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Arnautovska U, Trott M, Vitangcol KJ, Milton A, Brown E, Warren N, Leucht S, Firth J, Siskind D. Efficacy of User Self-Led and Human-Supported Digital Health Interventions for People With Schizophrenia: A Systematic Review and Meta-Analysis. Schizophr Bull 2024:sbae143. [PMID: 39340312 DOI: 10.1093/schbul/sbae143] [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] [Indexed: 09/30/2024]
Abstract
BACKGROUND Digital health interventions (DHIs) may enable low cost, scalable improvements in the quality of care for adults with schizophrenia. Given the fast-growing number of studies using these tools, this review aimed to assess the efficacy and feasibility of randomized controlled trials (RCTs) of DHIs among people with schizophrenia, focusing on human support. DESIGN A systematic search of PubMed, Embase, PsycINFO, CINAHL, Web of Science, and Cochrane databases was conducted in January 2024 to identify relevant RCTs. Random effects meta-analyses were undertaken to evaluate the effects on psychosis symptoms, cognition, and other health-related outcomes. RESULTS Twenty-six RCTs (n = 2481 participants) were included. Pooled recruitment and retention rates were 57.4% and 87.6%, respectively. DHIs showed no statistically significant effect sizes across all examined outcomes, including psychosis symptoms, depression, quality of life, global and social cognition, global and social functioning, and medication adherence. A third (34.6%) of DHIs were developed using co-design while the majority (70%) personalized the intervention to its users and 69.2% were deemed to be at high risk of bias. There were trends toward effects in favor of DHIs with human support for social cognition and quality of life. CONCLUSIONS DHIs are feasible for people with schizophrenia and potentially useful for improving health outcomes, particularly when including human support. More high-quality studies are required to examine the benefits of human support within DHIs. Future research should examine the feasibility of sustained adherence and benefits from digital interventions, possibly incorporating human interaction complemented with artificial intelligence, in real-world clinical settings.
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Affiliation(s)
- Urska Arnautovska
- Medical School, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Addiction and Mental Health Service, Metro South Health, Brisbane, QLD, Australia
- Queensland Centre for Mental Health Research, Wacol, QLD, Australia
| | - Mike Trott
- Medical School, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Queensland Centre for Mental Health Research, Wacol, QLD, Australia
| | | | - Alyssa Milton
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Ellie Brown
- Orygen The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia
| | - Nicola Warren
- Medical School, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Addiction and Mental Health Service, Metro South Health, Brisbane, QLD, Australia
- Queensland Centre for Mental Health Research, Wacol, QLD, Australia
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, TUM School of Medicine and Health, Technical University of Munich, München, Germany
| | - Joseph Firth
- Division of Psychology and Mental Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Dan Siskind
- Medical School, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Addiction and Mental Health Service, Metro South Health, Brisbane, QLD, Australia
- Queensland Centre for Mental Health Research, Wacol, QLD, Australia
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de Oliveira C, Mason J, Luu L, Iwajomo T, Simbulan F, Kurdyak P, Pechlivanoglou P. The PSY-SIM Model: Using Real-World Data to Inform Health Care Policy for Individuals With Chronic Psychotic Disorders. Schizophr Bull 2024; 50:1094-1103. [PMID: 38104255 PMCID: PMC11349024 DOI: 10.1093/schbul/sbad175] [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] [Indexed: 12/19/2023]
Abstract
BACKGROUND AND HYPOTHESIS Few microsimulation models have been developed for chronic psychotic disorders, severe and disabling mental disorders associated with poor medical and psychiatric outcomes, and high costs of care. The objective of this work was to develop a microsimulation model for individuals with chronic psychotic disorders and to use the model to examine the impact of a smoking cessation initiative on patient outcomes. STUDY DESIGN Using health records and survey data from Ontario, Canada, the PSY-SIM model was developed to simulate health and cost outcomes of individuals with chronic psychotic disorders. The model was then used to examine the impact of the Smoking Treatment for Ontario Patients (STOP) program from Ontario on the development of chronic conditions, life expectancy, quality of life, and lifetime health care costs. STUDY RESULTS Individuals with chronic psychotic disorders had a lifetime risk of 63% for congestive heart failure and roughly 50% for respiratory disease, cancer and diabetes, and a life expectancy of 76 years. The model suggests the STOP program can reduce morbidity and lead to survival and quality of life gains with modest increases in health care costs. At a long-term quit rate of 4.4%, the incremental cost-effectiveness ratio of the STOP program was $41,936/QALY compared with status quo. CONCLUSIONS Smoking cessation initiatives among individuals with chronic psychotic disorders can be cost-effective. These findings will be relevant for decision-makers and clinicians looking to improving health outcomes among this patient population.
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Affiliation(s)
- Claire de Oliveira
- Institute for Mental Health Policy Research and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Joyce Mason
- Institute for Mental Health Policy Research and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Linda Luu
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Tomisin Iwajomo
- Institute for Mental Health Policy Research and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Frances Simbulan
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Paul Kurdyak
- Institute for Mental Health Policy Research and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Petros Pechlivanoglou
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
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Kapral MK, Porter J, Kurdyak P, Yu AYX, Matheson E, Fang J, Casaubon LK, Kapoor E, Sheehan KA. Secondary Stroke Prevention in People With Schizophrenia. J Am Heart Assoc 2024; 13:e035589. [PMID: 39056334 DOI: 10.1161/jaha.124.035589] [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: 04/27/2024] [Accepted: 06/12/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND People with schizophrenia are less likely than those without to be treated for cardiovascular disease. We aimed to evaluate the association between schizophrenia and secondary preventive care after ischemic stroke. METHODS AND RESULTS In this retrospective cohort study, we used linked population-based administrative data to identify adults who survived 1 year after ischemic stroke hospitalization in Ontario, Canada between 2004 and 2017. Outcomes were screening, treatment, and control of risk factors, and receipt of outpatient physician services. We used modified Poisson regression to model the relative risk of each outcome among people with and without schizophrenia, adjusting for age and other factors. Among 81 163 people with ischemic stroke, 844 (1.04%) had schizophrenia. Schizophrenia was associated with lower rates of screening for hyperlipidemia (60.5% versus 66.0%, adjusted relative risk [aRR] 0.88 [95% CI, 0.84-0.93]) and diabetes (69.4% versus 73.9%, aRR 0.93 [95% CI, 0.89-0.97]), prescription of antihypertensive medications (91.2% versus 94.7%, aRR 0.96 [95% CI, 0.93-0.99]), achievement of target lipid levels (low-density lipoprotein <2 mmol/L) (30.6% versus 34.6%, aRR 0.86 [95% CI, 0.78-0.96]), and outpatient specialist visits (55.3% versus 67.8%, aRR 0.78 [95% CI, 0.74-0.83]) or primary care physician visits (94.5% versus 98.5%; aRR 0.96 [95% CI, 0.95-0.98]) within 1 year. There were no differences in prescription of antilipemic, antiglycemic, or anticoagulant medications, or in achievement of target hemoglobin A1c ≤7%. CONCLUSIONS People with stroke and schizophrenia are less likely than those without to receive secondary preventive care. This may inform interventions to improve poststroke care and outcomes in those with schizophrenia.
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Affiliation(s)
- Moira K Kapral
- Department of Medicine, Division of General Internal Medicine University of Toronto Canada
- ICES Toronto Canada
- Department of Medicine, Division of Neurology University of Toronto Canada
| | | | - Paul Kurdyak
- ICES Toronto Canada
- Department of Medicine, Division of Neurology University of Toronto Canada
- Department of Psychiatry University of Toronto Canada
| | - Amy Y X Yu
- ICES Toronto Canada
- Department of Medicine, Division of Neurology University of Toronto Canada
- Division of Neurology, Department of Medicine University of Toronto Canada
| | - Emilie Matheson
- Faculty of Arts and Science Queen's University Kingston Ontario Canada
| | | | - Leanne K Casaubon
- Division of Neurology, Department of Medicine University of Toronto Canada
| | - Eshita Kapoor
- Department of Medicine, Division of General Internal Medicine University of Toronto Canada
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Nagy DK, Bresee LC, Eurich DT, Simpson SH. Are Guideline-concordant Processes of Care Consistent Across the Rural-Urban Continuum? A Retrospective Cohort Study of Adults Newly Treated for Type 2 Diabetes. Can J Diabetes 2024; 48:322-329.e5. [PMID: 38583767 DOI: 10.1016/j.jcjd.2024.03.007] [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: 11/07/2023] [Revised: 03/07/2024] [Accepted: 03/27/2024] [Indexed: 04/09/2024]
Abstract
OBJECTIVES Our aim in this study was to identify the association between place of residence (metropolitan, urban, rural) and guideline-concordant processes of care in the first year of type 2 diabetes management. METHODS We conducted a retrospective cohort study of new metformin users between April 2015 and March 2020 in Alberta, Canada. Outcomes were identified as guideline-concordant processes of care through the review of clinical practice guidelines and published literature. Using multivariable logistic regression, the following outcomes were examined by place of residence: dispensation of a statin, angiotensin-converting enzyme inhibitor (ACEi) or angiotensin II receptor blocker (ARB), eye examination, glycated hemoglobin (A1C), cholesterol, and kidney function testing. RESULTS Of 60,222 new metformin users, 67% resided in a metropolitan area, 10% in an urban area, and 23% in a rural area. After confounder adjustment, rural residents were less likely to have a statin dispensed (adjusted odds ratio [aOR] 0.83, 95% confidence interval [CI] 0.79 to 0.87) or undergo cholesterol testing (aOR 0.86, 95% CI 0.83 to 0.90) when compared with metropolitan residents. In contrast, rural residents were more likely to receive A1C and kidney function testing (aOR 1.14, 95% CI 1.08 to 1.21 and aOR 1.17, 95% CI 1.11 to 1.24, respectively). ACEi/ARB use and eye examinations were similar across place of residence. CONCLUSIONS Processes of care varied by place of residence. Limited cholesterol management in rural areas is concerning because this may lead to increased cardiovascular outcomes.
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Affiliation(s)
- Danielle K Nagy
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Lauren C Bresee
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Dean T Eurich
- School of Public Health, Li Ka Shing Centre for Research, University of Alberta, Edmonton, Alberta, Canada
| | - Scot H Simpson
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada.
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Liao CH, Chang CS, Kung PT, Chou WY, Tsai WC. Stroke and suicide among people with severe mental illnesses. Sci Rep 2024; 14:4991. [PMID: 38424228 PMCID: PMC10904760 DOI: 10.1038/s41598-024-55564-x] [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: 06/29/2023] [Accepted: 02/25/2024] [Indexed: 03/02/2024] Open
Abstract
The associations between people with severe mental illnesses (SMI) and the risks of stroke, suicide, and death remain unclear. We examined healthcare service usage among adults with and without SMI and explored the risk of stroke, suicide, and death. We divided 18-80-year-old adults with SMI into catastrophic and non-catastrophic illness groups. These groups were subjected to a 1:5:5 propensity score matching with people without SMI. Data on demographic characteristics, economic factors, environmental factors, comorbid conditions, self-injury behavior, the number of outpatients and ED visits, and hospitalization were collected. The primary outcomes were risks of stroke, suicide, and death. We included 19,570 people with catastrophic SMI, 97,850 with non-catastrophic SMI, and 97,850 controls. Patients with SMI, especially those with catastrophic illnesses, had higher stroke risk, suicide, and death than those without SMI. People with SMI used health services more frequently than those without SMI. Patients with a history of hospitalization or ED access had a higher risk of stroke, suicide, and death. Our data indicate that special attention should be given to patients with SMI, particularly those with a history of healthcare service utilization, such as through more extended hospital stays with high-intensity interventions.
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Affiliation(s)
- Chun-Hui Liao
- Department of Psychiatry, China Medical University Hospital, Taichung, Taiwan
- College of Medicine, China Medical University, Taichung, Taiwan
| | - Chen-Shu Chang
- Department of Neurology, Vascular and Genomic Research Center, Changhua Christian Hospital, Changhua, Taiwan
- Department of Medical Laboratory Science and Biotechnology, Central-Taiwan University of Science and Technology, Taichung, Taiwan
| | - Pei-Tseng Kung
- Department of Healthcare Administration, Asia University, Taichung, Taiwan
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Wen-Yu Chou
- Department of Health Services Administration, China Medical University, No. 100, Sec. 1, Jingmao Rd., Beitun Dist., Taichung, 406040, Taiwan
| | - Wen-Chen Tsai
- Department of Health Services Administration, China Medical University, No. 100, Sec. 1, Jingmao Rd., Beitun Dist., Taichung, 406040, Taiwan.
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O’Neill B, Yusuf A, Lofters A, Huang A, Ekeleme N, Kiran T, Greiver M, Sullivan F, Kurdyak P. Breast Cancer Screening Among Females With and Without Schizophrenia. JAMA Netw Open 2023; 6:e2345530. [PMID: 38019514 PMCID: PMC10687664 DOI: 10.1001/jamanetworkopen.2023.45530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 10/19/2023] [Indexed: 11/30/2023] Open
Abstract
Importance Breast cancer screening with mammography is recommended in Ontario, Canada, for females 50 years or older. Females with schizophrenia are at higher risk of breast cancer, but in Ontario it is currently unknown whether breast cancer screening completion differs between those with vs without schizophrenia and whether primary care payment models are a factor. Objective To compare breast cancer screening completion within 2 years after the 50th birthday among females with and without schizophrenia, and to identify the association between breast cancer screening completion and different primary care payment models. Design, Setting, and Participants This case-control study analyzed Ontario-wide administrative data on females with and without schizophrenia who turned 50 years of age between January 1, 2010, and December 31, 2019. Those with schizophrenia (cases) were matched 1:10 to those without schizophrenia (controls) on local health integration network, income quintile, rural residence, birth dates, and weighted Aggregated Diagnosis Group score. Data analysis was performed from November 2021 to February 2023. Exposures Exposures were schizophrenia and primary care payment models. Main Outcomes and Measures Outcomes included breast cancer screening completion among cases and controls within 2 years after their 50th birthday and the association with receipt of care from primary care physicians enrolled in different primary care payment models, which were analyzed using logistic regression and reported as odds ratios (ORs) and 95% CIs. Results The study included 11 631 females with schizophrenia who turned 50 years of age during the study period and a matched cohort of 115 959 females without schizophrenia, for a total of 127 590 patients. Overall, 69.3% of cases and 77.1% of controls had a mammogram within 2 years after their 50th birthday. Cases had lower odds of breast cancer screening completion within 2 years after their 50th birthday (OR, 0.67; 95% CI, 0.64-0.70). Cases who received care from a primary care physician in a fee-for-service (OR, 0.57; 95% CI, 0.53-0.60) or enhanced fee-for-service (OR, 0.79; 95% CI, 0.75-0.82) payment model had lower odds of having a mammogram than cases whose physicians were paid under a Family Health Team model. Conclusions and Relevance This case-control study found that, in Ontario, Canada, breast cancer screening completion was lower among females with schizophrenia, and differences from those without schizophrenia may partially be explained by differences in primary care payment models. Widening the availability of team-based primary care for females with schizophrenia may play a role in increased breast cancer screening rates.
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Affiliation(s)
- Braden O’Neill
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Unity Health Toronto, Ontario, Canada
- Department of Family and Community Medicine, St Michael’s Hospital, Toronto, Ontario, Canada
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Abban Yusuf
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Unity Health Toronto, Ontario, Canada
| | - Aisha Lofters
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
- Women’s College Research Institute, Toronto, Ontario, Canada
| | | | - Ngozi Ekeleme
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Unity Health Toronto, Ontario, Canada
| | - Tara Kiran
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Unity Health Toronto, Ontario, Canada
- Department of Family and Community Medicine, St Michael’s Hospital, Toronto, Ontario, Canada
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Michelle Greiver
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
- Department of Family and Community Medicine, North York General Hospital, Toronto, Ontario, Canada
| | - Frank Sullivan
- School of Medicine, Sir James Mackenzie Institute for Early Diagnosis, Population and Behavioural Science Division, University of St Andrews, St Andrews, Scotland
| | - Paul Kurdyak
- ICES, Toronto, Ontario, Canada
- Institute for Mental Health Policy Research and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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Tzeng WC, Tai YM, Feng HP, Lin CH, Chang YC. Diabetes self-care behaviours among people diagnosed with serious mental illness: A cross-sectional correlational study. J Psychiatr Ment Health Nurs 2023. [PMID: 37902110 DOI: 10.1111/jpm.12993] [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: 03/21/2023] [Revised: 09/13/2023] [Accepted: 10/09/2023] [Indexed: 10/31/2023]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: People diagnosed with serious mental illness have a high risk of diabetes and are more likely to develop type 2 diabetes at ages below 60 years. Effective diabetes self-care behaviours among people diagnosed with serious mental illness can improve glycaemic control and reduce vascular complications. Few studies have investigated diabetes self-care behaviours and their associations with health literacy and self-efficacy in people diagnosed with serious mental illness. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Diabetes self-care behaviours in people diagnosed with serious mental illness were suboptimal; the least frequently performed self-care activities were self-monitoring of blood glucose. Factors associated with diabetes self-care behaviours are gender, age, communicative and critical health literacy and self-efficacy. Self-efficacy is the strongest predictor of self-care behaviours among people diagnosed with comorbid serious mental illness and type 2 diabetes. WHAT ARE THE IMPLICATIONS OF PRACTICE?: Mental health nurses should assess diabetes-specific health literacy of people diagnosed with serious mental illness to ensure that they possess the knowledge and skills related to diabetes self-care. When treating young people and those with newly diagnosed type 2 diabetes, nurses should incorporate strategies to minimise their perceptions of diabetes-related distress and increase their confidence in managing comorbid diabetes. ABSTRACT: Introduction People diagnosed with serious mental illness (SMI) experience greater challenges in managing their type 2 diabetes mellitus (T2DM) than do those diagnosed with T2DM alone. Aim This study investigated diabetes self-care activities and the factors associated with these activities in people diagnosed with SMI in a hospital setting. Methods A cross-sectional correlational study was conducted among 126 people diagnosed with comorbid SMI and T2DM in Taipei, Taiwan, between October 2020 and April 2021. Data were collected using self-report questionnaires and a chart review. Three-step hierarchical multiple regression analysis was used to identify factors associated with diabetes self-care behaviours. Results Diabetes self-care behaviours in people diagnosed with SMI were suboptimal overall. Hierarchical multiple regression analyses revealed that age (β = 0.18, p = .037) and self-efficacy (β = 0.27, p = .004) significantly associated with diabetes self-care behaviours. Discussion Self-efficacy is the strongest predictor of self-care behaviours among people diagnosed with comorbid SMI and T2DM. Implications for Practice Mental health professionals should focus on enhancing confidence in managing comorbid diabetes in people diagnosed with comorbid SMI, especially young people and those with newly diagnosed T2DM.
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Affiliation(s)
| | - Yueh-Ming Tai
- Tri-Service General Hospital Beitou Branch, Taipei City, Taiwan
| | - Hsin-Pei Feng
- National Defense Medical Center, Taipei City, Taiwan
| | - Chia-Huei Lin
- National Defense Medical Center, Taipei City, Taiwan
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Bell N, Perera G, Chandran D, Stubbs B, Gaughran F, Stewart R. HbA1c recording in patients following a first diagnosis of serious mental illness: the South London and Maudsley Biomedical Research Centre case register. BMJ Open 2023; 13:e069635. [PMID: 37463814 PMCID: PMC10357777 DOI: 10.1136/bmjopen-2022-069635] [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: 10/31/2022] [Accepted: 06/23/2023] [Indexed: 07/20/2023] Open
Abstract
OBJECTIVES To investigate factors associated with the recording of glycated haemoglobin (HbA1c) in people with first diagnoses of serious mental illness (SMI) in a large mental healthcare provider, and factors associated with HbA1c levels, when recorded. To our knowledge this is the first such investigation, although attention to dysglycaemia in SMI is an increasing priority in mental healthcare. DESIGN The study was primarily descriptive in nature, seeking to ascertain the frequency of HbA1c recording in the mental healthcare sector for people following first SMI diagnosis. SETTINGS A large mental healthcare provider, the South London and Maudsley National Health Service Trust. PARTICIPANTS Using electronic mental health records data, we ascertained patients with first SMI diagnoses (schizophrenia, schizoaffective disorder, bipolar disorder) from 2008 to 2018. OUTCOME MEASURES Recording or not of HbA1c level was ascertained from routine local laboratory data and supplemented by a natural language processing (NLP) algorithm for extracting recorded values in text fields (precision 0.89%, recall 0.93%). Age, gender, ethnic group, year of diagnosis, and SMI diagnosis were investigated as covariates in relation to recording or not of HbA1c and first recorded levels. RESULTS Of 21 462 patients in the sample (6546 bipolar disorder; 14 916 schizophrenia or schizoaffective disorder; mean age 38.8 years, 49% female), 4106 (19.1%) had at least one HbA1c result recorded from laboratory data, increasing to 6901 (32.2%) following NLP. HbA1c recording was independently more likely in non-white ethnic groups (black compared with white: OR 2.45, 95% CI 2.29 to 2.62), and was negatively associated with age (OR per year increase 0.93, 0.92-0.95), female gender (0.83, 0.78-0.88) and bipolar disorder (0.49, 0.45-0.52). CONCLUSIONS Over a 10-year period, relatively low level of recording of HbA1c was observed, although this has increased over time and ascertainment was increased with text extraction. It remains important to improve the routine monitoring of dysglycaemia in these at-risk disorders.
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Affiliation(s)
- Nikeysha Bell
- Psychological Medicine, King's College London Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Gayan Perera
- Psychological Medicine, King's College London Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - David Chandran
- Psychological Medicine, King's College London Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Brendon Stubbs
- Institute of Psychiatry, Psychology and Neuroscience, Psychosis Studies, King's College London, London, UK
- National Psychosis Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Fiona Gaughran
- Institute of Psychiatry, Psychology and Neuroscience, Psychosis Studies, King's College London, London, UK
- National Psychosis Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Robert Stewart
- Psychological Medicine, King's College London Institute of Psychiatry, Psychology and Neuroscience, London, UK
- National Psychosis Service, South London and Maudsley NHS Foundation Trust, London, UK
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Solmi M, Cortese S, Wooten JC, Anderson KK. From cancer prevention to death: the case for transdiagnostic services for physical health in people with mental disorders. Lancet Psychiatry 2023; 10:475-476. [PMID: 37353252 DOI: 10.1016/s2215-0366(23)00188-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 05/24/2023] [Indexed: 06/25/2023]
Affiliation(s)
- Marco Solmi
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada; Regional Centre for the Treatment of Eating Disorders and On Track: The Champlain First Episode Psychosis Program, Department of Mental Health, The Ottawa Hospital, Ottawa, ON Canada; Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program, University of Ottawa, Ottawa, ON, Canada; Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany; School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
| | - Samuele Cortese
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK; Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK; Solent NHS Trust, Southampton, UK; Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York City, NY, USA
| | - Jared C Wooten
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Kelly K Anderson
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada; Department of Psychiatry, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
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Murphy KA, Daumit GL. Establishing a Care Continuum for Cardiometabolic Conditions for Patients with Serious Mental Illness. Curr Cardiol Rep 2023; 25:193-202. [PMID: 36847991 PMCID: PMC10042919 DOI: 10.1007/s11886-023-01848-z] [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] [Accepted: 02/03/2023] [Indexed: 03/01/2023]
Abstract
PURPOSE OF REVIEW Addressing cardiometabolic risk factors in persons with serious mental illness requires early screening and proactive medical management in both medical and mental health settings. RECENT FINDINGS Cardiovascular disease remains the leading cause of death for persons with serious mental illness (SMI), such as schizophrenia or bipolar disorder, much of which is driven by a high prevalence of metabolic syndrome, diabetes, and tobacco use. We summarize barriers and recent approaches to screening and treatment for metabolic cardiovascular risk factors within physical health and specialty mental health settings. Incorporating system-based and provider-level support within physical health and psychiatric clinical settings should contribute to improvement for screening, diagnosis, and treatment for cardiometabolic conditions for patients with SMI. Targeted education for clinicians and leveraging multi-disciplinary teams are important first steps to recognize and treat populations with SMI at risk of CVD.
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Affiliation(s)
- Karly A. Murphy
- Division of General Internal Medicine, University of California San Francisco School of Medicine, 1701 Divisidero Street, Suite 500, 94117 San Francisco, CA USA
| | - Gail L. Daumit
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD USA
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O'Neill B, Yusuf A, Kurdyak P, Kiran T, Sullivan F, Chen T, Kalia S, Eisen D, Anderson E, Selby P, Campbell D. Diabetes care among individuals with and without schizophrenia in three Canadian provinces: A retrospective cohort study. Gen Hosp Psychiatry 2023; 82:19-25. [PMID: 36898192 DOI: 10.1016/j.genhosppsych.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 02/24/2023] [Accepted: 02/27/2023] [Indexed: 03/12/2023]
Abstract
OBJECTIVE Diabetes is present in approximately 10% of people living with schizophrenia and substantially contributes to early mortality, but some aspects of diabetes care among those with schizophrenia have been inadequately investigated to date. We assessed diabetes care and comorbidity management among people with and without schizophrenia. METHODS We conducted a cohort study with data obtained from primary care electronic medical records stored in the Diabetes Action Canada (DAC) National Repository from Alberta, Ontario, and Quebec, Canada. The population studied included patients with diabetes, with and without schizophrenia, who had at least 3 primary care visits in a 2 year period between July 2017 and June 2019. Outcomes included glycemia; diabetes complication screening and monitoring; antihyperglycemic and cardioprotective medication prescription; health service use. RESULTS We identified 69,512 patients with diabetes; 911 (1.3%) of whom also had schizophrenia. Prevalence of high HbA1C (>8.5%) (9083/68601; 13.2% vs. 137/911; 15.0%) and high blood pressure (>130/80 mmHg) (4248/68601; 6.2% vs. 73/911; 8.0%) was similar between the two groups. Half (50.0%) of patients with schizophrenia (n = 455) had 11 or more primary care visits in the past year, compared with 27.8% of people without schizophrenia. (p < 0.0001). Patients with schizophrenia had lower odds of ever having blood pressure recorded (OR = 0.81, 95% CI 0.71-0.94) and fewer of those with chronic kidney disease (CKD) were prescribed renin-angiotensin aldosterone system inhibitors, compared to patients without schizophrenia (10.3% vs 15.8%, p = 0.0005). CONCLUSIONS Patients with diabetes and schizophrenia achieved similar blood glucose and blood pressure levels to those without schizophrenia, and had more primary care visits. However, they had fewer blood pressure readings and lower prescription of recommended medications among those who also had CKD. These results are both encouraging and represent opportunities for improvement in care.
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Affiliation(s)
- Braden O'Neill
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON, Canada; St. Michael's Hospital Academic Family Health Team, Toronto ON, Canada; Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Canada.
| | - Abban Yusuf
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON, Canada
| | - Paul Kurdyak
- ICES, Toronto, ON, Canada; Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Tara Kiran
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON, Canada; St. Michael's Hospital Academic Family Health Team, Toronto ON, Canada; Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Canada
| | - Frank Sullivan
- School of Medicine, University of St. Andrews, St. Andrews, UK
| | - Tao Chen
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Canada
| | - Sumeet Kalia
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Canada; Research and Innovation, North York General Hospital, Toronto, ON, Canada
| | - David Eisen
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Canada; Research and Innovation, North York General Hospital, Toronto, ON, Canada
| | | | - Peter Selby
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Canada; Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - David Campbell
- Departments of Medicine, Community Health Sciences & Cardiac Sciences, University of Calgary, Calgary, AB, Canada
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Knudsen L, Scheuer SH, Diaz LJ, Jackson CA, Wild SH, Benros ME, Hansen DL, Jørgensen ME, Andersen GS. Indicators of quality of diabetes care in persons with type 2 diabetes with and without severe mental illness: a Danish nationwide register-based cohort study. THE LANCET REGIONAL HEALTH. EUROPE 2023; 26:100565. [PMID: 36895449 PMCID: PMC9989638 DOI: 10.1016/j.lanepe.2022.100565] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 11/30/2022] [Accepted: 11/30/2022] [Indexed: 06/18/2023]
Abstract
BACKGROUND This study aims to examine quality of diabetes care in persons with type 2 diabetes with and without severe mental illness (SMI). METHODS In a nationwide prospective register-based study, we followed persons with type 2 diabetes in Denmark with and without SMI including schizophrenia, bipolar disorder, or major depression. Quality of care was measured as receipt of care (hemoglobin A1c, low-density lipoprotein-cholesterol and urine albumin creatinine ratio assessment and eye and foot screening) and achievement of treatment targets between 2015 and 2019. Quality of care was compared in persons with and without SMI using generalized linear mixed models adjusted for key confounders. FINDINGS We included 216,537 persons with type 2 diabetes. At entry 16,874 (8%) had SMI. SMI was associated with lower odds of receiving care, with the most pronounced difference in urine albumin creatinine ratio assessment and eye screening (OR: 0.55, 95% CI: 0.53-0.58 and OR: 0.37 95% CI: 0.32-0.42, respectively). Among those with an assessment, we found that SMI was associated with higher achievement of recommended hemoglobin A1c levels and lower achievement of recommended low-density lipoprotein-cholesterol levels. Achievement of recommended low-density lipoprotein-cholesterol levels was similar in persons with versus without schizophrenia. INTERPRETATION Compared to persons without SMI, persons with SMI were less likely to receive process of care, with the most pronounced differences in urine albumin creatinine ratio assessment and eye screening. FUNDING This study was funded by Steno Diabetes Center Copenhagen through an unrestricted grant from Novo Nordisk Foundation.
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Affiliation(s)
- Lenette Knudsen
- Copenhagen University Hospital, Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Stine H. Scheuer
- Copenhagen University Hospital, Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Lars J. Diaz
- Copenhagen University Hospital, Steno Diabetes Center Copenhagen, Herlev, Denmark
| | | | - Sarah H. Wild
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Michael E. Benros
- Biological and Precision Psychiatry, Copenhagen Research Centre for Mental Health, Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Dorte L. Hansen
- Copenhagen University Hospital, Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Marit E. Jørgensen
- Copenhagen University Hospital, Steno Diabetes Center Copenhagen, Herlev, Denmark
- Steno Diabetes Center Greenland, Nuuk, Greenland
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Gregers S. Andersen
- Copenhagen University Hospital, Steno Diabetes Center Copenhagen, Herlev, Denmark
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Bayoumi I, Whitehead M, Li W, Kurdyak P, Glazier RH. Association of physician financial incentives with primary care enrolment of adults with serious mental illnesses in Ontario: a retrospective observational population-based study. CMAJ Open 2023; 11:E1-E12. [PMID: 36627127 PMCID: PMC9842098 DOI: 10.9778/cmajo.20210190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Financial incentives may improve primary care access for adults with schizophrenia or bipolar disorder (serious mental illness [SMI]). We studied the association between receipt of the SMI financial premium paid to primary care physicians and rostering of adults with SMI in different patient enrolment models (PEMs), including enhanced fee-for-service and capitation-based models with and without interdisciplinary team-based care. METHODS We conducted a retrospective cohort study involving Ontario adults (≥18 yr) with SMI in PEM practices, in fiscal years 2016/17 and 2017/18. Using negative binomial models, we examined relations between rostering and the primary care model and the contribution of the incentive. Similar models were developed for adults with type 1 or 2 diabetes mellitus and the general population. RESULTS Among 9730 physicians in PEM practices, 4866 (50.0%) received a premium and 448 319 (88.4%) people with SMI in PEMs were rostered. Compared with enhanced fee for service, the likelihood of rostering people with SMI was 3.0% higher for patients in capitation with team-based care (adjusted relative risk [RR] 1.03, 95% confidence interval [CI] 1.02-1.04), with similar results for capitation without team-based care (adjusted RR 1.00 95% CI 0.99-1.01). Rostering for people with diabetes was similar in team-based care (adjusted RR 1.02, 95% CI 1.02-1.03) but higher in capitation without team-based care (adjusted RR 1.03, 95% CI 1.02-1.03) and slightly higher for the Ontario population (team-based care 1.04, 95% CI 1.04-1.05, capitation without team-based care 1.03, 95% CI 1.03-1.04). INTERPRETATION Rostering of people with SMI was lower than for the general population. Additional policy measures are needed to address persisting inequities and to promote rostering of this underserved population with complex needs.
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Affiliation(s)
- Imaan Bayoumi
- ICES Queen's (Bayoumi, Whitehead, Li), Queen's University, Kingston, Ont.; ICES Central (Kurdyak, Glazier), Toronto, Ont.; Department of Family Medicine (Bayoumi), Queen's University, Kingston, Ont.; Centre for Addiction and Mental Health (Kurdyak), Toronto, Ont.; Department of Psychiatry (Kurdyak), University of Toronto; Department of Family and Community Medicine (Glazier), University of Toronto and St. Michael's Hospital; MAP Centre for Urban Health Solutions (Glazier), St. Michael's Hospital, Toronto, Ont.
| | - Marlo Whitehead
- ICES Queen's (Bayoumi, Whitehead, Li), Queen's University, Kingston, Ont.; ICES Central (Kurdyak, Glazier), Toronto, Ont.; Department of Family Medicine (Bayoumi), Queen's University, Kingston, Ont.; Centre for Addiction and Mental Health (Kurdyak), Toronto, Ont.; Department of Psychiatry (Kurdyak), University of Toronto; Department of Family and Community Medicine (Glazier), University of Toronto and St. Michael's Hospital; MAP Centre for Urban Health Solutions (Glazier), St. Michael's Hospital, Toronto, Ont
| | - Wenbin Li
- ICES Queen's (Bayoumi, Whitehead, Li), Queen's University, Kingston, Ont.; ICES Central (Kurdyak, Glazier), Toronto, Ont.; Department of Family Medicine (Bayoumi), Queen's University, Kingston, Ont.; Centre for Addiction and Mental Health (Kurdyak), Toronto, Ont.; Department of Psychiatry (Kurdyak), University of Toronto; Department of Family and Community Medicine (Glazier), University of Toronto and St. Michael's Hospital; MAP Centre for Urban Health Solutions (Glazier), St. Michael's Hospital, Toronto, Ont
| | - Paul Kurdyak
- ICES Queen's (Bayoumi, Whitehead, Li), Queen's University, Kingston, Ont.; ICES Central (Kurdyak, Glazier), Toronto, Ont.; Department of Family Medicine (Bayoumi), Queen's University, Kingston, Ont.; Centre for Addiction and Mental Health (Kurdyak), Toronto, Ont.; Department of Psychiatry (Kurdyak), University of Toronto; Department of Family and Community Medicine (Glazier), University of Toronto and St. Michael's Hospital; MAP Centre for Urban Health Solutions (Glazier), St. Michael's Hospital, Toronto, Ont
| | - Richard H Glazier
- ICES Queen's (Bayoumi, Whitehead, Li), Queen's University, Kingston, Ont.; ICES Central (Kurdyak, Glazier), Toronto, Ont.; Department of Family Medicine (Bayoumi), Queen's University, Kingston, Ont.; Centre for Addiction and Mental Health (Kurdyak), Toronto, Ont.; Department of Psychiatry (Kurdyak), University of Toronto; Department of Family and Community Medicine (Glazier), University of Toronto and St. Michael's Hospital; MAP Centre for Urban Health Solutions (Glazier), St. Michael's Hospital, Toronto, Ont
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14
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Stephenson E, Yusuf A, Gronsbell J, Tu K, Melamed O, Mitiku T, Selby P, O'Neill B. Disruptions in Primary Care among People with Schizophrenia in Ontario, Canada, During the COVID-19 Pandemic. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2022:7067437221140384. [PMID: 36453004 PMCID: PMC9720063 DOI: 10.1177/07067437221140384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
OBJECTIVE To investigate how primary care access, intensity and quality of care changed among patients living with schizophrenia before and after the onset of the COVID-19 pandemic in Ontario, Canada. METHODS This cohort study was performed using primary care electronic medical record data from the University of Toronto Practice-Based Research Network (UTOPIAN), a network of > 500 family physicians in Ontario, Canada. Data were collected during primary care visits from 2643 patients living with schizophrenia. Rates of primary care health service use (in-person and virtual visits with family physicians) and key preventive health indices indicated in antipsychotic monitoring (blood pressure readings, hemoglobin A1c, cholesterol and complete blood cell count [CBC] tests) were measured and compared in the 12 months before and after onset of the COVID-19 pandemic. RESULTS Access to in-person care dropped with the onset of the COVID-19 pandemic. During the first year of the pandemic only 39.5% of patients with schizophrenia had at least one in-person visit compared to 81.0% the year prior. There was a corresponding increase in virtual visits such that 78.0% of patients had a primary care appointment virtually during the pandemic period. Patients prescribed injectable antipsychotics were more likely to continue having more frequent in-person appointments during the pandemic than patients prescribed only oral or no antipsychotic medications. The proportion of patients who did not have recommended tests increased from 41.0% to 72.4% for blood pressure readings, from 48.9% to 60.2% for hemoglobin A1c, from 57.0% to 67.8% for LDL cholesterol and 45.0% to 56.0% for CBC tests during the pandemic. CONCLUSIONS There were substantial decreases in preventive care after the onset of the pandemic, although primary care access was largely maintained through virtual care. Addressing these deficiencies will be essential to promoting health equity and reducing the risk of poor health outcomes.
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Affiliation(s)
- Ellen Stephenson
- Department of Family and Community Medicine, Temerty Faculty of Medicine, 7938University of Toronto, Toronto, Ontario, Canada
| | - Abban Yusuf
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Jessica Gronsbell
- Department of Statistical Sciences, 7938University of Toronto, Toronto, Ontario, Canada
| | - Karen Tu
- Department of Family and Community Medicine, Temerty Faculty of Medicine, 7938University of Toronto, Toronto, Ontario, Canada.,Department of Family and Community Medicine, 8613North York General Hospital, Toronto, Ontario, Canada.,Department of Family and Community Medicine, 26625Toronto Western Hospital, Toronto, Ontario, Canada
| | - Osnat Melamed
- Department of Family and Community Medicine, Temerty Faculty of Medicine, 7938University of Toronto, Toronto, Ontario, Canada.,Centre for Mental Health and Addiction (CAMH), Toronto, Ontario, Canada
| | - Tezeta Mitiku
- Department of Psychiatry, 6363University of Ottawa, Ottawa, Ontario, Canada
| | - Peter Selby
- Department of Family and Community Medicine, Temerty Faculty of Medicine, 7938University of Toronto, Toronto, Ontario, Canada.,Centre for Mental Health and Addiction (CAMH), Toronto, Ontario, Canada
| | - Braden O'Neill
- Department of Family and Community Medicine, Temerty Faculty of Medicine, 7938University of Toronto, Toronto, Ontario, Canada.,MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Family and Community Medicine, St. Michael's Hospital, 508783Unity Health Toronto, Toronto, Ontario, Canada
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15
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Gabet M, Cao Z, Fleury MJ. Profiles, Correlates and Outcomes Among Patients Experiencing an Onset of Mental Disorder Based on Outpatient Care Received Following Index Emergency Department Visits. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2022; 67:787-801. [PMID: 35289196 PMCID: PMC9510995 DOI: 10.1177/07067437221087004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This 5-year longitudinal study evaluated patients with an onset of mental disorder (MD) following index emergency department (ED) visits, in terms of (1) patient profiles based on 12-month outpatient follow-up care received, (2) sociodemographic and clinical correlates, and (3) adverse health outcomes for the subsequent 2 years. METHODS Data from administrative databases were collected for 2541 patients with an onset of MD, following discharge from Quebec ED. Latent class analysis was performed to identify patient profiles based on the adequacy of follow-up care after ED discharge. Bivariate analyses examined associations between class membership and sociodemographic and clinical correlates, high ED use (3 + visits/yearly), hospitalizations, and suicidal behaviors. RESULTS Five classes of patients were identified. Class 1, the smallest, labeled "patient psychiatrist only," included mainly young patients with serious MD. Classes 2 and 3, roughly 20%, were labeled "high use of patient general practitioner (GP) and psychiatrist" and "low use of patient GP and psychiatrist," respectively. Both included patients with complex MD, but Class 2 had more women and older patients with chronic physical illnesses. The 2 largest classes were labeled "no usual patient service provider" (Class 5) and "patient GP only" (Class 4). Class 5 included more younger men with substance-related disorders, while Class 4 had the older patients living in rural areas, many with common MD and chronic physical illnesses. Class 3 patients had the poorest outcomes, followed by Classes 1 and 2, while Classes 4 and 5 had the best outcomes. CONCLUSIONS Results revealed that nearly 40% of patients experiencing an onset of MD received little or no outpatient care following ED discharge. Higher severity or complexity of MD and, to a lesser extent, no or low GP follow-up may explain these adverse outcomes. More adequate, continuous care, including collaborative care, is needed for these vulnerable, high-needs patients.
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Affiliation(s)
- Morgane Gabet
- Department of Health Administration, School of Public Health, 248214Université de Montréal, Montreal, Quebec, Canada.,Douglas Hospital Research Centre, 26632Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Zhirong Cao
- Douglas Hospital Research Centre, 26632Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Marie-Josée Fleury
- Department of Health Administration, School of Public Health, 248214Université de Montréal, Montreal, Quebec, Canada.,Douglas Hospital Research Centre, 26632Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Department of Psychiatry, 405737McGill University, Montreal, Quebec, Canada
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16
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Goff Z, House A, Guthrie E, Weston H, Mansbridge L. Diabetes care in the acute psychiatric inpatient setting: A logic model for service delivery. Gen Hosp Psychiatry 2022; 78:135-137. [PMID: 35637034 DOI: 10.1016/j.genhosppsych.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/01/2022] [Accepted: 05/08/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Zoe Goff
- University of Leeds, United Kingdom; Leeds and York Partnership Foundation Trust, United Kingdom.
| | | | | | - Hannah Weston
- Leeds and York Partnership Foundation Trust, United Kingdom
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17
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Prigge R, Wild SH, Jackson CA. Depression, diabetes, comorbid depression and diabetes and risk of all-cause and cause-specific mortality: a prospective cohort study. Diabetologia 2022; 65:1450-1460. [PMID: 35622126 PMCID: PMC9345808 DOI: 10.1007/s00125-022-05723-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 04/08/2022] [Indexed: 01/11/2023]
Abstract
AIMS/HYPOTHESIS The aim of this study was to investigate the risks of all-cause and cause-specific mortality among participants with neither, one or both of diabetes and depression in a large prospective cohort study in the UK. METHODS Our study population included 499,830 UK Biobank participants without schizophrenia and bipolar disorder at baseline. Type 1 and type 2 diabetes and depression were identified using self-reported diagnoses, prescribed medication and hospital records. Mortality was identified from death records using the primary cause of death to define cause-specific mortality. We performed Cox proportional hazards models to estimate the risk of all-cause mortality and mortality from cancer, circulatory disease and causes of death other than circulatory disease or cancer among participants with either depression (n=41,791) or diabetes (n=22,677) alone and with comorbid diabetes and depression (n=3597) compared with the group with neither condition (n=431,765), adjusting for sociodemographic and lifestyle factors, comorbidities and history of CVD or cancer. We also investigated the interaction between diabetes and depression. RESULTS During a median of 6.8 (IQR 6.1-7.5) years of follow-up, there were 13,724 deaths (cancer, n=7976; circulatory disease, n=2827; other causes, n=2921). Adjusted HRs of all-cause mortality and mortality from cancer, circulatory disease and other causes were highest among people with comorbid depression and diabetes (HRs 2.16 [95% CI 1.94, 2.42]; 1.62 [95% CI 1.35, 1.93]; 2.22 [95% CI 1.80, 2.73]; and 3.60 [95% CI 2.93, 4.42], respectively). The risks of all-cause, cancer and other mortality among those with comorbid depression and diabetes exceeded the sum of the risks due to diabetes and depression alone. CONCLUSIONS/INTERPRETATION We confirmed that depression and diabetes individually are associated with an increased mortality risk and also identified that comorbid depression and diabetes have synergistic effects on the risk of all-cause mortality that are largely driven by deaths from cancer and causes other than circulatory disease and cancer.
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Affiliation(s)
- Regina Prigge
- Usher Institute, Centre for Population Health Sciences, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK.
| | - Sarah H Wild
- Usher Institute, Centre for Population Health Sciences, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Caroline A Jackson
- Usher Institute, Centre for Population Health Sciences, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
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18
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Launders N, Dotsikas K, Marston L, Price G, Osborn DPJ, Hayes JF. The impact of comorbid severe mental illness and common chronic physical health conditions on hospitalisation: A systematic review and meta-analysis. PLoS One 2022; 17:e0272498. [PMID: 35980891 PMCID: PMC9387848 DOI: 10.1371/journal.pone.0272498] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 07/20/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND People with severe mental illness (SMI) are at higher risk of physical health conditions compared to the general population, however, the impact of specific underlying health conditions on the use of secondary care by people with SMI is unknown. We investigated hospital use in people managed in the community with SMI and five common physical long-term conditions: cardiovascular diseases, COPD, cancers, diabetes and liver disease. METHODS We performed a systematic review and meta-analysis (Prospero: CRD42020176251) using terms for SMI, physical health conditions and hospitalisation. We included observational studies in adults under the age of 75 with a diagnosis of SMI who were managed in the community and had one of the physical conditions of interest. The primary outcomes were hospital use for all causes, physical health causes and related to the physical condition under study. We performed random-effects meta-analyses, stratified by physical condition. RESULTS We identified 5,129 studies, of which 50 were included: focusing on diabetes (n = 21), cardiovascular disease (n = 19), COPD (n = 4), cancer (n = 3), liver disease (n = 1), and multiple physical health conditions (n = 2). The pooled odds ratio (pOR) of any hospital use in patients with diabetes and SMI was 1.28 (95%CI:1.15-1.44) compared to patients with diabetes alone and pooled hazard ratio was 1.19 (95%CI:1.08-1.31). The risk of 30-day readmissions was raised in patients with SMI and diabetes (pOR: 1.18, 95%CI:1.08-1.29), SMI and cardiovascular disease (pOR: 1.27, 95%CI:1.06-1.53) and SMI and COPD (pOR:1.18, 95%CI: 1.14-1.22) compared to patients with those conditions but no SMI. CONCLUSION People with SMI and five physical conditions are at higher risk of hospitalisation compared to people with that physical condition alone. Further research is warranted into the combined effects of SMI and physical conditions on longer-term hospital use to better target interventions aimed at reducing inappropriate hospital use and improving disease management and outcomes.
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Affiliation(s)
| | | | - Louise Marston
- Department of Primary Care and Population Health, UCL, London, United Kingdom
| | - Gabriele Price
- Health Improvement Directorate, Public Health England, London, United Kingdom
| | - David P. J. Osborn
- Division of Psychiatry, UCL, London, United Kingdom
- Camden and Islington NHS Foundation Trust, St Pancras Hospital, London, United Kingdom
| | - Joseph F. Hayes
- Division of Psychiatry, UCL, London, United Kingdom
- Camden and Islington NHS Foundation Trust, St Pancras Hospital, London, United Kingdom
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19
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Scheuer SH, Fleetwood KJ, Licence KAM, Mercer SW, Smith DJ, Sudlow CLM, Andersen GS, Wild SH, Jackson CA. Severe mental illness and quality of care for type 2 diabetes: A retrospective population-based cohort study. Diabetes Res Clin Pract 2022; 190:110026. [PMID: 35917991 DOI: 10.1016/j.diabres.2022.110026] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/23/2022] [Accepted: 07/28/2022] [Indexed: 11/25/2022]
Abstract
AIMS To compare quality of care for type 2 diabetes in people with severe mental illness (SMI) versus no mental illness. METHODS We used routinely collected linked data to create a retrospective cohort study. We included 158,901 people diagnosed with type 2 diabetes in Scotland during 2009-2018 of whom 1701 (1%), 768 (0.5%) and 5211 (3%) had a prior hospital admission record for schizophrenia, bipolar disorder, and major depression, respectively. We compared recording of HbA1c, cholesterol, creatinine, blood pressure, urinary albumin, foot examination, retinopathy screening, body mass index and smoking during the first year after diabetes diagnosis using logistic regression and recording of HbA1c and retinopathy screening over longer follow-up using generalised linear mixed effects model, adjusting for confounding factors. RESULTS Receipt of care during the first year was generally similar, or better, for people with each SMI than for people without any mental illness. During mean follow up of 4.8 (SD 2.5) years, depression and bipolar disorder were associated with lower odds of receiving retinopathy screening. CONCLUSIONS Receipt of diabetes care was similar or better among people with SMI versus without SMI. However, mechanisms to support improved retinopathy screening for people with SMI are needed.
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Affiliation(s)
| | | | - Kirsty A M Licence
- Information Services Division, National Services Scotland, NHS Scotland, Edinburgh, UK
| | | | - Daniel J Smith
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Cathie L M Sudlow
- Usher Institute, University of Edinburgh, Edinburgh, UK; British Heart Foundation Data Science Centre, UK
| | | | - Sarah H Wild
- Usher Institute, University of Edinburgh, Edinburgh, UK
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20
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Vigod SN, Ray JG, Cohen E, Wilton AS, Saunders NR, Barker LC, Berard A, Dennis CL, Holloway AC, Morrison K, Oberlander TF, Hanley G, Tu K, Brown HK. Maternal Schizophrenia and the Risk of a Childhood Chronic Condition. Schizophr Bull 2022; 48:1252-1262. [PMID: 35900007 PMCID: PMC9673258 DOI: 10.1093/schbul/sbac091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND HYPOTHESIS Maternal schizophrenia heightens the risk for certain perinatal complications, yet it is not known to what degree future childhood chronic health conditions (Childhood-CC) might arise. STUDY DESIGN This population-based cohort study using health administrative data from Ontario, Canada (1995-2018) compared 5066 children of mothers with schizophrenia to 25 324 children of mothers without schizophrenia, propensity-matched on birth-year, maternal age, parity, immigrant status, income, region of residence, and maternal medical and psychiatric conditions other than schizophrenia. Cox proportional hazard models generated hazard ratios (HR) and 95% confidence intervals (CI) for incident Childhood-CCs, and all-cause mortality, up to age 19 years. STUDY RESULTS Six hundred and fifty-six children exposed to maternal schizophrenia developed a Childhood-CC (20.5/1000 person-years) vs. 2872 unexposed children (17.1/1000 person-years)-an HR of 1.18, 95% CI 1.08-1.28. Corresponding rates were 3.3 vs. 1.9/1000 person-years (1.77, 1.44-2.18) for mental health Childhood-CC, and 18.0 vs. 15.7/1000 person-years (1.13, 1.04-1.24) for non-mental health Childhood-CC. All-cause mortality rates were 1.2 vs. 0.8/1000 person-years (1.34, 0.96-1.89). Risk for children exposed to maternal schizophrenia was similar whether or not children were discharged to social service care. From age 1 year, risk was greater for children whose mothers were diagnosed with schizophrenia prior to pregnancy than for children whose mothers were diagnosed with schizophrenia postnatally. CONCLUSIONS A child exposed to maternal schizophrenia is at elevated risk of chronic health conditions including mental and physical subtypes. Future research should examine what explains the increased risk particularly for physical health conditions, and what preventive and treatment efforts are needed for these children.
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Affiliation(s)
- Simone N Vigod
- To whom correspondence should be addressed; Department of Psychiatry, Women’s College Hospital, 76 Grenville Street, Toronto, ON, Canada; tel: 416-323-6400, ext. 4080, e-mail:
| | - Joel G Ray
- Institute for Health Policy, Management and Evaluation, Toronto, ON, Canada,ICES, Toronto, ON, Canada,St. Michael’s Hospital, Toronto, ON, Canada,Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Eyal Cohen
- Institute for Health Policy, Management and Evaluation, Toronto, ON, Canada,ICES, Toronto, ON, Canada,Edwin S.H. Leong Centre for Healthy Children, Hospital for Sick Children, Toronto, ON, Canada,Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Natasha R Saunders
- Institute for Health Policy, Management and Evaluation, Toronto, ON, Canada,ICES, Toronto, ON, Canada,Edwin S.H. Leong Centre for Healthy Children, Hospital for Sick Children, Toronto, ON, Canada,Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Lucy C Barker
- Women’s College Hospital and Women’s College Research Institute, Toronto, ON, Canada,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada,Institute for Health Policy, Management and Evaluation, Toronto, ON, Canada,ICES, Toronto, ON, Canada
| | - Anick Berard
- Universite de Montreal, Faculty of Pharmacy, Montreal, QC, Canada,CHU Ste-Justine, Montreal, QC, Canada
| | - Cindy-Lee Dennis
- Women’s College Hospital and Women’s College Research Institute, Toronto, ON, Canada,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada,Lawrence S. BloombergFaculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Alison C Holloway
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON, Canada
| | | | - Tim F Oberlander
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Gillian Hanley
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada
| | - Karen Tu
- Institute for Health Policy, Management and Evaluation, Toronto, ON, Canada,Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, North York General Hospital, Toronto Western Hospital Family Health Team-UHN, Toronto, ON, Canada
| | - Hilary K Brown
- Women’s College Hospital and Women’s College Research Institute, Toronto, ON, Canada,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada,Institute for Health Policy, Management and Evaluation, Toronto, ON, Canada,ICES, Toronto, ON, Canada,Department of Health and Society, University of Toronto, Scarborough, Toronto, ON, Canada
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21
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Scheuer SH, Kosjerina V, Lindekilde N, Pouwer F, Carstensen B, Jørgensen ME, Benros ME, Andersen GS. Severe Mental Illness and the Risk of Diabetes Complications: A Nationwide, Register-based Cohort Study. J Clin Endocrinol Metab 2022; 107:e3504-e3514. [PMID: 35359003 DOI: 10.1210/clinem/dgac204] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Individuals with severe mental illness (SMI) are at increased risk of developing type 2 diabetes. OBJECTIVE This work explores whether individuals with diabetes and SMI are also at increased risk of diabetes complications and the potential age-specific differences in development of these. METHODS Using nationwide registry data, we followed the entire Danish population with type 2 diabetes from January 1, 1996 to December 31, 2018. Exposure was SMI (schizophrenia, bipolar, or depression disorders). Outcome was diabetes complications (nephropathy, retinopathy, lower limp amputations, and cardiovascular disease). We applied Poisson regression models to estimate overall incidence rate ratios (IRRs) and age-specific incidence rates (IRs) and IRRs of the first event of each complication in individuals with SMI compared to individuals without SMI. The models were adjusted for sex, age, diabetes duration, calendar year, education, and migration status. RESULTS We followed 371 625 individuals with type 2 diabetes, of whom 30 102 had coexisting diagnosed SMI. Individuals with SMI had a higher IR of nephropathy (IRR: 1.15; 95% CI, 1.12-1.18), amputations (IRR: 1.15; 95% CI, 1.04-1.28), and cardiovascular disease (men: IRR: 1.10; 95% CI, 1.05-1.15, women: IRR: 1.18; 95% CI, 1.13-1.22) but a lower IR of retinopathy (IRR: 0.75; 95% CI, 0.70-0.81) when compared to individuals without SMI, after adjustment for confounders. For all complications except amputations, the difference in IR was highest in the younger age groups. CONCLUSION Individuals with type 2 diabetes and SMI had a higher risk and an earlier onset of several diabetes complications diagnoses, emphasizing focusing on improving diabetes management in younger age groups with SMI.
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Affiliation(s)
| | - Vanja Kosjerina
- Steno Diabetes Center Copenhagen, 2730 Herlev, Denmark
- Department of Endocrinology, Copenhagen University Hospital, Bispebjerg-Frederiksberg Hospital, 2400 Copenhagen NV, Denmark
| | - Nanna Lindekilde
- Department of Psychology, University of Southern Denmark, 5230 Odense M, Denmark
| | - Frans Pouwer
- Department of Psychology, University of Southern Denmark, 5230 Odense M, Denmark
- Steno Diabetes Center Odense, Odense University Hospital, 5000 Odense C, Denmark
- School of Psychology, Deakin University, 3220 Geelong, Australia
| | | | - Marit E Jørgensen
- Steno Diabetes Center Copenhagen, 2730 Herlev, Denmark
- National Institute of Public Health, University of Southern Denmark, 1455 Copenhagen K, Denmark
| | - Michael E Benros
- Copenhagen Research Centre for Mental Health, Mental Health Centre Copenhagen, Copenhagen University Hospital, 2900 Hellerup, Denmark
- Department of Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen N, Denmark
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22
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Wang HI, Han L, Jacobs R, Doran T, Holt RIG, Prady SL, Gilbody S, Shiers D, Alderson S, Hewitt C, Taylor J, Kitchen CEW, Bellass S, Siddiqi N. Healthcare resource use and costs for people with type 2 diabetes mellitus with and without severe mental illness in England: longitudinal matched-cohort study using the Clinical Practice Research Datalink. Br J Psychiatry 2022; 221:402-409. [PMID: 35049484 DOI: 10.1192/bjp.2021.131] [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] [Indexed: 12/25/2022]
Abstract
BACKGROUND Approximately 60 000 people in England have coexisting type 2 diabetes mellitus (T2DM) and severe mental illness (SMI). They are more likely to have poorer health outcomes and require more complex care pathways compared with those with T2DM alone. Despite increasing prevalence, little is known about the healthcare resource use and costs for people with both conditions. AIMS To assess the impact of SMI on healthcare resource use and service costs for adults with T2DM, and explore the predictors of healthcare costs and lifetime costs for people with both conditions. METHOD This was a matched-cohort study using data from the Clinical Practice Research Datalink linked to Hospital Episode Statistics for 1620 people with comorbid SMI and T2DM and 4763 people with T2DM alone. Generalised linear models and the Bang and Tsiatis method were used to explore cost predictors and mean lifetime costs respectively. RESULTS There were higher average annual costs for people with T2DM and SMI (£1930 higher) than people with T2DM alone, driven primarily by mental health and non-mental health-related hospital admissions. Key predictors of higher total costs were older age, comorbid hypertension, use of antidepressants, use of first-generation antipsychotics, and increased duration of living with both conditions. Expected lifetime costs were approximately £35 000 per person with both SMI and T2DM. Extrapolating nationally, this would generate total annual costs to the National Health Service of around £250 m per year. CONCLUSIONS Our estimates of resource use and costs for people with both T2DM and SMI will aid policymakers and commissioners in service planning and resource allocation.
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Affiliation(s)
- Han-I Wang
- Department of Health Sciences, Seebohm Rowntree Building, University of York, UK
| | - Lu Han
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, UK
| | | | - Tim Doran
- Department of Health Sciences, Seebohm Rowntree Building, University of York, UK
| | - Richard I G Holt
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, UK; and Southampton National Institute for Health Research Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, UK
| | - Stephanie L Prady
- Department of Health Sciences, Seebohm Rowntree Building, University of York, UK
| | - Simon Gilbody
- Department of Health Sciences, Seebohm Rowntree Building, University of York, UK; and Hull York Medical School, University of York, UK
| | - David Shiers
- Division of Psychology and Mental Health/Greater Manchester Mental Health NHS Trust/Primary Care and Health Sciences (Keele University), University of Manchester, UK
| | - Sarah Alderson
- Leeds Institute for Health Sciences, University of Leeds, UK
| | - Catherine Hewitt
- Department of Health Sciences, Seebohm Rowntree Building, University of York, UK
| | - Jo Taylor
- Department of Health Sciences, Seebohm Rowntree Building, University of York, UK
| | | | - Sue Bellass
- Leeds Institute for Health Sciences, University of Leeds, UK
| | - Najma Siddiqi
- Department of Health Sciences, Seebohm Rowntree Building, University of York, UK; Hull York Medical School, University of York, UK; and Bradford District Care NHS Foundation Trust, UK
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23
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de Oliveira C, Iwajomo T, Kurdyak P. Health Care Expenditures Among Individuals With Chronic Psychotic Disorders in Ontario: An Analysis Over Time. FRONTIERS IN HEALTH SERVICES 2022; 2:848072. [PMID: 36925777 PMCID: PMC10012663 DOI: 10.3389/frhs.2022.848072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 02/22/2022] [Indexed: 06/18/2023]
Abstract
Chronic psychotic disorders are severe and disabling mental disorders associated with poor psychiatric and medical outcomes, and among the most costly mental disorders to treat. Understanding trends in aggregate health care expenditures over time, and respective drivers, can provide relevant insights for decision makers, namely around appropriate allocation of scarce resources within the health care sector. Using administrative health care times series data from Ontario, this analysis examined trends in aggregate public health care expenditures and activity from 2012 to 2019 among all individuals with a diagnosis of a chronic psychotic disorder. Total aggregate health care expenditures for individuals with a chronic psychotic disorder in Ontario increased at a moderate rate over this time period, in line with the growth of the number of people diagnosed, and thus not likely driven by unit costs or resource use. Psychiatric hospitalizations made up the largest share of health care expenditures (~30%). Nonetheless, among all health services, expenditures of acute medical hospitalizations, outpatient prescription drugs and home care saw the largest growth over time. Mean/per capita health care expenditures were greater for females, and increased with age as well as with the presence of comorbidities/chronic conditions. In particular, mean/per capita health care expenditures increased steadily with the number of comorbidities and were highest for individuals with 5 or more comorbidities and those with congestive heart failure, highlighting the ever-increasing importance of addressing physical health conditions among this patient population. These findings will have important implications for decision makers, namely around the appropriate allocation of health care resources for patients with chronic psychotic disorders. Future research should continue to monitor health care expenditures for individuals with chronic psychotic disorders as well as extend this analysis beyond 2019 to understand how the COVID-19 pandemic, and resulting lockdowns, has impacted aggregate health care expenditures and outcomes for patients living with chronic psychotic disorders.
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Affiliation(s)
- Claire de Oliveira
- Centre for Health Economics and Hull York Medical School, University of York, York, United Kingdom
- Institute for Mental Health Policy Research and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Tomisin Iwajomo
- Institute for Mental Health Policy Research and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
| | - Paul Kurdyak
- Institute for Mental Health Policy Research and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Mental Health and Addictions Centre of Excellence, Ontario Health, Toronto, ON, Canada
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24
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Squires JE, Cho-Young D, Aloisio LD, Bell R, Bornstein S, Brien SE, Decary S, Varin MD, Dobrow M, Estabrooks CA, Graham ID, Greenough M, Grinspun D, Hillmer M, Horsley T, Hu J, Katz A, Krause C, Lavis J, Levinson W, Levy A, Mancuso M, Morgan S, Nadalin-Penno L, Neuner A, Rader T, Santos WJ, Teare G, Tepper J, Vandyk A, Wilson M, Grimshaw JM. Inappropriate use of clinical practices in Canada: a systematic review. CMAJ 2022; 194:E279-E296. [PMID: 35228321 PMCID: PMC9053971 DOI: 10.1503/cmaj.211416] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2021] [Indexed: 12/18/2022] Open
Abstract
Background: Inappropriate health care leads to negative patient experiences, poor health outcomes and inefficient use of resources. We aimed to conduct a systematic review of inappropriately used clinical practices in Canada. Methods: We searched multiple bibliometric databases and grey literature to identify inappropriately used clinical practices in Canada between 2007 and 2021. Two team members independently screened citations, extracted data and assessed methodological quality. Findings were synthesized in 2 categories: diagnostics and therapeutics. We reported ranges of proportions of inappropriate use for all practices. Medians and interquartile ranges (IQRs), based on the percentage of patients not receiving recommended practices (underuse) or receiving practices not recommended (overuse), were calculated. All statistics are at the study summary level. Results: We included 174 studies, representing 228 clinical practices and 28 900 762 patients. The median proportion of inappropriate care, as assessed in the studies, was 30.0% (IQR 12.0%–56.6%). Underuse (median 43.9%, IQR 23.8%–66.3%) was more frequent than overuse (median 13.6%, IQR 3.2%–30.7%). The most frequently investigated diagnostics were glycated hemoglobin (underused, range 18.0%–85.7%, n = 9) and thyroid-stimulating hormone (overused, range 3.0%–35.1%, n = 5). The most frequently investigated therapeutics were statin medications (underused, range 18.5%–71.0%, n = 6) and potentially inappropriate medications (overused, range 13.5%–97.3%, n = 9). Interpretation: We have provided a summary of inappropriately used clinical practices in Canadian health care systems. Our findings can be used to support health care professionals and quality agencies to improve patient care and safety in Canada.
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Affiliation(s)
- Janet E Squires
- Ottawa Hospital Research Institute (Squires, Cho-Young, Aloisio, Graham, Santos, Grimshaw); School of Epidemiology and Public Health (Graham), School of Nursing (Squires, Demery Varin, Greenough, Nadalin-Penno, Vandyk) and Department of Medicine (Grimshaw), University of Ottawa, University of Ottawa, Ottawa, Ont.; Department of Surgery (Bell), Dalla Lana School of Public Health (Dobrow), Department of Medicine (Levinson), and Department of Family and Community Medicine (Tepper), University of Toronto, Toronto, Ont.; Division of Community Health and Humanities (Bornstein), Memorial University of Newfoundland, St. John's, Nfld.; Public Reports (Brien), Health Quality Ontario, Toronto, Ont.; Faculty of Medicine (Decary), University of Montreal, Montréal, Que.; Faculty of Nursing (Estabrooks), University of Alberta, Edmonton, Alta.; Registered Nurses Association of Ontario (Grinspun); Ontario Ministry of Health and Long-Term Care (Hillmer), Toronto, Ont.; Royal College of Physicians and Surgeons of Canada (Horsley), Ottawa, Ont.; Virginia Commonwealth University (Hu), Richmond, Va.; Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; BC Patient Safety and Quality Council (Krause), Vancouver, BC; Clinical Epidemiology and Biostatistics (Lavis) and McMaster Health Forum (Wilson), McMaster University, Hamilton, Ont.; Department of Community Health and Epidemiology (Levy), Dalhousie University, Halifax, NS; New Brunswick Health Council (Mancuso), Moncton, NB; Faculty of Medicine (Morgan), The University of British Columbia, Vancouver, BC; Health Quality Council of Alberta (Neuner), Calgary, Alta.; Canadian Agency for Drugs and Technologies in Health (Rader), Ottawa, Ont.; Alberta Health Services (Teare), Edmonton, Alta.
| | - Danielle Cho-Young
- Ottawa Hospital Research Institute (Squires, Cho-Young, Aloisio, Graham, Santos, Grimshaw); School of Epidemiology and Public Health (Graham), School of Nursing (Squires, Demery Varin, Greenough, Nadalin-Penno, Vandyk) and Department of Medicine (Grimshaw), University of Ottawa, University of Ottawa, Ottawa, Ont.; Department of Surgery (Bell), Dalla Lana School of Public Health (Dobrow), Department of Medicine (Levinson), and Department of Family and Community Medicine (Tepper), University of Toronto, Toronto, Ont.; Division of Community Health and Humanities (Bornstein), Memorial University of Newfoundland, St. John's, Nfld.; Public Reports (Brien), Health Quality Ontario, Toronto, Ont.; Faculty of Medicine (Decary), University of Montreal, Montréal, Que.; Faculty of Nursing (Estabrooks), University of Alberta, Edmonton, Alta.; Registered Nurses Association of Ontario (Grinspun); Ontario Ministry of Health and Long-Term Care (Hillmer), Toronto, Ont.; Royal College of Physicians and Surgeons of Canada (Horsley), Ottawa, Ont.; Virginia Commonwealth University (Hu), Richmond, Va.; Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; BC Patient Safety and Quality Council (Krause), Vancouver, BC; Clinical Epidemiology and Biostatistics (Lavis) and McMaster Health Forum (Wilson), McMaster University, Hamilton, Ont.; Department of Community Health and Epidemiology (Levy), Dalhousie University, Halifax, NS; New Brunswick Health Council (Mancuso), Moncton, NB; Faculty of Medicine (Morgan), The University of British Columbia, Vancouver, BC; Health Quality Council of Alberta (Neuner), Calgary, Alta.; Canadian Agency for Drugs and Technologies in Health (Rader), Ottawa, Ont.; Alberta Health Services (Teare), Edmonton, Alta
| | - Laura D Aloisio
- Ottawa Hospital Research Institute (Squires, Cho-Young, Aloisio, Graham, Santos, Grimshaw); School of Epidemiology and Public Health (Graham), School of Nursing (Squires, Demery Varin, Greenough, Nadalin-Penno, Vandyk) and Department of Medicine (Grimshaw), University of Ottawa, University of Ottawa, Ottawa, Ont.; Department of Surgery (Bell), Dalla Lana School of Public Health (Dobrow), Department of Medicine (Levinson), and Department of Family and Community Medicine (Tepper), University of Toronto, Toronto, Ont.; Division of Community Health and Humanities (Bornstein), Memorial University of Newfoundland, St. John's, Nfld.; Public Reports (Brien), Health Quality Ontario, Toronto, Ont.; Faculty of Medicine (Decary), University of Montreal, Montréal, Que.; Faculty of Nursing (Estabrooks), University of Alberta, Edmonton, Alta.; Registered Nurses Association of Ontario (Grinspun); Ontario Ministry of Health and Long-Term Care (Hillmer), Toronto, Ont.; Royal College of Physicians and Surgeons of Canada (Horsley), Ottawa, Ont.; Virginia Commonwealth University (Hu), Richmond, Va.; Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; BC Patient Safety and Quality Council (Krause), Vancouver, BC; Clinical Epidemiology and Biostatistics (Lavis) and McMaster Health Forum (Wilson), McMaster University, Hamilton, Ont.; Department of Community Health and Epidemiology (Levy), Dalhousie University, Halifax, NS; New Brunswick Health Council (Mancuso), Moncton, NB; Faculty of Medicine (Morgan), The University of British Columbia, Vancouver, BC; Health Quality Council of Alberta (Neuner), Calgary, Alta.; Canadian Agency for Drugs and Technologies in Health (Rader), Ottawa, Ont.; Alberta Health Services (Teare), Edmonton, Alta
| | - Robert Bell
- Ottawa Hospital Research Institute (Squires, Cho-Young, Aloisio, Graham, Santos, Grimshaw); School of Epidemiology and Public Health (Graham), School of Nursing (Squires, Demery Varin, Greenough, Nadalin-Penno, Vandyk) and Department of Medicine (Grimshaw), University of Ottawa, University of Ottawa, Ottawa, Ont.; Department of Surgery (Bell), Dalla Lana School of Public Health (Dobrow), Department of Medicine (Levinson), and Department of Family and Community Medicine (Tepper), University of Toronto, Toronto, Ont.; Division of Community Health and Humanities (Bornstein), Memorial University of Newfoundland, St. John's, Nfld.; Public Reports (Brien), Health Quality Ontario, Toronto, Ont.; Faculty of Medicine (Decary), University of Montreal, Montréal, Que.; Faculty of Nursing (Estabrooks), University of Alberta, Edmonton, Alta.; Registered Nurses Association of Ontario (Grinspun); Ontario Ministry of Health and Long-Term Care (Hillmer), Toronto, Ont.; Royal College of Physicians and Surgeons of Canada (Horsley), Ottawa, Ont.; Virginia Commonwealth University (Hu), Richmond, Va.; Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; BC Patient Safety and Quality Council (Krause), Vancouver, BC; Clinical Epidemiology and Biostatistics (Lavis) and McMaster Health Forum (Wilson), McMaster University, Hamilton, Ont.; Department of Community Health and Epidemiology (Levy), Dalhousie University, Halifax, NS; New Brunswick Health Council (Mancuso), Moncton, NB; Faculty of Medicine (Morgan), The University of British Columbia, Vancouver, BC; Health Quality Council of Alberta (Neuner), Calgary, Alta.; Canadian Agency for Drugs and Technologies in Health (Rader), Ottawa, Ont.; Alberta Health Services (Teare), Edmonton, Alta
| | - Stephen Bornstein
- Ottawa Hospital Research Institute (Squires, Cho-Young, Aloisio, Graham, Santos, Grimshaw); School of Epidemiology and Public Health (Graham), School of Nursing (Squires, Demery Varin, Greenough, Nadalin-Penno, Vandyk) and Department of Medicine (Grimshaw), University of Ottawa, University of Ottawa, Ottawa, Ont.; Department of Surgery (Bell), Dalla Lana School of Public Health (Dobrow), Department of Medicine (Levinson), and Department of Family and Community Medicine (Tepper), University of Toronto, Toronto, Ont.; Division of Community Health and Humanities (Bornstein), Memorial University of Newfoundland, St. John's, Nfld.; Public Reports (Brien), Health Quality Ontario, Toronto, Ont.; Faculty of Medicine (Decary), University of Montreal, Montréal, Que.; Faculty of Nursing (Estabrooks), University of Alberta, Edmonton, Alta.; Registered Nurses Association of Ontario (Grinspun); Ontario Ministry of Health and Long-Term Care (Hillmer), Toronto, Ont.; Royal College of Physicians and Surgeons of Canada (Horsley), Ottawa, Ont.; Virginia Commonwealth University (Hu), Richmond, Va.; Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; BC Patient Safety and Quality Council (Krause), Vancouver, BC; Clinical Epidemiology and Biostatistics (Lavis) and McMaster Health Forum (Wilson), McMaster University, Hamilton, Ont.; Department of Community Health and Epidemiology (Levy), Dalhousie University, Halifax, NS; New Brunswick Health Council (Mancuso), Moncton, NB; Faculty of Medicine (Morgan), The University of British Columbia, Vancouver, BC; Health Quality Council of Alberta (Neuner), Calgary, Alta.; Canadian Agency for Drugs and Technologies in Health (Rader), Ottawa, Ont.; Alberta Health Services (Teare), Edmonton, Alta
| | - Susan E Brien
- Ottawa Hospital Research Institute (Squires, Cho-Young, Aloisio, Graham, Santos, Grimshaw); School of Epidemiology and Public Health (Graham), School of Nursing (Squires, Demery Varin, Greenough, Nadalin-Penno, Vandyk) and Department of Medicine (Grimshaw), University of Ottawa, University of Ottawa, Ottawa, Ont.; Department of Surgery (Bell), Dalla Lana School of Public Health (Dobrow), Department of Medicine (Levinson), and Department of Family and Community Medicine (Tepper), University of Toronto, Toronto, Ont.; Division of Community Health and Humanities (Bornstein), Memorial University of Newfoundland, St. John's, Nfld.; Public Reports (Brien), Health Quality Ontario, Toronto, Ont.; Faculty of Medicine (Decary), University of Montreal, Montréal, Que.; Faculty of Nursing (Estabrooks), University of Alberta, Edmonton, Alta.; Registered Nurses Association of Ontario (Grinspun); Ontario Ministry of Health and Long-Term Care (Hillmer), Toronto, Ont.; Royal College of Physicians and Surgeons of Canada (Horsley), Ottawa, Ont.; Virginia Commonwealth University (Hu), Richmond, Va.; Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; BC Patient Safety and Quality Council (Krause), Vancouver, BC; Clinical Epidemiology and Biostatistics (Lavis) and McMaster Health Forum (Wilson), McMaster University, Hamilton, Ont.; Department of Community Health and Epidemiology (Levy), Dalhousie University, Halifax, NS; New Brunswick Health Council (Mancuso), Moncton, NB; Faculty of Medicine (Morgan), The University of British Columbia, Vancouver, BC; Health Quality Council of Alberta (Neuner), Calgary, Alta.; Canadian Agency for Drugs and Technologies in Health (Rader), Ottawa, Ont.; Alberta Health Services (Teare), Edmonton, Alta
| | - Simon Decary
- Ottawa Hospital Research Institute (Squires, Cho-Young, Aloisio, Graham, Santos, Grimshaw); School of Epidemiology and Public Health (Graham), School of Nursing (Squires, Demery Varin, Greenough, Nadalin-Penno, Vandyk) and Department of Medicine (Grimshaw), University of Ottawa, University of Ottawa, Ottawa, Ont.; Department of Surgery (Bell), Dalla Lana School of Public Health (Dobrow), Department of Medicine (Levinson), and Department of Family and Community Medicine (Tepper), University of Toronto, Toronto, Ont.; Division of Community Health and Humanities (Bornstein), Memorial University of Newfoundland, St. John's, Nfld.; Public Reports (Brien), Health Quality Ontario, Toronto, Ont.; Faculty of Medicine (Decary), University of Montreal, Montréal, Que.; Faculty of Nursing (Estabrooks), University of Alberta, Edmonton, Alta.; Registered Nurses Association of Ontario (Grinspun); Ontario Ministry of Health and Long-Term Care (Hillmer), Toronto, Ont.; Royal College of Physicians and Surgeons of Canada (Horsley), Ottawa, Ont.; Virginia Commonwealth University (Hu), Richmond, Va.; Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; BC Patient Safety and Quality Council (Krause), Vancouver, BC; Clinical Epidemiology and Biostatistics (Lavis) and McMaster Health Forum (Wilson), McMaster University, Hamilton, Ont.; Department of Community Health and Epidemiology (Levy), Dalhousie University, Halifax, NS; New Brunswick Health Council (Mancuso), Moncton, NB; Faculty of Medicine (Morgan), The University of British Columbia, Vancouver, BC; Health Quality Council of Alberta (Neuner), Calgary, Alta.; Canadian Agency for Drugs and Technologies in Health (Rader), Ottawa, Ont.; Alberta Health Services (Teare), Edmonton, Alta
| | - Melissa Demery Varin
- Ottawa Hospital Research Institute (Squires, Cho-Young, Aloisio, Graham, Santos, Grimshaw); School of Epidemiology and Public Health (Graham), School of Nursing (Squires, Demery Varin, Greenough, Nadalin-Penno, Vandyk) and Department of Medicine (Grimshaw), University of Ottawa, University of Ottawa, Ottawa, Ont.; Department of Surgery (Bell), Dalla Lana School of Public Health (Dobrow), Department of Medicine (Levinson), and Department of Family and Community Medicine (Tepper), University of Toronto, Toronto, Ont.; Division of Community Health and Humanities (Bornstein), Memorial University of Newfoundland, St. John's, Nfld.; Public Reports (Brien), Health Quality Ontario, Toronto, Ont.; Faculty of Medicine (Decary), University of Montreal, Montréal, Que.; Faculty of Nursing (Estabrooks), University of Alberta, Edmonton, Alta.; Registered Nurses Association of Ontario (Grinspun); Ontario Ministry of Health and Long-Term Care (Hillmer), Toronto, Ont.; Royal College of Physicians and Surgeons of Canada (Horsley), Ottawa, Ont.; Virginia Commonwealth University (Hu), Richmond, Va.; Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; BC Patient Safety and Quality Council (Krause), Vancouver, BC; Clinical Epidemiology and Biostatistics (Lavis) and McMaster Health Forum (Wilson), McMaster University, Hamilton, Ont.; Department of Community Health and Epidemiology (Levy), Dalhousie University, Halifax, NS; New Brunswick Health Council (Mancuso), Moncton, NB; Faculty of Medicine (Morgan), The University of British Columbia, Vancouver, BC; Health Quality Council of Alberta (Neuner), Calgary, Alta.; Canadian Agency for Drugs and Technologies in Health (Rader), Ottawa, Ont.; Alberta Health Services (Teare), Edmonton, Alta
| | - Mark Dobrow
- Ottawa Hospital Research Institute (Squires, Cho-Young, Aloisio, Graham, Santos, Grimshaw); School of Epidemiology and Public Health (Graham), School of Nursing (Squires, Demery Varin, Greenough, Nadalin-Penno, Vandyk) and Department of Medicine (Grimshaw), University of Ottawa, University of Ottawa, Ottawa, Ont.; Department of Surgery (Bell), Dalla Lana School of Public Health (Dobrow), Department of Medicine (Levinson), and Department of Family and Community Medicine (Tepper), University of Toronto, Toronto, Ont.; Division of Community Health and Humanities (Bornstein), Memorial University of Newfoundland, St. John's, Nfld.; Public Reports (Brien), Health Quality Ontario, Toronto, Ont.; Faculty of Medicine (Decary), University of Montreal, Montréal, Que.; Faculty of Nursing (Estabrooks), University of Alberta, Edmonton, Alta.; Registered Nurses Association of Ontario (Grinspun); Ontario Ministry of Health and Long-Term Care (Hillmer), Toronto, Ont.; Royal College of Physicians and Surgeons of Canada (Horsley), Ottawa, Ont.; Virginia Commonwealth University (Hu), Richmond, Va.; Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; BC Patient Safety and Quality Council (Krause), Vancouver, BC; Clinical Epidemiology and Biostatistics (Lavis) and McMaster Health Forum (Wilson), McMaster University, Hamilton, Ont.; Department of Community Health and Epidemiology (Levy), Dalhousie University, Halifax, NS; New Brunswick Health Council (Mancuso), Moncton, NB; Faculty of Medicine (Morgan), The University of British Columbia, Vancouver, BC; Health Quality Council of Alberta (Neuner), Calgary, Alta.; Canadian Agency for Drugs and Technologies in Health (Rader), Ottawa, Ont.; Alberta Health Services (Teare), Edmonton, Alta
| | - Carole A Estabrooks
- Ottawa Hospital Research Institute (Squires, Cho-Young, Aloisio, Graham, Santos, Grimshaw); School of Epidemiology and Public Health (Graham), School of Nursing (Squires, Demery Varin, Greenough, Nadalin-Penno, Vandyk) and Department of Medicine (Grimshaw), University of Ottawa, University of Ottawa, Ottawa, Ont.; Department of Surgery (Bell), Dalla Lana School of Public Health (Dobrow), Department of Medicine (Levinson), and Department of Family and Community Medicine (Tepper), University of Toronto, Toronto, Ont.; Division of Community Health and Humanities (Bornstein), Memorial University of Newfoundland, St. John's, Nfld.; Public Reports (Brien), Health Quality Ontario, Toronto, Ont.; Faculty of Medicine (Decary), University of Montreal, Montréal, Que.; Faculty of Nursing (Estabrooks), University of Alberta, Edmonton, Alta.; Registered Nurses Association of Ontario (Grinspun); Ontario Ministry of Health and Long-Term Care (Hillmer), Toronto, Ont.; Royal College of Physicians and Surgeons of Canada (Horsley), Ottawa, Ont.; Virginia Commonwealth University (Hu), Richmond, Va.; Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; BC Patient Safety and Quality Council (Krause), Vancouver, BC; Clinical Epidemiology and Biostatistics (Lavis) and McMaster Health Forum (Wilson), McMaster University, Hamilton, Ont.; Department of Community Health and Epidemiology (Levy), Dalhousie University, Halifax, NS; New Brunswick Health Council (Mancuso), Moncton, NB; Faculty of Medicine (Morgan), The University of British Columbia, Vancouver, BC; Health Quality Council of Alberta (Neuner), Calgary, Alta.; Canadian Agency for Drugs and Technologies in Health (Rader), Ottawa, Ont.; Alberta Health Services (Teare), Edmonton, Alta
| | - Ian D Graham
- Ottawa Hospital Research Institute (Squires, Cho-Young, Aloisio, Graham, Santos, Grimshaw); School of Epidemiology and Public Health (Graham), School of Nursing (Squires, Demery Varin, Greenough, Nadalin-Penno, Vandyk) and Department of Medicine (Grimshaw), University of Ottawa, University of Ottawa, Ottawa, Ont.; Department of Surgery (Bell), Dalla Lana School of Public Health (Dobrow), Department of Medicine (Levinson), and Department of Family and Community Medicine (Tepper), University of Toronto, Toronto, Ont.; Division of Community Health and Humanities (Bornstein), Memorial University of Newfoundland, St. John's, Nfld.; Public Reports (Brien), Health Quality Ontario, Toronto, Ont.; Faculty of Medicine (Decary), University of Montreal, Montréal, Que.; Faculty of Nursing (Estabrooks), University of Alberta, Edmonton, Alta.; Registered Nurses Association of Ontario (Grinspun); Ontario Ministry of Health and Long-Term Care (Hillmer), Toronto, Ont.; Royal College of Physicians and Surgeons of Canada (Horsley), Ottawa, Ont.; Virginia Commonwealth University (Hu), Richmond, Va.; Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; BC Patient Safety and Quality Council (Krause), Vancouver, BC; Clinical Epidemiology and Biostatistics (Lavis) and McMaster Health Forum (Wilson), McMaster University, Hamilton, Ont.; Department of Community Health and Epidemiology (Levy), Dalhousie University, Halifax, NS; New Brunswick Health Council (Mancuso), Moncton, NB; Faculty of Medicine (Morgan), The University of British Columbia, Vancouver, BC; Health Quality Council of Alberta (Neuner), Calgary, Alta.; Canadian Agency for Drugs and Technologies in Health (Rader), Ottawa, Ont.; Alberta Health Services (Teare), Edmonton, Alta
| | - Megan Greenough
- Ottawa Hospital Research Institute (Squires, Cho-Young, Aloisio, Graham, Santos, Grimshaw); School of Epidemiology and Public Health (Graham), School of Nursing (Squires, Demery Varin, Greenough, Nadalin-Penno, Vandyk) and Department of Medicine (Grimshaw), University of Ottawa, University of Ottawa, Ottawa, Ont.; Department of Surgery (Bell), Dalla Lana School of Public Health (Dobrow), Department of Medicine (Levinson), and Department of Family and Community Medicine (Tepper), University of Toronto, Toronto, Ont.; Division of Community Health and Humanities (Bornstein), Memorial University of Newfoundland, St. John's, Nfld.; Public Reports (Brien), Health Quality Ontario, Toronto, Ont.; Faculty of Medicine (Decary), University of Montreal, Montréal, Que.; Faculty of Nursing (Estabrooks), University of Alberta, Edmonton, Alta.; Registered Nurses Association of Ontario (Grinspun); Ontario Ministry of Health and Long-Term Care (Hillmer), Toronto, Ont.; Royal College of Physicians and Surgeons of Canada (Horsley), Ottawa, Ont.; Virginia Commonwealth University (Hu), Richmond, Va.; Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; BC Patient Safety and Quality Council (Krause), Vancouver, BC; Clinical Epidemiology and Biostatistics (Lavis) and McMaster Health Forum (Wilson), McMaster University, Hamilton, Ont.; Department of Community Health and Epidemiology (Levy), Dalhousie University, Halifax, NS; New Brunswick Health Council (Mancuso), Moncton, NB; Faculty of Medicine (Morgan), The University of British Columbia, Vancouver, BC; Health Quality Council of Alberta (Neuner), Calgary, Alta.; Canadian Agency for Drugs and Technologies in Health (Rader), Ottawa, Ont.; Alberta Health Services (Teare), Edmonton, Alta
| | - Doris Grinspun
- Ottawa Hospital Research Institute (Squires, Cho-Young, Aloisio, Graham, Santos, Grimshaw); School of Epidemiology and Public Health (Graham), School of Nursing (Squires, Demery Varin, Greenough, Nadalin-Penno, Vandyk) and Department of Medicine (Grimshaw), University of Ottawa, University of Ottawa, Ottawa, Ont.; Department of Surgery (Bell), Dalla Lana School of Public Health (Dobrow), Department of Medicine (Levinson), and Department of Family and Community Medicine (Tepper), University of Toronto, Toronto, Ont.; Division of Community Health and Humanities (Bornstein), Memorial University of Newfoundland, St. John's, Nfld.; Public Reports (Brien), Health Quality Ontario, Toronto, Ont.; Faculty of Medicine (Decary), University of Montreal, Montréal, Que.; Faculty of Nursing (Estabrooks), University of Alberta, Edmonton, Alta.; Registered Nurses Association of Ontario (Grinspun); Ontario Ministry of Health and Long-Term Care (Hillmer), Toronto, Ont.; Royal College of Physicians and Surgeons of Canada (Horsley), Ottawa, Ont.; Virginia Commonwealth University (Hu), Richmond, Va.; Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; BC Patient Safety and Quality Council (Krause), Vancouver, BC; Clinical Epidemiology and Biostatistics (Lavis) and McMaster Health Forum (Wilson), McMaster University, Hamilton, Ont.; Department of Community Health and Epidemiology (Levy), Dalhousie University, Halifax, NS; New Brunswick Health Council (Mancuso), Moncton, NB; Faculty of Medicine (Morgan), The University of British Columbia, Vancouver, BC; Health Quality Council of Alberta (Neuner), Calgary, Alta.; Canadian Agency for Drugs and Technologies in Health (Rader), Ottawa, Ont.; Alberta Health Services (Teare), Edmonton, Alta
| | - Michael Hillmer
- Ottawa Hospital Research Institute (Squires, Cho-Young, Aloisio, Graham, Santos, Grimshaw); School of Epidemiology and Public Health (Graham), School of Nursing (Squires, Demery Varin, Greenough, Nadalin-Penno, Vandyk) and Department of Medicine (Grimshaw), University of Ottawa, University of Ottawa, Ottawa, Ont.; Department of Surgery (Bell), Dalla Lana School of Public Health (Dobrow), Department of Medicine (Levinson), and Department of Family and Community Medicine (Tepper), University of Toronto, Toronto, Ont.; Division of Community Health and Humanities (Bornstein), Memorial University of Newfoundland, St. John's, Nfld.; Public Reports (Brien), Health Quality Ontario, Toronto, Ont.; Faculty of Medicine (Decary), University of Montreal, Montréal, Que.; Faculty of Nursing (Estabrooks), University of Alberta, Edmonton, Alta.; Registered Nurses Association of Ontario (Grinspun); Ontario Ministry of Health and Long-Term Care (Hillmer), Toronto, Ont.; Royal College of Physicians and Surgeons of Canada (Horsley), Ottawa, Ont.; Virginia Commonwealth University (Hu), Richmond, Va.; Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; BC Patient Safety and Quality Council (Krause), Vancouver, BC; Clinical Epidemiology and Biostatistics (Lavis) and McMaster Health Forum (Wilson), McMaster University, Hamilton, Ont.; Department of Community Health and Epidemiology (Levy), Dalhousie University, Halifax, NS; New Brunswick Health Council (Mancuso), Moncton, NB; Faculty of Medicine (Morgan), The University of British Columbia, Vancouver, BC; Health Quality Council of Alberta (Neuner), Calgary, Alta.; Canadian Agency for Drugs and Technologies in Health (Rader), Ottawa, Ont.; Alberta Health Services (Teare), Edmonton, Alta
| | - Tanya Horsley
- Ottawa Hospital Research Institute (Squires, Cho-Young, Aloisio, Graham, Santos, Grimshaw); School of Epidemiology and Public Health (Graham), School of Nursing (Squires, Demery Varin, Greenough, Nadalin-Penno, Vandyk) and Department of Medicine (Grimshaw), University of Ottawa, University of Ottawa, Ottawa, Ont.; Department of Surgery (Bell), Dalla Lana School of Public Health (Dobrow), Department of Medicine (Levinson), and Department of Family and Community Medicine (Tepper), University of Toronto, Toronto, Ont.; Division of Community Health and Humanities (Bornstein), Memorial University of Newfoundland, St. John's, Nfld.; Public Reports (Brien), Health Quality Ontario, Toronto, Ont.; Faculty of Medicine (Decary), University of Montreal, Montréal, Que.; Faculty of Nursing (Estabrooks), University of Alberta, Edmonton, Alta.; Registered Nurses Association of Ontario (Grinspun); Ontario Ministry of Health and Long-Term Care (Hillmer), Toronto, Ont.; Royal College of Physicians and Surgeons of Canada (Horsley), Ottawa, Ont.; Virginia Commonwealth University (Hu), Richmond, Va.; Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; BC Patient Safety and Quality Council (Krause), Vancouver, BC; Clinical Epidemiology and Biostatistics (Lavis) and McMaster Health Forum (Wilson), McMaster University, Hamilton, Ont.; Department of Community Health and Epidemiology (Levy), Dalhousie University, Halifax, NS; New Brunswick Health Council (Mancuso), Moncton, NB; Faculty of Medicine (Morgan), The University of British Columbia, Vancouver, BC; Health Quality Council of Alberta (Neuner), Calgary, Alta.; Canadian Agency for Drugs and Technologies in Health (Rader), Ottawa, Ont.; Alberta Health Services (Teare), Edmonton, Alta
| | - Jiale Hu
- Ottawa Hospital Research Institute (Squires, Cho-Young, Aloisio, Graham, Santos, Grimshaw); School of Epidemiology and Public Health (Graham), School of Nursing (Squires, Demery Varin, Greenough, Nadalin-Penno, Vandyk) and Department of Medicine (Grimshaw), University of Ottawa, University of Ottawa, Ottawa, Ont.; Department of Surgery (Bell), Dalla Lana School of Public Health (Dobrow), Department of Medicine (Levinson), and Department of Family and Community Medicine (Tepper), University of Toronto, Toronto, Ont.; Division of Community Health and Humanities (Bornstein), Memorial University of Newfoundland, St. John's, Nfld.; Public Reports (Brien), Health Quality Ontario, Toronto, Ont.; Faculty of Medicine (Decary), University of Montreal, Montréal, Que.; Faculty of Nursing (Estabrooks), University of Alberta, Edmonton, Alta.; Registered Nurses Association of Ontario (Grinspun); Ontario Ministry of Health and Long-Term Care (Hillmer), Toronto, Ont.; Royal College of Physicians and Surgeons of Canada (Horsley), Ottawa, Ont.; Virginia Commonwealth University (Hu), Richmond, Va.; Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; BC Patient Safety and Quality Council (Krause), Vancouver, BC; Clinical Epidemiology and Biostatistics (Lavis) and McMaster Health Forum (Wilson), McMaster University, Hamilton, Ont.; Department of Community Health and Epidemiology (Levy), Dalhousie University, Halifax, NS; New Brunswick Health Council (Mancuso), Moncton, NB; Faculty of Medicine (Morgan), The University of British Columbia, Vancouver, BC; Health Quality Council of Alberta (Neuner), Calgary, Alta.; Canadian Agency for Drugs and Technologies in Health (Rader), Ottawa, Ont.; Alberta Health Services (Teare), Edmonton, Alta
| | - Alan Katz
- Ottawa Hospital Research Institute (Squires, Cho-Young, Aloisio, Graham, Santos, Grimshaw); School of Epidemiology and Public Health (Graham), School of Nursing (Squires, Demery Varin, Greenough, Nadalin-Penno, Vandyk) and Department of Medicine (Grimshaw), University of Ottawa, University of Ottawa, Ottawa, Ont.; Department of Surgery (Bell), Dalla Lana School of Public Health (Dobrow), Department of Medicine (Levinson), and Department of Family and Community Medicine (Tepper), University of Toronto, Toronto, Ont.; Division of Community Health and Humanities (Bornstein), Memorial University of Newfoundland, St. John's, Nfld.; Public Reports (Brien), Health Quality Ontario, Toronto, Ont.; Faculty of Medicine (Decary), University of Montreal, Montréal, Que.; Faculty of Nursing (Estabrooks), University of Alberta, Edmonton, Alta.; Registered Nurses Association of Ontario (Grinspun); Ontario Ministry of Health and Long-Term Care (Hillmer), Toronto, Ont.; Royal College of Physicians and Surgeons of Canada (Horsley), Ottawa, Ont.; Virginia Commonwealth University (Hu), Richmond, Va.; Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; BC Patient Safety and Quality Council (Krause), Vancouver, BC; Clinical Epidemiology and Biostatistics (Lavis) and McMaster Health Forum (Wilson), McMaster University, Hamilton, Ont.; Department of Community Health and Epidemiology (Levy), Dalhousie University, Halifax, NS; New Brunswick Health Council (Mancuso), Moncton, NB; Faculty of Medicine (Morgan), The University of British Columbia, Vancouver, BC; Health Quality Council of Alberta (Neuner), Calgary, Alta.; Canadian Agency for Drugs and Technologies in Health (Rader), Ottawa, Ont.; Alberta Health Services (Teare), Edmonton, Alta
| | - Christina Krause
- Ottawa Hospital Research Institute (Squires, Cho-Young, Aloisio, Graham, Santos, Grimshaw); School of Epidemiology and Public Health (Graham), School of Nursing (Squires, Demery Varin, Greenough, Nadalin-Penno, Vandyk) and Department of Medicine (Grimshaw), University of Ottawa, University of Ottawa, Ottawa, Ont.; Department of Surgery (Bell), Dalla Lana School of Public Health (Dobrow), Department of Medicine (Levinson), and Department of Family and Community Medicine (Tepper), University of Toronto, Toronto, Ont.; Division of Community Health and Humanities (Bornstein), Memorial University of Newfoundland, St. John's, Nfld.; Public Reports (Brien), Health Quality Ontario, Toronto, Ont.; Faculty of Medicine (Decary), University of Montreal, Montréal, Que.; Faculty of Nursing (Estabrooks), University of Alberta, Edmonton, Alta.; Registered Nurses Association of Ontario (Grinspun); Ontario Ministry of Health and Long-Term Care (Hillmer), Toronto, Ont.; Royal College of Physicians and Surgeons of Canada (Horsley), Ottawa, Ont.; Virginia Commonwealth University (Hu), Richmond, Va.; Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; BC Patient Safety and Quality Council (Krause), Vancouver, BC; Clinical Epidemiology and Biostatistics (Lavis) and McMaster Health Forum (Wilson), McMaster University, Hamilton, Ont.; Department of Community Health and Epidemiology (Levy), Dalhousie University, Halifax, NS; New Brunswick Health Council (Mancuso), Moncton, NB; Faculty of Medicine (Morgan), The University of British Columbia, Vancouver, BC; Health Quality Council of Alberta (Neuner), Calgary, Alta.; Canadian Agency for Drugs and Technologies in Health (Rader), Ottawa, Ont.; Alberta Health Services (Teare), Edmonton, Alta
| | - John Lavis
- Ottawa Hospital Research Institute (Squires, Cho-Young, Aloisio, Graham, Santos, Grimshaw); School of Epidemiology and Public Health (Graham), School of Nursing (Squires, Demery Varin, Greenough, Nadalin-Penno, Vandyk) and Department of Medicine (Grimshaw), University of Ottawa, University of Ottawa, Ottawa, Ont.; Department of Surgery (Bell), Dalla Lana School of Public Health (Dobrow), Department of Medicine (Levinson), and Department of Family and Community Medicine (Tepper), University of Toronto, Toronto, Ont.; Division of Community Health and Humanities (Bornstein), Memorial University of Newfoundland, St. John's, Nfld.; Public Reports (Brien), Health Quality Ontario, Toronto, Ont.; Faculty of Medicine (Decary), University of Montreal, Montréal, Que.; Faculty of Nursing (Estabrooks), University of Alberta, Edmonton, Alta.; Registered Nurses Association of Ontario (Grinspun); Ontario Ministry of Health and Long-Term Care (Hillmer), Toronto, Ont.; Royal College of Physicians and Surgeons of Canada (Horsley), Ottawa, Ont.; Virginia Commonwealth University (Hu), Richmond, Va.; Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; BC Patient Safety and Quality Council (Krause), Vancouver, BC; Clinical Epidemiology and Biostatistics (Lavis) and McMaster Health Forum (Wilson), McMaster University, Hamilton, Ont.; Department of Community Health and Epidemiology (Levy), Dalhousie University, Halifax, NS; New Brunswick Health Council (Mancuso), Moncton, NB; Faculty of Medicine (Morgan), The University of British Columbia, Vancouver, BC; Health Quality Council of Alberta (Neuner), Calgary, Alta.; Canadian Agency for Drugs and Technologies in Health (Rader), Ottawa, Ont.; Alberta Health Services (Teare), Edmonton, Alta
| | - Wendy Levinson
- Ottawa Hospital Research Institute (Squires, Cho-Young, Aloisio, Graham, Santos, Grimshaw); School of Epidemiology and Public Health (Graham), School of Nursing (Squires, Demery Varin, Greenough, Nadalin-Penno, Vandyk) and Department of Medicine (Grimshaw), University of Ottawa, University of Ottawa, Ottawa, Ont.; Department of Surgery (Bell), Dalla Lana School of Public Health (Dobrow), Department of Medicine (Levinson), and Department of Family and Community Medicine (Tepper), University of Toronto, Toronto, Ont.; Division of Community Health and Humanities (Bornstein), Memorial University of Newfoundland, St. John's, Nfld.; Public Reports (Brien), Health Quality Ontario, Toronto, Ont.; Faculty of Medicine (Decary), University of Montreal, Montréal, Que.; Faculty of Nursing (Estabrooks), University of Alberta, Edmonton, Alta.; Registered Nurses Association of Ontario (Grinspun); Ontario Ministry of Health and Long-Term Care (Hillmer), Toronto, Ont.; Royal College of Physicians and Surgeons of Canada (Horsley), Ottawa, Ont.; Virginia Commonwealth University (Hu), Richmond, Va.; Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; BC Patient Safety and Quality Council (Krause), Vancouver, BC; Clinical Epidemiology and Biostatistics (Lavis) and McMaster Health Forum (Wilson), McMaster University, Hamilton, Ont.; Department of Community Health and Epidemiology (Levy), Dalhousie University, Halifax, NS; New Brunswick Health Council (Mancuso), Moncton, NB; Faculty of Medicine (Morgan), The University of British Columbia, Vancouver, BC; Health Quality Council of Alberta (Neuner), Calgary, Alta.; Canadian Agency for Drugs and Technologies in Health (Rader), Ottawa, Ont.; Alberta Health Services (Teare), Edmonton, Alta
| | - Adrian Levy
- Ottawa Hospital Research Institute (Squires, Cho-Young, Aloisio, Graham, Santos, Grimshaw); School of Epidemiology and Public Health (Graham), School of Nursing (Squires, Demery Varin, Greenough, Nadalin-Penno, Vandyk) and Department of Medicine (Grimshaw), University of Ottawa, University of Ottawa, Ottawa, Ont.; Department of Surgery (Bell), Dalla Lana School of Public Health (Dobrow), Department of Medicine (Levinson), and Department of Family and Community Medicine (Tepper), University of Toronto, Toronto, Ont.; Division of Community Health and Humanities (Bornstein), Memorial University of Newfoundland, St. John's, Nfld.; Public Reports (Brien), Health Quality Ontario, Toronto, Ont.; Faculty of Medicine (Decary), University of Montreal, Montréal, Que.; Faculty of Nursing (Estabrooks), University of Alberta, Edmonton, Alta.; Registered Nurses Association of Ontario (Grinspun); Ontario Ministry of Health and Long-Term Care (Hillmer), Toronto, Ont.; Royal College of Physicians and Surgeons of Canada (Horsley), Ottawa, Ont.; Virginia Commonwealth University (Hu), Richmond, Va.; Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; BC Patient Safety and Quality Council (Krause), Vancouver, BC; Clinical Epidemiology and Biostatistics (Lavis) and McMaster Health Forum (Wilson), McMaster University, Hamilton, Ont.; Department of Community Health and Epidemiology (Levy), Dalhousie University, Halifax, NS; New Brunswick Health Council (Mancuso), Moncton, NB; Faculty of Medicine (Morgan), The University of British Columbia, Vancouver, BC; Health Quality Council of Alberta (Neuner), Calgary, Alta.; Canadian Agency for Drugs and Technologies in Health (Rader), Ottawa, Ont.; Alberta Health Services (Teare), Edmonton, Alta
| | - Michelina Mancuso
- Ottawa Hospital Research Institute (Squires, Cho-Young, Aloisio, Graham, Santos, Grimshaw); School of Epidemiology and Public Health (Graham), School of Nursing (Squires, Demery Varin, Greenough, Nadalin-Penno, Vandyk) and Department of Medicine (Grimshaw), University of Ottawa, University of Ottawa, Ottawa, Ont.; Department of Surgery (Bell), Dalla Lana School of Public Health (Dobrow), Department of Medicine (Levinson), and Department of Family and Community Medicine (Tepper), University of Toronto, Toronto, Ont.; Division of Community Health and Humanities (Bornstein), Memorial University of Newfoundland, St. John's, Nfld.; Public Reports (Brien), Health Quality Ontario, Toronto, Ont.; Faculty of Medicine (Decary), University of Montreal, Montréal, Que.; Faculty of Nursing (Estabrooks), University of Alberta, Edmonton, Alta.; Registered Nurses Association of Ontario (Grinspun); Ontario Ministry of Health and Long-Term Care (Hillmer), Toronto, Ont.; Royal College of Physicians and Surgeons of Canada (Horsley), Ottawa, Ont.; Virginia Commonwealth University (Hu), Richmond, Va.; Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; BC Patient Safety and Quality Council (Krause), Vancouver, BC; Clinical Epidemiology and Biostatistics (Lavis) and McMaster Health Forum (Wilson), McMaster University, Hamilton, Ont.; Department of Community Health and Epidemiology (Levy), Dalhousie University, Halifax, NS; New Brunswick Health Council (Mancuso), Moncton, NB; Faculty of Medicine (Morgan), The University of British Columbia, Vancouver, BC; Health Quality Council of Alberta (Neuner), Calgary, Alta.; Canadian Agency for Drugs and Technologies in Health (Rader), Ottawa, Ont.; Alberta Health Services (Teare), Edmonton, Alta
| | - Steve Morgan
- Ottawa Hospital Research Institute (Squires, Cho-Young, Aloisio, Graham, Santos, Grimshaw); School of Epidemiology and Public Health (Graham), School of Nursing (Squires, Demery Varin, Greenough, Nadalin-Penno, Vandyk) and Department of Medicine (Grimshaw), University of Ottawa, University of Ottawa, Ottawa, Ont.; Department of Surgery (Bell), Dalla Lana School of Public Health (Dobrow), Department of Medicine (Levinson), and Department of Family and Community Medicine (Tepper), University of Toronto, Toronto, Ont.; Division of Community Health and Humanities (Bornstein), Memorial University of Newfoundland, St. John's, Nfld.; Public Reports (Brien), Health Quality Ontario, Toronto, Ont.; Faculty of Medicine (Decary), University of Montreal, Montréal, Que.; Faculty of Nursing (Estabrooks), University of Alberta, Edmonton, Alta.; Registered Nurses Association of Ontario (Grinspun); Ontario Ministry of Health and Long-Term Care (Hillmer), Toronto, Ont.; Royal College of Physicians and Surgeons of Canada (Horsley), Ottawa, Ont.; Virginia Commonwealth University (Hu), Richmond, Va.; Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; BC Patient Safety and Quality Council (Krause), Vancouver, BC; Clinical Epidemiology and Biostatistics (Lavis) and McMaster Health Forum (Wilson), McMaster University, Hamilton, Ont.; Department of Community Health and Epidemiology (Levy), Dalhousie University, Halifax, NS; New Brunswick Health Council (Mancuso), Moncton, NB; Faculty of Medicine (Morgan), The University of British Columbia, Vancouver, BC; Health Quality Council of Alberta (Neuner), Calgary, Alta.; Canadian Agency for Drugs and Technologies in Health (Rader), Ottawa, Ont.; Alberta Health Services (Teare), Edmonton, Alta
| | - Letitia Nadalin-Penno
- Ottawa Hospital Research Institute (Squires, Cho-Young, Aloisio, Graham, Santos, Grimshaw); School of Epidemiology and Public Health (Graham), School of Nursing (Squires, Demery Varin, Greenough, Nadalin-Penno, Vandyk) and Department of Medicine (Grimshaw), University of Ottawa, University of Ottawa, Ottawa, Ont.; Department of Surgery (Bell), Dalla Lana School of Public Health (Dobrow), Department of Medicine (Levinson), and Department of Family and Community Medicine (Tepper), University of Toronto, Toronto, Ont.; Division of Community Health and Humanities (Bornstein), Memorial University of Newfoundland, St. John's, Nfld.; Public Reports (Brien), Health Quality Ontario, Toronto, Ont.; Faculty of Medicine (Decary), University of Montreal, Montréal, Que.; Faculty of Nursing (Estabrooks), University of Alberta, Edmonton, Alta.; Registered Nurses Association of Ontario (Grinspun); Ontario Ministry of Health and Long-Term Care (Hillmer), Toronto, Ont.; Royal College of Physicians and Surgeons of Canada (Horsley), Ottawa, Ont.; Virginia Commonwealth University (Hu), Richmond, Va.; Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; BC Patient Safety and Quality Council (Krause), Vancouver, BC; Clinical Epidemiology and Biostatistics (Lavis) and McMaster Health Forum (Wilson), McMaster University, Hamilton, Ont.; Department of Community Health and Epidemiology (Levy), Dalhousie University, Halifax, NS; New Brunswick Health Council (Mancuso), Moncton, NB; Faculty of Medicine (Morgan), The University of British Columbia, Vancouver, BC; Health Quality Council of Alberta (Neuner), Calgary, Alta.; Canadian Agency for Drugs and Technologies in Health (Rader), Ottawa, Ont.; Alberta Health Services (Teare), Edmonton, Alta
| | - Andrew Neuner
- Ottawa Hospital Research Institute (Squires, Cho-Young, Aloisio, Graham, Santos, Grimshaw); School of Epidemiology and Public Health (Graham), School of Nursing (Squires, Demery Varin, Greenough, Nadalin-Penno, Vandyk) and Department of Medicine (Grimshaw), University of Ottawa, University of Ottawa, Ottawa, Ont.; Department of Surgery (Bell), Dalla Lana School of Public Health (Dobrow), Department of Medicine (Levinson), and Department of Family and Community Medicine (Tepper), University of Toronto, Toronto, Ont.; Division of Community Health and Humanities (Bornstein), Memorial University of Newfoundland, St. John's, Nfld.; Public Reports (Brien), Health Quality Ontario, Toronto, Ont.; Faculty of Medicine (Decary), University of Montreal, Montréal, Que.; Faculty of Nursing (Estabrooks), University of Alberta, Edmonton, Alta.; Registered Nurses Association of Ontario (Grinspun); Ontario Ministry of Health and Long-Term Care (Hillmer), Toronto, Ont.; Royal College of Physicians and Surgeons of Canada (Horsley), Ottawa, Ont.; Virginia Commonwealth University (Hu), Richmond, Va.; Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; BC Patient Safety and Quality Council (Krause), Vancouver, BC; Clinical Epidemiology and Biostatistics (Lavis) and McMaster Health Forum (Wilson), McMaster University, Hamilton, Ont.; Department of Community Health and Epidemiology (Levy), Dalhousie University, Halifax, NS; New Brunswick Health Council (Mancuso), Moncton, NB; Faculty of Medicine (Morgan), The University of British Columbia, Vancouver, BC; Health Quality Council of Alberta (Neuner), Calgary, Alta.; Canadian Agency for Drugs and Technologies in Health (Rader), Ottawa, Ont.; Alberta Health Services (Teare), Edmonton, Alta
| | - Tamara Rader
- Ottawa Hospital Research Institute (Squires, Cho-Young, Aloisio, Graham, Santos, Grimshaw); School of Epidemiology and Public Health (Graham), School of Nursing (Squires, Demery Varin, Greenough, Nadalin-Penno, Vandyk) and Department of Medicine (Grimshaw), University of Ottawa, University of Ottawa, Ottawa, Ont.; Department of Surgery (Bell), Dalla Lana School of Public Health (Dobrow), Department of Medicine (Levinson), and Department of Family and Community Medicine (Tepper), University of Toronto, Toronto, Ont.; Division of Community Health and Humanities (Bornstein), Memorial University of Newfoundland, St. John's, Nfld.; Public Reports (Brien), Health Quality Ontario, Toronto, Ont.; Faculty of Medicine (Decary), University of Montreal, Montréal, Que.; Faculty of Nursing (Estabrooks), University of Alberta, Edmonton, Alta.; Registered Nurses Association of Ontario (Grinspun); Ontario Ministry of Health and Long-Term Care (Hillmer), Toronto, Ont.; Royal College of Physicians and Surgeons of Canada (Horsley), Ottawa, Ont.; Virginia Commonwealth University (Hu), Richmond, Va.; Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; BC Patient Safety and Quality Council (Krause), Vancouver, BC; Clinical Epidemiology and Biostatistics (Lavis) and McMaster Health Forum (Wilson), McMaster University, Hamilton, Ont.; Department of Community Health and Epidemiology (Levy), Dalhousie University, Halifax, NS; New Brunswick Health Council (Mancuso), Moncton, NB; Faculty of Medicine (Morgan), The University of British Columbia, Vancouver, BC; Health Quality Council of Alberta (Neuner), Calgary, Alta.; Canadian Agency for Drugs and Technologies in Health (Rader), Ottawa, Ont.; Alberta Health Services (Teare), Edmonton, Alta
| | - Wilmer J Santos
- Ottawa Hospital Research Institute (Squires, Cho-Young, Aloisio, Graham, Santos, Grimshaw); School of Epidemiology and Public Health (Graham), School of Nursing (Squires, Demery Varin, Greenough, Nadalin-Penno, Vandyk) and Department of Medicine (Grimshaw), University of Ottawa, University of Ottawa, Ottawa, Ont.; Department of Surgery (Bell), Dalla Lana School of Public Health (Dobrow), Department of Medicine (Levinson), and Department of Family and Community Medicine (Tepper), University of Toronto, Toronto, Ont.; Division of Community Health and Humanities (Bornstein), Memorial University of Newfoundland, St. John's, Nfld.; Public Reports (Brien), Health Quality Ontario, Toronto, Ont.; Faculty of Medicine (Decary), University of Montreal, Montréal, Que.; Faculty of Nursing (Estabrooks), University of Alberta, Edmonton, Alta.; Registered Nurses Association of Ontario (Grinspun); Ontario Ministry of Health and Long-Term Care (Hillmer), Toronto, Ont.; Royal College of Physicians and Surgeons of Canada (Horsley), Ottawa, Ont.; Virginia Commonwealth University (Hu), Richmond, Va.; Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; BC Patient Safety and Quality Council (Krause), Vancouver, BC; Clinical Epidemiology and Biostatistics (Lavis) and McMaster Health Forum (Wilson), McMaster University, Hamilton, Ont.; Department of Community Health and Epidemiology (Levy), Dalhousie University, Halifax, NS; New Brunswick Health Council (Mancuso), Moncton, NB; Faculty of Medicine (Morgan), The University of British Columbia, Vancouver, BC; Health Quality Council of Alberta (Neuner), Calgary, Alta.; Canadian Agency for Drugs and Technologies in Health (Rader), Ottawa, Ont.; Alberta Health Services (Teare), Edmonton, Alta
| | - Gary Teare
- Ottawa Hospital Research Institute (Squires, Cho-Young, Aloisio, Graham, Santos, Grimshaw); School of Epidemiology and Public Health (Graham), School of Nursing (Squires, Demery Varin, Greenough, Nadalin-Penno, Vandyk) and Department of Medicine (Grimshaw), University of Ottawa, University of Ottawa, Ottawa, Ont.; Department of Surgery (Bell), Dalla Lana School of Public Health (Dobrow), Department of Medicine (Levinson), and Department of Family and Community Medicine (Tepper), University of Toronto, Toronto, Ont.; Division of Community Health and Humanities (Bornstein), Memorial University of Newfoundland, St. John's, Nfld.; Public Reports (Brien), Health Quality Ontario, Toronto, Ont.; Faculty of Medicine (Decary), University of Montreal, Montréal, Que.; Faculty of Nursing (Estabrooks), University of Alberta, Edmonton, Alta.; Registered Nurses Association of Ontario (Grinspun); Ontario Ministry of Health and Long-Term Care (Hillmer), Toronto, Ont.; Royal College of Physicians and Surgeons of Canada (Horsley), Ottawa, Ont.; Virginia Commonwealth University (Hu), Richmond, Va.; Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; BC Patient Safety and Quality Council (Krause), Vancouver, BC; Clinical Epidemiology and Biostatistics (Lavis) and McMaster Health Forum (Wilson), McMaster University, Hamilton, Ont.; Department of Community Health and Epidemiology (Levy), Dalhousie University, Halifax, NS; New Brunswick Health Council (Mancuso), Moncton, NB; Faculty of Medicine (Morgan), The University of British Columbia, Vancouver, BC; Health Quality Council of Alberta (Neuner), Calgary, Alta.; Canadian Agency for Drugs and Technologies in Health (Rader), Ottawa, Ont.; Alberta Health Services (Teare), Edmonton, Alta
| | - Joshua Tepper
- Ottawa Hospital Research Institute (Squires, Cho-Young, Aloisio, Graham, Santos, Grimshaw); School of Epidemiology and Public Health (Graham), School of Nursing (Squires, Demery Varin, Greenough, Nadalin-Penno, Vandyk) and Department of Medicine (Grimshaw), University of Ottawa, University of Ottawa, Ottawa, Ont.; Department of Surgery (Bell), Dalla Lana School of Public Health (Dobrow), Department of Medicine (Levinson), and Department of Family and Community Medicine (Tepper), University of Toronto, Toronto, Ont.; Division of Community Health and Humanities (Bornstein), Memorial University of Newfoundland, St. John's, Nfld.; Public Reports (Brien), Health Quality Ontario, Toronto, Ont.; Faculty of Medicine (Decary), University of Montreal, Montréal, Que.; Faculty of Nursing (Estabrooks), University of Alberta, Edmonton, Alta.; Registered Nurses Association of Ontario (Grinspun); Ontario Ministry of Health and Long-Term Care (Hillmer), Toronto, Ont.; Royal College of Physicians and Surgeons of Canada (Horsley), Ottawa, Ont.; Virginia Commonwealth University (Hu), Richmond, Va.; Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; BC Patient Safety and Quality Council (Krause), Vancouver, BC; Clinical Epidemiology and Biostatistics (Lavis) and McMaster Health Forum (Wilson), McMaster University, Hamilton, Ont.; Department of Community Health and Epidemiology (Levy), Dalhousie University, Halifax, NS; New Brunswick Health Council (Mancuso), Moncton, NB; Faculty of Medicine (Morgan), The University of British Columbia, Vancouver, BC; Health Quality Council of Alberta (Neuner), Calgary, Alta.; Canadian Agency for Drugs and Technologies in Health (Rader), Ottawa, Ont.; Alberta Health Services (Teare), Edmonton, Alta
| | - Amanda Vandyk
- Ottawa Hospital Research Institute (Squires, Cho-Young, Aloisio, Graham, Santos, Grimshaw); School of Epidemiology and Public Health (Graham), School of Nursing (Squires, Demery Varin, Greenough, Nadalin-Penno, Vandyk) and Department of Medicine (Grimshaw), University of Ottawa, University of Ottawa, Ottawa, Ont.; Department of Surgery (Bell), Dalla Lana School of Public Health (Dobrow), Department of Medicine (Levinson), and Department of Family and Community Medicine (Tepper), University of Toronto, Toronto, Ont.; Division of Community Health and Humanities (Bornstein), Memorial University of Newfoundland, St. John's, Nfld.; Public Reports (Brien), Health Quality Ontario, Toronto, Ont.; Faculty of Medicine (Decary), University of Montreal, Montréal, Que.; Faculty of Nursing (Estabrooks), University of Alberta, Edmonton, Alta.; Registered Nurses Association of Ontario (Grinspun); Ontario Ministry of Health and Long-Term Care (Hillmer), Toronto, Ont.; Royal College of Physicians and Surgeons of Canada (Horsley), Ottawa, Ont.; Virginia Commonwealth University (Hu), Richmond, Va.; Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; BC Patient Safety and Quality Council (Krause), Vancouver, BC; Clinical Epidemiology and Biostatistics (Lavis) and McMaster Health Forum (Wilson), McMaster University, Hamilton, Ont.; Department of Community Health and Epidemiology (Levy), Dalhousie University, Halifax, NS; New Brunswick Health Council (Mancuso), Moncton, NB; Faculty of Medicine (Morgan), The University of British Columbia, Vancouver, BC; Health Quality Council of Alberta (Neuner), Calgary, Alta.; Canadian Agency for Drugs and Technologies in Health (Rader), Ottawa, Ont.; Alberta Health Services (Teare), Edmonton, Alta
| | - Michael Wilson
- Ottawa Hospital Research Institute (Squires, Cho-Young, Aloisio, Graham, Santos, Grimshaw); School of Epidemiology and Public Health (Graham), School of Nursing (Squires, Demery Varin, Greenough, Nadalin-Penno, Vandyk) and Department of Medicine (Grimshaw), University of Ottawa, University of Ottawa, Ottawa, Ont.; Department of Surgery (Bell), Dalla Lana School of Public Health (Dobrow), Department of Medicine (Levinson), and Department of Family and Community Medicine (Tepper), University of Toronto, Toronto, Ont.; Division of Community Health and Humanities (Bornstein), Memorial University of Newfoundland, St. John's, Nfld.; Public Reports (Brien), Health Quality Ontario, Toronto, Ont.; Faculty of Medicine (Decary), University of Montreal, Montréal, Que.; Faculty of Nursing (Estabrooks), University of Alberta, Edmonton, Alta.; Registered Nurses Association of Ontario (Grinspun); Ontario Ministry of Health and Long-Term Care (Hillmer), Toronto, Ont.; Royal College of Physicians and Surgeons of Canada (Horsley), Ottawa, Ont.; Virginia Commonwealth University (Hu), Richmond, Va.; Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; BC Patient Safety and Quality Council (Krause), Vancouver, BC; Clinical Epidemiology and Biostatistics (Lavis) and McMaster Health Forum (Wilson), McMaster University, Hamilton, Ont.; Department of Community Health and Epidemiology (Levy), Dalhousie University, Halifax, NS; New Brunswick Health Council (Mancuso), Moncton, NB; Faculty of Medicine (Morgan), The University of British Columbia, Vancouver, BC; Health Quality Council of Alberta (Neuner), Calgary, Alta.; Canadian Agency for Drugs and Technologies in Health (Rader), Ottawa, Ont.; Alberta Health Services (Teare), Edmonton, Alta
| | - Jeremy M Grimshaw
- Ottawa Hospital Research Institute (Squires, Cho-Young, Aloisio, Graham, Santos, Grimshaw); School of Epidemiology and Public Health (Graham), School of Nursing (Squires, Demery Varin, Greenough, Nadalin-Penno, Vandyk) and Department of Medicine (Grimshaw), University of Ottawa, University of Ottawa, Ottawa, Ont.; Department of Surgery (Bell), Dalla Lana School of Public Health (Dobrow), Department of Medicine (Levinson), and Department of Family and Community Medicine (Tepper), University of Toronto, Toronto, Ont.; Division of Community Health and Humanities (Bornstein), Memorial University of Newfoundland, St. John's, Nfld.; Public Reports (Brien), Health Quality Ontario, Toronto, Ont.; Faculty of Medicine (Decary), University of Montreal, Montréal, Que.; Faculty of Nursing (Estabrooks), University of Alberta, Edmonton, Alta.; Registered Nurses Association of Ontario (Grinspun); Ontario Ministry of Health and Long-Term Care (Hillmer), Toronto, Ont.; Royal College of Physicians and Surgeons of Canada (Horsley), Ottawa, Ont.; Virginia Commonwealth University (Hu), Richmond, Va.; Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; BC Patient Safety and Quality Council (Krause), Vancouver, BC; Clinical Epidemiology and Biostatistics (Lavis) and McMaster Health Forum (Wilson), McMaster University, Hamilton, Ont.; Department of Community Health and Epidemiology (Levy), Dalhousie University, Halifax, NS; New Brunswick Health Council (Mancuso), Moncton, NB; Faculty of Medicine (Morgan), The University of British Columbia, Vancouver, BC; Health Quality Council of Alberta (Neuner), Calgary, Alta.; Canadian Agency for Drugs and Technologies in Health (Rader), Ottawa, Ont.; Alberta Health Services (Teare), Edmonton, Alta
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25
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Knudsen L, Hansen DL, Joensen LE, Wibaek R, Benros ME, Jørgensen ME, Andersen GS. Need for improved diabetes support among people with psychiatric disorders and diabetes treated in psychiatric outpatient clinics: results from a Danish cross-sectional study. BMJ Open Diabetes Res Care 2022; 10:10/1/e002366. [PMID: 35078855 PMCID: PMC8796247 DOI: 10.1136/bmjdrc-2021-002366] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 01/04/2022] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION People with psychiatric disorders have increased risk of premature death partly due to diabetes. This study aims to explore the quality of diabetes care, diabetes management, diabetes support and well-being of people with psychiatric disorders and diabetes. RESEARCH DESIGN AND METHODS A total of 107 participants aged ≥18 years with diabetes and psychiatric disorders treated at psychiatric outpatient clinics in Denmark were recruited from August 2018 to June 2019. This descriptive cross-sectional study includes data from medical records on quality of diabetes care (eg, level and annual examination of hemoglobin A1c (HbA1c)) and questionnaires on diabetes management (measured on items from the Summary of Diabetes Self-Care Activities Scale and diabetes distress based on Problem Areas in Diabetes Scale (PAID-5)), diabetes support (no, some or high support from eight potential support persons and experience of care actions measured on items from Patient Assessment of Chronic Illness Care) and well-being (WHO 5-Item Scale and self-rated general health). RESULTS The mean age was 52 years, 56% were men, the mean body mass index was 31.9 kg/m2, the median HbA1c was 53 mmol/mol (7.0%) and the mean blood pressure was 131/83 mm Hg. The proportion with annual measurements of HbA1c was 93%, blood pressure 80%, cholesterol 93%, foot examination 77% and eye examination 75%. Fifty-one per cent had high diabetes distress (PAID-5 score ≥8). Diabetologists and general practitioners (39% and 37%) were the health professionals most frequently reported to provide high diabetes support. CONCLUSIONS This study highlights a need for improved diabetes support in people with psychiatric disorders and diabetes. Although a high proportion received appropriate diabetes care, we found high levels of diabetes distress, moderate levels of optimal self-management behaviors, low well-being and low diabetes support from psychiatric health professionals, while one-third of the population found it relevant to receive diabetes support from psychiatric health professionals.
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Affiliation(s)
- Lenette Knudsen
- Education, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | | | - Lene Eide Joensen
- Diabetes Management Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Rasmus Wibaek
- Clinical Epidemiology, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Michael Eriksen Benros
- Biological and Precision Psychiatry, Copenhagen Research Centre for Mental Health, Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Marit Eika Jørgensen
- Clinical Epidemiology, Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Center for Health Research in Greenland, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark
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26
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Aloudah NM, Almanea H, Alotaibi K, Al Rubeaan KA. Quality of diabetes care among patients with schizophrenia. A mixed-methods study. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2021; 4:100070. [PMID: 35479839 PMCID: PMC9029903 DOI: 10.1016/j.rcsop.2021.100070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 09/11/2021] [Accepted: 09/11/2021] [Indexed: 11/09/2022] Open
Abstract
Objectives Patients with schizophrenia are at high risk of developing diabetes. Our study aimed to determine the prevalence of diabetes in patients with schizophrenia and assess their quality of diabetes care. We further aimed to explore the factors affecting diabetes care in patients with schizophrenia. Research design and methods We conducted a retrospective review of medical records for patients presenting with schizophrenia from October 2017 to October 2018. Thereafter, we conducted semi-structured interviews based on the Theoretical Domains Framework to explore healthcare providers' attitudes and perspectives toward diabetes care in patients with schizophrenia at a tertiary hospital for mental health services in Saudi Arabia. Results The prevalence of diabetes in patients with schizophrenia was 3.7%. The rates of annual testing for quality indicators of diabetes were 8.6% for HgbA1c and 31.4% for low-density lipoprotein cholesterol (LDL-C). Screenings for albuminuria and examinations of the eyes and feet were not conducted. Documentation of smoking status was done infrequently (8.6%). The in-depth interviews uncovered issues with managing diabetes in patients with schizophrenia. We identified four themes: the consequences of poor quality diabetic care provided to patients with schizophrenia; problems with the identification of diabetes in patients with schizophrenia; challenges in the management of patients with both diabetes and schizophrenia; and opportunities to improve the quality of diabetes care provided to patients with schizophrenia. Conclusions This study identified areas that need a considerable amount of work to be undertaken in Saudi Arabia to help patients with schizophrenia. There are numerous opportunities for improving the quality of Type 2 diabetes care such as the involvement of pharmacists to effectively manage diabetes and expanding community-based health services to include mental health, which could accelerate improved care services.
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Chan JKN, Wong CSM, Or PCF, Chen EYH, Chang WC. Diabetes complication burden and patterns and risk of mortality in people with schizophrenia and diabetes: A population-based cohort study with 16-year follow-up. Eur Neuropsychopharmacol 2021; 53:79-88. [PMID: 34481187 DOI: 10.1016/j.euroneuro.2021.08.263] [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: 06/04/2021] [Revised: 07/29/2021] [Accepted: 08/17/2021] [Indexed: 10/20/2022]
Abstract
Schizophrenia is associated with increased prevalence of diabetes. However, risk of diabetes complications as well as the impact of complication burden and patterns on subsequent mortality risk in schizophrenia patients with co-existing diabetes is understudied. This population-based, propensity-score matched (1:10) cohort study identified 6991 patients with incident diabetes and pre-existing schizophrenia and 68,682 patients with incident diabetes only (comparison group) between 2001 and 2016 in Hong Kong, using territory-wide medical-record database of public healthcare services. Complications were measured by Diabetes Complications Severity Index (DCSI), which stratified complication burden into 6 levels (DCSI score=0, 1, 2, 3, 4, or ≥5). Associations of diabetes complications, in terms of DCSI scores (complication burden), specific types and two-way combinations of complications (complication patterns), with all-cause mortality rate in schizophrenia were evaluated using Cox proportional-hazards models. Schizophrenia group had comparable macrovascular (adjusted OR 0.99 [95% CI 0.92-1.06]) and lower microvascular (0.79 [0.73-0.86]) complication rates relative to comparison group. Mortality risk ratio for schizophrenia was elevated at all complication burden levels, which conferred incremental impact on excess mortality in both groups. Cardiovascular diseases (1.60 [1.45-1.77]) and cerebrovascular-metabolic diseases (2.74 [1.25-5.99]) were associated with the highest differential mortality in schizophrenia among various specific complications and complication combinations, respectively. Our results indicate that schizophrenia patients with co-existing diabetes are at increased risk of excess mortality relative to those with diabetes alone, regardless of complication burden levels. Implementation of multilevel, targeted interventions is needed to improve diabetes-related outcomes and reduce mortality gap in this vulnerable population.
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Affiliation(s)
- Joe Kwun Nam Chan
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
| | - Corine Sau Man Wong
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
| | - Philip Chi Fai Or
- Department of Psychiatry, Queen Mary Hospital, Hospital Authority, Hong Kong
| | - Eric Yu Hai Chen
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong; State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
| | - Wing Chung Chang
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong; State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong.
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Selby P, Vojtila L, Ashfaq I, Dragonetti R, Melamed OC, Carriere R, LaChance L, Kohut SA, Hahn M, Mulsant BH. Technology-enabled collaborative care for youth with early psychosis: A protocol for a feasibility study to improve physical health behaviours. Early Interv Psychiatry 2021; 15:828-836. [PMID: 32748501 DOI: 10.1111/eip.13018] [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: 12/24/2019] [Revised: 04/29/2020] [Accepted: 06/24/2020] [Indexed: 12/22/2022]
Abstract
AIM Individuals with psychotic disorders have poorer health outcomes and die earlier due to cardiovascular diseases when compared to healthy populations. Contributing factors include low levels of physical activity, poor nutrition and tobacco smoking. Currently, patients navigate a fragmented health-care system to seek physical and mental health services, often without access to evidence-based health promotion interventions, especially in non-academic settings or rural areas, increasing client barriers at the individual and provider level. To address these gaps, we wish to test the feasibility and impact of a Technology-Enabled Collaborative Care for Youth (TECC-Y) model to improve healthy behaviours among youth with early psychosis. The model addresses geographical barriers and maldistribution of physical and mental health care. METHODS A randomized controlled trial, including youth (ages of 16-29) with early psychosis (diagnosed in the past 5 years) residing in Ontario, Canada. Our primary outcome is client engagement. Secondary outcomes include smoking status, physical health and nutrition. Participants are randomly assigned to either a health coach supervised by a virtual care team, or a self-directed learning group (e-platform with psychoeducational materials). Assessments are conducted at baseline, 6, 12 and 24 weeks. RESULTS This paper presents the protocol of the study. Recruitment commenced in August 2018. This study was registered on 16 July 2018 on clinicaltrials.gov (Registry ID: NCT03610087). CONCLUSIONS TECC-Y will determine if a technology-based collaborative care model engages youth with early psychosis, and whether this will be associated with changes in smoking, physical health and nutrition.
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Affiliation(s)
- Peter Selby
- Addictions Research Program, Centre for Addiction and Mental Health, Toronto, Canada.,Dalla Lana School of Public Health, Toronto, Canada.,Department of Family and Community Medicine, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
| | - Lenka Vojtila
- Nicotine Dependence Clinic, Centre for Addiction and Mental Health, Toronto, Canada
| | - Iqra Ashfaq
- Nicotine Dependence Clinic, Centre for Addiction and Mental Health, Toronto, Canada
| | - Rosa Dragonetti
- Nicotine Dependence Clinic, Centre for Addiction and Mental Health, Toronto, Canada
| | - Osnat C Melamed
- Department of Family and Community Medicine, Toronto, Canada.,Nicotine Dependence Clinic, Centre for Addiction and Mental Health, Toronto, Canada
| | - Rebecca Carriere
- Department of Psychiatry, University of Toronto, Toronto, Canada.,Trillium Health Partners, Mississauga, Canada
| | - Laura LaChance
- St. Mary's Hospital Centre, McGill University, Montreal, Canada.,Department of Psychiatry, McGill University, Montreal, Canada
| | - Sara Ahola Kohut
- Department of Psychiatry, University of Toronto, Toronto, Canada.,IBD Centre, Toronto, Canada.,SickKids Research Institute, Hospital for Sick Children, Toronto, Canada
| | - Margaret Hahn
- Department of Psychiatry, Institute of Medical Science, Toronto, Canada.,Banting and Best Diabetes Centre, University of Toronto, Toronto, Canada.,Mental Health and Metabolism Clinic, Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, Canada
| | - Benoit H Mulsant
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada.,Department of Psychiatry, Geriatric Psychiatry, University of Toronto, Toronto, Canada
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29
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Chan JKN, Wong CSM, Or PCF, Chen EYH, Chang WC. Risk of mortality and complications in patients with schizophrenia and diabetes mellitus: population-based cohort study. Br J Psychiatry 2021; 219:375-382. [PMID: 33407970 DOI: 10.1192/bjp.2020.248] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Schizophrenia patients have markedly elevated prevalence of diabetes compared with the general population. However, risk of mortality and diabetes-related complications among schizophrenia patients with co-occurring diabetes is understudied. AIMS We investigated whether schizophrenia increased the risk of overall mortality, complications and post-complication mortality in people with diabetes. METHOD This population-based, propensity-score matched (1:10) cohort study identified 6991 patients with incident diabetes and pre-existing schizophrenia and 68 682 patients with incident diabetes only between 2001 and 2016 in Hong Kong using a medical record database of public healthcare services. Association between schizophrenia and all-cause mortality was examined with a Cox proportional hazards model. Effect of schizophrenia on first-year complication occurrence following diabetes diagnosis and post-complication mortality rates were evaluated. RESULTS Schizophrenia was associated with increased all-cause mortality (adjusted hazards ratio [aHR] 1.11, 95% CI 1.05-1.18), particularly among men and older age groups. Schizophrenia patients with diabetes had higher metabolic complication rate (aHR 1.99, 95% CI 1.63-2.42), lower microvascular complication rate (aHR 0.75, 95% CI 0.65-0.86) and comparable macrovascular complication rate (aHR 0.93, 95% CI 0.85-1.03), relative to patients with diabetes only. Among patients with diabetes complications, schizophrenia was associated with elevated all-cause mortality after macrovascular (aHR 1.19, 95% CI 1.04-1.37) and microvascular (aHR 1.33, 95% CI 1.08-1.64) complications. Gender-stratified analyses revealed that a significant effect of schizophrenia on heightened post-complication mortality was observed in men only. CONCLUSIONS Schizophrenia patients with co-occurring diabetes are at increased risk of excess mortality, including post-complication mortality. Further research identifying effective interventions is warranted to optimise diabetes-related outcomes in this vulnerable population.
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Affiliation(s)
- Joe Kwun Nam Chan
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - Corine Sau Man Wong
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - Philip Chi Fai Or
- Department of Psychiatry, Queen Mary Hospital, Hospital Authority, Hong Kong
| | - Eric Yu Hai Chen
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Hong Kong; and State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
| | - Wing Chung Chang
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Hong Kong; and State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
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30
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Chen PH, Tsai SY, Pan CH, Chang HM, Chen YL, Su SS, Chen CC, Kuo CJ. Age Effect on Incidence, Physical, and Psychiatric Comorbidity for Sudden Cardiac Death in Schizophrenia: Effet de l'âge sur l'incidence, la comorbidité physique et psychiatrique de la mort cardiaque subite dans la schizophrénie. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2021; 66:367-375. [PMID: 32799653 PMCID: PMC8172351 DOI: 10.1177/0706743720948429] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The pathogenesis of sudden cardiac death may differ between younger and older adults in schizophrenia, but evidence remains scant. This study investigated the age effect on the incidence and risk of the physical and psychiatric comorbidity for sudden cardiac death. METHODS Using 2000 to 2016 data from the Taiwan National Health Insurance Research Database and Department of Health Death Certification System, we identified a national cohort of 170,322 patients with schizophrenia, 1,836 of whom had a sudden cardiac death. Standardized mortality ratios (SMRs) were estimated. Hazard ratios and population attributable fractions of distinctive comorbidities for sudden cardiac death were assessed. RESULTS The SMRs of sudden cardiac death were all >1.00 across each age group for both sexes, with the highest SMR in male patients aged <35 years (30.88, 95% CI: 26.18-36.18). The fractions of sudden cardiac death attributable to hypertension and congestive heart failure noticeably increased with age. By contrast, the fraction attributable to drug-induced mental disorder decreased with age. Additionally, chronic hepatic disease and sleep disorder increased the risk of sudden cardiac death in patients aged <35 years. Dementia and organic mental disorder elevated the risk in patients aged between 35-54 years. Ischemic heart disease raised the risk in patients aged ≥55 years. CONCLUSIONS The risk is increased across the lifespan in schizophrenia, particularly for younger male patients. Furthermore, physical and psychiatric comorbidities have age-dependent risks. The findings suggest that prevention strategies targeted toward sudden cardiac death in patients with schizophrenia must consider the age effect.
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Affiliation(s)
- Pao-Huan Chen
- Department of Psychiatry, 63474Taipei Medical University Hospital, Taipei.,Psychiatric Research Center, 63474Taipei Medical University Hospital, Taipei.,Department of Psychiatry, School of Medicine, College of Medicine, 63474Taipei Medical University, Taipei
| | - Shang-Ying Tsai
- Department of Psychiatry, 63474Taipei Medical University Hospital, Taipei.,Psychiatric Research Center, 63474Taipei Medical University Hospital, Taipei.,Department of Psychiatry, School of Medicine, College of Medicine, 63474Taipei Medical University, Taipei
| | - Chun-Hung Pan
- Taipei City Psychiatric Center, 433112Taipei City Hospital, Taipei.,Department of Psychology, National Chengchi University, Taipei
| | - Hu-Ming Chang
- Taipei City Psychiatric Center, 433112Taipei City Hospital, Taipei
| | - Yi-Lung Chen
- Taipei City Psychiatric Center, 433112Taipei City Hospital, Taipei
| | - Sheng-Siang Su
- Taipei City Psychiatric Center, 433112Taipei City Hospital, Taipei
| | - Chiao-Chicy Chen
- Department of Psychiatry, School of Medicine, College of Medicine, 63474Taipei Medical University, Taipei.,Department of Psychiatry, 36897Mackay Memorial Hospital, Taipei.,Department of Psychiatry, Mackay Medical College, Taipei
| | - Chian-Jue Kuo
- Psychiatric Research Center, 63474Taipei Medical University Hospital, Taipei.,Department of Psychiatry, School of Medicine, College of Medicine, 63474Taipei Medical University, Taipei.,Taipei City Psychiatric Center, 433112Taipei City Hospital, Taipei
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31
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Quality of diabetes care in patients with schizophrenia: a case-control study in Qatar. BMC Psychiatry 2021; 21:149. [PMID: 33706754 PMCID: PMC7953779 DOI: 10.1186/s12888-021-03121-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 02/17/2021] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Patients with schizophrenia are at least twice as likely to develop diabetes mellitus compared to the general population. This is of significance in Qatar given the high prevalence of obesity and diabetes. Furthermore, the lifespan of people with schizophrenia is shortened by approximately 15 years, partly due to long-term microvascular and macrovascular complications. High quality diabetes care can significantly reduce morbidity and mortality. We assessed the level of diabetes care delivered to patients in Qatar with schizophrenia and diabetes compared to those with diabetes alone. METHODS We performed a retrospective chart review of patients with diabetes mellitus with (n = 73) and without (n = 73) schizophrenia. Demographic information and electronic medical records were reviewed to determine adherence to American Diabetes Association standards of diabetes care in the last 6 and 12 months. Optimal diabetes care was defined as having completed glycated hemoglobin (HbA1c), lipid profile and retinal examination within 12 months. RESULTS Optimal diabetes care was significantly lower in patients with schizophrenia and diabetes compared to diabetes alone [26.0% (n = 19/73) vs 52.1% (n = 38/73), p = 0.002]. Patients with diabetes and schizophrenia were also significantly less likely to have had body mass index recorded within 6 months (p = 0.008) and HbA1c (p = 0.006), lipid profile (p = 0.015), estimated glomerular filtration rate (eGFR) (p = 0.001) and order for retinal examination (p = 0.004) over 12 months. After adjusting for multiple comparisons, only assessment of eGFR (p = 0.01) and order for retinal examination (p = 0.04) remained significant. CONCLUSION Patients in Qatar with schizophrenia and diabetes, receive sub-optimal diabetes care compared to those with diabetes alone.
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Davies SJC, Iwajomo T, de Oliveira C, Versloot J, Reid RJ, Kurdyak P. The impact of psychiatric and medical comorbidity on the risk of mortality: a population-based analysis. Psychol Med 2021; 51:320-328. [PMID: 31775914 DOI: 10.1017/s003329171900326x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND As life expectancy increases, more people have chronic psychiatric and medical health disorders. Comorbidity may increase the risk of premature mortality, an important challenge for health service delivery. METHODS Population-based cohort study in Ontario, Canada of all 11 246 910 residents aged ⩾16 and <105 on 1 April 2012 and alive on 31 March 2014. Secondary analyses included subjects having common medical disorders in 10 separate cohorts. Exposures were psychiatric morbidity categories identified using aggregated diagnosis groups (ADGs) from Johns Hopkins Adjusted Clinical Groups software® (v10.0); ADG 25: Persistent/Recurrent unstable conditions; e.g. acute schizophrenic episode, major depressive disorder (recurrent episode), ADG 24: Persistent/Recurrent stable conditions; e.g. depressive disorder, paranoid personality disorder, ADG 23: Time-limited/minor conditions; e.g. adjustment reaction with brief depressive reaction. The outcome was all-cause mortality (April 2014-March 2016). RESULTS Over 2 years' follow-up, there were 188 014 deaths (1.7%). ADG 25 conferred an almost threefold excess mortality after adjustment compared to having no psychiatric morbidity [adjusted hazard ratio 2.94 (95% CI 2.91-2.98, p < 0.0001)]. Adjusted hazard ratios for ADG 24 and ADG 23 were 1.12 (95% CI 1.11-1.14, p < 0.0001) and 1.31 (95% CI 1.26-1.36, p < 0.0001). In all 10 medical disorder cohorts, ADG 25 carried significantly greater mortality risk compared to no psychiatric comorbidity. CONCLUSIONS Psychiatric disorders, particularly those graded persistent/recurrent and unstable, were associated with excess mortality in the whole population, and in the medical disorder cohorts examined. Future research should examine whether service design accounting for psychiatric disorder comorbidity improves outcomes across the spectrum of medical disorders.
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Affiliation(s)
- Simon J C Davies
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Tomisin Iwajomo
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Institute of Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Claire de Oliveira
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Institute of Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Judith Versloot
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Institute for Better Health, Mississauga, Ontario, Canada
| | - Robert J Reid
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Institute for Better Health, Mississauga, Ontario, Canada
| | - Paul Kurdyak
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Institute of Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Gentil L, Grenier G, Meng X, Fleury MJ. Impact of Co-occurring Mental Disorders and Chronic Physical Illnesses on Frequency of Emergency Department Use and Hospitalization for Mental Health Reasons. Front Psychiatry 2021; 12:735005. [PMID: 34880788 PMCID: PMC8645581 DOI: 10.3389/fpsyt.2021.735005] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 11/01/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Patients with mental disorders (MD) are at high risk for a wide range of chronic physical illnesses (CPI), often resulting in greater use of acute care services. This study estimated risk of emergency department (ED) use and hospitalization for mental health (MH) reasons among 678 patients with MD and CPI compared to 1,999 patients with MD only. Methods: Patients visiting one of six Quebec (Canada) ED for MH reasons and at onset of a MD in 2014-15 (index year) were included. Negative binomial models comparing the two groups estimated risk of ED use and hospitalization at 12-month follow-up to index ED visit, controlling for clinical, sociodemographic, and service use variables. Results: Patients with MD, more severe overall clinical conditions and those who received more intensive specialized MH care had higher risks of frequent ED use and hospitalization. Continuity of medical care protected against both ED use and hospitalization, while general practitioner (GP) consultations protected against hospitalization only. Patients aged 65+ had lower risk of ED use, whereas risk of hospitalization was higher for the 45-64- vs. 12-24-year age groups, and for men vs. women. Conclusion: Strategies including assertive community treatment, intensive case management, integrated co-occurring treatment, home treatment, and shared care may improve adequacy of care for patients with MD-CPI, as well as those with MD only whose clinical profiles were severe. Prevention and outreach strategies may also be promoted, especially among men and older age groups.
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Affiliation(s)
- Lia Gentil
- Douglas Mental Health University Institute Research Centre, Montréal, QC, Canada.,Department of Psychiatry, McGill University, Montréal, QC, Canada
| | - Guy Grenier
- Douglas Mental Health University Institute Research Centre, Montréal, QC, Canada
| | - Xiangfei Meng
- Douglas Mental Health University Institute Research Centre, Montréal, QC, Canada.,Department of Psychiatry, McGill University, Montréal, QC, Canada
| | - Marie-Josée Fleury
- Douglas Mental Health University Institute Research Centre, Montréal, QC, Canada.,Department of Psychiatry, McGill University, Montréal, QC, Canada
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de Oliveira C, Mason J, Kurdyak P. Characteristics of patients with mental illness and persistent high-cost status: a population-based analysis. CMAJ 2020; 192:E1793-E1801. [PMID: 33318090 DOI: 10.1503/cmaj.200274] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Most of the literature on high-cost users of health care has evaluated this population as a whole, but few studies have focused on high-cost patients with mental illness and whether they persist in the high-cost state. We sought to analyze this patient population in depth and determine predictors of persistency in the high-cost state. METHODS We used 8 years of longitudinal patient-level population data (2010-2017) from Ontario to follow high-cost patients (those in and above the 90th percentile of the cost distribution) with mental illness. We classified high-cost status, based on the proportion of the study period that patients spent in the high-cost state, as persistent (6-8 yr), sporadic (1-2 yr) or moderate (3-5 yr). We compared characteristics between groups and determined predictors of being a patient with mental illness and persistent high-cost status. RESULTS Among 52 638 patients with mental illness and high-cost status, 18 149 (34.5%) were considered persistent high cost. These patients had higher mean annual costs of care ($44 714, 95% confidence interval [CI] $43 724-$45 703) than patients with sporadic ($23 205, 95% CI $22 741-$23 668) and moderate ($31 055, 95% CI $30 359-31 751) status, largely owing to psychiatric hospital admissions. Patients with mental illness and persistent high-cost status were more likely to be female, older, long-term residents of Ontario (information ascertained from the Immigrants, Refugees and Citizenship Canada Database), living in low-income or urban areas, or to have comorbidities. The strongest predictors of persistent (v. sporadic) high-cost status were HIV (relative risk ratio [RRR] 4.32, 95% CI 3.08-6.06), psychosis (RRR 3.41, 95% CI 3.25-3.58) and dementia (RRR 3.21, 95% CI 2.81-3.68). INTERPRETATION Among patients with mental illness and high-cost status, persistence in the high-cost state was determined mainly by psychosis and other comorbidities. Quality-of-care interventions directed at managing psychosis and multimorbidity, as well as preventive interventions to target patients with mental illness before they enter the persistent high-cost state, are needed.
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Affiliation(s)
- Claire de Oliveira
- Centre for Health Economics and Hull York Medical School (de Oliveira), University of York, York, UK; Institute for Mental Health Policy Research (de Oliveira, Mason, Kurdyak), Centre for Addiction and Mental Health; ICES (de Oliveira, Mason, Kurdyak); Institute of Health Policy, Management and Evaluation (de Oliveira, Kurdyak), and Department of Psychiatry (Kurdyak), University of Toronto, Toronto, Ont.
| | - Joyce Mason
- Centre for Health Economics and Hull York Medical School (de Oliveira), University of York, York, UK; Institute for Mental Health Policy Research (de Oliveira, Mason, Kurdyak), Centre for Addiction and Mental Health; ICES (de Oliveira, Mason, Kurdyak); Institute of Health Policy, Management and Evaluation (de Oliveira, Kurdyak), and Department of Psychiatry (Kurdyak), University of Toronto, Toronto, Ont
| | - Paul Kurdyak
- Centre for Health Economics and Hull York Medical School (de Oliveira), University of York, York, UK; Institute for Mental Health Policy Research (de Oliveira, Mason, Kurdyak), Centre for Addiction and Mental Health; ICES (de Oliveira, Mason, Kurdyak); Institute of Health Policy, Management and Evaluation (de Oliveira, Kurdyak), and Department of Psychiatry (Kurdyak), University of Toronto, Toronto, Ont
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Ronaldson A, Elton L, Jayakumar S, Jieman A, Halvorsrud K, Bhui K. Severe mental illness and health service utilisation for nonpsychiatric medical disorders: A systematic review and meta-analysis. PLoS Med 2020; 17:e1003284. [PMID: 32925912 PMCID: PMC7489517 DOI: 10.1371/journal.pmed.1003284] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 08/10/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Psychiatric comorbidity is known to impact upon use of nonpsychiatric health services. The aim of this systematic review and meta-analysis was to assess the specific impact of severe mental illness (SMI) on the use of inpatient, emergency, and primary care services for nonpsychiatric medical disorders. METHODS AND FINDINGS PubMed, Web of Science, PsychINFO, EMBASE, and The Cochrane Library were searched for relevant studies up to October 2018. An updated search was carried out up to the end of February 2020. Studies were included if they assessed the impact of SMI on nonpsychiatric inpatient, emergency, and primary care service use in adults. Study designs eligible for review included observational cohort and case-control studies and randomised controlled trials. Random-effects meta-analyses of the effect of SMI on inpatient admissions, length of hospital stay, 30-day hospital readmission rates, and emergency department use were performed. This review protocol is registered in PROSPERO (CRD42019119516). Seventy-four studies were eligible for review. All were observational cohort or case-control studies carried out in high-income countries. Sample sizes ranged from 27 to 10,777,210. Study quality was assessed using the Newcastle-Ottawa Scale for observational studies. The majority of studies (n = 45) were deemed to be of good quality. Narrative analysis showed that SMI led to increases in use of inpatient, emergency, and primary care services. Meta-analyses revealed that patients with SMI were more likely to be admitted as nonpsychiatric inpatients (pooled odds ratio [OR] = 1.84, 95% confidence interval [CI] 1.21-2.80, p = 0.005, I2 = 100%), had hospital stays that were increased by 0.59 days (pooled standardised mean difference = 0.59 days, 95% CI 0.36-0.83, p < 0.001, I2 = 100%), were more likely to be readmitted to hospital within 30 days (pooled OR = 1.37, 95% CI 1.28-1.47, p < 0.001, I2 = 83%), and were more likely to attend the emergency department (pooled OR = 1.97, 95% CI 1.41-2.76, p < 0.001, I2 = 99%) compared to patients without SMI. Study limitations include considerable heterogeneity across studies, meaning that results of meta-analyses should be interpreted with caution, and the fact that it was not always possible to determine whether service use outcomes definitively excluded mental health treatment. CONCLUSIONS In this study, we found that SMI impacts significantly upon the use of nonpsychiatric health services. Illustrating and quantifying this helps to build a case for and guide the delivery of system-wide integration of mental and physical health services.
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Affiliation(s)
- Amy Ronaldson
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine, Queen Mary University of London, London, United Kingdom
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Lotte Elton
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine, Queen Mary University of London, London, United Kingdom
| | - Simone Jayakumar
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine, Queen Mary University of London, London, United Kingdom
| | - Anna Jieman
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine, Queen Mary University of London, London, United Kingdom
| | - Kristoffer Halvorsrud
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine, Queen Mary University of London, London, United Kingdom
| | - Kamaldeep Bhui
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine, Queen Mary University of London, London, United Kingdom
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
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Jackson CA, Kerssens J, Fleetwood K, Smith DJ, Mercer SW, Wild SH. Incidence of ischaemic heart disease and stroke among people with psychiatric disorders: retrospective cohort study. Br J Psychiatry 2020; 217:442-449. [PMID: 31753047 PMCID: PMC7511900 DOI: 10.1192/bjp.2019.250] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Psychiatric disorders are associated with increased risk of ischaemic heart disease (IHD) and stroke, but it is not known whether the associations or the role of sociodemographic factors have changed over time. AIMS To investigate the association between psychiatric disorders and IHD and stroke, by time period and sociodemographic factors. METHOD We used Scottish population-based records from 1991 to 2015 to create retrospective cohorts with a hospital record for psychiatric disorders of interest (schizophrenia, bipolar disorder or depression) or no record of hospital admission for mental illness. We estimated incidence and relative risks of IHD and stroke in people with versus without psychiatric disorders by calendar year, age, gender and area-based deprivation level. RESULTS In all cohorts, incidence of IHD (645 393 events) and stroke (276 073 events) decreased over time, but relative risks decreased for depression only. In 2015, at the mean age at event onset, relative risks were 2- to 2.5-fold higher in people with versus without a psychiatric disorder. Age at incidence of outcome differed by cohort, gender and socioeconomic status. Relative but not absolute risks were generally higher in women than men. Increasing deprivation conveys a greater absolute risk of IHD for people with bipolar disorder or depression. CONCLUSIONS Despite declines in absolute rates of IHD and stroke, relative risks remain high in those with versus without psychiatric disorders. Cardiovascular disease monitoring and prevention approaches may need to be tailored by psychiatric disorder and cardiovascular outcome, and be targeted, for example, by age and deprivation level.
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Affiliation(s)
- Caroline A. Jackson
- Chancellor's Fellow, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Scotland, UK,Correspondence: Caroline A. Jackson.
| | - Joannes Kerssens
- Principal Information Analyst, Information Services Division, National Services Scotland, NHS Scotland, Scotland, UK
| | - Kelly Fleetwood
- Statistician, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Scotland, UK
| | - Daniel J. Smith
- Professor, Institute of Health and Wellbeing, University of Glasgow, Scotland, UK
| | - Stewart W. Mercer
- Professor, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Scotland, UK
| | - Sarah H. Wild
- Professor, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Scotland, UK
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Brown HK, Cairncross ZF, Lipscombe LL, Wilton AS, Dennis CL, Ray JG, Guttmann A, Vigod SN. Prepregnancy Diabetes and Perinatal Mental Illness: A Population-Based Latent Class Analysis. Am J Epidemiol 2020; 189:573-582. [PMID: 31712817 DOI: 10.1093/aje/kwz254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 10/24/2019] [Accepted: 10/25/2019] [Indexed: 12/20/2022] Open
Abstract
We examined the risk of any perinatal mental illness associated with prepregnancy diabetes and identified how diabetes duration, complexity, and intensity of care affect this risk. We performed a population-based study of women aged 15-49 years with (n = 14,186) and without (n = 843,818) prepregnancy diabetes who had a singleton livebirth (Ontario, Canada, 2005-2015) and no recent mental illness. Modified Poisson regression estimated perinatal mental illness risk between conception and 1 year postpartum in women with versus without diabetes and in diabetes groups, defined by a latent class analysis of diabetes duration, complexity, and intensity-of-care variables, versus women without diabetes. Women with diabetes were more likely than those without to develop perinatal mental illness (18.1% vs. 16.0%; adjusted relative risk = 1.11, 95% confidence interval: 1.07, 1.15). Latent classes of women with diabetes were: uncomplicated and not receiving regular care (59.7%); complicated, with longstanding diabetes, and receiving regular care (16.4%); and recently diagnosed, with comorbidities, and receiving regular care (23.9%). Perinatal mental illness risk was elevated in all classes versus women without diabetes (adjusted relative risks: 1.09-1.12), but results for class 2 were nonsignificant after adjustment. Women with diabetes could benefit from preconception and perinatal strategies to reduce their mental illness risk.
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Bayoumi I, Schultz SE, Glazier RH. Primary care reform and funding equity for mental health disorders in Ontario: a retrospective observational population-based study. CMAJ Open 2020; 8:E455-E461. [PMID: 32561592 PMCID: PMC7850171 DOI: 10.9778/cmajo.20190153] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Mental health disorders are associated with high morbidity and reduced life expectancy, and are largely managed in primary care. We sought to assess the equity of distribution of new alternative payment models and teams introduced under primary care reform in Ontario for patients with mental health disorders. METHODS We conducted a retrospective observational study using population-level administrative data for insured Ontario adults (age ≥ 18 yr) to identify all primary care payments to physicians that were allocated to individual patients in 2002/03 and 2011/12. We identified patients with mental health disorders using validated algorithms, and modelled the relations between per capita primary care costs and mental health disorders over time, stratified by type of mental health or substance use disorder and type of primary care payment. In an adjusted model, we adjusted for age, sex, rurality, neighbourhood income quintile, immigrant status, comorbidity and primary care model. For comparative purposes, we also examined the distribution of primary care payments for people with diabetes mellitus. RESULTS Total per capita primary care payments increased more slowly over the study period for patients with mental health disorders (62.0%) than for the general population (88.3%). Total payments for patients with substance use disorders increased by 142.7%, largely owing to urine drug testing in opioid substitution clinics. Adjusted total payments for those with versus without mental health disorders decreased by 10% between 2002/03 and 2011/12, driven by lower alternative payments. Similar decreases, also driven by lower alternative payments, were found for all mental health disorder subgroups except substance use and for diabetes. INTERPRETATION Payment and team reforms were associated with inequitable resource allocation to people with mental health disorders. The findings suggest the need for monitoring reforms for their impact on high-needs populations and making appropriate adjustments.
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Affiliation(s)
- Imaan Bayoumi
- Department of Family Medicine (Bayoumi), Queen's University, Kingston, Ont.; ICES (Bayoumi, Schultz, Glazier); Department of Family and Community Medicine (Glazier), University of Toronto; Department of Family and Community Medicine (Glazier), St. Michael's Hospital, Toronto, Ont.
| | - Susan E Schultz
- Department of Family Medicine (Bayoumi), Queen's University, Kingston, Ont.; ICES (Bayoumi, Schultz, Glazier); Department of Family and Community Medicine (Glazier), University of Toronto; Department of Family and Community Medicine (Glazier), St. Michael's Hospital, Toronto, Ont
| | - Richard H Glazier
- Department of Family Medicine (Bayoumi), Queen's University, Kingston, Ont.; ICES (Bayoumi, Schultz, Glazier); Department of Family and Community Medicine (Glazier), University of Toronto; Department of Family and Community Medicine (Glazier), St. Michael's Hospital, Toronto, Ont
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Hsu JH, Calzavara A, Vigod S, Stukel TA, Kiran T, Kurdyak P. Factors Associated With Diabetes Care Quality Among Patients With Schizophrenia in Ontario, Canada. Psychiatr Serv 2020; 71:188-191. [PMID: 31744427 DOI: 10.1176/appi.ps.201900009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors investigated demographic, clinical, and service-utilization factors that affected the quality of diabetes care among patients with schizophrenia. METHODS This was a retrospective cohort study of adults with schizophrenia and diabetes (N=26,259) in Ontario, Canada. Quality of care was based on receipt of three guideline-concordant diabetes care procedures between 2011 and 2013. A cumulative logit regression model was used to determine characteristics associated with optimal testing. RESULTS Factors associated with optimal diabetes testing included more frequent outpatient psychiatrist visits (odds ratio [OR]=1.28, 95% confidence interval [CI]=1.20-1.37) and primary care visits for nonmental health reasons (OR=2.10, 95% CI=1.85-2.39). High-frequency primary care visits for mental health reasons, any hospitalizations, and emergency visits for mental health reasons were associated with lower odds of testing. CONCLUSIONS Diabetes quality of care may be contingent on receipt of medically focused primary care, psychiatric stability, and receipt of specialist psychiatric care.
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Affiliation(s)
- Jonathan H Hsu
- Department of Psychiatry, Faculty of Medicine (Hsu), Institute of Health Policy, Management and Evaluation (Stukel), and Department of Family and Community Medicine (Kiran), all at University of Toronto, Toronto; Institute for Clinical Evaluative Sciences, Toronto (Calzavara, Vigod, Stukel, Kiran, Kurdyak); Women's College Research Institute, Women's College Hospital, Toronto (Vigod); Family Health Team, St. Michael's Hospital, Toronto (Kiran); Centre for Addiction and Mental Health, Toronto (Hsu, Kurdyak)
| | - Andrew Calzavara
- Department of Psychiatry, Faculty of Medicine (Hsu), Institute of Health Policy, Management and Evaluation (Stukel), and Department of Family and Community Medicine (Kiran), all at University of Toronto, Toronto; Institute for Clinical Evaluative Sciences, Toronto (Calzavara, Vigod, Stukel, Kiran, Kurdyak); Women's College Research Institute, Women's College Hospital, Toronto (Vigod); Family Health Team, St. Michael's Hospital, Toronto (Kiran); Centre for Addiction and Mental Health, Toronto (Hsu, Kurdyak)
| | - Simone Vigod
- Department of Psychiatry, Faculty of Medicine (Hsu), Institute of Health Policy, Management and Evaluation (Stukel), and Department of Family and Community Medicine (Kiran), all at University of Toronto, Toronto; Institute for Clinical Evaluative Sciences, Toronto (Calzavara, Vigod, Stukel, Kiran, Kurdyak); Women's College Research Institute, Women's College Hospital, Toronto (Vigod); Family Health Team, St. Michael's Hospital, Toronto (Kiran); Centre for Addiction and Mental Health, Toronto (Hsu, Kurdyak)
| | - Therese A Stukel
- Department of Psychiatry, Faculty of Medicine (Hsu), Institute of Health Policy, Management and Evaluation (Stukel), and Department of Family and Community Medicine (Kiran), all at University of Toronto, Toronto; Institute for Clinical Evaluative Sciences, Toronto (Calzavara, Vigod, Stukel, Kiran, Kurdyak); Women's College Research Institute, Women's College Hospital, Toronto (Vigod); Family Health Team, St. Michael's Hospital, Toronto (Kiran); Centre for Addiction and Mental Health, Toronto (Hsu, Kurdyak)
| | - Tara Kiran
- Department of Psychiatry, Faculty of Medicine (Hsu), Institute of Health Policy, Management and Evaluation (Stukel), and Department of Family and Community Medicine (Kiran), all at University of Toronto, Toronto; Institute for Clinical Evaluative Sciences, Toronto (Calzavara, Vigod, Stukel, Kiran, Kurdyak); Women's College Research Institute, Women's College Hospital, Toronto (Vigod); Family Health Team, St. Michael's Hospital, Toronto (Kiran); Centre for Addiction and Mental Health, Toronto (Hsu, Kurdyak)
| | - Paul Kurdyak
- Department of Psychiatry, Faculty of Medicine (Hsu), Institute of Health Policy, Management and Evaluation (Stukel), and Department of Family and Community Medicine (Kiran), all at University of Toronto, Toronto; Institute for Clinical Evaluative Sciences, Toronto (Calzavara, Vigod, Stukel, Kiran, Kurdyak); Women's College Research Institute, Women's College Hospital, Toronto (Vigod); Family Health Team, St. Michael's Hospital, Toronto (Kiran); Centre for Addiction and Mental Health, Toronto (Hsu, Kurdyak)
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Ouk M, Edwards JD, Colby-Milley J, Kiss A, Swardfager W, Law M. Psychiatric morbidity and cervical cancer screening: a retrospective population-based case-cohort study. CMAJ Open 2020; 8:E134-E141. [PMID: 32161045 PMCID: PMC7065560 DOI: 10.9778/cmajo.20190184] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Cervical cancer screening reduces disease-specific mortality. This study aimed to estimate whether bipolar disorder or schizophrenia is associated with disparities in cervical cancer screening rates. METHODS This was a retrospective population-based matched case-cohort study of community-dwelling women aged 19-69 in Ontario using linked health administrative databases. We used odds ratios (ORs), hazards ratios and rate ratios (RRs) adjusted for demographic characteristics and relevant comorbidities to compare cervical cancer screening outcomes between women with a diagnosis of bipolar disorder or schizophrenia to women without that history matched on key demographic characteristics, between 2003 and 2015. RESULTS In total, 1 245 457 women were identified for inclusion in the analyses, 119 948 with a diagnosis of bipolar disorder or schizophrenia, and 1 125 509 without. Over a median follow-up duration of 12.5 years, women with the exposure were 36% less likely to be screened (OR 0.64, 95% confidence interval [CI] 0.64-0.65) than those without, and they took longer to undergo screening (median 18.98 mo v. 16.63 mo; χ2 = 3718.2, p < 0.001). They were also screened less frequently (median 6.16 yr v. 4.69 yr per screen; RR 0.85, 95% CI 0.84-0.85). These effects were consistent after we excluded the 86 475 women (6.9%) with suspected major depressive disorder, and they were larger for the 59 141 women (4.7%) not attached to a family physician. INTERPRETATION Women with bipolar disorder or schizophrenia were less likely to undergo cervical cancer screening, their screening was delayed, and they were screened at a lower rate compared to women without this psychiatric history. This practice gap suggests a need to further address barriers to screening, including access to a family physician, among women with bipolar disorder or schizophrenia.
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Affiliation(s)
- Michael Ouk
- Hurvitz Brain Sciences Program (Ouk, Colby-Milley, Swardfager), Sunnybrook Research Institute, University of Toronto; Departments of Pharmacology & Toxicology (Ouk, Swardfager) and Family & Community Medicine (Law), University of Toronto, Toronto, Ont.; University of Ottawa Heart Institute (Edwards); School of Epidemiology and Public Health (Edwards), University of Ottawa, Ottawa, Ont.; ICES (Kiss), Toronto, Ont
| | - Jodi D Edwards
- Hurvitz Brain Sciences Program (Ouk, Colby-Milley, Swardfager), Sunnybrook Research Institute, University of Toronto; Departments of Pharmacology & Toxicology (Ouk, Swardfager) and Family & Community Medicine (Law), University of Toronto, Toronto, Ont.; University of Ottawa Heart Institute (Edwards); School of Epidemiology and Public Health (Edwards), University of Ottawa, Ottawa, Ont.; ICES (Kiss), Toronto, Ont
| | - Jessica Colby-Milley
- Hurvitz Brain Sciences Program (Ouk, Colby-Milley, Swardfager), Sunnybrook Research Institute, University of Toronto; Departments of Pharmacology & Toxicology (Ouk, Swardfager) and Family & Community Medicine (Law), University of Toronto, Toronto, Ont.; University of Ottawa Heart Institute (Edwards); School of Epidemiology and Public Health (Edwards), University of Ottawa, Ottawa, Ont.; ICES (Kiss), Toronto, Ont
| | - Alexander Kiss
- Hurvitz Brain Sciences Program (Ouk, Colby-Milley, Swardfager), Sunnybrook Research Institute, University of Toronto; Departments of Pharmacology & Toxicology (Ouk, Swardfager) and Family & Community Medicine (Law), University of Toronto, Toronto, Ont.; University of Ottawa Heart Institute (Edwards); School of Epidemiology and Public Health (Edwards), University of Ottawa, Ottawa, Ont.; ICES (Kiss), Toronto, Ont
| | - Walter Swardfager
- Hurvitz Brain Sciences Program (Ouk, Colby-Milley, Swardfager), Sunnybrook Research Institute, University of Toronto; Departments of Pharmacology & Toxicology (Ouk, Swardfager) and Family & Community Medicine (Law), University of Toronto, Toronto, Ont.; University of Ottawa Heart Institute (Edwards); School of Epidemiology and Public Health (Edwards), University of Ottawa, Ottawa, Ont.; ICES (Kiss), Toronto, Ont.
| | - Marcus Law
- Hurvitz Brain Sciences Program (Ouk, Colby-Milley, Swardfager), Sunnybrook Research Institute, University of Toronto; Departments of Pharmacology & Toxicology (Ouk, Swardfager) and Family & Community Medicine (Law), University of Toronto, Toronto, Ont.; University of Ottawa Heart Institute (Edwards); School of Epidemiology and Public Health (Edwards), University of Ottawa, Ottawa, Ont.; ICES (Kiss), Toronto, Ont
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Walsan R, Mayne DJ, Pai N, Feng X, Bonney A. Exploring the geography of serious mental illness and type 2 diabetes comorbidity in Illawarra-Shoalhaven, Australia (2010 -2017). PLoS One 2019; 14:e0225992. [PMID: 31805173 PMCID: PMC6894846 DOI: 10.1371/journal.pone.0225992] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 11/18/2019] [Indexed: 11/19/2022] Open
Abstract
Objectives The primary aim of this study was to describe the geography of serious mental illness (SMI)–type 2 diabetes comorbidity (T2D) in the Illawarra-Shoalhaven region of NSW, Australia. The Secondary objective was to determine the geographic concordance if any, between the comorbidity and the single diagnosis of SMI and diabetes. Methods Spatial analytical techniques were applied to clinical data to explore the above objectives. The geographic variation in comorbidity was determined by Moran’s I at the global level and the local clusters of significance were determined by Local Moran’s I and spatial scan statistic. Choropleth hotspot maps and spatial scan statistics were generated to assess the geographic convergence of SMI, diabetes and their comorbidity. Additionally, we used bivariate LISA (Local Indicators of Spatial Association) and multivariate spatial scan to identify coincident areas with higher rates of both SMI and T2D. Results The study identified significant geographic variation in the distribution of SMI–T2D comorbidity in Illawarra Shoalhaven. Consistently higher burden of comorbidity was observed in some urban suburbs surrounding the major metropolitan city. Comparison of comorbidity hotspots with the hotspots of single diagnosis SMI and T2D further revealed a geographic concordance of high-risk areas again in the urban areas outside the major metropolitan city. Conclusion The identified comorbidity hotspots in our study may serve as a basis for future prioritisation and targeted interventions. Further investigation is required to determine whether contextual environmental factors, such as neighbourhood socioeconomic disadvantage, may be explanatory. Implications for public health Ours is the first study to explore the geographic variations in the distribution of SMI and T2D comorbidity. Findings highlight the importance of considering the role of neighbourhood environments in influencing the T2D risk in people with SMI.
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Affiliation(s)
- Ramya Walsan
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
- * E-mail:
| | - Darren J. Mayne
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
- Public Health Unit, Illawarra Shoalhaven Local Health District, Warrawong, Australia
- The University of Sydney, School of Public Health, Sydney, Australia
| | - Nagesh Pai
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
- Mental Health Services, Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, Australia
| | - Xiaoqi Feng
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
- Population Wellbeing and Environment Research Lab (PowerLab), School of Health and Society, Faculty of Social Sciences, University of Wollongong, Wollongong, Australia
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Andrew Bonney
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
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Walsan R, Bonney A, Mayne DJ, Pai N, Feng X, Toms R. Serious Mental Illness, Neighborhood Disadvantage, and Type 2 Diabetes Risk: A Systematic Review of the Literature. J Prim Care Community Health 2019; 9:2150132718802025. [PMID: 30255730 PMCID: PMC6158606 DOI: 10.1177/2150132718802025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim of the Study: This review aims to systematically synthesize the body of literature examining the association between neighborhood socioeconomic disadvantage and serious mental illness (SMI)–type 2 diabetes (T2D) co-occurrence. Methods: We conducted an electronic search of four databases: PubMed, Scopus, Medline, and Web of Science. Studies were considered eligible if they were published in English, peer reviewed, quantitative, and focused on the association between neighborhood disadvantage and SMI-T2D comorbidity. Study conduct and reporting complied with PRISMA guidelines, and the protocol is made available at PROSPERO (CRD42017083483). Results: The one eligible study identified reported a higher burden of T2D in persons with SMI but provided only a tentative support for the association between neighborhood disadvantage and SMI-T2D co-occurrence. Conclusion: Research into neighborhood effects on SMI-T2D comorbidity is still in its infancy and the available evidence inconclusive. This points to an urgent need for attention to the knowledge gap in this important area of public health. Further research is needed to understand the health resource implications of the association between neighborhood deprivation and SMI-T2D comorbidity and the casual pathways linking them.
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Affiliation(s)
- Ramya Walsan
- 1 School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
| | - Andrew Bonney
- 1 School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia.,2 Illawarra Health and Medical Research Institute,Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Darren J Mayne
- 1 School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia.,2 Illawarra Health and Medical Research Institute,Wollongong Hospital, Wollongong, New South Wales, Australia.,3 Public Health Unit, Illawarra Shoalhaven Local Health District, Warrawong, Warrawong, New South Wales, Australia
| | - Nagesh Pai
- 1 School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia.,2 Illawarra Health and Medical Research Institute,Wollongong Hospital, Wollongong, New South Wales, Australia.,4 Mental Health Services, Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
| | - Xiaoqi Feng
- 2 Illawarra Health and Medical Research Institute,Wollongong Hospital, Wollongong, New South Wales, Australia.,5 Population Wellbeing and Environment Research Lab (Powerlab), School of Health and Society, University of Wollongong, New South Wales, Australia
| | - Renin Toms
- 1 School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
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Walsan R, Mayne DJ, Feng X, Pai N, Bonney A. Examining the Association between Neighbourhood Socioeconomic Disadvantage and Type 2 Diabetes Comorbidity in Serious Mental Illness. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16203905. [PMID: 31618833 PMCID: PMC6843457 DOI: 10.3390/ijerph16203905] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 09/26/2019] [Accepted: 10/12/2019] [Indexed: 11/16/2022]
Abstract
This study examined the association between neighbourhood socioeconomic disadvantage and serious mental illness (SMI)-type 2 diabetes (T2D) comorbidity in an Australian population using routinely collected clinical data. We hypothesised that neighbourhood socioeconomic disadvantage is positively associated with T2D comorbidity in SMI. The analysis considered 3816 individuals with an SMI living in the Illawarra and Shoalhaven regions of NSW, Australia, between 2010 and 2017. Multilevel logistic regression models accounting for suburb (neighbourhood) level clustering were used to assess the association between neighbourhood disadvantage and SMI -T2D comorbidity. Models were adjusted for age, sex, and country of birth. Compared with the most advantaged neighbourhoods, residents in the most disadvantaged neighbourhoods had 3.2 times greater odds of having SMI-T2D comorbidity even after controlling for confounding factors (OR 3.20, 95% CI 1.42-7.20). The analysis also revealed significant geographic variation in the distribution of SMI -T2D comorbidity in our sample (Median Odds Ratio = 1.35) Neighbourhood socioeconomic disadvantage accounted for approximately 17.3% of this geographic variation. These findings indicate a potentially important role for geographically targeted initiatives designed to enhance prevention and management of SMI-T2D comorbidity in disadvantaged communities.
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Affiliation(s)
- Ramya Walsan
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong 2522, Australia.
| | - Darren J Mayne
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong 2522, Australia.
- Illawarra Health and Medical Research Institute, Wollongong 2522, Australia.
- Illawarra Shoalhaven Local Health District, Public Health Unit, Warrawong 2502, Australia.
- The University of Sydney, School of Public Health, Sydney 2006, Australia.
| | - Xiaoqi Feng
- Illawarra Health and Medical Research Institute, Wollongong 2522, Australia.
- Population Wellbeing and Environment Research Lab (PowerLab), School of Health and Society, Faculty of Social Sciences, University of Wollongong, Wollongong 2522, Australia.
- School of Public Health and Community Medicine, University of New South Wales, Kennington 2031, Australia.
| | - Nagesh Pai
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong 2522, Australia.
- Illawarra Health and Medical Research Institute, Wollongong 2522, Australia.
- Mental Health Services, Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong 2500, Australia.
| | - Andrew Bonney
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong 2522, Australia.
- Illawarra Health and Medical Research Institute, Wollongong 2522, Australia.
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Barker LC, Kurdyak P, Jacob B, Vigod SN. Quality of Diabetes Care for Individuals with Comorbid Chronic Psychotic Illness: A Sex-Based Analysis. J Womens Health (Larchmt) 2017; 27:290-296. [PMID: 29211592 DOI: 10.1089/jwh.2017.6490] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Diabetes is common among individuals with chronic psychotic illness, yet they receive lower quality of diabetes care than those without psychosis. Men usually receive higher quality diabetes care than women, but whether this holds true in chronic psychotic illness populations is unknown. We aimed to determine whether quality of diabetes care differs between men and women with chronic psychotic illness. METHODS This population-based cohort study used Ontario health administrative data to compare women and men with comorbid chronic psychotic illness and diabetes mellitus (2011-2013). The primary outcome was adherence to diabetes monitoring guidelines, defined as ≥1 retinal exam, ≥4 hemoglobin A1c (HbA1c) tests, and ≥1 dyslipidemia test during a 2-year period. Logistic regression models compared women to men to generate adjusted odds ratios (aOR) and confidence intervals (95% CI), adjusting for potential confounding variables. RESULTS Women with chronic psychotic illness (n = 13,972) were slightly more likely to receive guideline-adherent diabetes monitoring than men (n = 12,287) (25.2% vs. 23.0%; aOR 1.20, 95% CI 1.10-1.30), including a greater likelihood of receiving ≥1 retinal exam (aOR 1.13, 95% CI 1.08-1.19) and ≥4 HbA1c tests (aOR 1.06, 95% CI 1.01-1.12). There was no difference in receipt of ≥1 dyslipidemia test (aOR 1.04, 95% CI 0.99-1.11). CONCLUSIONS Quality of diabetes monitoring is similarly poor in women and men with chronic psychotic illness, with women receiving only marginally more optimal monitoring than men. This differs from patterns in the general population, and could have implications when designing and implementing interventions to improve diabetes care in women and men with chronic psychotic illness.
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Affiliation(s)
| | - Paul Kurdyak
- 1 Department of Psychiatry, University of Toronto , Toronto, Canada .,2 Institute for Clinical Evaluative Sciences , Toronto, Canada .,3 Centre for Addiction and Mental Health , Toronto, Canada
| | - Binu Jacob
- 3 Centre for Addiction and Mental Health , Toronto, Canada
| | - Simone N Vigod
- 1 Department of Psychiatry, University of Toronto , Toronto, Canada .,2 Institute for Clinical Evaluative Sciences , Toronto, Canada .,4 Women's College Research Institute , Women's College Hospital, Toronto, Canada
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