 2021; 22:145. [PMID: 34217212 PMCID: PMC8254900 DOI: 10.1186/s12875-021-01493-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 06/17/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND The rising prevalence of non-communicable diseases (NCDs) such as diabetes mellitus (DM) and hypertension (HT) has placed a tremendous burden on healthcare systems around the world, resulting in a call for more effective service delivery models. Better continuity of care (CoC) has been associated with improved health outcomes. This review examines the association between CoC and health outcomes in patients with DM and/or HT. METHODS This was a systematic review with searches carried out on 13 March 2021 through PubMed, Embase, MEDLINE and CINAHL plus, clinical trials registry and bibliography reviews. Eligibility criteria were: published in English; from 2000 onwards; included adult DM and/or HT patients; examined CoC as their main intervention/exposure; and utilised quantifiable outcome measures (categorised into health indicators and service utilisation). The study quality was evaluated with Critical Appraisal Skills Programme (CASP) appraisal checklists. RESULTS Initial searching yielded 21,090 results with 42 studies meeting the inclusion criteria. High CoC was associated with reduced hospitalisation (16 out of 18 studies), emergency room attendances (eight out of eight), mortality rate (six out of seven), disease-related complications (seven out of seven), and healthcare expenses (four out of four) but not with blood pressure (two out of 13), lipid profile (one out of six), body mass index (zero out of three). Six out of 12 studies on diabetic outcomes reported significant improvement in haemoglobin A1c by higher CoC. Variations in the classification of continuity of care and outcome definition were identified, making meta-analyses inappropriate. CASP evaluation rated most studies fair in quality, but found insufficient adjustment on confounders, selection bias and short follow-up period were common limitations of current literatures. CONCLUSION There is evidence of a strong association between higher continuity of care and reduced mortality rate, complication risks and health service utilisation among DM and/or HT patients but little to no improvement in various health indicators. Significant methodological heterogeneity in how CoC and patient outcomes are assessed limits the ability for meta-analysis of findings. Further studies comprising sufficient confounding adjustment and standardised definitions are needed to provide stronger evidence of the benefits of CoC on patients with DM and/or HT.
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Affiliation(s)
- Kam-Suen Chan
- Department of Family Medicine and Primary Care, The University of Hong Kong, 3/F Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Hong Kong, China
| | - Eric Yuk-Fai Wan
- Department of Family Medicine and Primary Care, The University of Hong Kong, 3/F Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Hong Kong, China.
- Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong, China.
| | - Weng-Yee Chin
- Department of Family Medicine and Primary Care, The University of Hong Kong, 3/F Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Hong Kong, China
| | - Will Ho-Gi Cheng
- Department of Family Medicine and Primary Care, The University of Hong Kong, 3/F Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Hong Kong, China
| | - Margaret Kay Ho
- Department of Family Medicine and Primary Care, The University of Hong Kong, 3/F Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Hong Kong, China
| | - Esther Yee-Tak Yu
- Department of Family Medicine and Primary Care, The University of Hong Kong, 3/F Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Hong Kong, China
| | - Cindy Lo-Kuen Lam
- Department of Family Medicine and Primary Care, The University of Hong Kong, 3/F Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Hong Kong, China
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24
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van der Lee APM, Hoogendoorn A, de Haan L, Beekman ATF. Discontinuity of psychiatric care for patients with schizophrenia, relation to previous psychiatric care and practice variation between providers: a retrospective longitudinal cohort study. BMC Psychiatry 2021; 21:319. [PMID: 34187433 PMCID: PMC8244203 DOI: 10.1186/s12888-021-03319-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 06/09/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Patients with schizophrenia need continuous integrated healthcare, but many discontinue their treatment, often experiencing adverse outcomes. The first objective of this study is to assess whether patient characteristics or treatment history are associated with discontinuity of psychiatric elective care. The second objective is to assess whether practice variation between providers of psychiatric care contributes to discontinuity of elective care. METHODS A large registry-based retrospective cohort of 9194 schizophrenia patients, who were included if they received elective psychiatric care in December 2014-January 2015. Logistic regression models were used to identify predictive factors of discontinuity of care. The dependent variable was the binary variable discontinuity of care in 2016. Potential independent predictive variables were: age, sex, urbanization, and treatment history in 2013-2014. Practice variation between providers was assessed, adjusting for the case mix of patients regarding their demographic and care utilization characteristics. RESULTS 12.9% of the patients showed discontinuity of elective psychiatric care in the follow-up year 2016. The risk of discontinuity of care in 2016 was higher in younger patients (between age 18 and 26), patients with a history of receiving less elective psychiatric care, more acute psychiatric care, more quarters with elective psychiatric care without antipsychotic medication, or receiving no elective treatment at all. No evidence for practice variation between providers was found. CONCLUSIONS Our findings show that the pattern of previous care consumption is an important prognostic factor of future discontinuity of elective care. We propose that previous care consumption can be used to design strategies to improve treatment retention and focus resources on those most at risk of dropping out.
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Affiliation(s)
- Arnold P. M. van der Lee
- grid.7177.60000000084992262Department Psychiatry Amsterdam University Medical Centre – location VUmc, Oldenaller 1, 1081 HJ Amsterdam, The Netherlands
| | - Adriaan Hoogendoorn
- grid.7177.60000000084992262Department Psychiatry Amsterdam University Medical Centre – location VUmc, Oldenaller 1, 1081 HJ Amsterdam, The Netherlands
| | - Lieuwe de Haan
- grid.5650.60000000404654431Department Psychiatry Amsterdam University Medical Centre – location AMC, Amsterdam, The Netherlands
| | - Aartjan T. F. Beekman
- grid.7177.60000000084992262Department Psychiatry Amsterdam University Medical Centre – location VUmc, Oldenaller 1, 1081 HJ Amsterdam, The Netherlands
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25
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Hoertel N, Rotenberg L, Schuster JP, Blanco C, Lavaud P, Hanon C, Hozer F, Teruel E, Manetti A, Costemale-Lacoste JF, Seigneurie AS, Limosin F. Generalizability of pharmacologic and psychotherapy trial results for late-life unipolar depression. Aging Ment Health 2021; 25:367-377. [PMID: 31726850 DOI: 10.1080/13607863.2019.1691146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Despite evidence of low representativeness of clinical trial results for depression in adults, the generalizability of clinical trial results for late-life depression is unknown. This study sought to quantify the representativeness of pharmacologic and psychotherapy clinical trial results for late-life unipolar depression. METHOD Data were derived from the 2004-2005 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a nationally representative sample of 34,653 adults from the United States population. To assess the generalizability of clinical trial results for late-life depression, we applied a standard set of eligibility criteria representative of pharmacologic and psychotherapy clinical trials to all individuals aged 65 years and older in NESARC with a DSM-IV diagnosis of MDE and no lifetime history of mania/hypomania (n = 273) and in a subsample of individuals seeking help for depression (n = 78). RESULTS More than four of ten respondents and about two of ten respondents would have been excluded by at least one exclusion criterion in a typical pharmacologic and psychotherapy efficacy trial, respectively. Similar results (i.e.41.1% and 25.9%, respectively) were found in the subsample of individuals seeking help for depression. Excess percentage of exclusion in typical pharmacologic studies was accounted for by the criterion "significant medical condition". We also found that populations typically included in pharmacologic and psychotherapy clinical trials for late-life unipolar depression may substantially differ. CONCLUSION Psychotherapy trial results may be representative of most patients with late-life unipolar depression in routine clinical practice. By contrast, pharmacologic clinical trials may not be readily generalizable to community samples.
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Affiliation(s)
- Nicolas Hoertel
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Corentin-Celton, Service de Psychiatrie, Issy-les-Moulineaux, France.,Université Paris Descartes, PRES Sorbonne Paris Cité, Paris, France.,Centre Psychiatrie et Neurosciences, Inserm Umr 894, Paris, France.,Université de Paris, Université Paris Descartes, Paris, France
| | - Léa Rotenberg
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Corentin-Celton, Service de Psychiatrie, Issy-les-Moulineaux, France
| | - Jean-Pierre Schuster
- Service of Old Age Psychiatry, Department of Psychiatry, Lausanne University Hospital, Prilly, Switzerland
| | - Carlos Blanco
- Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, Bethesda, MD, USA
| | - Pierre Lavaud
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Corentin-Celton, Service de Psychiatrie, Issy-les-Moulineaux, France
| | - Cécile Hanon
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Corentin-Celton, Service de Psychiatrie, Issy-les-Moulineaux, France
| | - Franz Hozer
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Corentin-Celton, Service de Psychiatrie, Issy-les-Moulineaux, France
| | - Elisabeth Teruel
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Corentin-Celton, Service de Psychiatrie, Issy-les-Moulineaux, France
| | - Aude Manetti
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Corentin-Celton, Service de Psychiatrie, Issy-les-Moulineaux, France
| | | | - Anne-Sophie Seigneurie
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Corentin-Celton, Service de Psychiatrie, Issy-les-Moulineaux, France
| | - Frédéric Limosin
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Corentin-Celton, Service de Psychiatrie, Issy-les-Moulineaux, France.,Université Paris Descartes, PRES Sorbonne Paris Cité, Paris, France.,Centre Psychiatrie et Neurosciences, Inserm Umr 894, Paris, France.,Université de Paris, Université Paris Descartes, Paris, France
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Cheng N, Farley J, Qian J, Zeng P, Chou C, Hansen R. The association of continuity of care and risk of mortality in breast cancer patients with cardiometabolic comorbidities. J Psychosoc Oncol 2021; 40:184-202. [PMID: 33459213 DOI: 10.1080/07347332.2020.1867692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The association of continuity of care (COC) among providers and mortality risk for breast cancer patients with comorbidities is not sufficiently studied. DESIGN A retrospective cohort study using the 2006-2014 Surveillance, Epidemiology and End Results (SEER)-Medicare data. PARTICIPANTS Newly diagnosed female breast cancer patients (n = 57,578) with comorbidities (hypertension, hyperlipidemia, and/or diabetes). METHODS All-cause mortality was assessed annually for up to 5 years. COC was estimated using the Bice-Boxerman index, which included: 1) specialty COC capturing continuity of visits to the same provider type (Primary Care Physicians, Oncologists, and Other specialists) and 2) individual COC capturing continuous care to the same provider regardless of provider specialty. Cox proportional hazards models estimated the hazard ratio (HR) of all-cause mortality across quartile of the COC index. RESULTS Mortality was positively associated with advanced tumor stages and number of comorbidities (p < 0.05). Patients with high specialty COC (4th vs. 1st quartile, HR 1.34, 95%CI 1.29-1.40) had higher risks of mortality compared with those with low specialty COC. However, patients with high individual COC (4th vs. 1st quartile, HR 0.53, 95%CI 0.51-0.54) had lower risks of mortality compared to those with low individual COC. CONCLUSION Receiving care from fewer providers is associated with lower mortality and from fewer types of provider is associated with higher mortality. The results might be confounded by uncontrolled factors and provoke the need for alternative patient care models that recognize the balance between appropriate subspecialties and minimizing the fragmentation of care within and across subspecialties.
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Affiliation(s)
- Ning Cheng
- Department of Biomedical Affair, Edward Via College of Osteopathic Medicine Auburn Campus, Auburn, Alabama, USA
| | - Joel Farley
- Department of Pharmaceutical Care & Health Systems, University of Minnesota, Minneapolis, Minnesota, USA
| | - Jingjing Qian
- Harrison School of Pharmacy, Department of Health Outcomes Research and Policy, Auburn University, Auburn, Alabama, USA
| | - Peng Zeng
- Department of Mathematics and Statistics, Auburn University, Auburn, Alabama, USA
| | - Chiahung Chou
- Harrison School of Pharmacy, Department of Health Outcomes Research and Policy, Auburn University, Auburn, Alabama, USA
| | - Richard Hansen
- Harrison School of Pharmacy, Department of Health Outcomes Research and Policy, Auburn University, Auburn, Alabama, USA
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Kaminskiy E, Zisman-Ilani Y, Morant N, Ramon S. Barriers and Enablers to Shared Decision Making in Psychiatric Medication Management: A Qualitative Investigation of Clinician and Service Users' Views. Front Psychiatry 2021; 12:678005. [PMID: 34220584 PMCID: PMC8245843 DOI: 10.3389/fpsyt.2021.678005] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/17/2021] [Indexed: 11/13/2022] Open
Abstract
Shared decisionmaking (SDM) is a recommended health communication approach in mental health settings. Yet, implementation of SDM in psychiatric consultations discussing medication management is challenging. Insufficient attention has been given to examine the views of both clinicians and service users together about the experiences of SDM in psychiatric medication management. The purpose of this paper is to examine the views of service users, community psychiatric nurses, and psychiatrists about enablers and barriers of SDM. A thematic analysis of 30 semi structured interviews with service users, psychiatrists, and community psychiatric nurses, in a community mental health team in the UK, was conducted. A service user advisory group was involved in all phases of the research cycle, including data collection, analysis, and dissemination. The results offer a detailed contextualized account of how medication decisions are made. For psychiatrists and service user participants SDM is seen as a way of enhancing service users' engagement in and control over treatment decisions. While psychiatrists value the transactional benefits of SDM, service user participants and psychiatric nurses conceptualize SDM as a long-term endeavor embedded within therapeutic partnerships. For service users these partnerships mitigate acknowledged problems of feeling unable to be fully involved during times of crisis. This study identified a range of barriers and facilitators to SDM concerning psychiatric medications from the lived experience of service users and the professional experience of clinicians. Furthermore, it indicates new potential intervention points to support SDM in psychiatric medication decisions.
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Affiliation(s)
- Emma Kaminskiy
- School of Psychology and Sports Science, Anglia Ruskin University, Cambridge, United Kingdom
| | - Yaara Zisman-Ilani
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, United States.,Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, London, United Kingdom
| | - Nicola Morant
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, United Kingdom
| | - Shulamit Ramon
- School of Health and Social Work, University of Hertfordshire, Hatfield, United Kingdom
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Scheer V, Blanco C, Olfson M, Lemogne C, Airagnes G, Peyre H, Limosin F, Hoertel N. A comprehensive model of predictors of suicide attempt in individuals with panic disorder: Results from a national 3-year prospective study. Gen Hosp Psychiatry 2020; 67:127-135. [PMID: 33129137 DOI: 10.1016/j.genhosppsych.2020.09.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/20/2020] [Accepted: 09/28/2020] [Indexed: 02/04/2023]
Abstract
OBJECTIVE People with panic disorder are at increased risk of suicide. Multiple factors influence their risk suggesting a need to combine them into an integrative model to develop more effective suicide prevention strategies for this population. In this report, we sought to build a comprehensive model of the 3-year risk of suicide attempt in individuals with panic disorder using a longitudinal nationally representative study, the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; wave 1, 2001-2002; wave 2, 2004-2005). METHOD We used structural equation modeling to simultaneously examine effects of six broad groups of clinical factors previously identified as potential predictors of suicide attempt in adults with panic disorder: 1) severity of panic disorder, 2) severity of comorbidity, 3) prior history of suicide attempt, 4) family history of psychiatric disorders, 5) sociodemographic characteristics and 6) treatment-seeking behavior. RESULTS The 3-year prevalence rate of suicide attempt was 4.6%. A general psychopathology factor, lower physical health-related quality of life, prior suicide attempt and a greater number of stressful life events at baseline significantly and independently predicted suicide attempt between the two waves (p < .05). R-square of the models ranged from 0.47 to 0.50. CONCLUSION This model may help inform future research and identify high-risk individuals among adults with panic disorder.
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Affiliation(s)
- Valentin Scheer
- Service de Psychiatrie et d'Addictologie de l'adulte et du sujet âgé, DMU Psychiatrie et Addictologie, AP-HP.Centre-Université de Paris, France.
| | - Carlos Blanco
- Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, Bethesda, MD, USA
| | - Mark Olfson
- Department of Psychiatry, New York State Psychiatric Institute / Columbia University, New York, NY 10032, USA
| | - Cédric Lemogne
- Service de Psychiatrie et d'Addictologie de l'adulte et du sujet âgé, DMU Psychiatrie et Addictologie, AP-HP.Centre-Université de Paris, France; Faculté de médecine Paris Descartes, Université de Paris, Paris, France; Inserm U1266, Institut de Psychiatrie et Neurosciences de Paris, Paris, France
| | - Guillaume Airagnes
- Service de Psychiatrie et d'Addictologie de l'adulte et du sujet âgé, DMU Psychiatrie et Addictologie, AP-HP.Centre-Université de Paris, France; UMS 011, Population-based Epidemiological Cohorts, Inserm, Villejuif, France
| | - Hugo Peyre
- Robert Debré Hospital, Child and Adolescent Psychiatry Department, Assistance Publique-Hôpitaux de Paris, Paris, France; Cognitive Sciences and Psycholinguistic Laboratory, Ecole Normale Supérieure, Paris, France
| | - Frédéric Limosin
- Service de Psychiatrie et d'Addictologie de l'adulte et du sujet âgé, DMU Psychiatrie et Addictologie, AP-HP.Centre-Université de Paris, France; Faculté de médecine Paris Descartes, Université de Paris, Paris, France; Inserm U1266, Institut de Psychiatrie et Neurosciences de Paris, Paris, France
| | - Nicolas Hoertel
- Service de Psychiatrie et d'Addictologie de l'adulte et du sujet âgé, DMU Psychiatrie et Addictologie, AP-HP.Centre-Université de Paris, France; Faculté de médecine Paris Descartes, Université de Paris, Paris, France; Inserm U1266, Institut de Psychiatrie et Neurosciences de Paris, Paris, France
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Psychiatric symptoms and quality of life in older adults with schizophrenia spectrum disorder: results from a multicenter study. Eur Arch Psychiatry Clin Neurosci 2020; 270:673-688. [PMID: 31134378 DOI: 10.1007/s00406-019-01026-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 05/15/2019] [Indexed: 12/16/2022]
Abstract
The severity of psychopathology has a strong negative impact on quality of life (QoL) among older adults with schizophrenia spectrum disorder. However, because these subjects generally experience multiple psychiatric symptoms, it remains unclear whether decreased QoL in this population is due to specific symptoms (e.g., hallucinations), specific dimensions of psychopathology (e.g., negative symptoms), a general psychopathology dimension representing the shared effect across all psychiatric symptoms, or a combination of these explanations. Data were derived from the Cohort of individuals with Schizophrenia Aged 55 years or more (CSA) study, a large (N = 353) multicenter sample of older adults with schizophrenia spectrum disorder recruited from French public-sector psychiatric departments. We used structural equation modeling to examine the shared and specific effects of psychiatric symptoms on QoL, while adjusting for sociodemographic characteristics, general medical conditions, global cognitive functioning and psychotropic medications. Psychiatric symptoms and QoL were assessed face-to-face by psychiatrists using the Brief Psychiatric Rating Scale (BPRS) and the Quality of Life Scale (QLS). Among older adults with schizophrenia spectrum disorder, effects of psychiatric symptoms on QoL were exerted mostly through a general psychopathology dimension (β = - 0.43, p < 0.01). Negative symptom dimension had an additional negative effect on QoL beyond the effect of that factor (β = - 0.28, p < 0.01). Because psychiatric symptoms affect QoL mainly through two dimensions of psychopathology, i.e., a general psychopathology dimension and a negative symptom dimension, mechanisms underlying those dimensions should be considered as promising targets for therapeutic interventions to substantially improve quality of life of this vulnerable population.
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Choi Y, Nam CM, Lee SG, Park S, Ryu HG, Park EC. Association of continuity of care with readmission, mortality and suicide after hospital discharge among psychiatric patients. Int J Qual Health Care 2020; 32:569-576. [DOI: 10.1093/intqhc/mzaa093] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 07/16/2020] [Accepted: 08/07/2020] [Indexed: 02/03/2023] Open
Abstract
Abstract
Objectives
The objective of this study was to identify the association between continuity of ambulatory psychiatric care after hospital discharge among psychiatric patients and readmission, mortality and suicide.
Design
Nationwide nested case-control study.
Settings
South Korea.
Participants
Psychiatric inpatients.
Interventions
Continuity of psychiatric outpatient care was measured from the time of hospital discharge until readmission or death occurred, using the continuity of care index.
Main Outcome Measures
Readmission, all-cause mortality and suicides within 1-year post-discharge.
Results
Of 18 702 psychiatric inpatients in the study, 8022 (42.9%) were readmitted, 355 (1.9%) died, and 108 (0.6%) died by suicide within 1 year after discharge. Compared with the psychiatric inpatients with a high continuity-of-care score, a significant increase in the readmission risk within 1 year after discharge was found in those with medium and low continuity of care scores. An increased risk of all-cause mortality within 1 year after hospital discharge was shown in the patients in the low continuity group, relative to those in the high-continuity group. The risk of suicide within 1 year after hospital discharge was higher in those with medium and low continuity of care than those with high continuity of care.
Conclusion
The results of this study provide empirical evidence of the importance of continuity of care when designing policies to improve the quality of mental health care, such as increasing patient awareness of the importance of continuity and implementation of policies to promote continuity.
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Affiliation(s)
- Young Choi
- Department of Health Care Management, Catholic University of Pusan, Busan 46265, South Korea
- Institute of Health Services Research, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Chung Mo Nam
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
- Department of Biostatistics, Graduate School of Public Health, Yonsei University, Seoul 03722, Republic of Korea
- Institute of Health Services Research, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Sang Gyu Lee
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
- Department of Hospital Administration, Graduate School of Public Health, Yonsei University, Seoul 03722, Republic of Korea
- Institute of Health Services Research, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Sohee Park
- Department of Biostatistics, Graduate School of Public Health, Yonsei University, Seoul 03722, Republic of Korea
- Institute of Health Services Research, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Hwang-Gun Ryu
- Department of Health Care Administration,Kosin University, Busan 49267, Republic of Korea
| | - Eun-Cheol Park
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
- Institute of Health Services Research, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
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Chamberlain JD, Eriks-Hoogland IE, Hug K, Jordan X, Schubert M, Brinkhof MWG. Attrition from specialised rehabilitation associated with an elevated mortality risk: results from a vital status tracing study in Swiss spinal cord injured patients. BMJ Open 2020; 10:e035752. [PMID: 32647022 PMCID: PMC7351285 DOI: 10.1136/bmjopen-2019-035752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Study drop-out and attrition from treating clinics is common among persons with chronic health conditions. However, if attrition is associated with adverse health outcomes, it may bias or mislead inferences for health policy and resource allocation. METHODS This retrospective cohort study uses data attained through the Swiss Spinal Cord Injury (SwiSCI) cohort study on persons with spinal cord injury (SCI). Vital status (VS) was ascertained either through clinic medical records (MRs) or through municipalities in a secondary tracing effort. Flexible parametric survival models were used to investigate risk factors for going lost to clinic (LTC) and the association of LTC with subsequent risk of mortality. RESULTS 1924 individuals were included in the tracing study; for 1608 of these cases, contemporary VS was initially checked in the MRs. VS was ascertained for 704 cases of the 1608 cases initially checked in MRs; of the remaining cases (n=904), nearly 90% were identified in municipalities (n=804). LTC was associated with a nearly fourfold higher risk of mortality (HR=3.62; 95% CI 2.18 to 6.02) among persons with traumatic SCI. Extended driving time (ie, less than 30 min compared with 30 min and longer to reach the nearest specialised rehabilitation facility) was associated with an increased risk of mortality (HR=1.51, 95% CI 1.02 to 2.22) for individuals with non-traumatic SCI. CONCLUSION The differential risk of LTC according to sociodemographic and SCI lesion characteristics underscores the importance of accounting for attrition in cohort studies on chronic disease populations requiring long-term care. In addition, given the associated risk of mortality, LTC is an issue of concern to clinicians and policy makers aiming to optimise the long-term survival of community-dwelling individuals with traumatic SCI. Future studies are necessary to verify whether it is possible to improve survival prospects of individuals LTC through more persistent outreach and targeted care.
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Affiliation(s)
- Jonviea D Chamberlain
- Swiss Paraplegic Research, Nottwil, Switzerland
- Centre INSERM U1219, CIC 1401-EC, Institut de Santé Publique, d'Epidémiologie et de Développement (ISPED), Bordeaux School of Public Health, University of Bordeaux, Bordeaux, France
| | | | | | | | | | - Martin W G Brinkhof
- Swiss Paraplegic Research, Nottwil, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Luzern, Switzerland
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Jones A, Bronskill SE, Seow H, Junek M, Feeny D, Costa AP. Associations between continuity of primary and specialty physician care and use of hospital-based care among community-dwelling older adults with complex care needs. PLoS One 2020; 15:e0234205. [PMID: 32559214 PMCID: PMC7304563 DOI: 10.1371/journal.pone.0234205] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 05/20/2020] [Indexed: 12/21/2022] Open
Abstract
Objective While research suggests that higher continuity of primary and specialty physician care can improve patient outcomes, their effects have rarely been examined and compared concurrently. We investigated associations between continuity of primary and specialty physician care and emergency department visits and hospital admissions among community-dwelling older adults with complex care needs. Methods We conducted a retrospective cohort study of home care patients in Ontario, Canada, from October 2014 to September 2016. We measured continuity of primary and specialty physician care over the two years prior to a home care assessment and categorized them into low, medium, and high groups using terciles of the distribution. We used Cox regression models to concurrently test the associations between continuity of primary and specialty care and risk of an emergency department visit and hospital admission within six months of assessment, controlling for potential confounders. We examined interactions between continuity of care and count of chronic conditions, count of physician specialties seen, functional impairment, and cognitive impairment. Results Of 178,686 participants, 49% had an emergency department visit during follow-up and 27% had a hospital admission. High vs. low continuity of primary care was associated with a reduced risk of an emergency department visit (HR = 0.90 (0.89–0.92)) as was continuity of specialty care (HR = 0.93 (0.91–0.95)). High vs. low continuity of primary care was associated also with a reduced risk of a hospital admission (HR = 0.94 (0.92–0.96)) as was continuity of specialty care (HR = 0.92 (0.90–0.94)). The effect of continuity of specialty care was moderately stronger among patients who saw four or more physician specialties. Conclusion Higher continuity of primary physician and specialty physician care had independent, protective effects of similar magnitude against emergency department use and hospital admissions. Improving continuity of specialty care should be a priority alongside improving continuity of primary care in complex, older adult populations with significant specialist use.
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Affiliation(s)
- Aaron Jones
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- * E-mail:
| | - Susan E. Bronskill
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Hsien Seow
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Mats Junek
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - David Feeny
- Department of Economics, McMaster University, Hamilton, Ontario, Canada
| | - Andrew P. Costa
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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Shoesmith W, Chua SH, Giridharan B, Forman D, Fyfe S. Creation of consensus recommendations for collaborative practice in the Malaysian psychiatric system: a modified Delphi study. Int J Ment Health Syst 2020; 14:45. [PMID: 32577126 PMCID: PMC7304147 DOI: 10.1186/s13033-020-00374-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 05/30/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND There is strong evidence that collaborative practice in mental healthcare improves outcomes for patients. The concept of collaborative practice can include collaboration between healthcare workers of different professional backgrounds and collaboration with patients, families and communities. Most models of collaborative practice were developed in Western and high-income countries and are not easily translatable to settings which are culturally diverse and lower in resources. This project aimed to develop a set of recommendations to improve collaborative practice in Malaysia. METHODS In the first phase, qualitative research was conducted to better understand collaboration in a psychiatric hospital (previously published). In the second phase a local hospital level committee from the same hospital was created to act on the qualitative research and create a set of recommendations to improve collaborative practice at the hospital for the hospital. Some of these recommendations were implemented, where feasible and the outcomes discussed. These recommendations were then sent to a nationwide Delphi panel. These committees consisted of healthcare staff of various professions, patients and carers. RESULTS The Delphi panel reached consensus after three rounds. The recommendations include ways to improve collaborative problem solving and decision making in the hospital, ways to improve the autonomy and relatedness of patients, carers and staff and ways to improve the levels of resources (e.g. skills training in staff, allowing people with lived experience of mental disorder to contribute). CONCLUSIONS This study showed that the Delphi method is a feasible method of developing recommendations and guidelines in Malaysia and allowed a wider range of stakeholders to contribute than traditional methods of developing guidelines and recommendations.Trial registration Registered in the National Medical Research Register, Malaysia, NMRR-13-308-14792.
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Affiliation(s)
- Wendy Shoesmith
- Faculty of Medicine and Health Sciences, University Malaysia Sabah, Kota Kinabalu, Malaysia
- Curtin University, Miri, Sarawak Malaysia
| | - Sze Hung Chua
- Hospital Mesra Bukit Padang, Ministry of Health, Kota Kinabalu, Malaysia
| | | | - Dawn Forman
- School of Public Health, Curtin University, Perth, Australia
- University of Derby, Derby, UK
| | - Sue Fyfe
- School of Public Health, Curtin University, Perth, Australia
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Jacobs R, Aylott L, Dare C, Doran T, Gilbody S, Goddard M, Gravelle H, Gutacker N, Kasteridis P, Kendrick T, Mason A, Rice N, Ride J, Siddiqi N, Williams R. The association between primary care quality and health-care use, costs and outcomes for people with serious mental illness: a retrospective observational study. HEALTH SERVICES AND DELIVERY RESEARCH 2020. [DOI: 10.3310/hsdr08250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background
Serious mental illness, including schizophrenia, bipolar disorder and other psychoses, is linked with high disease burden, poor outcomes, high treatment costs and lower life expectancy. In the UK, most people with serious mental illness are treated in primary care by general practitioners, who are financially incentivised to meet quality targets for patients with chronic conditions, including serious mental illness, under the Quality and Outcomes Framework. The Quality and Outcomes Framework, however, omits important aspects of quality.
Objectives
We examined whether or not better quality of primary care for people with serious mental illness improved a range of outcomes.
Design and setting
We used administrative data from English primary care practices that contribute to the Clinical Practice Research Datalink GOLD database, linked to Hospital Episode Statistics, accident and emergency attendances, Office for National Statistics mortality data and community mental health records in the Mental Health Minimum Data Set. We used survival analysis to estimate whether or not selected quality indicators affect the time until patients experience an outcome.
Participants
Four cohorts of people with serious mental illness, depending on the outcomes examined and inclusion criteria.
Interventions
Quality of care was measured with (1) Quality and Outcomes Framework indicators (care plans and annual physical reviews) and (2) non-Quality and Outcomes Framework indicators identified through a systematic review (antipsychotic polypharmacy and continuity of care provided by general practitioners).
Main outcome measures
Several outcomes were examined: emergency admissions for serious mental illness and ambulatory care sensitive conditions; all unplanned admissions; accident and emergency attendances; mortality; re-entry into specialist mental health services; and costs attributed to primary, secondary and community mental health care.
Results
Care plans were associated with lower risk of accident and emergency attendance (hazard ratio 0.74, 95% confidence interval 0.69 to 0.80), serious mental illness admission (hazard ratio 0.67, 95% confidence interval 0.59 to 0.75), ambulatory care sensitive condition admission (hazard ratio 0.73, 95% confidence interval 0.64 to 0.83), and lower overall health-care (£53), primary care (£9), hospital (£26) and mental health-care costs (£12). Annual reviews were associated with reduced risk of accident and emergency attendance (hazard ratio 0.80, 95% confidence interval 0.76 to 0.85), serious mental illness admission (hazard ratio 0.75, 95% confidence interval 0.67 to 0.84), ambulatory care sensitive condition admission (hazard ratio 0.76, 95% confidence interval 0.67 to 0.87), and lower overall health-care (£34), primary care (£9) and mental health-care costs (£30). Higher general practitioner continuity was associated with lower risk of accident and emergency presentation (hazard ratio 0.89, 95% confidence interval 0.83 to 0.97) and ambulatory care sensitive condition admission (hazard ratio 0.77, 95% confidence interval 0.65 to 0.92), but not with serious mental illness admission. High continuity was associated with lower primary care costs (£3). Antipsychotic polypharmacy was not statistically significantly associated with the risk of unplanned admission, death or accident and emergency presentation. None of the quality measures was statistically significantly associated with risk of re-entry into specialist mental health care.
Limitations
There is risk of bias from unobserved factors. To mitigate this, we controlled for observed patient characteristics at baseline and adjusted for the influence of time-invariant unobserved patient differences.
Conclusions
Better performance on Quality and Outcomes Framework measures and continuity of care are associated with better outcomes and lower resource utilisation, and could generate moderate cost savings.
Future work
Future research should examine the impact of primary care quality on measures that capture broader aspects of health and functioning.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 25. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Rowena Jacobs
- Centre for Health Economics, University of York, York, UK
| | - Lauren Aylott
- Expert by experience
- Hull York Medical School, York, UK
| | | | | | - Simon Gilbody
- Hull York Medical School, York, UK
- Department of Health Sciences, University of York, York, UK
| | - Maria Goddard
- Centre for Health Economics, University of York, York, UK
| | - Hugh Gravelle
- Centre for Health Economics, University of York, York, UK
| | - Nils Gutacker
- Centre for Health Economics, University of York, York, UK
| | | | - Tony Kendrick
- Primary Care and Population Sciences, Aldermoor Health Centre, University of Southampton, Southampton, UK
| | - Anne Mason
- Centre for Health Economics, University of York, York, UK
| | - Nigel Rice
- Centre for Health Economics, University of York, York, UK
| | - Jemimah Ride
- Centre for Health Economics, University of York, York, UK
| | - Najma Siddiqi
- Hull York Medical School, York, UK
- Department of Health Sciences, University of York, York, UK
- Bradford District Care NHS Foundation Trust, Bradford, UK
| | - Rachael Williams
- Clinical Practice Research Datalink, Medicines and Healthcare products Regulatory Agency, London, UK
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Benzodiazepine use among older adults with schizophrenia spectrum disorder: prevalence and associated factors in a multicenter study. Int Psychogeriatr 2020; 32:441-451. [PMID: 31062670 DOI: 10.1017/s1041610219000358] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Data on psychotropic medications of older patients with schizophrenia spectrum disorder are scarce. Specifically, information about the use of benzodiazepines among older patients with schizophrenia spectrum disorder is very limited. Because benzodiazepine use in older patients has been associated with many disabling side effects, its use in actual practice must be described and questioned. This study aimed at exploring the prevalence of benzodiazepine use and the clinical factors associated with such use among older patients with schizophrenia spectrum disorder. METHODS/DESIGN Data from the Cohort of individuals with Schizophrenia Aged 55 years or more (CSA) were used to examine the prevalence of benzodiazepine use among older patients with schizophrenia spectrum disorder. Demographic and clinical characteristics associated with benzodiazepine prescription were also explored. RESULTS The prevalence of benzodiazepine use was 29.8% of older patients with schizophrenia spectrum disorder. These patients were significantly more likely to have medical comorbidities, cognitive and social functioning impairments, to report a lifetime history of suicide attempt, to be institutionalized, and to have been hospitalized in a psychiatric service in the past year compared to those without a benzodiazepine prescription (all p<0.05). There were no between-group differences in schizophrenia severity and psychiatric comorbidity. CONCLUSIONS Although it can be hypothesized that benzodiazepine prescription is part of a short-term therapeutic strategy toward patients with more severe trouble or comorbid disorders, our results suggest a strong link between benzodiazepine prescription and a particularly vulnerable subpopulation of older patients with schizophrenia spectrum disorder.
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Morlet E, Costemale-Lacoste JF, Poulet E, McMahon K, Hoertel N, Limosin F, Alezrah C, Amado I, Amar G, Andréi O, Arbault D, Archambault G, Aurifeuille G, Barrière S, Béra-Potelle C, Blumenstock Y, Bardou H, Bareil-Guérin M, Barrau P, Barrouillet C, Baup E, Bazin N, Beaufils B, Ben Ayed J, Benoit M, Benyacoub K, Bichet T, Blanadet F, Blanc O, Blanc-Comiti J, Boussiron D, Bouysse AM, Brochard A, Brochart O, Bucheron B, Cabot M, Camus V, Chabannes JM, Charlot V, Charpeaud T, Clad-Mor C, Combes C, Comisu M, Cordier B, Costi F, Courcelles JP, Creixell M, Cuche H, Cuervo-Lombard C, Dammak A, Da Rin D, Denis JB, Denizot H, Deperthuis A, Diers E, Dirami S, Donneau D, Dreano P, Dubertret C, Duprat E, Duthoit D, Fernandez C, Fonfrede P, Freitas N, Gasnier P, Gauillard J, Getten F, Gierski F, Godart F, Gourevitch R, Grassin Delyle A, Gremion J, Gres H, Griner V, Guerin-Langlois C, Guggiari C, Guillin O, Hadaoui H, Haffen E, Hanon C, Haouzir S, Hazif-Thomas C, Heron A, Hubsch B, Jalenques I, Januel D, Kaladjian A, Karnycheff JF, Kebir O, Krebs MO, Lajugie C, Leboyer M, Legrand P, Lejoyeux M, Lemaire V, Leroy E, Levy-Chavagnat D, Leydier A, Liling C, Llorca PM, Loeffel P, Louville P, Lucas Navarro S, Mages N, Mahi M, Maillet O, Manetti A, Martelli C, Martin P, Masson M, Maurs-Ferrer I, Mauvieux J, Mazmanian S, Mechin E, Mekaoui L, Meniai M, Metton A, Mihoubi A, Miron M, Mora G, Niro Adès V, Nubukpo P, Omnes C, Papin S, Paris P, Passerieux C, Pellerin J, Perlbarg J, Perron S, Petit A, Petitjean F, Portefaix C, Pringuey D, Radtchenko A, Rahiou H, Raucher-Chéné D, Rauzy A, Reinheimer L, Renard M, René M, Rengade CE, Reynaud P, Robin D, Rodrigues C, Rollet A, Rondepierre F, Rousselot B, Rubingher S, Saba G, Salvarelli JP, Samuelian JC, Scemama-Ammar C, Schurhoff F, Schuster JP, Sechter D, Segalas B, Seguret T, Seigneurie AS, Semmak A, Slama F, Taisne S, Taleb M, Terra JL, Thefenne D, Tran E, Tourtauchaux R, Vacheron MN, Vandel P, Vanhoucke V, Venet E, Verdoux H, Viala A, Vidon G, Vitre M, Vurpas JL, Wagermez C, Walter M, Yon L, Zendjidjian X. Psychiatric and physical outcomes of long-term use of lithium in older adults with bipolar disorder and major depressive disorder: A cross-sectional multicenter study. J Affect Disord 2019; 259:210-217. [PMID: 31446382 DOI: 10.1016/j.jad.2019.08.056] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 07/11/2019] [Accepted: 08/18/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Although lithium is widely used in current practice to treat bipolar disorder (BD) and treatment-resistant major depressive disorder (MDD) among older adults, little is known about its efficacy and tolerability in this population, which is generally excluded from randomized clinical trials. The objective of this study was to evaluate the efficacy and tolerability of long-term use of lithium among older adults with BD and MDD. METHOD Data from the Cohort of individuals with Schizophrenia and mood disorders Aged 55 years or more (CSA) were used. Two groups of patients with BD and MDD were compared: those who were currently receiving lithium versus those who were not. The effects of lithium on psychiatric (i.e., depressive symptoms severity, perceived clinical severity, rates of psychiatric admissions in the past-year), geriatric (overall and cognitive functioning) and physical outcomes (i.e., rates of non-psychiatric medical comorbidities and general hospital admissions in the past-year) were evaluated. All analyses were adjusted for age, sex, duration of disorder, diagnosis, smoking status, alcohol use, and use of antipsychotics, antiepileptics or antidepressants. RESULTS Among the 281 older participants with BD or MDD, 15.7% were taking lithium for a mean duration of 12.5(SD = 11.6) years. Lithium use was associated with lower intensity of depressive symptoms, reduced perceived clinical global severity and lower benzodiazepine use (all p < 0.05), without being linked to greater rates of medical comorbidities, except for hypothyroidism. LIMITATIONS Data were cross-sectional and data on lifetime history of psychotropic medications was not assessed. CONCLUSION Our results suggest that long-term lithium use may be efficient and relatively well-tolerated in older adults with BD or treatment-resistant MDD.
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Affiliation(s)
- Elise Morlet
- Department of Psychiatry, Corentin Celton Hospital, 4 Parvis Corentin Celton, 92130 Issy-les-Moulineaux, France
| | - Jean-François Costemale-Lacoste
- Department of Psychiatry, Corentin Celton Hospital, 4 Parvis Corentin Celton, 92130 Issy-les-Moulineaux, France; INSERM UMRS 1178, CESP, Le Kremlin Bicêtre, France.
| | - Emmanuel Poulet
- INSERM, U1028, CNRS, UMR5292, Lyon Neuroscience Research Center, PSY-R2 Team, Lyon F-69000, France
| | - Kibby McMahon
- Department of Psychology & Neuroscience, Duke University, 2213 Elba Street, Durham, NC 27710, United States
| | - Nicolas Hoertel
- Department of Psychiatry, Corentin Celton Hospital, 4 Parvis Corentin Celton, 92130 Issy-les-Moulineaux, France; INSERM UMR 894, Psychiatry and Neurosciences Center, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France
| | - Frédéric Limosin
- Department of Psychiatry, Corentin Celton Hospital, 4 Parvis Corentin Celton, 92130 Issy-les-Moulineaux, France; INSERM UMR 894, Psychiatry and Neurosciences Center, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France
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Nicaise P, Giacco D, Soltmann B, Pfennig A, Miglietta E, Lasalvia A, Welbel M, Wciórka J, Bird VJ, Priebe S, Lorant V. Healthcare system performance in continuity of care for patients with severe mental illness: A comparison of five European countries. Health Policy 2019; 124:25-36. [PMID: 31831211 DOI: 10.1016/j.healthpol.2019.11.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 10/14/2019] [Accepted: 11/11/2019] [Indexed: 10/25/2022]
Abstract
Most healthcare systems struggle to provide continuity of care for people with chronic conditions, such as patients with severe mental illness. In this study, we reviewed how system features in two national health systems (NHS) - England and Veneto (Italy) - and three regulated-market systems (RMS) - Germany, Belgium, and Poland -, were likely to affect continuing care delivery and we empirically assessed system performance. 6418 patients recruited from psychiatric hospitals were followed up one year after admission. We collected data on their use of services and contact with professionals and assessed care continuity using indicators on the gap between hospital discharge and outpatient care, access to services, number of contacts with care professionals, satisfaction with care continuity, and helping alliance. Multivariate regressions were used to control for patients' characteristics. Important differences were found between healthcare systems. NHS countries had more effective longitudinal and cross-sectional care continuity than RMS countries, though Germany had similar results to England. Relational continuity seemed less affected by organisational mechanisms. This study provides straightforward empirical indicators for assessing healthcare system performance in care continuity. Despite systems' complexity, findings suggest that stronger regulation of care provision and financing at a local level should be considered for effective care continuity.
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Affiliation(s)
- Pablo Nicaise
- Institute of Health and Society (IRSS), Université Catholique de Louvain, Bruxelles, B1.30.15. Clos Chapelle-Aux-Champs, 1200 Brussels, Belgium.
| | - Domenico Giacco
- Unit for Social and Community Psychiatry (World Health Organisation Collaborating Centre for Mental Health Services Development), Queen Mary University of London, London, UK
| | - Bettina Soltmann
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Andrea Pfennig
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Elisabetta Miglietta
- Section of Psychiatry, Department of Public Health and Community Medicine, University of Verona, Verona, Italy
| | - Antonio Lasalvia
- UOC di Psichiatria, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Verona, Italy
| | - Marta Welbel
- Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Jacek Wciórka
- Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Victoria Jane Bird
- Unit for Social and Community Psychiatry (World Health Organisation Collaborating Centre for Mental Health Services Development), Queen Mary University of London, London, UK
| | - Stefan Priebe
- Unit for Social and Community Psychiatry (World Health Organisation Collaborating Centre for Mental Health Services Development), Queen Mary University of London, London, UK
| | - Vincent Lorant
- Institute of Health and Society (IRSS), Université Catholique de Louvain, Bruxelles, B1.30.15. Clos Chapelle-Aux-Champs, 1200 Brussels, Belgium
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Chatzidamianos G, Fletcher I, Wedlock L, Lever R. Clinical communication and the 'triangle of care' in mental health and deafness: Sign language interpreters' perspectives. PATIENT EDUCATION AND COUNSELING 2019; 102:2010-2015. [PMID: 31122818 DOI: 10.1016/j.pec.2019.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 05/07/2019] [Accepted: 05/14/2019] [Indexed: 06/09/2023]
Abstract
Objective To explore the processes by which therapeutic alliance develops in mental health consultations with Sign Language interpreters. Method Semi-structured interviews with 7 qualified interpreters were transcribed and analysed with interpretative phenomenological analysis. Results Two key themes were generated: (1) Nurturing the triangle of care, where the therapeutic process relied on collaboration, continuity, and trust; and (2) Shared vision and knowledge, in which participants felt misunderstood and unsupported; there was a lack of deaf awareness and clinicians appeared to feel deskilled. Conclusions Interpreters should be viewed as valued members of clinical teams and have access to clinical supervision so that they can be supported in interpreting emotional distressing content. Clinicians can aim to be collaborative with interpreters and improve their knowledge of mental health issues that are relevant to deaf people. Practice Implications An aide-memoire of the role and practicalities of working with SL interpreters should be developed and disseminated to relevant services to support collaborative working with clinicians. A core competence in SL interpreter training is reflexivity. This should be embedded in educational curricula and facilitated through clinical supervision. Funding by commissioning services should be subject to services being deaf aware and interpreters being mental health aware.
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Affiliation(s)
| | - Ian Fletcher
- Division of Health Research, Lancaster University, UK
| | - Laura Wedlock
- Division of Health Research, Lancaster University, UK
| | - Rachel Lever
- John Denmark Unit, Greater Manchester Mental Health NHS Foundation Trust, UK
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Ride J, Kasteridis P, Gutacker N, Doran T, Rice N, Gravelle H, Kendrick T, Mason A, Goddard M, Siddiqi N, Gilbody S, Williams R, Aylott L, Dare C, Jacobs R. Impact of family practice continuity of care on unplanned hospital use for people with serious mental illness. Health Serv Res 2019; 54:1316-1325. [PMID: 31598965 PMCID: PMC6863233 DOI: 10.1111/1475-6773.13211] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Objective To investigate whether continuity of care in family practice reduces unplanned hospital use for people with serious mental illness (SMI). Data Sources Linked administrative data on family practice and hospital utilization by people with SMI in England, 2007‐2014. Study Design This observational cohort study used discrete‐time survival analysis to investigate the relationship between continuity of care in family practice and unplanned hospital use: emergency department (ED) presentations, and unplanned admissions for SMI and ambulatory care‐sensitive conditions (ACSC). The analysis distinguishes between relational continuity and management/ informational continuity (as captured by care plans) and accounts for unobserved confounding by examining deviation from long‐term averages. Data Collection/Extraction Methods Individual‐level family practice administrative data linked to hospital administrative data. Principal Findings Higher relational continuity was associated with 8‐11 percent lower risk of ED presentation and 23‐27 percent lower risk of ACSC admissions. Care plans were associated with 29 percent lower risk of ED presentation, 39 percent lower risk of SMI admissions, and 32 percent lower risk of ACSC admissions. Conclusions Family practice continuity of care can reduce unplanned hospital use for physical and mental health of people with SMI.
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Affiliation(s)
- Jemimah Ride
- Health Economics Unit, Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Vic., Australia
| | | | - Nils Gutacker
- Centre for Health Economics, University of York, York, UK
| | - Tim Doran
- Department of Health Sciences, University of York, York, UK
| | - Nigel Rice
- Centre for Health Economics, University of York, York, UK
| | - Hugh Gravelle
- Centre for Health Economics, University of York, York, UK
| | - Tony Kendrick
- Department of Primary Care, University of Southampton, Southampton, UK
| | - Anne Mason
- Centre for Health Economics, University of York, York, UK
| | - Maria Goddard
- Centre for Health Economics, University of York, York, UK
| | - Najma Siddiqi
- Department of Health Sciences, University of York, York, UK.,Hull York Medical School, York, UK.,Bradford District Care, NHS Foundation Trust, Bradford, UK
| | - Simon Gilbody
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, UK
| | | | - Lauren Aylott
- Health Professions Education Unit, Hull York Medical School, York, UK
| | - Ceri Dare
- Service User, York, North Yorkshire, UK
| | - Rowena Jacobs
- Centre for Health Economics, University of York, York, UK
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van der Lee APM, de Haan L, Beekman ATF. Rising co-payments coincide with unwanted effects on continuity of healthcare for patients with schizophrenia in the Netherlands. PLoS One 2019; 14:e0222046. [PMID: 31513629 PMCID: PMC6742391 DOI: 10.1371/journal.pone.0222046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 08/20/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Co-payments, used to control rising costs of healthcare, may lead to disruption of appropriate outpatient care and to increases in acute crisis treatment or hospital admission in patients with schizophrenia. An abrupt rise in co-payments in 2012 in the Netherlands offered a natural experiment to study the effects of co-payments on continuity of healthcare in schizophrenia. METHODS Retrospective longitudinal registry-based cohort study. Outcome measures were (i) continuity of elective (planned) psychiatric care (outpatient care and/or antipsychotic medication); (ii) acute psychiatric care (crisis treatment and hospital admission); and (iii) somatic care per quarter of the years 2009-2014. RESULTS 10 911 patients with schizophrenia were included. During the six-year follow-up period the level of elective psychiatric outpatient care (-20%); and acute psychiatric care (-37%) decreased. Treatment restricted to antipsychotic medication (without concurrent outpatient psychiatric care) increased (67%). The use of somatic care also increased (24%). Use of acute psychiatric care was highest in quarters when only antipsychotic medication was received. The majority (59%) of patients received continuous elective psychiatric care in 2009-2014. Patients receiving continuous care needed only half the acute psychiatric care needed by patients not in continuous care. On top of these trends time series analysis (ARIMA) showed that the abrupt rise in co-payments from 2012 onwards coincided with significant increases in stand-alone treatment with antipsychotic medication and acute psychiatric care. CONCLUSIONS The use of psychiatric care decreased substantially among a cohort of patients with schizophrenia. The high rise in co-payments from 2012 onwards coincided with significant increases in stand-alone treatment with antipsychotic medication and acute psychiatric care.
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Affiliation(s)
- Arnold P. M. van der Lee
- Department Psychiatry Amsterdam University Medical Centre–location VUmc, Amsterdam, The Netherlands
- * E-mail:
| | - Lieuwe de Haan
- Department Psychiatry Amsterdam University Medical Centre–location AMC, Amsterdam, The Netherlands
| | - Aartjan T. F. Beekman
- Department Psychiatry Amsterdam University Medical Centre–location VUmc, Amsterdam, The Netherlands
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Effects of depression and cognitive impairment on quality of life in older adults with schizophrenia spectrum disorder: Results from a multicenter study. J Affect Disord 2019; 256:164-175. [PMID: 31176189 DOI: 10.1016/j.jad.2019.05.063] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 04/14/2019] [Accepted: 05/27/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Little is known about the respective effects of depression and cognitive impairment on quality of life among older adults with schizophrenia spectrum disorder. METHODS We used data from the Cohort of individuals with Schizophrenia Aged 55-years or more (CSA) study, a large multicenter sample of older adults with schizophrenia or schizoaffective disorder (N = 353). Quality of life (QoL), depression and cognitive impairment were assessed using the Quality of Life Scale (QLS), the Center of Epidemiologic Studies Depression scale and the Mini-Mental State Examination, respectively. We used structural equation modeling to examine the shared and specific effects of depression and cognitive impairment on QoL, while adjusting for sociodemographic characteristics, general medical conditions, psychotropic medications and the duration of the disorder. RESULTS Depression and cognitive impairment were positively associated (r = 0.24, p < 0.01) and both independently and negatively impacted on QoL (standardized β = -0.41 and β = -0.32, both p < 0.01) and on each QLS quality-of-life domains, except for depression on instrumental role and cognitive impairment on interpersonal relations in the sensitivity analyses excluding respondents with any missing data. Effects of depression and cognitive impairment on QoL were not due to specific depressive symptoms or specific cognitive domains, but rather mediated through two broad dimensions representing the shared effects across all depressive symptoms and all cognitive deficits, respectively. LIMITATIONS Because of the cross-sectional design of this study, measures of association do not imply causal associations. CONCLUSIONS Mechanisms underlying these two broad dimensions should be considered as important potential targets to improve quality of life of this vulnerable population.
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Metabolic syndrome among older adults with schizophrenia spectrum disorder: Prevalence and associated factors in a multicenter study. Psychiatry Res 2019; 275:238-246. [PMID: 30933701 DOI: 10.1016/j.psychres.2019.03.036] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 03/21/2019] [Accepted: 03/21/2019] [Indexed: 02/02/2023]
Abstract
Metabolic syndrome and its associated morbidity and mortality have been well documented in adults with schizophrenia. However, data is lacking for their geriatric counterparts. We sought to investigate the frequency of screening and the prevalence of metabolic syndrome in older adults with schizophrenia, as well as its possible correlates, using the Cohort of individuals with schizophrenia Aged 55 years or more study (n = 353). We found that 42.2% (n = 149) of our sample was screened for metabolic syndrome. Almost half of those (n = 77; 51.7%) screened positive according to ATPIII criteria. Hypertension and abdominal obesity were the two most prevalent metabolic abnormalities. Screening was positively associated with male gender and urbanicity, and metabolic syndrome diagnosis was positively associated with cardiovascular disorders and consultation with a general practitioner (all p < 0.05). However, there were no significant associations of metabolic syndrome with socio-demographic or clinical characteristics, psychotropic medications, other medical conditions and other indicators of mental health care utilization. Our findings support that the prevalence of metabolic syndrome among older adults with schizophrenia spectrum disorder is high and screening is crucial mainly in those patients with hypertension and/or abdominal obesity. Factors at play might be different than those in the younger population.
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Yang CP, Wang YY, Lin SY, Hong YJ, Liao KY, Hsieh SK, Pan PH, Chen CJ, Chen WY. Olanzapine Induced Dysmetabolic Changes Involving Tissue Chromium Mobilization in Female Rats. Int J Mol Sci 2019; 20:E640. [PMID: 30717287 PMCID: PMC6387243 DOI: 10.3390/ijms20030640] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 01/28/2019] [Accepted: 01/30/2019] [Indexed: 12/30/2022] Open
Abstract
Atypical antipsychotics, such as olanzapine, are commonly prescribed to patients with schizophrenic symptoms and other psychiatric disorders. However, weight gain and metabolic disturbance cause adverse effects, impair patient compliance and limit clinical utility. Thus, a better understanding of treatment-acquired adverse effects and identification of targets for therapeutic intervention are believed to offer more clinical benefits for patients with schizophrenia. Beyond its nutritional effects, studies have indicated that supplementation of chromium brings about beneficial outcomes against numerous metabolic disorders. In this study, we investigated whether olanzapine-induced weight gain and metabolic disturbance involved chromium dynamic mobilization in a female Sprague-Dawley rat model, and whether a dietary supplement of chromium improved olanzapine-acquired adverse effects. Olanzapine medicated rats experienced weight gain and adiposity, as well as the development of hyperglycemia, hyperinsulinemia, insulin resistance, hyperlipidemia, and inflammation. The olanzapine-induced metabolic disturbance was accompanied by a decrease in hepatic Akt and AMP-activated Protein Kinase (AMPK) actions, as well as an increase in serum interleukin-6 (IL-6), along with tissue chromium depletion. A daily intake of chromium supplements increased tissue chromium levels and thermogenic uncoupling protein-1 (UCP-1) expression in white adipose tissues, as well as improved both post-olanzapine weight gain and metabolic disturbance. Our findings suggest that olanzapine medicated rats showed a disturbance of tissue chromium homeostasis by inducing tissue depletion and urinary excretion. This loss may be an alternative mechanism responsible for olanzapine-induced weight gain and metabolic disturbance.
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Affiliation(s)
- Ching-Ping Yang
- Department of Medical Research, Taichung Veterans General Hospital, Taichung 407, Taiwan.
| | - Ya-Yu Wang
- Department of Family Medicine, Taichung Veterans General Hospital, Taichung 407, Taiwan.
| | - Shih-Yi Lin
- Center for Geriatrics and Gerontology, Taichung Veterans General Hospital, Taichung 407, Taiwan.
| | - Yi-Jheng Hong
- Department of Veterinary Medicine, National Chung Hsing University, Taichung 402, Taiwan.
| | - Keng-Ying Liao
- Department of Veterinary Medicine, National Chung Hsing University, Taichung 402, Taiwan.
| | - Sheng-Kuo Hsieh
- Graduate Institute of Biotechnology, National Chung Hsing University, Taichung 402, Taiwan.
| | - Ping-Ho Pan
- Department of Veterinary Medicine, National Chung Hsing University, Taichung 402, Taiwan.
- Department of Pediatrics, Tungs' Taichung Metro Harbor Hospital, Taichung 435, Taiwan.
| | - Chun-Jung Chen
- Department of Medical Research, Taichung Veterans General Hospital, Taichung 407, Taiwan.
- Department of Medical Laboratory Science and Biotechnology, China Medical University, Taichung 447, Taiwan.
| | - Wen-Ying Chen
- Department of Veterinary Medicine, National Chung Hsing University, Taichung 402, Taiwan.
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Fernandes S, Fond G, Zendjidjian X, Michel P, Baumstarck K, Lancon C, Berna F, Schurhoff F, Aouizerate B, Henry C, Etain B, Samalin L, Leboyer M, Llorca PM, Coldefy M, Auquier P, Boyer L. The Patient-Reported Experience Measure for Improving qUality of care in Mental health (PREMIUM) project in France: study protocol for the development and implementation strategy. Patient Prefer Adherence 2019; 13:165-177. [PMID: 30718945 PMCID: PMC6345324 DOI: 10.2147/ppa.s172100] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Measuring the quality and performance of health care is a major challenge in improving the efficiency of a health system. Patient experience is one important measure of the quality of health care, and the use of patient-reported experience measures (PREMs) is recommended. The aims of this project are 1) to develop item banks of PREMs that assess the quality of health care for adult patients with psychiatric disorders (schizophrenia, bipolar disorder, and depression) and to validate computerized adaptive testing (CAT) to support the routine use of PREMs; and 2) to analyze the implementation and acceptability of the CAT among patients, professionals, and health authorities. METHODS This multicenter and cross-sectional study is based on a mixed method approach, integrating qualitative and quantitative methodologies in two main phases: 1) item bank and CAT development based on a standardized procedure, including conceptual work and definition of the domain mapping, item selection, calibration of the item bank and CAT simulations to elaborate the administration algorithm, and CAT validation; and 2) a qualitative study exploring the implementation and acceptability of the CAT among patients, professionals, and health authorities. DISCUSSION The development of a set of PREMs on quality of care in mental health that overcomes the limitations of previous works (ie, allowing national comparisons regardless of the characteristics of patients and care and based on modern testing using item banks and CAT) could help health care professionals and health system policymakers to identify strategies to improve the quality and efficiency of mental health care. TRIAL REGISTRATION NCT02491866.
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Affiliation(s)
- Sara Fernandes
- Aix-Marseille University, School of Medicine, CEReSS - Health Service Research and Quality of Life Center - EA 3279 Research Unit, Marseille, France, Email
| | - Guillaume Fond
- Aix-Marseille University, School of Medicine, CEReSS - Health Service Research and Quality of Life Center - EA 3279 Research Unit, Marseille, France, Email
| | - Xavier Zendjidjian
- Aix-Marseille University, School of Medicine, CEReSS - Health Service Research and Quality of Life Center - EA 3279 Research Unit, Marseille, France, Email
| | - Pierre Michel
- Aix-Marseille University, School of Medicine, CEReSS - Health Service Research and Quality of Life Center - EA 3279 Research Unit, Marseille, France, Email
| | - Karine Baumstarck
- Aix-Marseille University, School of Medicine, CEReSS - Health Service Research and Quality of Life Center - EA 3279 Research Unit, Marseille, France, Email
| | - Christophe Lancon
- Aix-Marseille University, School of Medicine, CEReSS - Health Service Research and Quality of Life Center - EA 3279 Research Unit, Marseille, France, Email
| | | | | | | | | | | | | | | | | | - Magali Coldefy
- Institute for Research and Information in Health Economics (IRDES), Paris, France
| | - Pascal Auquier
- Aix-Marseille University, School of Medicine, CEReSS - Health Service Research and Quality of Life Center - EA 3279 Research Unit, Marseille, France, Email
| | - Laurent Boyer
- Aix-Marseille University, School of Medicine, CEReSS - Health Service Research and Quality of Life Center - EA 3279 Research Unit, Marseille, France, Email
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Baune BT, Christensen MC. Differences in Perceptions of Major Depressive Disorder Symptoms and Treatment Priorities Between Patients and Health Care Providers Across the Acute, Post-Acute, and Remission Phases of Depression. Front Psychiatry 2019; 10:335. [PMID: 31178765 PMCID: PMC6537882 DOI: 10.3389/fpsyt.2019.00335] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 04/29/2019] [Indexed: 11/15/2022] Open
Abstract
Limited data exist on concordance between patients' and health care providers' (HCPs) perceptions regarding symptoms of major depressive disorder (MDD) and treatment priorities, particularly across disease phases. This study examined concordance during the acute, post-acute, and remission phases of MDD. In an online survey, 2,008 patients responded based on their experience with MDD, and 1,046 HCPs responded based on their clinical experience treating patients with MDD. Questions included symptom frequency and severity, treatment priorities, and impact on psychosocial functioning. Patients reported more frequently mood, physical, and cognitive symptoms than HCPs in the post-acute and remission phases and greater impact on psychosocial functioning. Patients reported that all these symptoms require high treatment priority across the phases of MDD, generally to a greater extent than HCPs. Patients also gave high emphasis to addressing impairment in psychosocial functioning early in the treatment course. A substantial difference in the effectiveness of treating symptoms of MDD between patients and HCPs was observed. This is the first study to quantify, broadly, differences in perceptions of MDD symptom prevalence, severity, and treatment priorities across MDD phases, and the study findings highlight a need for improved communication between patients and HCPs about symptoms, their impact on psychosocial functioning, and treatment priorities across phases.
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Affiliation(s)
- Bernhard T Baune
- Department of Psychiatry and Psychotherapy, University of Münster, Münster, Germany.,Department of Psychiatry, Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia.,Discipline of Psychiatry, Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
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Fefeu M, De Maricourt P, Cachia A, Hoertel N, Vacheron MN, Wehbe E, Rieu C, Olie JP, Krebs MO, Gaillard R, Plaze M. One-year mirror-image study of the impact of olanzapine long-acting injection on healthcare resource utilization and costs in severe schizophrenia. Psychiatry Res 2018; 270:205-210. [PMID: 30267984 DOI: 10.1016/j.psychres.2018.09.041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 08/27/2018] [Accepted: 09/18/2018] [Indexed: 12/31/2022]
Abstract
Olanzapine long-acting injections (OLAIs) are often prescribed to patients with severe schizophrenia who are typically excluded from randomized clinical trials. To date, no mirror-image study has examined the impact of OLAIs on healthcare resource utilizations in these patients. We conducted a retrospective, one-year mirror-image study of OLAIs on 40 patients with severe schizophrenic disorder. Illness severity was defined by failure to respond to two sequential antipsychotics. Outcomes included: (i) healthcare resource utilizations via hospitalization admissions, bed days, outpatient visits, and inpatient service costs computations (ii) clinical efficacy through changes in the Brief Psychiatric Rating Scale (BPRS) and in the Clinical Global Impression-Schizophrenia Scale (CGI-SCH), and (iii) adverse effects. After one year, OLAIs were associated with significant decreases of 65.7%, 86.2% and 86.2% in hospitalization admissions, bed days, and inpatient service costs respectively. A significant mean change of -0.47 and -0.63 was determined the BPRS and the CGI-SCH scores, respectively. There were no significant differences in the number of outpatient visits and adverse effects, except for post-injection sedation/delirium syndrome whose incidence was 0.30% per injection. This mirror-image study provides the first evidence that prescribing OLAIs reduces in a cost-effective manner average bed days and hospital admissions in patients with severe schizophrenia.
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Affiliation(s)
- Mylène Fefeu
- Centre Hospitalier Sainte-Anne, Service Hospitalo-Universitaire, Paris, France; Centre de Psychiatrie et Neurosciences, INSERM UMR 894, CNRS, France; Institut de Psychiatrie (GDR 3557), Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France.
| | - Pierre De Maricourt
- Centre de Psychiatrie et Neurosciences, INSERM UMR 894, CNRS, France; Institut de Psychiatrie (GDR 3557), Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Centre Hospitalier Sainte-Anne, Secteur 15, Paris, France
| | - Arnaud Cachia
- Centre de Psychiatrie et Neurosciences, INSERM UMR 894, CNRS, France; Institut de Psychiatrie (GDR 3557), Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Laboratory for the Psychology of Child Development and Education, CNRS, UMR 8240, Sorbonne, Paris, France & Institut Universitaire de France, Paris, France
| | - Nicolas Hoertel
- Centre de Psychiatrie et Neurosciences, INSERM UMR 894, CNRS, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Assistance Publique-Hôpitaux de Paris (APHP), Corentin-Celton Hospital, Department of Psychiatry, Issy-les-Moulineaux, France
| | | | - Elie Wehbe
- Centre Hospitalier Sainte-Anne, Secteur 13, Paris, France
| | - Christine Rieu
- Centre Hospitalier Sainte-Anne, Pharmacie, Paris, France
| | - Jean-Pierre Olie
- Centre Hospitalier Sainte-Anne, Service Hospitalo-Universitaire, Paris, France; Centre de Psychiatrie et Neurosciences, INSERM UMR 894, CNRS, France; Institut de Psychiatrie (GDR 3557), Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Marie-Odile Krebs
- Centre Hospitalier Sainte-Anne, Service Hospitalo-Universitaire, Paris, France; Centre de Psychiatrie et Neurosciences, INSERM UMR 894, CNRS, France; Institut de Psychiatrie (GDR 3557), Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Raphaël Gaillard
- Centre Hospitalier Sainte-Anne, Service Hospitalo-Universitaire, Paris, France; Centre de Psychiatrie et Neurosciences, INSERM UMR 894, CNRS, France; Institut de Psychiatrie (GDR 3557), Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Marion Plaze
- Centre Hospitalier Sainte-Anne, Service Hospitalo-Universitaire, Paris, France; Centre de Psychiatrie et Neurosciences, INSERM UMR 894, CNRS, France; Institut de Psychiatrie (GDR 3557), Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France
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Kim W, Jang SY, Lee TH, Lee JE, Park EC. Association between continuity of care and subsequent hospitalization and mortality in patients with mood disorders: Results from the Korea National Health Insurance cohort. PLoS One 2018; 13:e0207740. [PMID: 30452465 PMCID: PMC6242689 DOI: 10.1371/journal.pone.0207740] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 11/06/2018] [Indexed: 11/18/2022] Open
Abstract
Concerns have been raised about the loss of treatment continuity in unipolar and bipolar depressive disorder patients as continuity of care (COC) may be associated with patient outcomes. This study aimed to examine the relationship between COC and subsequent hospitalization, all-cause mortality, and suicide mortality in individuals with unipolar and bipolar disorder. Data were from the National Health Insurance (NHI) cohort, 2002 to 2013. Study participants included individuals first diagnosed with unipolar depressive disorder or bipolar affective disorder. The independent variable was COC for the first year of outpatient visits after diagnosis, measured using the usual provider of care (UPC) index. The dependent variables were hospitalization in the year after COC measurement, all-cause mortality, and suicide mortality. Analysis was conducted using logistic regression and Cox proportional hazards survival regression. A total of 48,558 individuals were analyzed for hospitalization and 48,947 for all-cause and suicide mortality. Compared to the low COC group, the medium [odds ratio (OR) 0.30, 95 percent confidence interval (95% CI) 0.19–0.47] and the high COC group (OR 0.14, 95% CI 0.09–0.21) showed statistically significant decreased odds of hospitalization. Additionally, lower likelihoods of suicide death were found in the high (HR 0.35, 95% CI 0.16–0.74) compared to the low COC group. The results infer an association between COC after first diagnosis of unipolar or bipolar depressive disorder and hospitalization and suicide mortality, suggesting the potential importance of treatment continuity in improving patient outcomes.
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Affiliation(s)
- Woorim Kim
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Suk-Yong Jang
- Department of Preventive Medicine, Eulji University College of Medicine, Daejeon, Republic of Korea
| | - Tae-Hoon Lee
- Health Insurance Review and Assessment Service, Wonju, Republic of Korea
| | - Joo Eun Lee
- Ajou University School of Medicine, Suwon, Gyeonggi-do, Republic of Korea
| | - Eun-Cheol Park
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- * E-mail:
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Pereira Gray DJ, Sidaway-Lee K, White E, Thorne A, Evans PH. Continuity of care with doctors-a matter of life and death? A systematic review of continuity of care and mortality. BMJ Open 2018; 8:e021161. [PMID: 29959146 PMCID: PMC6042583 DOI: 10.1136/bmjopen-2017-021161] [Citation(s) in RCA: 357] [Impact Index Per Article: 59.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 03/15/2018] [Accepted: 04/20/2018] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE Continuity of care is a long-standing feature of healthcare, especially of general practice. It is associated with increased patient satisfaction, increased take-up of health promotion, greater adherence to medical advice and decreased use of hospital services. This review aims to examine whether there is a relationship between the receipt of continuity of doctor care and mortality. DESIGN Systematic review without meta-analysis. DATA SOURCES MEDLINE, Embase and the Web of Science, from 1996 to 2017. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Peer-reviewed primary research articles, published in English which reported measured continuity of care received by patients from any kind of doctor, in any setting, in any country, related to measured mortality of those patients. RESULTS Of the 726 articles identified in searches, 22 fulfilled the eligibility criteria. The studies were all cohort or cross-sectional and most adjusted for multiple potential confounding factors. These studies came from nine countries with very different cultures and health systems. We found such heterogeneity of continuity and mortality measurement methods and time frames that it was not possible to combine the results of studies. However, 18 (81.8%) high-quality studies reported statistically significant reductions in mortality, with increased continuity of care. 16 of these were with all-cause mortality. Three others showed no association and one demonstrated mixed results. These significant protective effects occurred with both generalist and specialist doctors. CONCLUSIONS This first systematic review reveals that increased continuity of care by doctors is associated with lower mortality rates. Although all the evidence is observational, patients across cultural boundaries appear to benefit from continuity of care with both generalist and specialist doctors. Many of these articles called for continuity to be given a higher priority in healthcare planning. Despite substantial, successive, technical advances in medicine, interpersonal factors remain important. PROSPERO REGISTRATION NUMBER CRD42016042091.
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Affiliation(s)
| | | | - Eleanor White
- St Leonard's Practice, Exeter, UK
- Medical School, University of Exeter, Exeter, UK
| | - Angus Thorne
- St Leonard's Practice, Exeter, UK
- Medical School, University of Manchester, Manchester, UK
| | - Philip H Evans
- St Leonard's Practice, Exeter, UK
- Medical School, University of Exeter, Exeter, UK
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Mortality in people with mental disorders in the Czech Republic: a nationwide, register-based cohort study. LANCET PUBLIC HEALTH 2018; 3:e289-e295. [DOI: 10.1016/s2468-2667(18)30077-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 04/02/2018] [Accepted: 04/09/2018] [Indexed: 02/01/2023]
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Geoffroy PA, Hoertel N, Etain B, Bellivier F, Delorme R, Limosin F, Peyre H. Insomnia and hypersomnia in major depressive episode: Prevalence, sociodemographic characteristics and psychiatric comorbidity in a population-based study. J Affect Disord 2018; 226:132-141. [PMID: 28972930 DOI: 10.1016/j.jad.2017.09.032] [Citation(s) in RCA: 133] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 07/15/2017] [Accepted: 09/23/2017] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To examine (i) the frequency of different sleep complaints (early wake-up, trouble falling asleep, hypersomnia) and their co-occurrence and (ii) the sociodemographic characteristics and psychiatric comorbidity associated with each type of sleep profiles. METHODS Data were drawn from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions, a nationally representative survey of the US adult population (wave 1, 2001-2002; wave 2, 2004-2005). The primary analyses were limited to 3573 participants who had a DSM-IV-TR diagnosis of major depressive episode (MDE) between the two waves. We used a multiple regression model to estimate the strength of independent associations between self-reported sleep complaints, sociodemographic characteristics and lifetime psychiatric comorbidity. RESULTS Most of participants with MDE (92%) reported significant sleep complaints, from whom 85.2% had insomnia and 47.5% hypersomnia symptoms. The prevalence rates were for insomnia "only" of 48.5%, hypersomnia "only" of 13.7%, and their co-occurrence of 30.2%. We found that several sociodemographic characteristics (gender, age, education, individual and familial income, marital status) and psychiatric disorders (bipolar disorders, post-traumatic disorders and panic disorder) were significantly and independently associated with different sleep profiles. The co-occurrence of insomnia (especially early wake-up) and hypersomnia presented with a two-/three- fold increase risk of bipolar disorders. LIMITATIONS Definitions of sleep complaints were qualitative and subjective. CONCLUSION Sleep complaints are prevalent and heterogeneous in expression during MDE. Sleep disturbance profiles are associated with specific patterns of comorbidity. Our findings highlight the importance of continued research on sleep complaints during MDE while taking into account psychiatric comorbidity.
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Affiliation(s)
- Pierre A Geoffroy
- Inserm, U1144, Paris F-75006, France; Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1144, Paris F-75013, France; AP-HP, GH Saint-Louis - Lariboisière - F. Widal, Département de Psychiatrie et de Médecine Addictologique, 75475 Paris cedex 10, France; Fondation FondaMental, Créteil 94000, France.
| | - Nicolas Hoertel
- Assistance Publique-Hôpitaux de Paris (APHP), Corentin Celton Hospital, Department of Psychiatry, 92130 Issy-les-Moulineaux, France; INSERM UMR 894, Psychiatry and Neurosciences Center; Paris Descartes University, PRES Sorbonne Paris Cité, Paris, France; Paris Descartes University, PRES Sorbonne Paris Cité, Paris, France
| | - Bruno Etain
- Inserm, U1144, Paris F-75006, France; Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1144, Paris F-75013, France; AP-HP, GH Saint-Louis - Lariboisière - F. Widal, Département de Psychiatrie et de Médecine Addictologique, 75475 Paris cedex 10, France; Fondation FondaMental, Créteil 94000, France
| | - Frank Bellivier
- Inserm, U1144, Paris F-75006, France; Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1144, Paris F-75013, France; AP-HP, GH Saint-Louis - Lariboisière - F. Widal, Département de Psychiatrie et de Médecine Addictologique, 75475 Paris cedex 10, France; Fondation FondaMental, Créteil 94000, France
| | - Richard Delorme
- Assistance Publique-Hôpitaux de Paris, Robert Debré Hospital, Child and Adolescent Psychiatry Department, Paris, France
| | - Frédéric Limosin
- Assistance Publique-Hôpitaux de Paris (APHP), Corentin Celton Hospital, Department of Psychiatry, 92130 Issy-les-Moulineaux, France; INSERM UMR 894, Psychiatry and Neurosciences Center; Paris Descartes University, PRES Sorbonne Paris Cité, Paris, France; Paris Descartes University, PRES Sorbonne Paris Cité, Paris, France
| | - Hugo Peyre
- Assistance Publique-Hôpitaux de Paris, Robert Debré Hospital, Child and Adolescent Psychiatry Department, Paris, France; Cognitive Sciences and Psycholinguistic Laboratory, Ecole Normale Supérieure, Paris, France
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