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Orchard C, Lin E, Rosella L, Smith PM. Using unsupervised clustering approaches to identify common mental health profiles and associated mental health-care service-use patterns in Ontario, Canada. Am J Epidemiol 2024; 193:976-986. [PMID: 38576175 PMCID: PMC11228863 DOI: 10.1093/aje/kwae030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 02/28/2024] [Accepted: 03/28/2024] [Indexed: 04/06/2024] Open
Abstract
Mental health is a complex, multidimensional concept that goes beyond clinical diagnoses, including psychological distress, life stress, and well-being. In this study, we aimed to use unsupervised clustering approaches to identify multidimensional mental health profiles that exist in the population, and their associated service-use patterns. The data source was the 2012 Canadian Community Health Survey-Mental Health, linked to administrative health-care data; all Ontario, Canada, adult respondents were included. We used a partitioning around medoids clustering algorithm with Gower's proximity to identify groups with distinct combinations of mental health indicators and described them according to their sociodemographic and service-use characteristics. We identified 4 groups with distinct mental health profiles, including 1 group that met the clinical threshold for a depressive diagnosis, with the remaining 3 groups expressing differences in positive mental health, life stress, and self-rated mental health. The 4 groups had different age, employment, and income profiles and exhibited differential access to mental health-care services. This study represents the first step in identifying complex profiles of mental health at the population level in Ontario. Further research is required to better understand the potential causes and consequences of belonging to each of the mental health profiles identified. This article is part of a Special Collection on Mental Health.
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Affiliation(s)
- Christa Orchard
- Corresponding author: Christa Orchard, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON M5T 3M7, Canada ()
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Bhasin AA, Molnar AO, McArthur E, Nash DM, Busse JW, Cooper R, Heale E, Ip J, Pang J, Blake PG, Garg AX, Kurdyak P, Kim SJ, Sultan H, Walsh M. Mental health and addiction service utilization among people living with chronic kidney disease. Nephrol Dial Transplant 2024; 39:1115-1124. [PMID: 38017620 DOI: 10.1093/ndt/gfad240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Mental health problems, particularly anxiety and depression, are common in patients with chronic kidney disease (CKD) and negatively impact quality of life, treatment adherence and mortality. However, the degree to which mental health and addiction services are utilized by those with CKD is unknown. We examined the history of mental health and addiction service use of individuals across levels of kidney function. METHODS We performed a population-based cross-sectional study using linked healthcare databases from Ontario, Canada from 2009 to 2017. We abstracted the prevalence of individuals with mental health and addiction service use within the previous 3 years across levels of kidney function [estimated glomerular filtration rate (eGFR) ≥60, 45 to <60, 30 to <45, 15 to <30, <15 ml/min/1.73 m2 and maintenance dialysis]. We calculated prevalence ratios (PRs) to compare prevalence across kidney function strata, while adjusting for age, sex, year of cohort entry, urban versus rural location, area-level marginalization and Charlson comorbidity index. RESULTS Of 5 956 589 adults, 9% (n = 534 605) had an eGFR <60 ml/min/1.73 m2 or were receiving maintenance dialysis. Fewer individuals with an eGFR <60 ml/min/1.73 m2 had a history of any mental health and addiction service utilization (crude prevalence range 28-31%) compared with individuals with an eGFR ≥60 ml/min/1.73 m2 (35%). Compared with an eGFR ≥60 ml/min/1.73 m2, the lowest prevalence of individuals with any mental health and addiction service utilization was among those with an eGFR of 15 to <30 ml/min/1.73 m2 {adjusted PR 0.86 [95% confidence interval (CI) 0.85 to 0.88]}, an eGFR <15 ml/min/1.73 m2 [adjusted PR 0.81 (95% CI 0.76-0.86)] and those receiving maintenance dialysis [adjusted PR 0.83 (95% CI 0.81-0.84)]. Less use of outpatient services accounted for differences in service utilization. CONCLUSIONS Mental health and addiction service utilization is common but less so in individuals with advanced CKD in Ontario, Canada.
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Affiliation(s)
- Arrti A Bhasin
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Amber O Molnar
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- ICES, Toronto, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Eric McArthur
- ICES, Toronto, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
| | - Danielle M Nash
- ICES, Toronto, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
| | - Jason W Busse
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
| | - Rebecca Cooper
- Ontario Renal Network, Ontario Health, Toronto, ON, Canada
| | - Esti Heale
- Ontario Renal Network, Ontario Health, Toronto, ON, Canada
| | - Jane Ip
- Ontario Renal Network, Ontario Health, Toronto, ON, Canada
| | - Jocelyn Pang
- Ontario Renal Network, Ontario Health, Toronto, ON, Canada
| | - Peter G Blake
- Lawson Health Research Institute, London, ON, Canada
- Ontario Renal Network, Ontario Health, Toronto, ON, Canada
- Department of Medicine, London Health Sciences Centre, London, ON, Canada
| | - Amit X Garg
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- ICES, Toronto, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
- Ontario Renal Network, Ontario Health, Toronto, ON, Canada
- Department of Medicine, London Health Sciences Centre, London, ON, Canada
| | - Paul Kurdyak
- ICES, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - S Joseph Kim
- ICES, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Medicine, University Health Network, Toronto, ON, Canada
| | - Heebah Sultan
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Michael Walsh
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
- Ontario Renal Network, Ontario Health, Toronto, ON, Canada
- Population Health Research Institute, Hamilton, ON, Canada
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Hooley C, Adams DR, Ng WY, Wendt CLE, Dennis CB. Key actors in behavioral health services availability and accessibility research: a scoping review bibliometric analysis. DISCOVER MENTAL HEALTH 2024; 4:15. [PMID: 38700757 PMCID: PMC11068714 DOI: 10.1007/s44192-024-00068-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 04/18/2024] [Indexed: 05/06/2024]
Abstract
This bibliometric review aims to identify key actors in the behavioral health services availability/accessibility literature. Coalescing information about these actors could support subsequent research efforts to improve the availability and accessibility of behavioral health services. The authors used a scoping review method and a bibliometric approach. The articles came from Medline, Embase, Web of Science, CINAHL, and PsycINFO. Articles were included if they assessed behavioral health service availability or accessibility quantitatively and were written in English. The final sample included 265 articles. Bibliometric data were extracted, coded, and verified. The authors analyzed the data using univariate and social network analyses. Publishing in this area has become more consistent and has grown since 2002. Psychiatric Services and Graduate Theses were the most frequently used publication venues. The National Institute on Drug Abuse, National Institute of Mental Health, and the Veterans Administration funded the most research. The most frequently used keyword was "health services accessibility." The findings suggest that this literature is growing. There are a few clusters of researchers in this area. Government organizations primarily fund this research. The paper and supplementary materials list the top researchers, publication venues, funding sources, and key terms to promote further behavioral health availability/accessibility research.
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Affiliation(s)
- Cole Hooley
- School of Social Work Brigham Young University, 2190 JFSB, Provo, UT, 84602, USA.
| | - Danielle R Adams
- Center for Mental Health Services Research Brown School of Social Work and Public Health, Washington University in St. Louis, St. Louis, MO, USA
| | - Wai Yan Ng
- School of Social Work Brigham Young University, 2190 JFSB, Provo, UT, 84602, USA
| | - Carrie L E Wendt
- School of Social Work Brigham Young University, 2190 JFSB, Provo, UT, 84602, USA
| | - Cory B Dennis
- School of Social Work Brigham Young University, 2190 JFSB, Provo, UT, 84602, USA
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Yorke E, Toulany A, Chiu M, Gandhi S, Guttmann A, Emerson SD, Kurdyak P, Vigod S, Fung K, Saunders N. Population-Based Repeated Cross-Sectional Study of Hospitalizations for Comorbid Physical and Psychiatric Disorders in Young Adults in Ontario, Canada. J Adolesc Health 2023; 73:715-723. [PMID: 37410004 DOI: 10.1016/j.jadohealth.2023.05.031] [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: 10/07/2022] [Revised: 03/06/2023] [Accepted: 05/28/2023] [Indexed: 07/07/2023]
Abstract
PURPOSE To measure trends in the rates and costs of hospitalizations over a 15-year period among young adults with physical and/or psychiatric disorders. METHODS This population-based, repeated cross-sectional study identified all 18- to 26- year-olds hospitalized in Ontario, Canada from April 1, 2003 and March 31, 2018 (fiscal years 2003-2017). Using discharge diagnoses, we assigned hospitalizations to one of four categories: 1) psychiatric disorder only; 2) primary psychiatric disorder with comorbid physical illness; 3) primary physical with comorbid psychiatric disorder; and 4) physical illness only. We compared health service utilization and changes in rates of hospitalizations over time using restricted cubic spline regression. Secondary outcome measures included change in hospital costs for each hospitalization category over the study period. RESULTS Of 1,076,951 hospitalizations in young adults (73.7% female), 195,726 (18.2%) had a psychiatric disorder (either primary or comorbid). There were 129,676 hospitalizations (12.0%) with psychiatric disorders only, 36,287 (3.4%) with primary psychiatric and comorbid physical disorders, 29,763 (2.8%) with primary physical and comorbid psychiatric disorders, and 881,225 (81.8%) with physical disorders only. Rates of hospitalization for psychiatric disorders only increased 81% from 4.32 to 7.84/1,000 population, and those with physical health disorders with comorbid psychiatric disorders increased 172% from 0.47 to 1.28/1,000 population. Substance-related disorders were the most common comorbid psychiatric disorders among youth hospitalized for physical illness and increased 260% from 0.9 to 3.3/1,000 population. DISCUSSION Hospitalizations among young adults with primary and comorbid psychiatric disorders have increased significantly over the past 15 years. Health system resources should be adequately directed to meet the shifting and complex needs of hospitalized young adults.
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Affiliation(s)
- Elisabeth Yorke
- Department of General Academic Paediatrics, Children's Hospital of Western Ontario, London, Ontario, Canada
| | - Alene Toulany
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada; ICES (formerly the Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada; Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Edwin S. H. Leong Centre for Healthy Children, University of Toronto, Toronto, Ontario, Canada; Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
| | - Maria Chiu
- ICES (formerly the Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada; Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Sima Gandhi
- ICES (formerly the Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada
| | - Astrid Guttmann
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada; ICES (formerly the Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada; Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Edwin S. H. Leong Centre for Healthy Children, University of Toronto, Toronto, Ontario, Canada; Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
| | - Scott D Emerson
- ICES (formerly the Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada
| | - Paul Kurdyak
- ICES (formerly the Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada; Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Simone Vigod
- ICES (formerly the Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada; Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Kinwah Fung
- ICES (formerly the Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada
| | - Natasha Saunders
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada; ICES (formerly the Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada; Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Edwin S. H. Leong Centre for Healthy Children, University of Toronto, Toronto, Ontario, Canada; Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada.
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Antoniou T, Wang T, Pajer K, Gardner W, Lunsky Y, Penner M, Tadrous M, Mamdani M, Juurlink DN, Gomes T. Adherence to antipsychotic laboratory monitoring guidelines in children and youth: a population-based study. Front Psychiatry 2023; 14:1172559. [PMID: 37252150 PMCID: PMC10217777 DOI: 10.3389/fpsyt.2023.1172559] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 04/21/2023] [Indexed: 05/31/2023] Open
Abstract
Background In 2011, the Canadian Alliance for Monitoring Effectiveness and Safety of Antipsychotics in Children (CAMESA) published guidelines for the metabolic monitoring of antipsychotic-treated children and youth. Population-based studies examining adherence to these guidelines are needed to ensure the safe use of antipsychotics in children and youth. Methods We conducted a population-based study of all Ontario residents aged 0 to 24 who were newly dispensed an antipsychotic between April 1, 2018, and March 31, 2019. We estimated prevalence ratios (PRs) and 95% confidence intervals (CI) associating sociodemographic characteristics with the receipt of baseline and follow-up (3- and 6-month) laboratory testing using log-Poisson regression models. Results Overall, 6,505 of 27,718 (23.5%) children and youth newly dispensed an antipsychotic received at least one guideline-recommended baseline test. Monitoring was more prevalent among individuals aged 10 to 14 years (PR 1.20; 95% CI 1.04 to 1.38), 15 to 19 years (PR 1.60; 95% CI 1.41 to 1.82), and 20 to 24 years (PR 1.71; 95% CI 1.50 to 1.94) compared to children under the age of 10. Baseline monitoring was associated with mental health-related hospitalizations or emergency department visits in the year preceding therapy (PR 1.76; 95% CI 1.65 to 1.87), a prior diagnosis of schizophrenia (PR 1.20; 95% CI 1.14 to 1.26) or diabetes (PR 1.35; 95% CI 1.19 to 1.54), benzodiazepine use (PR 1.13; 95% CI 1.04 to 1.24), and receipt of a prescription from a child and adolescent psychiatrist or developmental pediatrician versus a family physician (PR 1.41; 95% CI 1.34 to 1.48). Conversely, monitoring was less frequent in individuals co-prescribed stimulants (PR 0.83; 95% CI 0.75 to 0.91). The prevalence of any 3- and 6-month follow-up monitoring among children and youth receiving continuous antipsychotic therapy at these time points was 13.0% (1,179 of 9,080) and 11.4% (597 of 5,261), respectively. Correlates of follow-up testing were similar to those of baseline monitoring. Conclusion Most children initiating antipsychotic therapy do not receive guideline-recommended metabolic laboratory monitoring. Further research is needed to understand reasons for poor guideline adherence and the role of clinician training and collaborative service models in promoting best monitoring practices.
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Affiliation(s)
- Tony Antoniou
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON, Canada
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Department of Family and Community Medicine, St. Michael’s Hospital, Toronto, ON, Canada
| | - Tianru Wang
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Kathleen Pajer
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
| | - William Gardner
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Yona Lunsky
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Melanie Penner
- Autism Research Centre, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
- Department of Pediatrics, University of Toronto, Toronto ON, Canada
| | - Mina Tadrous
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Muhammad Mamdani
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON, Canada
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Centre for Healthcare Analytics Research and Training, Unity Health Toronto, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | - David N. Juurlink
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
- Department of Pediatrics, University of Toronto, Toronto ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Tara Gomes
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON, Canada
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
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Yin C, Li J, Meng W, Hou S, Liu D, Liu M, Yu L, Guo R, Han X, Liu M. Trends in care quality in China from 2011 to 2017: An analysis based on the National Specific (Single) Disease Monitoring System. J Glob Health 2023; 13:04045. [PMID: 37114729 PMCID: PMC10141559 DOI: 10.7189/jogh.13.04045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
Background The Ministry of Health of China conducted a study targeting in single-disease quality control in 2009, aimed to strengthen quality management and improve health care services. This study retrospectively investigated the trends of quality indicators for six monitored diseases 2011-2017 to evaluate the improvement of care quality for the first batch of single-disease. Methods We extracted data from the National Specific (Single) Disease Monitoring System for 2011-2017. We focused on six conditions: acute myocardial infarction, heart failure, community-acquired pneumonia, coronary artery bypass graft, hip / knee replacement, and acute ischemic stroke. A total of 56 quality indicators (QIs) were adopted to monitor the quality change and determine the trends in care quality. We also calculated the hospital process composite performance (HPCP) using a denominator-based weighting method for each hospital per year. The estimated annual percentage changes (EAPC) 2011-2017 were calculated at national and regional levels. Results The results showed that use of four QIs had significant downward trends, whereas 25 QIs (including reversed indicators) showed significant upward trends from 2011 to 2017. The greatest improvement was observed in CAP-4 (antibiotic treatment within four hours after admission to the hospital for critical pneumonia) in the central region (EAPC = 48.36, 95% CI = 15.92-89.87); while the largest decrease appeared in AIS-1 (thrombolytic therapy within 4.5 hours of symptom onset) in the western region (EAPC = -13.44, 95% CI = -24.98,-0.11). An increased HPCP was observed in four diseases nationwide, but not for acute myocardial infarction and heart failure. However, there were significant differences across regions in the process of care and outcomes, with the performance of Eastern and Western regions showing remarkable advantages compared with the Central region. Conclusions We provide evidence for major advancement in care quality in China nationwide. However, the improvement of care in China was unbalanced geographically and should be carefully considered. Future challenges include expanding the coverage of quality monitoring, greater delivery efficiency, and region-balanced health care.
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Srivastava A, Nair R. Utility of Investigations, History, and Physical Examination in "Medical Clearance" of Psychiatric Patients: A Meta-Analysis. Psychiatr Serv 2022; 73:1140-1152. [PMID: 35734861 DOI: 10.1176/appi.ps.202000858] [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: 11/30/2022]
Abstract
OBJECTIVE Few reviews and no meta-analyses have explored the utility of investigations, such as laboratory tests, among patients presenting with psychiatric symptoms, and none has explored the yield of history and physical examination. A meta-analysis of studies exploring the utility of "medical clearance" among adult psychiatric patients was conducted. METHODS PubMed, PsycInfo, and Web of Science were systematically searched from inception until February 15, 2021. Primary outcome was detection by investigations (e.g., bloodwork and imaging), history, or physical examination of an illness that caused or aggravated psychiatric symptoms or was comorbid and that resulted in change in the patient's diagnosis or management ("yield"). A mixed-effects meta-analysis with inverse-variance weighting was used to pool results. RESULTS Twenty-five cross-sectional studies were included. Pooled yield of investigations was 1.1% (95% confidence interval [CI]=0.5%-2.2%), although yield was relatively higher among disoriented, agitated, or older patients. Yield was higher in the inpatient setting, compared with the emergency room, with similar results by approach (protocolized versus nonprotocolized). Compared with investigations, yield of history and physical examination was higher (15.6%, 95% CI=9.1%-25.6%, and 14.9%, 95% CI=8.1%-25.9%, respectively), with nonsignificant differences by evaluator (psychiatrist versus nonpsychiatrist) for physical examination. CONCLUSIONS Investigations were of relatively low yield, especially when weighed against cost and potential harm, and they should not be routinely conducted for patients presenting with primarily psychiatric complaints, although certain subgroups may benefit. History and physical examination, by contrast, should be undertaken for all patients, ideally with participation of the consulting psychiatrist.
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Affiliation(s)
- Anil Srivastava
- Department of Psychiatry, Humber River Hospital, Toronto (Srivastava); Island Health and Department of Family Medicine, University of Victoria, Victoria, British Columbia, Canada (Nair)
| | - Rajesh Nair
- Department of Psychiatry, Humber River Hospital, Toronto (Srivastava); Island Health and Department of Family Medicine, University of Victoria, Victoria, British Columbia, Canada (Nair)
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Lavergne MR, Loyal JP, Shirmaleki M, Kaoser R, Nicholls T, Schütz CG, Vaughan A, Samji H, Puyat JH, Kaulius M, Jones W, Small W. The relationship between outpatient service use and emergency department visits among people treated for mental and substance use disorders: analysis of population-based administrative data in British Columbia, Canada. BMC Health Serv Res 2022; 22:477. [PMID: 35410219 PMCID: PMC8996395 DOI: 10.1186/s12913-022-07759-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 03/07/2022] [Indexed: 01/02/2023] Open
Abstract
Background Research findings on the association between outpatient service use and emergency department (ED) visits for mental and substance use disorders (MSUDs) are mixed and may differ by disorder type. Methods We used population-based linked administrative data in British Columbia, Canada to examine associations between outpatient primary care and psychiatry service use and ED visits among people ages 15 and older, comparing across people treated for three disorder categories: common mental disorders (MDs) (depressive, anxiety, and/or post-traumatic stress disorders), serious MDs (schizophrenia spectrum and/or bipolar disorders), and substance use disorders (SUDs) in 2016/7. We used hurdle models to examine the association between outpatient service use and odds of any ED visit for MSUDs as well count of ED visits for MSUDs, stratified by cohort in 2017/8. Results Having had one or more MSUD-related primary care visit was associated with lower odds of any ED visit among people treated for common MDs and SUDs but not people treated for serious MDs. Continuity of primary care was associated with slightly lower ED use in all cohorts. One or more outpatient psychiatrist visits was associated with lower odds of ED visits among people treated for serious MDs and SUDs, but not among people with common MDs. Conclusion Findings highlight the importance of expanded access to outpatient specialist mental health services, particularly for people with serious MDs and SUDs, and collaborative models that can support primary care providers treating people with MSUDs. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07759-z.
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Affiliation(s)
- M Ruth Lavergne
- Department of Family Medicine, Faculty of Medicine, Primary Care Research Unit, Dalhousie University, 1465 Brenton Street, Suite 402, Halifax, NS, B3J 3T4, Canada.
| | - Jackson P Loyal
- Centre for Applied Research in Mental Health and Addiction, Simon Fraser University, Vancouver, BC, Canada.,BC Centre for Disease Control, Vancouver, BC, Canada
| | - Mehdi Shirmaleki
- Centre for Applied Research in Mental Health and Addiction, Simon Fraser University, Vancouver, BC, Canada
| | - Ridhwana Kaoser
- Centre for Applied Research in Mental Health and Addiction, Simon Fraser University, Vancouver, BC, Canada
| | - Tonia Nicholls
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.,Department of Psychology, Simon Fraser University, Burnaby, BC, Canada.,BC Mental Health and Substance Use Services, Vancouver, BC, Canada
| | - Christian G Schütz
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.,BC Mental Health and Substance Use Services, Vancouver, BC, Canada.,Centre for Health Evaluation and Outcome Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Adam Vaughan
- School of Criminal Justice and Criminology, Texas State University, San Marcos, TX, Canada
| | - Hasina Samji
- BC Centre for Disease Control, Vancouver, BC, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Joseph H Puyat
- Centre for Health Evaluation and Outcome Sciences, University of British Columbia, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Megan Kaulius
- Centre for Applied Research in Mental Health and Addiction, Simon Fraser University, Vancouver, BC, Canada
| | - Wayne Jones
- Centre for Applied Research in Mental Health and Addiction, Simon Fraser University, Vancouver, BC, Canada
| | - William Small
- Centre for Applied Research in Mental Health and Addiction, Simon Fraser University, Vancouver, BC, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.,BC Centre on Substance Use, Vancouver, BC, Canada
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Hadjistavropoulos HD, Peynenburg V, Thiessen DL, Nugent M, Karin E, Staples L, Dear BF, Titov N. Utilization, Patient Characteristics, and Longitudinal Improvements among Patients from a Provincially Funded Transdiagnostic Internet-delivered Cognitive Behavioural Therapy Program: Observational Study of Trends over 6 Years. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2022; 67:192-206. [PMID: 33840264 PMCID: PMC8935601 DOI: 10.1177/07067437211006873] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE There is strong evidence supporting internet-delivered cognitive behaviour therapy (iCBT) and consequently growing demand for iCBT in Canada. Transdiagnostic iCBT that addresses both depression and anxiety is particularly promising as it represents an efficient method of delivering iCBT in routine care. The Online Therapy Unit, funded by the Saskatchewan government, has been offering transdiagnostic iCBT for depression and anxiety since 2013. In this article, to broadly inform implementation efforts, we examined trends in utilization, patient characteristics, and longitudinal improvements for patients receiving transdiagnostic iCBT over 6 years. METHODS Patients who completed telephone screening between November 2013 and December 2019 were included in this observational study. Patients provided demographics and mental health history at screening and completed measures at pre-treatment, post-treatment and at 3- to 4-month follow-up. Treatment engagement and satisfaction were assessed. RESULTS A total of 5,321 telephone screenings were completed and 4,283 of patients were accepted for treatment over the 6-year period (80.5% acceptance). The most common reason for referral to another service was high suicide risk/severe symptoms (47.1%). Examination of trends showed growing use of transdiagnostic iCBT over time (37% increase per year). There was remarkable stability in patient characteristics across years. Most patients were concurrently using medication (57.3%) with 11.9% reporting using iCBT while on a waiting list for face-to-face treatment highlighting the importance of integrating iCBT with other services. Consistent across years, large improvements in depression and anxiety symptoms were found and maintained at 3- to 4-month follow-up. There was strong patient engagement with iCBT and positive ratings of treatment experiences. CONCLUSIONS As there is growing interest in iCBT in Canada, this large observational study provides valuable information for those implementing iCBT in terms of likely user characteristics, patterns of use, and improvements. This information has potential to assist with resource allocation and planning in Canada and elsewhere.
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Affiliation(s)
| | - Vanessa Peynenburg
- Online Therapy Unit, Department of Psychology, 6846University of Regina, Saskatchewan, Canada
| | - David L Thiessen
- Department of Mathematics & Statistics, 6846University of Regina, Saskatchewan, Canada
| | - Marcie Nugent
- Online Therapy Unit, Department of Psychology, 6846University of Regina, Saskatchewan, Canada
| | - Eyal Karin
- eCentre Clinic, Department of Psychology, 7788Macquarie University, Sydney, Australia
| | - Lauren Staples
- eCentre Clinic, Department of Psychology, 7788Macquarie University, Sydney, Australia
| | - Blake F Dear
- eCentre Clinic, Department of Psychology, 7788Macquarie University, Sydney, Australia
| | - Nickolai Titov
- eCentre Clinic, Department of Psychology, 7788Macquarie University, Sydney, Australia
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10
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Lavergne MR, Shirmaleki M, Loyal JP, Jones W, Nicholls TL, Schütz CG, Vaughan A, Samji H, Puyat JH, Kaoser R, Kaulius M, Small W. Emergency department use for mental and substance use disorders: descriptive analysis of population-based, linked administrative data in British Columbia, Canada. BMJ Open 2022; 12:e057072. [PMID: 35027424 PMCID: PMC8762129 DOI: 10.1136/bmjopen-2021-057072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVES Information on emergency department (ED) visits for mental and substance use disorders (MSUDs) is important for planning services but has not been explored in British Columbia (BC), Canada. We describe all MSUD ED visits for people ages 15 and older in the province of BC in 2017/2018 and document trends in MSUD ED visits between 2007/2008 and 2017/2018 by disorder group. DESIGN Population-based linked administrative data comprised of ED records and physician billings capturing all MSUD ED visits in BC. SETTING BC is Canada's westernmost province with a population of approximately 5 million. Permanent residents receive first-dollar coverage for all medically necessary services provided by licensed physicians or in hospitals, including ED services. POPULATION All people age >15 with MSUD ED visits during the study period. MEASURES All claims with a service location in the ED or corresponding to fee items billed only in the ED were examined alongside ED visits reported through a national reporting system. Patient characteristics (sex/gender, age, location of residence, income, treated disorders and comorbidities) and previous outpatient service use for all ED visits by visit diagnosis are also described. RESULTS A total of 72 363 people made 134 063 visits to the ED in 2017/2018 for needs related to MSUD. MSUD ED visits have increased since 2010, particularly visits for substance use and anxiety disorders. People with more frequent visits were more likely to be male, on public prescription drug plans for income assistance, prescribed psychiatric medications, and living in lower-income neighbourhoods. They used more community-based primary care and psychiatry services and had lower continuity of primary care. CONCLUSIONS MSUD ED visits are substantial and growing in BC. Findings underscore a need to strengthen and target community healthcare services and adequately resource and support EDs to manage growing patient populations.
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Affiliation(s)
- M Ruth Lavergne
- Department of Family Medicine, Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada
- Centre for Applied Research in Mental Health and Addiction, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Mehdi Shirmaleki
- Centre for Applied Research in Mental Health and Addiction, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Jackson P Loyal
- Centre for Applied Research in Mental Health and Addiction, Simon Fraser University, Vancouver, British Columbia, Canada
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Wayne Jones
- Centre for Applied Research in Mental Health and Addiction, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Tonia L Nicholls
- Department of Psychiatry, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
- Department of Psychology, Simon Fraser University, Burnaby, British Columbia, Canada
- British Columbia Mental Health and Substance Use Services, Vancouver, British Columbia, Canada
| | - Christian G Schütz
- Department of Psychiatry, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
- British Columbia Mental Health and Substance Use Services, Vancouver, British Columbia, Canada
- Centre for Health Evaluation and Outcome Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Adam Vaughan
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- School of Criminal Justice and Criminology, Texas State University San Marcos, San Marcos, Texas, USA
| | - Hasina Samji
- Centre for Applied Research in Mental Health and Addiction, Simon Fraser University, Vancouver, British Columbia, Canada
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Joseph H Puyat
- Centre for Applied Research in Mental Health and Addiction, Simon Fraser University, Vancouver, British Columbia, Canada
- Centre for Health Evaluation and Outcome Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Ridhwana Kaoser
- Centre for Applied Research in Mental Health and Addiction, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Megan Kaulius
- Centre for Applied Research in Mental Health and Addiction, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Will Small
- Centre for Applied Research in Mental Health and Addiction, Simon Fraser University, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
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11
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Doan Q, Barbic D. Are mood disorders associated with frequent emergency department visits? Question answered, or a dialogue just beginning? CAN J EMERG MED 2022; 24:3-4. [PMID: 35038154 PMCID: PMC8762438 DOI: 10.1007/s43678-021-00238-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 11/16/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Quynh Doan
- Department of Pediatrics, UBC; BC Children's Hospital, Vancouver, BC, Canada
| | - David Barbic
- Department of Emergency Medicine, UBC, Centre for Health Evaluation and Outcomes Sciences, Vancouver, BC, Canada.
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12
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Shyman L, Sukhorukov R, Barbic D, Mathias S, Chau S, Leon A, Barbic S. Social determinants of health and depression in adults presenting to the emergency department: Implications for family medicine. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2021; 67:e337-e347. [PMID: 34906952 PMCID: PMC8670658 DOI: 10.46747/cfp.6712e337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To estimate the extent to which social determinants of health (SDH) predict levels of depression in adults presenting to the emergency department (ED) with an acute mental health crisis. DESIGN Secondary data analysis. SETTING St Paul's Hospital, an urban tertiary care hospital in Vancouver, BC. PARTICIPANTS Patients 19 years and older presenting to the ED with an acute mental health crisis. MAIN OUTCOME MEASURES Responses to demographic questionnaires focused on SDH and to measures of self-perceived health and depression. Relationships between depression and SDH were described using t tests and χ 2 tests. The extent to which SDH variables predicted depression scores, as measured by the Patient Health Questionnaire-9 (PHQ-9), was determined using linear regression. RESULTS The primary study had 202 participants. Data for the 156 (77%) participants who completed the PHQ-9 were assessed in this secondary analysis. In this sample, 60% of participants identified as men, 37% as women, and 4% as other. The mean (SD) age was 39.1 (13.8) years, with most participants identifying as white (65%) or Indigenous (18%). Thirty-seven percent had a high school diploma or less education, and 72% reported being unemployed. Identifying as a woman, lack of access to clean drinking water, poor food security, feeling unsafe, little structured use of time, lack of a sense of community, and dissatisfaction with housing significantly predicted higher depression scores. Overall, 59% of respondents met the criteria for moderately severe or severe depression (PHQ-9 score ≥ 15), with 37% of those reporting thoughts of suicide nearly every day for the past 2 weeks. CONCLUSION This study demonstrates the importance of screening for both depression and SDH in the ED. Because the ED often does not have the capacity to address appropriate levels of follow-up for this population, this study has important implications for primary care. Developing a clear pathway of follow-up support for people with depression and SDH risk factors will be critical to optimize patient outcomes, promote patient safety, enhance patient satisfaction, and optimize the use of resources between the ED and primary care.
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Affiliation(s)
| | | | - David Barbic
- Emergency physician at St Paul's Hospital in Vancouver, BC
| | - Steve Mathias
- Psychiatrist at St Paul's Hospital and Executive Director of Foundry
| | - Shannon Chau
- Graduate student in the Dietetics Program at the University of British Columbia (UBC) in Vancouver and was a co-op student for this study
| | | | - Skye Barbic
- Health systems researcher, Research Lead at Foundry, and Assistant Professor in the Department of Occupational Science and Occupational Therapy at UBC.
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13
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Bougeard A, Guay Hottin1 R, Houde V, Jean T, Piront T, Potvin S, Bernard P, Tourjman V, De Benedictis L, Orban P. Le phénotypage digital pour une pratique clinique en santé mentale mieux informée. SANTE MENTALE AU QUEBEC 2021. [DOI: 10.7202/1081513ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectifs Cette revue trouve sa motivation dans l’observation que la prise de décision clinique en santé mentale est limitée par la nature des mesures typiquement obtenues lors de l’entretien clinique et la difficulté des cliniciens à produire des prédictions justes sur les états mentaux futurs des patients. L’objectif est de présenter un survol représentatif du potentiel du phénotypage digital couplé à l’apprentissage automatique pour répondre à cette limitation, tout en en soulignant les faiblesses actuelles.
Méthode Au travers d’une revue narrative de la littérature non systématique, nous identifions les avancées technologiques qui permettent de quantifier, instant après instant et dans le milieu de vie naturel, le phénotype humain au moyen du téléphone intelligent dans diverses populations psychiatriques. Des travaux pertinents sont également sélectionnés afin de déterminer l’utilité et les limitations de l’apprentissage automatique pour guider les prédictions et la prise de décision clinique. Finalement, la littérature est explorée pour évaluer les barrières actuelles à l’adoption de tels outils.
Résultats Bien qu’émergeant d’un champ de recherche récent, de très nombreux travaux soulignent déjà la valeur des mesures extraites des senseurs du téléphone intelligent pour caractériser le phénotype humain dans les sphères comportementale, cognitive, émotionnelle et sociale, toutes étant affectées par les troubles mentaux. L’apprentissage automatique permet d’utiles et justes prédictions cliniques basées sur ces mesures, mais souffre d’un manque d’interprétabilité qui freinera son emploi prochain dans la pratique clinique. Du reste, plusieurs barrières identifiées tant du côté du patient que du clinicien freinent actuellement l’adoption de ce type d’outils de suivi et d’aide à la décision clinique.
Conclusion Le phénotypage digital couplé à l’apprentissage automatique apparaît fort prometteur pour améliorer la pratique clinique en santé mentale. La jeunesse de ces nouveaux outils technologiques requiert cependant un nécessaire processus de maturation qui devra être encadré par les différents acteurs concernés pour que ces promesses puissent être pleinement réalisées.
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Affiliation(s)
- Alan Bougeard
- Étudiant, Centre de recherche de l’Institut universitaire en santé mentale de Montréal
| | - Rose Guay Hottin1
- Étudiante, Centre de recherche de l’Institut universitaire en santé mentale de Montréal
| | - Valérie Houde
- M.D., étudiante, Centre de recherche de l’Institut universitaire en santé mentale de Montréal
| | - Thierry Jean
- Étudiant, Centre de recherche de l’Institut universitaire en santé mentale de Montréal
| | - Thibault Piront
- Professionnel de recherche, Centre de recherche de l’Institut universitaire en santé mentale de Montréal
| | - Stéphane Potvin
- Ph. D., chercheur, Centre de recherche de l’Institut universitaire en santé mentale de Montréal – professeur sous octroi titulaire, Département de psychiatrie et d’addictologie, Université de Montréal
| | - Paquito Bernard
- Ph. D., chercheur, Centre de recherche de l’Institut universitaire en santé mentale de Montréal – professeur régulier, Département des sciences de l’activité physique, Université du Québec à Montréal
| | - Valérie Tourjman
- M.D., psychiatre, Institut universitaire en santé mentale de Montréal – professeure agrégée de clinique, Département de psychiatrie et d’addictologie, Université de Montréal
| | - Luigi De Benedictis
- M.D., psychiatre, Institut universitaire en santé mentale de Montréal – professeur adjoint de clinique, Département de psychiatrie et d’addictologie, Université de Montréal
| | - Pierre Orban
- Ph. D., chercheur, Centre de recherche de l’Institut universitaire en santé mentale de Montréal – professeur sous octroi adjoint, Département de psychiatrie et d’addictologie, Université de Montréal
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14
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Puangsri P, Jinanarong V, Wattanapisit A. Impacts on and Care of Psychiatric Patients during the Outbreak of COVID-19. Clin Pract Epidemiol Ment Health 2021; 17:52-60. [PMID: 34497660 PMCID: PMC8386085 DOI: 10.2174/1745017902117010052] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 03/22/2021] [Accepted: 04/13/2021] [Indexed: 12/13/2022]
Abstract
The outbreak of coronavirus disease (COVID-19) in December 2019 has led to massive lifestyle, economic, and health changes. The COVID-19 pandemic has had broad impacts on psychiatric patients, exacerbating symptoms such as psychosis, depression, and suicidal ideation. Therefore, we aimed to review the psychological impacts of COVID-19 on psychiatric patients and mental healthcare staff and provide practical guidance for medical staff and authorities. The main findings of this review included the impacts of COVID-19 on psychiatric patients and mental health professionals as well as the transformation of mental health care. Greater consideration should be given to the care of patients with psychosis and depression because of their lack of self-care ability, neurocognitive impairment, and impaired immune function. Depressive symptoms can be exacerbated due to several factors, such as economic crises, social isolation, and limited physical activity. Unemployment and financial problems can lead to an increased suicide rate. Consequently, mental healthcare workers’ workload can increase, which could lead to burnout and psychological symptoms such as insomnia, depression, and anxiety. A transformation of psychiatric care is needed during the time of the pandemic. While emergency care should be maintained, outpatient care should be limited to decrease viral spread. Shifting care to telemedicine and community-based psychiatry can be helpful. Inpatient services should be adapted by tightening admission criteria, shortening the length of hospital stays, suspending some group activities, limiting visitors, and preparing for quarantine if necessary. Mental healthcare workers can be supported with telecommunication, appropriate work shifts, alternative accommodations, and good communication between the team leader and staff.
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Affiliation(s)
- Pavarud Puangsri
- School of Medicine, Walailak University, Thasala, Nakhon Si Thammarat, Thailand
| | - Vinn Jinanarong
- Walailak University Hospital, Thasala, Nakhon Si Thammarat, Thailand
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15
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Changes in the top 25 reasons for primary care visits during the COVID-19 pandemic in a high-COVID region of Canada. PLoS One 2021; 16:e0255992. [PMID: 34383844 PMCID: PMC8360367 DOI: 10.1371/journal.pone.0255992] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 07/27/2021] [Indexed: 01/14/2023] Open
Abstract
Purpose We aimed to determine the degree to which reasons for primary care visits changed during the COVID-19 pandemic. Methods We used data from the University of Toronto Practice Based Research Network (UTOPIAN) to compare the most common reasons for primary care visits before and after the onset of the COVID-19 pandemic, focusing on the number of visits and the number of patients seen for each of the 25 most common diagnostic codes. The proportion of visits involving virtual care was assessed as a secondary outcome. Results UTOPIAN family physicians (N = 379) conducted 702,093 visits, involving 264,942 patients between March 14 and December 31, 2019 (pre-pandemic period), and 667,612 visits, involving 218,335 patients between March 14 and December 31, 2020 (pandemic period). Anxiety was the most common reason for visit, accounting for 9.2% of the total visit volume during the pandemic compared to 6.5% the year before. Diabetes and hypertension remained among the top 5 reasons for visit during the pandemic, but there were 23.7% and 26.2% fewer visits and 19.5% and 28.8% fewer individual patients accessing care for diabetes and hypertension, respectively. Preventive care visits were substantially reduced, with 89.0% fewer periodic health exams and 16.2% fewer well-baby visits. During the pandemic, virtual care became the dominant care format (77.5% virtual visits). Visits for anxiety and depression were the most common reasons for a virtual visit (90.6% virtual visits). Conclusion The decrease in primary care visit volumes during the COVID-19 pandemic varied based on the reason for the visit, with increases in visits for anxiety and decreases for preventive care and visits for chronic diseases. Implications of increased demands for mental health services and gaps in preventive care and chronic disease management may require focused efforts in primary care.
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16
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Chiu M, Gatov E, Fung K, Kurdyak P, Guttmann A. Deconstructing The Rise In Mental Health-Related ED Visits Among Children And Youth In Ontario, Canada. Health Aff (Millwood) 2021; 39:1728-1736. [PMID: 33017254 DOI: 10.1377/hlthaff.2020.00232] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Mental illness is a leading cause of disability among youth. In Ontario, Canada, rates of mental health or addiction-related emergency department (ED) visits continue to rise in children and youth; however, it is unclear what is driving this change. We deconstructed this trend by sociodemographic and clinical characteristics, using linked health administrative data sets. Mental health or addiction-related ED visit rates increased by 89.1 percent between 2006 and 2017, with the greatest rise observed for those ages 14-21, high-acuity cases, and anxiety and mood disorders. We observed a significantly sharp increase after 2009, when several socioenvironmental changes occurred, including the emergence of social media and the Great Recession. Our findings of greater numbers of teenagers and young adults experiencing mental health problems and a shift in acuity and diagnoses have important implications for both ED staffing and outpatient mental illness prevention efforts. Further research is needed to examine whether better case management, care coordination, and after-hours services will help reverse these trends.
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Affiliation(s)
- Maria Chiu
- Maria Chiu is a scientist in the Mental Health and Addictions Research Program at ICES and an assistant professor in the Institute of Health Policy, Management, and Evaluation at the University of Toronto, both in Toronto, Ontario, Canada
| | - Evgenia Gatov
- Evgenia Gatov is a senior epidemiologist in the Mental Health and Addictions Research Program at ICES
| | | | - Paul Kurdyak
- Paul Kurdyak is a lead in the Mental Health and Addictions Research Program at ICES and the medical director of performance improvement at the Centre for Addiction and Mental Health, in Toronto, Ontario, Canada
| | - Astrid Guttmann
- Astrid Guttmann is a chief science officer at ICES and a senior scientist at the Hospital for Sick Children, in Toronto, Ontario, Canada
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17
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Marshall R, Ribbers A, Sheridan D, Johnson KP. Mental Health Diagnoses and Seasonal Trends at a Pediatric Emergency Department and Hospital, 2015-2019. Hosp Pediatr 2021; 11:199-206. [PMID: 33526413 DOI: 10.1542/hpeds.2020-000653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Increasingly, youth with mental health disorders and suicidality are presenting to emergency departments (EDs) and requiring hospitalization. For youth with suicidality, studies reveal seasonal variations in frequency of presentations but do not identify associated diagnoses or whether other primary mental health complaints also reveal seasonal variations. METHODS Data were collected between January 2015 and December 2019 by a child and adolescent psychiatry consultation-liaison service in a pediatric ED and hospital. Descriptive analysis and multiple linear regression were performed to assess volume over time, seasonal trends, and associated diagnoses. RESULTS A total of 2367 patients were included, with an average age of 13.9 years and female predominance (62.3%). During the study period, annual ED consultations increased 87.5% and hospital consultations increased 27.5%. Consultations revealed seasonal trends, with highest volumes during January, April, May, October, and November (P < .001; adjusted R 2 = 0.59). The most frequent diagnostic categories were depressive disorders and trauma- or stressor-related disorders. Thirty-six percent of patients presented after a suicide attempt, with the highest rates in spring (P = .03; adjusted R 2 = 0.19). Boarding rates revealed significant seasonality, with higher instances in February, March, April, May, and October (P = .009; adjusted R 2 = 0.32). CONCLUSIONS Mental health presentations to a pediatric ED and hospital reveal seasonal trends, with the highest volumes in fall and spring and the most common diagnoses being depressive and trauma-related disorders. Suicide attempts are highest in late spring. Knowledge of these trends should inform hospitals, mental health services, and school systems regarding staffing, safety, surveillance, and prevention.
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Affiliation(s)
- Rebecca Marshall
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, and
| | - Amanda Ribbers
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, and
| | - David Sheridan
- Department of Emergency Medicine, Oregon Health & Science University, Portland, Oregon
| | - Kyle P Johnson
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, and
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18
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Barbic SP, Chan N, Rangi A, Bradley J, Pattison R, Brockmeyer K, Leznoff S, Smolski Y, Toor G, Bray B, Leon A, Jenkins M, Mathias S. Health provider and service-user experiences of sensory modulation rooms in an acute inpatient psychiatry setting. PLoS One 2019; 14:e0225238. [PMID: 31751373 PMCID: PMC6874072 DOI: 10.1371/journal.pone.0225238] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 10/31/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Sensory modulation rooms (SMRs) are therapeutic spaces that use sensory modulation concepts and strategies to assist service users to self-regulate and modulate arousal levels. SMRs are increasingly being explored as strength-based and person-centered adjuncts to care for people receiving inpatient psychiatry services. The aim of this study is to understand health provider and inpatient service user perceptions on the use of SMRs on acute psychiatric units. METHODS We conducted semi-structured interviews with ten service users and nine health providers (four occupational therapists and five nurses) regarding their experiences of the SMRs located on three acute inpatient units in a large urban tertiary care hospital. We audio recorded and transcribed the focus groups and used thematic analysis to analyze the data. RESULTS Our results suggested four common themes amongst health provider and service user experiences of sensory modulation rooms: (1) service user empowerment through self-management, (2) emotional regulation, (3) an alternative to current practices, and (4) health provider and service user education. CONCLUSION Our study supports the ecological utility of SMRs as person-centred adjunct therapeutic space viewed positively by both service users and health providers. This understanding of SMRs is critical for future service design, research and policy aimed at improving the service user experience and care for this population. Future research is needed to validate the experience of the SMRs with other patient groups and health providers.
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Affiliation(s)
- Skye P Barbic
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Occupational Science and Occupational Therapy, UBC, Vancouver, British Columbia, Canada.,Providence Health Care, Vancouver, British Columbia, Canada.,Department of Psychiatry, UBC, Vancouver, British Columbia, Canada.,Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada.,Foundry, Vancouver, British Columbia, Canada
| | - Nicole Chan
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Occupational Science and Occupational Therapy, UBC, Vancouver, British Columbia, Canada
| | - Amanpreet Rangi
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Occupational Science and Occupational Therapy, UBC, Vancouver, British Columbia, Canada
| | - James Bradley
- Providence Health Care, Vancouver, British Columbia, Canada
| | - Rachal Pattison
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Occupational Science and Occupational Therapy, UBC, Vancouver, British Columbia, Canada
| | | | - Sandy Leznoff
- Providence Health Care, Vancouver, British Columbia, Canada
| | - Yojo Smolski
- Providence Health Care, Vancouver, British Columbia, Canada
| | - Gagan Toor
- Providence Health Care, Vancouver, British Columbia, Canada
| | - Blaine Bray
- Providence Health Care, Vancouver, British Columbia, Canada
| | - Adelena Leon
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Occupational Science and Occupational Therapy, UBC, Vancouver, British Columbia, Canada
| | - Malcolm Jenkins
- Providence Health Care, Vancouver, British Columbia, Canada.,Foundry, Vancouver, British Columbia, Canada
| | - Steve Mathias
- Providence Health Care, Vancouver, British Columbia, Canada.,Department of Psychiatry, UBC, Vancouver, British Columbia, Canada.,Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada.,Foundry, Vancouver, British Columbia, Canada.,Department of Psychiatry, St. Paul's Hospital, Vancouver, British Columbia, Canada
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19
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Reid N, Castel S, Veldhuizen S, Roberts A, Stergiopoulos V. Effect of a Psychiatric Emergency Department Expansion on Acute Mental Health and Addiction Service Use Trends in a Large Urban Center. Psychiatr Serv 2019; 70:1053-1056. [PMID: 31357920 DOI: 10.1176/appi.ps.201900112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study examined recent growth in demand for acute mental health and addiction (MHA) care in a large urban center and changes in patient flow following the expansion of a psychiatric emergency department (ED). METHODS A retrospective observational design used administrative data in adjusted negative binomial regression models to identify time trends at seven hospitals over a 6-year period in central Toronto. Two-part linear spline models compared trends before and after a psychiatric ED expansion. RESULTS Per capita MHA-related ED visits grew rapidly across the acute care system over the study period, although admissions per MHA ED visit decreased. Expanding a psychiatric ED did not influence overall system-level growth, but it significantly shifted traffic; the annual MHA ED visit growth rate increased at the expanded ED while decreasing at surrounding hospitals. CONCLUSIONS Given increasing demand systemwide, individual hospital ED expansions may be inappropriate; planning should consider the whole system.
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Affiliation(s)
- Nadine Reid
- Centre for Addiction and Mental Health, Toronto (Reid, Veldhuizen, Stergiopoulos); Sunnybrook Health Sciences Centre, Toronto (Castel); Department of Psychiatry, University of Toronto, Toronto (Castel, Stergiopoulos); Adair Roberts and Associates, Inc., Toronto (Roberts)
| | - Saulo Castel
- Centre for Addiction and Mental Health, Toronto (Reid, Veldhuizen, Stergiopoulos); Sunnybrook Health Sciences Centre, Toronto (Castel); Department of Psychiatry, University of Toronto, Toronto (Castel, Stergiopoulos); Adair Roberts and Associates, Inc., Toronto (Roberts)
| | - Scott Veldhuizen
- Centre for Addiction and Mental Health, Toronto (Reid, Veldhuizen, Stergiopoulos); Sunnybrook Health Sciences Centre, Toronto (Castel); Department of Psychiatry, University of Toronto, Toronto (Castel, Stergiopoulos); Adair Roberts and Associates, Inc., Toronto (Roberts)
| | - Adair Roberts
- Centre for Addiction and Mental Health, Toronto (Reid, Veldhuizen, Stergiopoulos); Sunnybrook Health Sciences Centre, Toronto (Castel); Department of Psychiatry, University of Toronto, Toronto (Castel, Stergiopoulos); Adair Roberts and Associates, Inc., Toronto (Roberts)
| | - Vicky Stergiopoulos
- Centre for Addiction and Mental Health, Toronto (Reid, Veldhuizen, Stergiopoulos); Sunnybrook Health Sciences Centre, Toronto (Castel); Department of Psychiatry, University of Toronto, Toronto (Castel, Stergiopoulos); Adair Roberts and Associates, Inc., Toronto (Roberts)
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20
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Barbera L, Sutradhar R, Howell D, Corn E, O'Brien MA, Seow H, Dudgeon D, Atzema C, Earle CC, DeAngelis C, Sussman J. Factors Associated With Opioid Use in Long-term Cancer Survivors. J Pain Symptom Manage 2019; 58:100-107.e2. [PMID: 30831238 DOI: 10.1016/j.jpainsymman.2019.02.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 02/22/2019] [Accepted: 02/22/2019] [Indexed: 02/06/2023]
Abstract
PURPOSE To evaluate factors associated with opioid use in patients with cancer surviving more than five years without recurrence. We evaluated exposures of opioid use before cancer diagnosis, opioid use between cancer diagnosis and five-year anniversary, surgeries, and chemotherapy. METHODS We conducted a retrospective cohort study using linked provincial administrative data. Patients were aged 24-70 years and eligible for government-funded pharmacare. The index date was the five-year anniversary from diagnosis. Patients were accrued between 2010 and 2015. The main outcome was opioid prescription rate after index date. The main exposures were opioid use before diagnosis, opioid use between diagnosis and index, surgeries, and chemotherapy. A negative binomial regression model was used to estimate relative rates (RR) of opioid use after index date. RESULTS Our cohort included 7431 individuals. The overall crude prescription rate after the index date was 2 per person-year. The factor most strongly associated with a higher rate of opioid use after index was continuous opioid use between diagnosis and index (RR 46.1, 95% confidence interval 34.8-61.2). Opioid use before diagnosis was also a factor (RR = 1.8, 95% confidence interval 1.44-2.19). A history of depression, comorbidity, and more than two years of diabetes were also associated with higher risk of post-index date opioid use. Significant interactions were identified between prior opioid use and opioid use between diagnosis and index. Most prescriptions are from family physicians. CONCLUSION Patients who use opioids continuously between diagnosis and index date are at increased risk of continued use after five years of survival. Safe and appropriate pain management is an important survivorship issue.
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Affiliation(s)
- Lisa Barbera
- Tom Baker Cancer Centre, Calgary, Alberta, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
| | - Rinku Sutradhar
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Doris Howell
- University Health Network, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Elyse Corn
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Mary Ann O'Brien
- University of Toronto, Department of Family and Community Medicine, Toronto, Ontario, Canada
| | - Hsien Seow
- McMaster University, Department of Oncology, Hamilton, Ontario, Canada
| | - Deb Dudgeon
- Queen's University Department of Medicine and Oncology, Kingston, Ontario, Canada
| | - Clare Atzema
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Sunnybrook Health Sciences Centre, Department of Emergency Services, Toronto, Ontario, Canada
| | - Craig C Earle
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Department of Medicine, Toronto, Ontario, Canada
| | - Carlo DeAngelis
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Department of Pharmacy, Toronto, Ontario, Canada
| | - Jonathan Sussman
- McMaster University, Department of Oncology, Hamilton, Ontario, Canada
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21
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Rodrigues R, MacDougall AG, Zou G, Lebenbaum M, Kurdyak P, Li L, Shariff SZ, Anderson KK. Involuntary hospitalization among young people with early psychosis: A population-based study using health administrative data. Schizophr Res 2019; 208:276-284. [PMID: 30728106 DOI: 10.1016/j.schres.2019.01.043] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 01/24/2019] [Accepted: 01/27/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Early psychosis is an important window for establishing long-term trajectories. Involuntary hospitalization during this period may impact subsequent service engagement in people with newly diagnosed psychotic disorder. However, population-based studies of involuntary hospitalization in early psychosis are lacking. We sought to estimate the proportion of people aged 16 to 35 years with early psychosis in Ontario who are hospitalized involuntarily at first admission, and to identify the associated risk factors and outcomes. METHODS Using linked population-based health administrative data, we identified incident cases of non-affective psychosis over a five-year period (2009-2013) and followed cases for two years to ascertain the first psychiatric hospitalization. We used modified Poisson regression to model sociodemographic, clinical, and service-related risk factors, and compared service-related outcomes for cases admitted on an involuntary versus voluntary basis. RESULTS Among 17,725 incident cases of non-affective psychosis, 38% were hospitalized within two years, and 81% of these admissions occurred on an involuntary basis (26% of cohort). Sociodemographic factors associated with an increased risk of involuntary admission included younger age (16-20), and first-generation migrant status. The strongest risk factors were poor illness insight, recent police involvement, and admission to a general (versus psychiatric) hospital. Outcomes associated with involuntary admission included increased likelihood of control intervention use and a shorter length of stay. CONCLUSIONS One in four young people with first-episode psychosis will have an involuntary admission early in the course of their illness. Our findings highlight areas for intervention to improve pathways to care for people with psychotic disorder.
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Affiliation(s)
- Rebecca Rodrigues
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Arlene G MacDougall
- 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
| | - Guangyong Zou
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada; Robarts Research Institute, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | | | - Paul Kurdyak
- Institute for Clinical Evaluate Sciences, Toronto, ON, Canada; Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Lihua Li
- Institute for Clinical Evaluate Sciences, Toronto, 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; Institute for Clinical Evaluate Sciences, Toronto, ON, Canada.
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22
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Laliberté V, Stergiopoulos V, Jacob B, Kurdyak P. Homelessness at discharge and its impact on psychiatric readmission and physician follow-up: a population-based cohort study. Epidemiol Psychiatr Sci 2019; 29:e21. [PMID: 30841949 PMCID: PMC8061292 DOI: 10.1017/s2045796019000052] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 01/22/2019] [Accepted: 01/26/2019] [Indexed: 11/07/2022] Open
Abstract
AIMS A significant proportion of adults who are admitted to psychiatric hospitals are homeless, yet little is known about their outcomes after a psychiatric hospitalisation discharge. The aim of this study was to assess the impact of being homeless at the time of psychiatric hospitalisation discharge on psychiatric hospital readmission, mental health-related emergency department (ED) visits and physician-based outpatient care. METHODS This was a population-based cohort study using health administrative databases. All patients discharged from a psychiatric hospitalisation in Ontario, Canada, between 1 April 2011 and 31 March 2014 (N = 91 028) were included and categorised as homeless or non-homeless at the time of discharge. Psychiatric hospitalisation readmission rates, mental health-related ED visits and physician-based outpatient care were measured within 30 days following hospital discharge. RESULTS There were 2052 (2.3%) adults identified as homeless at discharge. Homeless individuals at discharge were significantly more likely to have a readmission within 30 days following discharge (17.1 v. 9.8%; aHR = 1.43 (95% CI 1.26-1.63)) and to have an ED visit (27.2 v. 11.6%; aHR = 1.87 (95% CI 1.68-2.0)). Homeless individuals were also over 50% less likely to have a psychiatrist visit (aHR = 0.46 (95% CI 0.40-0.53)). CONCLUSION Homeless adults are at higher risk of readmission and ED visits following discharge. They are also much less likely to receive post-discharge physician care. Efforts to improve access to services for this vulnerable population are required to reduce acute care service use and improve care continuity.
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Affiliation(s)
- V. Laliberté
- Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - V. Stergiopoulos
- Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - B. Jacob
- Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - P. Kurdyak
- Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
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