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Normand SL, Zelevinsky K, Finnerty M, Leckman-Westin E, Chen Q, Jeong J, Abing H, Tsuei J, Horvitz-Lennon M. Racial-Ethnic Disparities in Quality of Care Among Medicaid Beneficiaries With Schizophrenia. Psychiatr Serv 2024:appips20230564. [PMID: 38863327 DOI: 10.1176/appi.ps.20230564] [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: 06/13/2024]
Abstract
OBJECTIVE The authors sought to update and expand the evidence on the quality of health care and disparities in care among Medicaid beneficiaries with schizophrenia. METHODS Adult beneficiaries of New York State Medicaid with schizophrenia receiving care during 2016-2019 were identified. Composite quality scores were derived from item response theory models by using evidence-based indicators of the quality of mental and general medical health care. Risk-adjusted racial-ethnic differences in quality were estimated and summarized as percentiles relative to White beneficiaries' mean quality scores. RESULTS The study included 71,013 beneficiaries; 42.8% were Black, 22.9% Latinx, 27.4% White, and 6.9% other race-ethnicity. Overall, 68.8% had a mental health follow-up within 30 days of discharge, and 90.2% had no preventable hospitalizations for chronic obstructive pulmonary disease or asthma. Among beneficiaries receiving antipsychotic medications, medication adherence was adequate for 43.7%. Fourteen indicators for mental and general medical health care quality yielded three composites: two for mental health care (pharmacological and ambulatory) and one for acute mental and general medical health care. Mean quality of pharmacological mental health care for Black and Latinx beneficiaries was lower than for White beneficiaries (39th and 44th percentile, respectively). For Black beneficiaries, mean quality of ambulatory mental health care was also lower (46th percentile). In New York City, Black beneficiaries received lower-quality care in all domains. The only meaningful group difference in the quality of acute mental and general medical health care indicated higher-quality care for individuals with other race-ethnicity. CONCLUSIONS Disparities in the quality of Medicaid-financed health care persist, particularly for Black beneficiaries. Regional differences merit further attention.
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Affiliation(s)
- Sharon-Lise Normand
- Department of Health Care Policy, Harvard Medical School, Boston (Normand, Zelevinsky, Abing); Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston (Normand); Office of Mental Health, New York State Department of Health, Albany (Finnerty, Leckman-Westin, Chen, Jeong); Department of Epidemiology and Biostatistics, University at Albany School of Public Health, Rensselaer, New York (Leckman-Westin); RAND, Santa Monica, California (Tsuei), and Boston (Horvitz-Lennon); Department of Psychiatry, Cambridge Health Alliance and Harvard Medical School, Cambridge, Massachusetts (Horvitz-Lennon)
| | - Katya Zelevinsky
- Department of Health Care Policy, Harvard Medical School, Boston (Normand, Zelevinsky, Abing); Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston (Normand); Office of Mental Health, New York State Department of Health, Albany (Finnerty, Leckman-Westin, Chen, Jeong); Department of Epidemiology and Biostatistics, University at Albany School of Public Health, Rensselaer, New York (Leckman-Westin); RAND, Santa Monica, California (Tsuei), and Boston (Horvitz-Lennon); Department of Psychiatry, Cambridge Health Alliance and Harvard Medical School, Cambridge, Massachusetts (Horvitz-Lennon)
| | - Molly Finnerty
- Department of Health Care Policy, Harvard Medical School, Boston (Normand, Zelevinsky, Abing); Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston (Normand); Office of Mental Health, New York State Department of Health, Albany (Finnerty, Leckman-Westin, Chen, Jeong); Department of Epidemiology and Biostatistics, University at Albany School of Public Health, Rensselaer, New York (Leckman-Westin); RAND, Santa Monica, California (Tsuei), and Boston (Horvitz-Lennon); Department of Psychiatry, Cambridge Health Alliance and Harvard Medical School, Cambridge, Massachusetts (Horvitz-Lennon)
| | - Emily Leckman-Westin
- Department of Health Care Policy, Harvard Medical School, Boston (Normand, Zelevinsky, Abing); Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston (Normand); Office of Mental Health, New York State Department of Health, Albany (Finnerty, Leckman-Westin, Chen, Jeong); Department of Epidemiology and Biostatistics, University at Albany School of Public Health, Rensselaer, New York (Leckman-Westin); RAND, Santa Monica, California (Tsuei), and Boston (Horvitz-Lennon); Department of Psychiatry, Cambridge Health Alliance and Harvard Medical School, Cambridge, Massachusetts (Horvitz-Lennon)
| | - Qingxian Chen
- Department of Health Care Policy, Harvard Medical School, Boston (Normand, Zelevinsky, Abing); Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston (Normand); Office of Mental Health, New York State Department of Health, Albany (Finnerty, Leckman-Westin, Chen, Jeong); Department of Epidemiology and Biostatistics, University at Albany School of Public Health, Rensselaer, New York (Leckman-Westin); RAND, Santa Monica, California (Tsuei), and Boston (Horvitz-Lennon); Department of Psychiatry, Cambridge Health Alliance and Harvard Medical School, Cambridge, Massachusetts (Horvitz-Lennon)
| | - Junghye Jeong
- Department of Health Care Policy, Harvard Medical School, Boston (Normand, Zelevinsky, Abing); Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston (Normand); Office of Mental Health, New York State Department of Health, Albany (Finnerty, Leckman-Westin, Chen, Jeong); Department of Epidemiology and Biostatistics, University at Albany School of Public Health, Rensselaer, New York (Leckman-Westin); RAND, Santa Monica, California (Tsuei), and Boston (Horvitz-Lennon); Department of Psychiatry, Cambridge Health Alliance and Harvard Medical School, Cambridge, Massachusetts (Horvitz-Lennon)
| | - Haley Abing
- Department of Health Care Policy, Harvard Medical School, Boston (Normand, Zelevinsky, Abing); Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston (Normand); Office of Mental Health, New York State Department of Health, Albany (Finnerty, Leckman-Westin, Chen, Jeong); Department of Epidemiology and Biostatistics, University at Albany School of Public Health, Rensselaer, New York (Leckman-Westin); RAND, Santa Monica, California (Tsuei), and Boston (Horvitz-Lennon); Department of Psychiatry, Cambridge Health Alliance and Harvard Medical School, Cambridge, Massachusetts (Horvitz-Lennon)
| | - Jeannette Tsuei
- Department of Health Care Policy, Harvard Medical School, Boston (Normand, Zelevinsky, Abing); Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston (Normand); Office of Mental Health, New York State Department of Health, Albany (Finnerty, Leckman-Westin, Chen, Jeong); Department of Epidemiology and Biostatistics, University at Albany School of Public Health, Rensselaer, New York (Leckman-Westin); RAND, Santa Monica, California (Tsuei), and Boston (Horvitz-Lennon); Department of Psychiatry, Cambridge Health Alliance and Harvard Medical School, Cambridge, Massachusetts (Horvitz-Lennon)
| | - Marcela Horvitz-Lennon
- Department of Health Care Policy, Harvard Medical School, Boston (Normand, Zelevinsky, Abing); Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston (Normand); Office of Mental Health, New York State Department of Health, Albany (Finnerty, Leckman-Westin, Chen, Jeong); Department of Epidemiology and Biostatistics, University at Albany School of Public Health, Rensselaer, New York (Leckman-Westin); RAND, Santa Monica, California (Tsuei), and Boston (Horvitz-Lennon); Department of Psychiatry, Cambridge Health Alliance and Harvard Medical School, Cambridge, Massachusetts (Horvitz-Lennon)
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Baruth JM, Bateman DR, Kovacs RJ, Bateman PV, Pazdernik VM, Santivasi WL, Dunlay SM, Lapid MI. Cardiac healthcare disparities and electrocardiography (ECG) differences in schizophrenia at end of life. Schizophr Res 2023; 262:60-66. [PMID: 37925752 DOI: 10.1016/j.schres.2023.10.017] [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: 04/15/2022] [Revised: 09/11/2023] [Accepted: 10/22/2023] [Indexed: 11/07/2023]
Abstract
Schizophrenia is associated with early mortality of 15 to 20 years, and 80 % of deaths are due to cardiovascular disease with a three-times greater risk of sudden-cardiac-death. While lifestyle, medications, genetics, and healthcare disparities are contributing factors, the etiology of this complex process is not fully understood. The aim of this study is to examine cardiac-related healthcare utilization and electrocardiogram (ECG) outcomes in schizophrenia at the end of life (EOL). A cohort of individuals with schizophrenia (SG) (n = 610, ≥50 years) were identified retrospectively from a unified clinical data platform and measures of cardiovascular healthcare utilization were evaluated within a 12-month period prior to death. Similarly, a control group (n = 610) was randomly identified and matched by gender (53 % females) and age of death (72.8 ± 12.4 years). Statistical methods included Cochran-Mantel-Haenszel and mixed-effects logistic & linear regression tests with adjustments for match strata and marital status, race, age, and gender as covariates. Results indicate that SG was more likely to be unmarried, unemployed, or from minority groups (all p < 0.001), and more likely to have diabetes and/or cardiovascular disease (p < 0.001). SG was less likely to receive an ECG (p = 0.001) or cardiac catheterization procedure (p < 0.001). SG had a greater mean QTc (447.2 ms vs. 434.6 ms; p = 0.001) and were twice as likely to have "prolonged QT" on ECG report (p = 0.006). In conclusion, SG had reduced likelihood of cardiac-related healthcare interventions, and despite greater likelihood of prolonged QTc, a recognized biomarker of cardiac risk, ECG was less likely at EOL. Given greater cardiac comorbidity and risk of sudden cardiac death in schizophrenia, improved practice guidelines are needed.
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Affiliation(s)
- Joshua M Baruth
- Dept. of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA.
| | - Daniel R Bateman
- Dept. of Behavioral Health, Indiana University, Indianapolis, IN, USA
| | | | | | | | - Wil L Santivasi
- Center for Palliative Care, Department of Medicine, Duke University, Durham, NC, USA
| | - Shannon M Dunlay
- Dept. of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Maria I Lapid
- Dept. of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
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Kiadaliri A, Lohmander LS, Dahlberg LE, Englund M. Incipient dementia and avoidable hospital admission in persons with osteoarthritis. OSTEOARTHRITIS AND CARTILAGE OPEN 2023; 5:100341. [PMID: 36798737 PMCID: PMC9926213 DOI: 10.1016/j.ocarto.2023.100341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 01/11/2023] [Accepted: 01/17/2023] [Indexed: 01/21/2023] Open
Abstract
Objective To investigate the associations between incipient dementia (ID) and hospitalization for ambulatory care sensitive conditions (ACSCs) among people with osteoarthritis (OA) of the peripheral joints. Methods Among individuals aged 51-99 years residing in Skåne, Sweden, in 2009, we identified those with a doctor-diagnosed OA and no dementia during 1998-2009 (n = 57,733). Treating ID as a time-varying exposure, we followed people from January 1, 2010 or their 60th birthday (whichever occurred last) until hospitalization for ACSCs, death, 100th birthday, relocation outside Skåne, or December 31, 2019 (whichever occurred first). Using age as time scale, we applied flexible parametric survival models, adjusted for confounders, to assess the associations between ID and hospitalization for ACSCs. Results There were 58 and 33 hospitalizations for ACSCs per 1000 person-years among OA people with and without ID, respectively. The association between ID and hospitalization for any ACSCs was age-dependent with higher risk in ages<86 years and lower risks in older ages. Between ages 60 and 100 years, persons with ID had, on average, 5.8 (95% CI 0.9, 10.7), 1.6 (-2.6, 5.9) and 3.1 (2.3, 4.0) fewer hospital-free years for any, chronic and acute ACSCs, respectively, compared with persons without ID. Conclusions Among persons with OA, while ID was associated with increased risks of hospitalization for ACSCs in younger ages, it was associated with decreased risk in oldest ages. These results suggest the need for improvement in quality of ambulatory care including the continuity of care for people with OA having dementia.
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Affiliation(s)
- Ali Kiadaliri
- Clinical Epidemiology Unit, Orthopaedics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden,Centre for Economic Demography, Lund University, Lund, Sweden,Corresponding author. Skåne University Hospital, Clinical Epidemiology Unit, Remissgatan 4, SE-221 85 Lund, Sweden.
| | - L Stefan Lohmander
- Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund, Sweden
| | - Leif E. Dahlberg
- Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund, Sweden
| | - Martin Englund
- Clinical Epidemiology Unit, Orthopaedics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
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Weissinger GM, Brooks Carthon JM, Ahmed C, Brawner BM. Experiences of Hospitalization of Patients With Psychotic Disorders on Medical-Surgical Units: A Thematic Analysis. J Am Psychiatr Nurses Assoc 2021; 27:306-321. [PMID: 31795792 PMCID: PMC9254133 DOI: 10.1177/1078390319892313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND:Individuals with psychotic disorders are more likely to have nonpsychiatric hospitalizations than the general population. Moreover, they experience worse outcomes in terms of rehospitalization, adverse events, in-hospital mortality, and longer length of stay. AIM: A patient-centered understanding of inpatient medical-surgical hospitalization experiences could shed light on disparities in hospital outcomes among individuals with psychotic disorders. METHOD: This article reports findings from Phase 1 (Qualitative) of a mixed methods, exploratory sequential study of nonpsychiatric hospitalizations of patients with psychotic disorders. Patients on medical-surgical units with diagnosed psychotic disorders (n = 20) were interviewed about their experiences of hospitalization, and a thematic analysis was conducted of transcripts, case notes, and setting notes. RESULTS: Five themes emerged from analysis: (1) managing through hard times (subthemes: intense emotions, medically complex with many symptoms, strategies for self-management), (2) ignored and treated unfairly, (3) actively involved in health (subthemes: seeking health education, suggesting changes), (4) appreciation of caring providers, and (5) violence: expected and enacted. Participants connected the difficult nature of their hospitalization experiences with a variety of sources and outcomes, including strong emotions, variable relationships with providers and a struggle to receive health education. CONCLUSIONS: Nurses who care for patients with psychotic disorders in medical-surgical settings can better meet patients' needs by concentrating on relationship building, especially during initial interactions, and helping patients better manage their medical and psychiatric symptoms through both pharmaceutical and nursing interventions.
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Affiliation(s)
- Guy M Weissinger
- Guy M. Weissinger II, MPhil, PhD, RN, Drexel University, Philadelphia, PA, USA
| | - J Margo Brooks Carthon
- J. Margo Brooks Carthon, PhD, RN, FAAN, University of Pennsylvania, Philadelphia, PA, USA
| | - Charisse Ahmed
- Charisse Ahmed, BSN, University of Pennsylvania, Philadelphia, PA, USA
| | - Bridgette M Brawner
- Bridgette M. Brawner, MDiv, PhD, APRN, University of Pennsylvania, Philadelphia, PA, USA
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Germack HD, Weissinger G, Bizhanova Z, Martsolf GR. Psychiatric Medication Changes Associated With Increased Rate of Medical Readmissions in Patients With Serious Mental Illness. J Nerv Ment Dis 2021; 209:166-173. [PMID: 33315795 DOI: 10.1097/nmd.0000000000001282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
ABSTRACT To identify the impact of postdischarge psychiatric medication changes on general medical readmissions among patients with serious mental illness (SMI; bipolar disorder, major depressive disorder, and schizophrenia), claims from a 5% national sample of Medicare fee-for-service (FFS) beneficiaries hospitalized between 2013 and 2016 were studied. A total of 165,490 Medicare FFS beneficiaries with SMI 18 years or older with at least 1 year of continuous Medicare enrollment were identified. Within 30 days of discharge from index admission, 47.4% experienced a psychiatric medication change-including 75,892 beneficiaries experiencing a deletion and 55,713 experiencing an addition. After adjusting for potential confounders, those with a medication change experienced an 10% increase in the odds of 30-day readmission (odds ratio, 1.10; SE, 0.019; p < 0.001). Comorbid drug use disorder was also associated with an increased odds of readmission after controlling for other covariates. These findings suggest important factors that clinicians should be aware of when discharging patients with SMI.
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Affiliation(s)
- Hayley D Germack
- Department of Acute & Tertiary Care, University of Pittsburgh School of Nursing, Pittsburgh
| | - Guy Weissinger
- Drexel University College of Nursing and Health Professions, Philadelphia
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6
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Weissinger GM, Carthon JMB, Brawner BM. Non-psychiatric hospitalization length-of-stay for patients with psychotic disorders: A mixed methods study. Gen Hosp Psychiatry 2020; 67:1-9. [PMID: 32866772 PMCID: PMC7722147 DOI: 10.1016/j.genhosppsych.2020.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 07/22/2020] [Accepted: 07/23/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Patients with psychotic disorders experience higher rates of chronic and acute non-psychotic diseases and have frequent non-psychiatric hospitalizations which result in both longer and more varied length-of-stay (LoS) than other patients. This study seeks to use a patient-centered perspective to examine LoS. METHODS This article reports Phase Two of a mixed methods, exploratory sequential study on non-psychiatric hospitalizations for individuals with psychotic disorders. Patients' experiences were used to guide a quantitative analysis of LoS using a general linear model. RESULTS Medical comorbidities were the patient characteristics which had the largest effect on LoS. Certain processes of care highlighted by patients from Phase One were also associated with longer LoS, including: physical restraints (105%), psychiatric consults (20%) and continuous observation (133%). Only recent in-system outpatient appointments were associated with shorter LoS. Data integration highlighted that factors which were important to patients such as partner support, were not always quantitatively significant, while others like medical comorbidities and use of physical restraints were points of congruence. CONCLUSIONS Medical comorbidities were highly associated with LoS but processes relating to longer LoS are those that are used to manage symptoms of acute psychosis. Clinicians should develop policies and procedures that address psychosis symptoms effectively during non-psychiatric hospitalizations. Further research is needed to understand which patients with psychotic disorders are at highest risk of extended length-of-stay.
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Affiliation(s)
- Guy M Weissinger
- Drexel University, College of Nursing and Health Professions, 3020 Market Street, Suite 510, Philadelphia, PA 19104, United States of America; University of Pennsylvania School of Nursing, 418 Curie Blvd., Philadelphia, PA 19104, United States of America.
| | - J Margo Brooks Carthon
- University of Pennsylvania School of Nursing, 418 Curie Blvd., Philadelphia, PA 19104, United States of America
| | - Bridgette M Brawner
- University of Pennsylvania School of Nursing, 418 Curie Blvd., Philadelphia, PA 19104, United States of America
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Egglefield K, Cogan L, Leckman-Westin E, Finnerty M. Antipsychotic Medication Adherence and Diabetes-Related Hospitalizations Among Medicaid Recipients With Diabetes and Schizophrenia. Psychiatr Serv 2020; 71:236-242. [PMID: 31744428 DOI: 10.1176/appi.ps.201800505] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This cross-sectional study examined the relationship between antipsychotic medication adherence and preventable diabetes-related hospitalizations for individuals with diabetes and schizophrenia. METHODS Hospitalizations related to diabetes, an ambulatory care sensitive condition, were assessed among Medicaid recipients in New York State with comorbid diabetes and schizophrenia (N=14,365) for three levels of antipsychotic medication adherence: very low to no engagement (two or fewer prescriptions or none in first 6 months), moderate to low adherence, and adherent (proportion of days covered ≥80%). RESULTS Rates of preventable diabetes hospitalization were highest among individuals with very low to no engagement in antipsychotic treatment (4.7%), followed by those with moderate to low adherence (3.3%). Diabetes hospitalizations among adherent individuals were comparable with those of the total diabetes population (both 2.0%). The odds of a preventable diabetes hospitalization were significantly higher among individuals with very low to no engagement in antipsychotic treatment (adjusted odds ratio [AOR]=2.42) and among those with moderate to low adherence (AOR=1.57) than among adherent individuals. Black individuals were also at increased risk of a preventable diabetes hospitalization after the analyses adjusted for antipsychotic adherence and other variables (AOR=1.38). CONCLUSIONS This study indicates a relationship between antipsychotic adherence and improved diabetes outcomes among individuals with schizophrenia. Engagement in mental health treatment may be a critical path toward improving health disparities for individuals with schizophrenia. Individuals with very low to no engagement were a particularly vulnerable group, and the exclusion of persons with less than two prescriptions from research and quality measures should be revisited.
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Affiliation(s)
- Katie Egglefield
- Office of Quality and Patient Safety, New York State Department of Health, Albany (Egglefield, Cogan); School of Public Health, State University of New York at Albany, Rensselaer (Cogan, Leckman-Westin); New York State Office of Mental Health, Albany (Leckman-Westin) and New York (Finnerty); New York University Langone Health, New York (Finnerty)
| | - Lindsay Cogan
- Office of Quality and Patient Safety, New York State Department of Health, Albany (Egglefield, Cogan); School of Public Health, State University of New York at Albany, Rensselaer (Cogan, Leckman-Westin); New York State Office of Mental Health, Albany (Leckman-Westin) and New York (Finnerty); New York University Langone Health, New York (Finnerty)
| | - Emily Leckman-Westin
- Office of Quality and Patient Safety, New York State Department of Health, Albany (Egglefield, Cogan); School of Public Health, State University of New York at Albany, Rensselaer (Cogan, Leckman-Westin); New York State Office of Mental Health, Albany (Leckman-Westin) and New York (Finnerty); New York University Langone Health, New York (Finnerty)
| | - Molly Finnerty
- Office of Quality and Patient Safety, New York State Department of Health, Albany (Egglefield, Cogan); School of Public Health, State University of New York at Albany, Rensselaer (Cogan, Leckman-Westin); New York State Office of Mental Health, Albany (Leckman-Westin) and New York (Finnerty); New York University Langone Health, New York (Finnerty)
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Sara G, Arumuganathan M, Chen W, Wu F, Currow D, Large M, Mulder C, Ramanuj PP, Burgess PM. Cohort profile: Mental Health Living Longer: a population-wide data linkage to understand and reduce premature mortality in mental health service users in New South Wales, Australia. BMJ Open 2019; 9:e033588. [PMID: 31748314 PMCID: PMC6886992 DOI: 10.1136/bmjopen-2019-033588] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Health systems must move from recognition to action if we are to address premature mortality in people with mental illness. Population data registers are an essential tool for planning and monitoring improvement efforts. The Mental Health Living Longer (MHLL) programme establishes a population-wide data linkage to support research translation and service reform in New South Wales (NSW), Australia. PARTICIPANTS A total of 8.6 million people who have had contact with NSW public and private health services between July 2001 and June 2018 are currently included in the study. Data include more than 120 million linked records from NSW data collections covering public and private hospital care, emergency departments, ambulance, community mental health services, cancer notifications and care, and death registrations. Linkage is occurring with population-wide breast and cervical cancer screening programmes. Data will be updated 6 monthly. FINDINGS TO DATE The cohort includes 970 145 people who have received mental healthcare: 79% have received community mental healthcare, 35% a general hospital admission with a primary mental health diagnosis and 25% have received specialist mental health inpatient care. The most frequent pattern of care is receipt of community mental healthcare only (50%). The median age of the mental health cohort is 34 years, and three-quarters are younger than 53 years. Eleven per cent of the mental health cohort had died during the observation period. Their median age at death was 69 years, which was younger than the median age at death for people accessing other health services. FUTURE PLANS The MHLL programme will examine (i) all-cause mortality, (ii) suicide, (iii) cancer mortality and (iv) medical mortality. Within each theme, the programme will quantify the problem in mental health service users compared with the NSW population, describe the people most affected, describe the care received, identify predictors of premature mortality, and identify variation and opportunities for change.
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Affiliation(s)
- Grant Sara
- InforMH, System Information and Analytics Branch, NSW Ministry of Health, North Ryde, New South Wales, Australia
- Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Myu Arumuganathan
- InforMH, System Information and Analytics Branch, NSW Ministry of Health, North Ryde, New South Wales, Australia
| | - Wendy Chen
- InforMH, System Information and Analytics Branch, NSW Ministry of Health, North Ryde, New South Wales, Australia
| | - Fred Wu
- InforMH, System Information and Analytics Branch, NSW Ministry of Health, North Ryde, New South Wales, Australia
| | - David Currow
- Cancer Institute NSW, Eveleigh, New South Wales, Australia
| | - Matthew Large
- School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Cornelis Mulder
- Epidemiological and Social Psychiatric Research institute, Erasmus Medical Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Parnassia Psychiatric Institute, Mental Health Group Europoort, Barendrecht, The Netherlands
| | - Parashar Pravin Ramanuj
- London Spinal Cord Injury Centre, Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
| | - Philip M Burgess
- Queensland Centre for Mental Health Research, University of Queensland, Brisbane, Queensland, Australia
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Schmidt EM, Barnes J, Chen C, Trafton J, Frayne S, Harris AHS. Patient and Health Care Factors Associated With Long-term Diabetes Complications Among Adults With and Without Mental Health and Substance Use Disorders. JAMA Netw Open 2019; 2:e1912060. [PMID: 31553472 PMCID: PMC6763972 DOI: 10.1001/jamanetworkopen.2019.12060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
IMPORTANCE Among people with diabetes, co-occurring mental health (MH) or substance use (SU) disorders increase the risk of medical complications. Identifying how to effectively promote long-term medical benefits for at-risk populations, such as people with MH or SU disorders, is essential. Knowing more about how health care accessed before the onset of diabetes is associated with health benefits after the onset of diabetes could inform treatment planning and population health management. OBJECTIVE To analyze how preexisting MH or SU disorders and primary care utilization before a new diabetes diagnosis are associated with the long-term severity of diabetes complications. DESIGN, SETTING, AND PARTICIPANTS This cohort study analyzed medical record data from US Department of Veterans Affairs health care systems nationwide and used mixed-effects regressions to test associations between prediabetes patient or health care factors and longitudinal progression of diabetes complication severity from 2006 to 2015. Participants included patients who received a new diabetes diagnosis in 2008 and who were aged 18 to 85 years at the time of their diagnosis. Data analysis was conducted from March to August 2017. EXPOSURES Patients were assigned to groups on the basis of a 2-year look-back period for MH or SU disorders status (MH disorder only, SU disorder only, MH and SU disorder, or no MH or SU disorder diagnoses) and on the basis of the amount of primary care utilization before diabetes was diagnosed. MAIN OUTCOMES AND MEASURES Nine-year trajectories of Diabetes Complication Severity Index (DCSI) scores. RESULTS Among 122 992 patients with newly diagnosed diabetes, the mean (SD) age was 62.3 (11.1) years, 118 810 (96.6%) were male, and 28 633 (23.3%) had preexisting MH or SU disorders diagnoses. From the onset of diabetes to 7 years later, patients' mean estimated DCSI scores increased from 0.84 (95% CI, 0.82-0.87) to 1.42 (95% CI, 1.36-1.47). Controlling for sociodemographic characteristics and medical comorbidities, SU disorders only (decrease in DCSI score, -0.09; 95% CI, -0.13 to -0.04; P < .001) or both MH and SU disorders (decrease in DCSI score, -0.13; 95% CI, -0.16 to -0.09; P < .001), but not MH disorders only, were associated with lower DCSI scores at the time of the onset of diabetes compared with no MH or SU disorders. More than 90% of patients with MH or SU disorders had primary care visits before diabetes was newly diagnosed, compared with approximately 58% of patients without MH or SU disorders. Patients who had primary care visits before the onset of diabetes had lower baseline DCSI scores, compared with patients who did not have primary care visits (decrease in DCSI score, -0.41 [95% CI, -0.43 to -0.39] for 1-2 visits, -0.50 [95% CI, -0.52 to -0.48] for 3-4 visits, -0.39 [95% CI, -0.41 to -0.37] for 5-8 visits, and -0.15 [95% CI, -0.17 to -0.12] for ≥9 visits; P < .001 for all). Patients with MH or SU disorders had lower overall, but more rapidly progressing, mean DCSI scores through year 7 after the onset of diabetes (MH disorder only, 0.006 [95% CI, 0.005-0.008], P < .001; SU disorder only, 0.005 [95% CI, 0.001-0.008], P = .004; or both MH and SU disorders, 0.008 [95% CI, 0.006-0.011], P < .001), compared with patients without MH or SU disorders. CONCLUSIONS AND RELEVANCE Access to and engagement in integrated health care may be associated with modest, albeit impermanent, long-term health benefits for patients with MH and/or SU disorders with newly diagnosed diabetes.
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Affiliation(s)
- Eric M. Schmidt
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, California
- Stanford Health Policy, Stanford University, Stanford, California
- Program Evaluation and Resource Center, Office of Mental Health and Suicide Prevention, Veterans Affairs Palo Alto Health Care System, Menlo Park, California
| | - James Barnes
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, California
- Stanford Health Policy, Stanford University, Stanford, California
| | - Cheng Chen
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, California
| | - Jodie Trafton
- Program Evaluation and Resource Center, Office of Mental Health and Suicide Prevention, Veterans Affairs Palo Alto Health Care System, Menlo Park, California
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California
| | - Susan Frayne
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, California
- Division of Primary Care and Population Health, Stanford University, Stanford, California
| | - Alex H. S. Harris
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, California
- Department of Surgery, Stanford University, Stanford, California
- Department of Medicine, Stanford University, Stanford, California
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10
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Schmidt EM, Behar S, Barrera A, Cordova M, Beckum L. Potentially Preventable Medical Hospitalizations and Emergency Department Visits by the Behavioral Health Population. J Behav Health Serv Res 2019; 45:370-388. [PMID: 28905296 DOI: 10.1007/s11414-017-9570-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This study investigated geographic variation in potentially preventable medical outcomes that might be used to monitor access to high-quality medical care in the behavioral health population. Analyzing public and non-public data sources from California on adults admitted between 2009 and 2011 to all non-federal licensed medical inpatient (N = 6,603,146) or emergency department units (N = 21,011,958) revealed that 33.6% of nearly 1 million potentially preventable hospitalizations and 9.8% of 1.5 million potentially preventable emergency department visits were made by people with mental or substance use disorder diagnoses. Across California counties or county groups (N = 36), a higher preventable hospitalization rate in the behavioral health population was associated with higher poverty, higher primary care safety net utilization, and fewer mental health providers. Although further validation is required, rates of potentially preventable encounters, particularly hospitalizations, may be useful measures of access to high-quality care in the behavioral health population.
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Affiliation(s)
- Eric M Schmidt
- Center for Innovation to Implementation (Ci2i), HSR&D, VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA, 94025, USA. .,Center for Primary Care and Outcomes Research/Center for Health Policy, Stanford University, 117 Encina Commons, Stanford, CA, 94305, USA.
| | - Simone Behar
- Pacific Graduate School of Psychology, Palo Alto University, 1791 Arastradero Road, Palo Alto, CA, 94305, USA
| | - Alinne Barrera
- Pacific Graduate School of Psychology, Palo Alto University, 1791 Arastradero Road, Palo Alto, CA, 94305, USA
| | - Matthew Cordova
- Pacific Graduate School of Psychology, Palo Alto University, 1791 Arastradero Road, Palo Alto, CA, 94305, USA.,VA Northern California Health Care System, 150 Muir Road, Martinez, CA, 94553, USA
| | - Leonard Beckum
- Pacific Graduate School of Psychology, Palo Alto University, 1791 Arastradero Road, Palo Alto, CA, 94305, USA
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11
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Stockbridge EL, Chhetri S, Polcar LE, Loethen AD, Carney CP. Behavioral health conditions and potentially preventable diabetes-related hospitalizations in the United States: Findings from a national sample of commercial claims data. PLoS One 2019; 14:e0212955. [PMID: 30818377 PMCID: PMC6394977 DOI: 10.1371/journal.pone.0212955] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 02/12/2019] [Indexed: 01/22/2023] Open
Abstract
Objective To characterize the relationship between potentially preventable hospitalizations (PPHs) for diabetes and behavioral health conditions in commercially insured working-age persons with diabetes in the United States. Research design and methods We retrospectively analyzed medical and pharmacy claims from services rendered between 2011 and 2013 for 229,039 adults with diabetes. Diabetes PPHs were identified using the Agency for Healthcare Research and Quality’s Prevention Quality Indicators v6.0 logic. We used negative binomial-logit hurdle regression models to explore the adjusted relationships between diabetes PPHs and schizophrenia, bipolar, depression, anxiety, adjustment disorder, alcohol use disorder, and drug use disorder. Results A total of 4,521 diabetes PPHs were experienced by 3,246 of the persons in the sample. The 20.83% of persons with one or more behavioral health conditions experienced 43.62% (1,972/4,521; 95% CI 42.18%-45.07%) of all diabetes PPHs, and the 7.14% of persons with more than one diagnosed behavioral health condition experienced 24.77% (1,120/4,521; 95% CI 23.54%-26.05%) of all diabetes PPHs. After adjusting for sociodemographic and physical health covariates, patients with depression, schizophrenia, drug or alcohol use disorders, or multiple behavioral health conditions were at significantly increased risk of experiencing at least one diabetes PPH, while patients with depression, drug use disorder, or multiple behavioral health conditions were at significantly increased risk of experiencing recurring diabetes PPHs over time. Conclusions A number of behavioral health conditions are associated with diabetes PPHs, which are often preventable with timely, high-quality outpatient care. The results of this study will enable clinicians, payers, and policy-makers to better focus outpatient care interventions and resources within the population of persons with diabetes.
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Affiliation(s)
- Erica L. Stockbridge
- Department of Health Behavior & Health Systems, School of Public Health, University of North Texas Health Science Center, Fort Worth, Texas, United States of America
- Department of Advanced Health Analytics and Solutions, Magellan Healthcare, Magellan Inc., Scottsdale, Arizona, United States of America
- * E-mail:
| | - Shlesma Chhetri
- Department of Health Behavior & Health Systems, School of Public Health, University of North Texas Health Science Center, Fort Worth, Texas, United States of America
| | - Leah E. Polcar
- Department of Advanced Health Analytics and Solutions, Magellan Healthcare, Magellan Inc., Scottsdale, Arizona, United States of America
| | - Abiah D. Loethen
- Department of Advanced Health Analytics and Solutions, Magellan Healthcare, Magellan Inc., Scottsdale, Arizona, United States of America
| | - Caroline P. Carney
- Magellan Rx, Magellan Inc., Scottsdale, Arizona, United States of America
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12
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Linman S, Benjenk I, Chen J. The medical home functions of primary care practices that care for adults with psychological distress: a cross-sectional study. BMC Health Serv Res 2019; 19:21. [PMID: 30626378 PMCID: PMC6327378 DOI: 10.1186/s12913-018-3845-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 12/19/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Primary care practices are changing the way that they provide care by increasing their medical home functionality. Medical home functionality can improve access to care and increase patient-centeredness, which is essential for persons with mental health issues. This study aims to explore the degree to which medical home functions have been implemented by primary care practices that care for adults with psychological distress. METHODS Analysis of the 2015 Medical Expenditure Panel Survey Household Component and Medical Organizations Survey. This unique data set links data from a nationally representative sample of US households to the practices in which they receive primary care. This study focused on adults aged 18 and above. RESULTS As compared to adults without psychological distress, adults with psychological distress had significantly higher rates of chronic illness and poverty. Adults with psychological distress were more likely to receive care from practices that include advanced practitioners and are non-profit or hospital-based. Multivariate models that were adjusted for patient-level and practice-level characteristics indicated that adults with psychological distress are as likely to receive primary care from practices with medical home functionality, including case management, electronic health records, flexible scheduling, and PCMH certification, as adults without psychological distress. CONCLUSIONS Practices that care for adults with mental health issues have not been left behind in the transition towards medical home models of primary care. Policy makers should continue to prioritize adults with mental health issues to receive primary care through this model of delivery due to this population's great potential to benefit from improved access and care coordination. TRIAL REGISTRATION This study does not report the results of a health care intervention on human subject's participants.
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Affiliation(s)
- Shawn Linman
- School of Public Health, University of Maryland, 4200 Valley Dr #2242, College Park, MD 20742 USA
| | - Ivy Benjenk
- School of Public Health, University of Maryland, 4200 Valley Dr #2242, College Park, MD 20742 USA
| | - Jie Chen
- School of Public Health, University of Maryland, 4200 Valley Dr #2242, College Park, MD 20742 USA
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13
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Hensel JM, Taylor VH, Fung K, Yang R, Vigod SN. Acute Care Use for Ambulatory Care-Sensitive Conditions in High-Cost Users of Medical Care with Mental Illness and Addictions. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2018; 63:816-825. [PMID: 29347834 PMCID: PMC6309042 DOI: 10.1177/0706743717752880] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The role of mental illness and addiction in acute care use for chronic medical conditions that are sensitive to ambulatory care management requires focussed attention. This study examines how mental illness or addiction affects risk for repeat hospitalization and/or emergency department use for ambulatory care-sensitive conditions (ACSCs) among high-cost users of medical care. METHOD A retrospective, population-based cohort study using data from Ontario, Canada. Among the top 10% of medical care users ranked by cost, we determined rates of any and repeat care use (hospitalizations and emergency department [ED] visits) between April 1, 2011, and March 31, 2012, for 14 consensus established ACSCs and compared them between those with and without diagnosed mental illness or addiction during the 2 years prior. Risk ratios were adjusted (aRR) for age, sex, residence, and income quintile. RESULTS Among 314,936 high-cost users, 35.9% had a mental illness or addiction. Compared to those without, individuals with mental illness or addiction were more likely to have an ED visit or hospitalization for any ACSC (22.8% vs. 19.6%; aRR, 1.21; 95% confidence interval [CI], 1.20-1.23). They were also more likely to have repeat ED visits or hospitalizations for the same ACSC (6.2% vs. 4.4% of those without; aRR, 1.48; 95% CI, 1.44-1.53). These associations were stronger in stratifications by mental illness diagnostic subgroup, particularly for those with a major mental illness. CONCLUSIONS The presence of mental illness and addiction among high-cost users of medical services may represent an unmet need for quality ambulatory and primary care.
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Affiliation(s)
- Jennifer M Hensel
- Department of Psychiatry, Women's College Hospital and University of Toronto, Toronto, Ontario.,Women's College Institute for Health Systems Solutions and Virtual Care, Toronto, Ontario
| | - Valerie H Taylor
- Department of Psychiatry, Women's College Hospital and University of Toronto, Toronto, Ontario
| | - Kinwah Fung
- Institute for Clinical Evaluative Sciences, Toronto, Ontario
| | - Rebecca Yang
- Women's College Institute for Health Systems Solutions and Virtual Care, Toronto, Ontario
| | - Simone N Vigod
- Department of Psychiatry, Women's College Hospital and University of Toronto, Toronto, Ontario.,Institute for Clinical Evaluative Sciences, Toronto, Ontario
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14
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Waters HC, Furukawa MF, Jorissen SL. Evaluating the Impact of Integrated Care on Service Utilization in Serious Mental Illness. Community Ment Health J 2018; 54:1101-1108. [PMID: 29948631 DOI: 10.1007/s10597-018-0297-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 06/07/2018] [Indexed: 11/26/2022]
Abstract
Serious mental illness (SMI) affects 5% of the United States population and is associated with increased morbidity and mortality, and use of high-cost healthcare services including hospitalizations and emergency department visits. Integrating behavioral and physical healthcare may improve care for consumers with SMI, but prior research findings have been mixed. This quantitative retrospective cohort study assessed whether there was a predictive relationship between integrated healthcare clinic enrollment and inpatient and emergency department utilization for consumers with SMI when controlling for demographic characteristics and disease severity. While findings indicated no statistically significant impact of integrated care clinic enrollment on utilization, the sample had lower levels of utilization than would have been expected. Since policy and payment structures continue to support integrated care models, further research on different programs are encouraged, as each setting and practice pattern is unique.
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Affiliation(s)
- Heidi C Waters
- College of Health Sciences, Walden University, Minneapolis, MN, USA.
- , 1375 Bayport Ave, Marco Island, FL, 34145, USA.
| | | | - Shari L Jorissen
- College of Health Sciences, Walden University, Minneapolis, MN, USA
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15
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Parellada E, Bioque M, Serrano M, Herrera B, García Dorado M. An open-treatment six-week study of the clinical effectiveness of Paliperidone Palmitate in schizophrenia: data from acute units in Spain (SHADOW study). Int J Psychiatry Clin Pract 2018; 22:191-199. [PMID: 29161951 DOI: 10.1080/13651501.2017.1404112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To evaluate clinical evolution of patients with schizophrenia admitted in acute units because of a relapse and treated with once-monthly Paliperidone Palmitate (PP1M). METHODS This multicentre, open-label, prospective observational study followed patients with schizophrenia treated with PP1M in acute psychiatric units for up to 6 weeks. RESULTS Out of the 280 enrolled patients, 61 received PP1M as antipsychotic monotherapy, and 219 in combination with other antipsychotics. The average Clinical Global Impression-Schizophrenia (CGI-SCH) score decreased from 4.7 at baseline to 3.3 at final visit (p < .0001); the change was clinically and statistically significant both in patients treated with PP1M in monotherapy and in combination with other antipsychotics. Clear improvements in functioning and high patient satisfaction with the treatment were observed. Time from admission to PP1M therapy initiation correlated with the length of hospital stay (p < .0001); earlier start of PP1M treatment was associated with shorter hospital stay. Adverse events were reported in 7.1% of patients (all non-serious). CONCLUSIONS PP1M was effective and well tolerated in treatment of acute episodes of schizophrenia both in monotherapy and in combination with other antipsychotics in clinical setting. Early start of PP1M therapy in acute schizophrenia episodes might help to shorten hospital stay.
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Affiliation(s)
- Eduard Parellada
- a Centro de Investigación Biomédica en Salud Mental (CIBERSAM) , Unitat d'Esquizofrènia Clínic, Hospital Clínic de Barcelona, Universitat de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) , Barcelona , Spain
| | - Miquel Bioque
- a Centro de Investigación Biomédica en Salud Mental (CIBERSAM) , Unitat d'Esquizofrènia Clínic, Hospital Clínic de Barcelona, Universitat de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) , Barcelona , Spain
| | | | - Berta Herrera
- c Medical Affairs Department , Janssen-Cilag, S.A , Madrid , Spain
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16
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Yadav M, Parle M, Jindal DK, Sharma N. Potential effect of spermidine on GABA, dopamine, acetylcholinesterase, oxidative stress and proinflammatory cytokines to diminish ketamine-induced psychotic symptoms in rats. Biomed Pharmacother 2018; 98:207-213. [DOI: 10.1016/j.biopha.2017.12.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Revised: 11/13/2017] [Accepted: 12/04/2017] [Indexed: 12/31/2022] Open
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17
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Quality indicators in the treatment of patients with depression, bipolar disorder or schizophrenia. Consensus study. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2018; 11:66-75. [PMID: 29317210 DOI: 10.1016/j.rpsm.2017.09.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 07/18/2017] [Accepted: 09/18/2017] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To define a set of indicators for mental health care, monitoring quality assurance in schizophrenia, depression and bipolar disorders in Spain. MATERIAL AND METHOD Qualitative research. Consensus-based study involving 6 psychiatrists on the steering committee and a panel of 43 psychiatrists working in several health services in Spain. An initial proposal of 44 indicators for depression, 42 for schizophrenia and 58 for bipolar disorder was elaborated after reviewing the literature. This proposal was analysed by experts using the Delphi technique. The valuation of these indicators in successive rounds allowed those with less degree of consensus to be discarded. Feasibility, sensitivity and clinical relevance were considered. The study was carried out between July 2015 and March 2016. RESULTS Seventy indicators were defined by consensus: 17 for major depression, 16 for schizophrenia, 17 for bipolar disorder and 20 common to all three pathologies. These indicators included measures related to adequacy, patient safety, exacerbation, mechanical restraint, suicidal behaviour, psychoeducation, adherence, mortality and physical health. CONCLUSIONS This set of indicators allows quality monitoring in the treatment of patients with schizophrenia, depression or bipolar disorder. Mental health care authorities and professionals can use this proposal for developing a balanced scorecard adjusted to their priorities and welfare objectives.
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18
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Breslau J, Leckman-Westin E, Han B, Pritam R, Guarasi D, Horvitz-Lennon M, Scharf D, Finnerty M, Yu H. Impact of a mental health based primary care program on emergency department visits and inpatient stays. Gen Hosp Psychiatry 2018; 52:8-13. [PMID: 29475010 PMCID: PMC5936476 DOI: 10.1016/j.genhosppsych.2018.02.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 02/10/2018] [Accepted: 02/14/2018] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Integrating primary care services into specialty mental health clinics has been proposed as a method for improving health care utilization for medical conditions by adults with serious mental illness. This paper examines the impact of a mental health based primary care program on emergency department (ED) visits and hospitalizations. METHOD The program was implemented in seven New York City outpatient mental health clinics in two waves. Medicaid claims were used to identify patients treated in intervention clinics and a control group of patients treated in otherwise similar clinics in New York City. Impacts of the program were estimated using propensity score adjusted difference-in-differences models on a longitudinally followed cohort. RESULTS Hospital stays for medical conditions increased significantly in intervention clinics relative to control clinics in both waves (ORs = 1.21 (Wave 1) and 1.33 (Wave 2)). ED visits for behavioral health conditions decreased significantly relative to controls in Wave 1 (OR = 0.89), but not in Wave 2. No other significant differences in utilization trends between the intervention and control clinics were found. CONCLUSION Introducing primary care services into mental health clinics may increase utilization of inpatient services, perhaps due to newly identified unmet medical need in this population.
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Affiliation(s)
- Joshua Breslau
- RAND Corporation, 4570 Fifth Avenue, Suite, Pittsburgh, PA 15213, USA.
| | | | - Bing Han
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407, USA.
| | - Riti Pritam
- New York State Office of Mental Health, 44 Holland Ave, Albany, NY 12229, USA.
| | - Diana Guarasi
- New York State Office of Mental Health, 44 Holland Ave, Albany, NY 12229, USA.
| | | | - Deborah Scharf
- Lakehead University, Faculty of Education, 500 University Avenue, Orillia, ON L3V 0B9 Canada
| | - Molly Finnerty
- New York University, Langone Medical Center, New York, NY 10016 USA
| | - Hao Yu
- RAND Corporation, 4570 Fifth Avenue, Suite, Pittsburgh, PA 15213, USA.
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19
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Racial and Ethnic Disparities in Preventable Hospitalizations for Chronic Disease: Prevalence and Risk Factors. J Racial Ethn Health Disparities 2016; 4:1100-1106. [PMID: 27924622 DOI: 10.1007/s40615-016-0315-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 10/12/2016] [Accepted: 11/14/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Hospitalizations due to ambulatory care sensitive conditions (ACSCs) result in high morbidity and economic burden on the American healthcare system. Admissions due to chronic ACSCs, in particular, cost the American healthcare system over 30 billion dollars annually. OBJECTIVES AND METHODS This paper presents the current research on racial and ethnic disparities in the burden of hospitalizations due to chronic ACSCs. For this narrative review, we evaluated over 800 abstracts from MEDLINE and Google Scholar and cited 62 articles. RESULTS Since 1998, racial and ethnic disparities in hospitalizations from chronic ACSCs have increased resulting in over 430,000 excess hospitalizations among non-Hispanic Blacks compared to non-Hispanic Whites. CONCLUSIONS Racial disparities in chronic ACSCs hospitalizations are pervasive in the USA. There is need for more research on the pathways through which an individual's race modifies the risk for hospitalizations due to chronic ACSCs.
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Treisman GJ, Jayaram G, Margolis RL, Pearlson GD, Schmidt CW, Mihelish GL, Kennedy A, Howson A, Rasulnia M, Misiuta IE. Perspectives on the Use of eHealth in the Management of Patients With Schizophrenia. J Nerv Ment Dis 2016; 204:620-9. [PMID: 26828911 PMCID: PMC4972482 DOI: 10.1097/nmd.0000000000000471] [Citation(s) in RCA: 20] [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] [Indexed: 02/07/2023]
Abstract
Mobile devices, digital technologies, and web-based applications-known collectively as eHealth (electronic health)-could improve health care delivery for costly, chronic diseases such as schizophrenia. Pharmacologic and psychosocial therapies represent the primary treatment for individuals with schizophrenia; however, extensive resources are required to support adherence, facilitate continuity of care, and prevent relapse and its sequelae. This paper addresses the use of eHealth in the management of schizophrenia based on a roundtable discussion with a panel of experts, which included psychiatrists, a medical technology innovator, a mental health advocate, a family caregiver, a health policy maker, and a third-party payor. The expert panel discussed the uses, benefits, and limitations of emerging eHealth with the capability to integrate care and extend service accessibility, monitor patient status in real time, enhance medication adherence, and empower patients to take a more active role in managing their disease. In summary, to support this technological future, eHealth requires significant research regarding implementation, patient barriers, policy, and funding.
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Affiliation(s)
- Glenn J. Treisman
- *Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD; †Olin Neuropsychiatry Research Center, Hartford; ‡Department of Psychiatry and Neurobiology, Yale University, New Haven, CT; §Johns Hopkins HealthCare LLC, Glen Burnie, MD; ∥NAMI, Arlington, VA; ¶NAMI, Austin, TX; #Thistle Editorial, LLC, Snoqualmie, WA; **M Consulting LLC, Birmingham, AL; and ††Med-IQ, Baltimore, MD
| | - Geetha Jayaram
- *Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD; †Olin Neuropsychiatry Research Center, Hartford; ‡Department of Psychiatry and Neurobiology, Yale University, New Haven, CT; §Johns Hopkins HealthCare LLC, Glen Burnie, MD; ∥NAMI, Arlington, VA; ¶NAMI, Austin, TX; #Thistle Editorial, LLC, Snoqualmie, WA; **M Consulting LLC, Birmingham, AL; and ††Med-IQ, Baltimore, MD
| | - Russell L. Margolis
- *Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD; †Olin Neuropsychiatry Research Center, Hartford; ‡Department of Psychiatry and Neurobiology, Yale University, New Haven, CT; §Johns Hopkins HealthCare LLC, Glen Burnie, MD; ∥NAMI, Arlington, VA; ¶NAMI, Austin, TX; #Thistle Editorial, LLC, Snoqualmie, WA; **M Consulting LLC, Birmingham, AL; and ††Med-IQ, Baltimore, MD
| | - Godfrey D. Pearlson
- *Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD; †Olin Neuropsychiatry Research Center, Hartford; ‡Department of Psychiatry and Neurobiology, Yale University, New Haven, CT; §Johns Hopkins HealthCare LLC, Glen Burnie, MD; ∥NAMI, Arlington, VA; ¶NAMI, Austin, TX; #Thistle Editorial, LLC, Snoqualmie, WA; **M Consulting LLC, Birmingham, AL; and ††Med-IQ, Baltimore, MD
| | - Chester W. Schmidt
- *Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD; †Olin Neuropsychiatry Research Center, Hartford; ‡Department of Psychiatry and Neurobiology, Yale University, New Haven, CT; §Johns Hopkins HealthCare LLC, Glen Burnie, MD; ∥NAMI, Arlington, VA; ¶NAMI, Austin, TX; #Thistle Editorial, LLC, Snoqualmie, WA; **M Consulting LLC, Birmingham, AL; and ††Med-IQ, Baltimore, MD
| | - Gary L. Mihelish
- *Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD; †Olin Neuropsychiatry Research Center, Hartford; ‡Department of Psychiatry and Neurobiology, Yale University, New Haven, CT; §Johns Hopkins HealthCare LLC, Glen Burnie, MD; ∥NAMI, Arlington, VA; ¶NAMI, Austin, TX; #Thistle Editorial, LLC, Snoqualmie, WA; **M Consulting LLC, Birmingham, AL; and ††Med-IQ, Baltimore, MD
| | - Adrienne Kennedy
- *Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD; †Olin Neuropsychiatry Research Center, Hartford; ‡Department of Psychiatry and Neurobiology, Yale University, New Haven, CT; §Johns Hopkins HealthCare LLC, Glen Burnie, MD; ∥NAMI, Arlington, VA; ¶NAMI, Austin, TX; #Thistle Editorial, LLC, Snoqualmie, WA; **M Consulting LLC, Birmingham, AL; and ††Med-IQ, Baltimore, MD
| | - Alexandra Howson
- *Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD; †Olin Neuropsychiatry Research Center, Hartford; ‡Department of Psychiatry and Neurobiology, Yale University, New Haven, CT; §Johns Hopkins HealthCare LLC, Glen Burnie, MD; ∥NAMI, Arlington, VA; ¶NAMI, Austin, TX; #Thistle Editorial, LLC, Snoqualmie, WA; **M Consulting LLC, Birmingham, AL; and ††Med-IQ, Baltimore, MD
| | - Maziar Rasulnia
- *Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD; †Olin Neuropsychiatry Research Center, Hartford; ‡Department of Psychiatry and Neurobiology, Yale University, New Haven, CT; §Johns Hopkins HealthCare LLC, Glen Burnie, MD; ∥NAMI, Arlington, VA; ¶NAMI, Austin, TX; #Thistle Editorial, LLC, Snoqualmie, WA; **M Consulting LLC, Birmingham, AL; and ††Med-IQ, Baltimore, MD
| | - Iwona E. Misiuta
- *Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD; †Olin Neuropsychiatry Research Center, Hartford; ‡Department of Psychiatry and Neurobiology, Yale University, New Haven, CT; §Johns Hopkins HealthCare LLC, Glen Burnie, MD; ∥NAMI, Arlington, VA; ¶NAMI, Austin, TX; #Thistle Editorial, LLC, Snoqualmie, WA; **M Consulting LLC, Birmingham, AL; and ††Med-IQ, Baltimore, MD
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Chopra I, Wilkins TL, Sambamoorthi U. Ambulatory Care Sensitive Hospitalizations among Medicaid Beneficiaries with Chronic Conditions. Hosp Pract (1995) 2016; 44:48-59. [PMID: 26788839 DOI: 10.1080/21548331.2016.1144446] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES This study examined the relationship between ambulatory care sensitive hospitalizations (ACSH) and patient-level and county-level variables. METHODS Utilizing a retrospective cohort approach, multi-state Medicaid claims data from 2007-2008 was used to examine ACSH at baseline and follow-up periods. The study cohort consisted of adult, non-elderly Medicaid beneficiaries with chronic physical conditions, who were continuously enrolled in fee-for-service programs, not enrolled in Medicare, and did not die during the study period (N=7,021). The dependent variable, ACSH, was calculated in the follow-up year using an algorithm from the Agency for Healthcare Research and Quality algorithm. Patient-level (demographic, health status, continuity of care) and county-level (density of healthcare providers and facilities, socio-economic characteristics, local economic conditions) factors were included as independent variables. Multivariable logistic regression models were used to examine the relationship between ACSH and independent variables. RESULTS In this study population, 8.2% had an ACSH. African-Americans were more likely to have an ACSH [AOR=1.55, 95% CI 1.16, 2.07] than Caucasians. Adults with schizophrenia were more likely to have an ACSH, compared to those without schizophrenia [AOR=1.54, 95% CI 1.16, 2.04]. Residents in counties with a higher number of community mental health centers [AOR=0.88, 95% CI 0.80, 0.97] and rural health centers [AOR=0.98, 95% CI 0.95, 0.99] were less likely to have an ASCH. CONCLUSIONS Programs and interventions designed to reduce the risk of ACSH may be needed to target specific population subgroups and improve healthcare infrastructure.
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Affiliation(s)
- Ishveen Chopra
- a School of Pharmacy , West Virginia University , Morgantown , WV , USA
| | - Tricia Lee Wilkins
- b Department of Pharmaceutical Systems and Policy , U.S. Department of Health & Human Services , Washington , DC, District of Columbia , USA
| | - Usha Sambamoorthi
- a School of Pharmacy , West Virginia University , Morgantown , WV , USA
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Serious Mental Illness and Risk for Hospitalizations and Rehospitalizations for Ambulatory Care-sensitive Conditions in Denmark: A Nationwide Population-based Cohort Study. Med Care 2016; 54:90-7. [PMID: 26492210 DOI: 10.1097/mlr.0000000000000448] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Hospitalizations for ambulatory care-sensitive conditions (ACSCs) and early rehospitalizations increase health care costs. OBJECTIVES To determine if individuals with serious mental illnesses (SMIs) (eg, schizophrenia or bipolar disorder) are at increased risk for hospitalizations for ACSCs, and rehospitalization for the same or another ACSC, within 30 days. RESEARCH DESIGN Population-based cohort study. PARTICIPANTS A total of 5.9 million Danish persons aged 18 years and older between January 1, 1999 and December 31, 2013. MEASURES The Danish Psychiatric Central Register provided information on SMI diagnoses and the Danish National Patient Register on hospitalizations for ACSCs and 30-day rehospitalizations. RESULTS SMI was associated with increased risk for having any ACSC-related hospitalization after adjusting for demographics, socioeconomic factors, comorbidities, and prior primary care utilization [incidence rate ratio (IRR): 1.41; 95% confidence interval (95% CI), 1.37-1.45]. Among individual ACSCs, SMI was associated with increased risk for hospitalizations for angina (IRR: 1.14, 95% CI, 1.04-1.25), chronic obstructive pulmonary disease/asthma exacerbation (IRR: 1.87; 95% CI, 1.74-2.00), congestive heart failure exacerbation (IRR: 1.25; 95% CI, 1.16-1.35), and diabetes (IRR: 1.43; 95% CI, 1.31-1.57), appendiceal perforation (IRR: 1.49; 95% CI, 1.30-1.71), pneumonia (IRR: 1.72; 95% CI, 1.66-1.79), and urinary tract infection (IRR: 1.70; 95% CI, 1.62-1.78). SMI was also associated with increased risk for rehospitalization within 30 days for the same (IRR: 1.28; 95% CI, 1.18-1.40) or for another ACSC (IRR: 1.62; 95% CI, 1.49-1.76). CONCLUSION Persons with SMI are at increased risk for hospitalizations for ACSCs, and after discharge, are at increased risk for rehospitalizations for ACSCs within 30 days.
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Li H, Turkoz I, Zhang F. Efficacy and safety of once-monthly injection of paliperidone palmitate in hospitalized Asian patients with acute exacerbated schizophrenia: an open-label, prospective, noncomparative study. Neuropsychiatr Dis Treat 2016; 12:15-24. [PMID: 26730193 PMCID: PMC4694691 DOI: 10.2147/ndt.s83651] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION This single-group, open-label, prospective, noncomparative, multicenter, Phase IV study explored the efficacy and tolerability of paliperidone palmitate (PP) in hospitalized patients with acute exacerbation of schizophrenia. METHODS Asian patients of either sex, between 18 and 65 years of age, diagnosed with schizophrenia (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) with acute exacerbations within the previous 4 weeks, were enrolled. Intramuscular PP was initiated at doses of 150 milligram equivalent (mg eq) (day 1) and 100 mg eq (day 8), followed by a monthly maintenance dose between 75 mg eq and 150 mg eq (days 36 and 64). Primary efficacy endpoint was the change from baseline in the Positive and Negative Syndrome Scale (PANSS) total score (last-observation-carried-forward) at week 13. RESULTS Of the 212 enrolled patients, 152 (71.7%) completed the 13-week treatment; withdrawal of consent (24 [11.3%] patients) was the most common reason for study discontinuation. Mean (standard deviation) PANSS total score from baseline (90.0 [17.41]) improved significantly at day 4 (-6.1 [9.27]; 95% confidence interval: -7.38, -4.85; P<0.001) and week 13 endpoint (-23.9 [23.24]; 95% confidence interval: -27.10, -20.78; P<0.001). Similarly, the secondary endpoints (Clinical Global Impression-Severity, Physical and Social Performance, each PANSS subscale, and Marder factor scores) improved significantly from baseline to week 13 endpoint (P<0.001 for all). At week 13, 112/210 (53.3%) patients had a 40% improvement in the PANSS total score (responder rate), and 133/212 (62.7%) patients were ready for hospital discharge. Overall, 139 (65.6%) patients experienced at least one treatment-emergent adverse event (TEAE). Most common (>5%) TEAEs were hyperprolactinemia, constipation, nasopharyngitis, insomnia, increased weight, and tremor. Worsening of schizophrenia (3.3%) and sinus bradycardia (2.0%) were serious TEAEs; no deaths were reported. CONCLUSION PP was generally tolerable and efficacious in a hospital setting for the treatment of acute exacerbated schizophrenia with significant improvements in psychotic symptoms, social functioning, and severity of illness.
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Affiliation(s)
- HuaFang Li
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Ibrahim Turkoz
- Janssen Research & Development, LLC, Titusville, NJ, USA
| | - Fan Zhang
- Xi'an Janssen Pharmaceutical Ltd., Beijing, People's Republic of China
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Abstract
In recent years, the focus of mental health care for people with schizophrenia has shifted from an expectation of lifelong disability to a 'recovery' approach in which patients and specialists anticipate discharge to management within primary care. Although the active symptoms of mental illness are generally well-managed with modern pharmacotherapy, primary care physicians often express concern about their lack of understanding and expertise in general management of schizophrenia. Moreover, the ability of patients to access care for their physical disorders in a timely fashion together with a higher prevalence of physical co-morbidities is likely to be responsible for the greater mortality and premature death of this already stigmatised and disadvantaged group. This paper focuses on new evidence over the past 5 years, considering the management of physical and mental health of schizophrenia patients in primary care, optimal processes and the reasons why these may not always be realised in practice.
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Affiliation(s)
- Rose Jones
- 2Gether Foundation NHS Trust, Stonebow Unit, Stonebow Road, Hereford, HR1 2ER, UK,
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Ward M, Druss B. The epidemiology of diabetes in psychotic disorders. Lancet Psychiatry 2015; 2:431-451. [PMID: 26360287 DOI: 10.1016/s2215-0366(15)00007-3] [Citation(s) in RCA: 102] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 01/09/2015] [Indexed: 01/14/2023]
Abstract
Diabetes is highly prevalent in people with psychotic disorders, including schizophrenia and schizoaffective disorders. Exact prevalence is difficult to estimate, since diabetes is often underdiagnosed in people with psychosis. Results of several studies show that the prevalence of diabetes exceeds that in the general population, with documented prevalence in those with psychosis ranging from 1·26% to 50% across studies (median 13%). The association between diabetes and psychosis is complex and multifactorial. Many of the traditional risk factors for disease have increased prevalence in patients with psychotic disorders. In addition to these traditional risk factors, people with psychosis have unique risks that might have additive or even synergistic effects. These risks include the use of antipsychotic medication, the effects of adverse social determinants of health, and genetic loading. Despite evidence that rates of diabetes are increased in individuals with psychosis, many of these patients are not diagnosed or treated, resulting in increased diabetes-associated morbidity and mortality. Specific patient factors, provider issues, and systems-level factors contribute to the treatment gap. Interventions at both the clinical and public health levels are needed to successfully address this problem.
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Affiliation(s)
- Martha Ward
- Department of Psychiatry and Behavioral Sciences, Department of Medicine, Emory University, Atlanta, GA, USA.
| | - Benjamin Druss
- Department of Psychiatry and Behavioral Sciences, Department of Medicine, Emory University, Atlanta, GA, USA; Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Azevedo Da Silva M, Lemogne C, Melchior M, Zins M, Van Der Waerden J, Consoli SM, Goldberg M, Elbaz A, Singh-Manoux A, Nabi H. Excess non-psychiatric hospitalizations among employees with mental disorders: a 10-year prospective study of the GAZEL cohort. Acta Psychiatr Scand 2015; 131:307-17. [PMID: 25289581 PMCID: PMC4402031 DOI: 10.1111/acps.12341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/05/2014] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To examine whether non-psychiatric hospitalizations rates were higher in those with mental disorders. METHOD In a cohort of 15,811 employees, aged 35-50 years in 1989, mental disorder status was defined from 1989 to 2000. Hospitalizations for all-causes, myocardial infarction (MI), stroke, and cancer, were recorded yearly from 2001 to 2011. Negative binomial regression models were used to estimate hospitalization rates over the follow-up. RESULTS After controlling for baseline sociodemographic factors, health-related behaviors, self-rated health, and self-reported medical conditions, participants with a mental disorder had significantly higher rates of all-cause hospitalization [incidence rate ratio, IRR=1.20 (95%, 1.14-1.26)], as well as hospitalization due to MI [IRR=1.44 (95%, 1.12-1.85)]. For stroke, the IRR did not reach statistical significance [IRR=1.37 (95%, 0.95-1.99)] and there was no association with cancer [IRR=1.01 (95%, 0.86-1.19)]. A similar trend was observed when mental disorders groups were considered (no mental disorder, depressive disorder, mental disorders due to psychoactive substance use, other mental disorders, mixed mental disorders, and severe mental disorder). CONCLUSION In this prospective cohort of employees with stable employment as well as universal access to healthcare, we found participants with mental disorders to have higher rates of non-psychiatric hospitalizations.
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Affiliation(s)
- M Azevedo Da Silva
- Centre for Research in Epidemiology and Population Health, Epidemiology of Occupational and Social Determinants of Health, INSERM U1018Villejuif, France,Université de Versailles St QuentinVillejuif, France
| | - C Lemogne
- Faculté de Médecine, Sorbonne Paris Cité, Université Paris DescartesParis, France,Service universitaire de Psychiatrie de l'adulte et du sujet âgé, AP-HP, Hôpitaux Universitaires Paris OuestParis, France,Centre Psychiatrie et Neurosciences, INSERM U894Paris, France
| | - M Melchior
- Centre for Research in Epidemiology and Population Health, Epidemiology of Occupational and Social Determinants of Health, INSERM U1018Villejuif, France,Université de Versailles St QuentinVillejuif, France
| | - M Zins
- Université de Versailles St QuentinVillejuif, France,Cohortes épidémiologiques en population, Unité Mixte de Service 011 INSERM-UNSQVillejuif, France
| | - J Van Der Waerden
- Centre for Research in Epidemiology and Population Health, Epidemiology of Occupational and Social Determinants of Health, INSERM U1018Villejuif, France,Université de Versailles St QuentinVillejuif, France
| | - S M Consoli
- Faculté de Médecine, Sorbonne Paris Cité, Université Paris DescartesParis, France,Service universitaire de Psychiatrie de l'adulte et du sujet âgé, AP-HP, Hôpitaux Universitaires Paris OuestParis, France
| | - M Goldberg
- Université de Versailles St QuentinVillejuif, France,Cohortes épidémiologiques en population, Unité Mixte de Service 011 INSERM-UNSQVillejuif, France
| | - A Elbaz
- Centre for Research in Epidemiology and Population Health, Epidemiology of Occupational and Social Determinants of Health, INSERM U1018Villejuif, France,Université de Versailles St QuentinVillejuif, France
| | - A Singh-Manoux
- Centre for Research in Epidemiology and Population Health, Epidemiology of Occupational and Social Determinants of Health, INSERM U1018Villejuif, France,Université de Versailles St QuentinVillejuif, France,Centre de Gérontologie, Hôpital Ste Périne, AP-HPParis, France,Department of Epidemiology and Public Health, University College LondonLondon, UK
| | - H Nabi
- Centre for Research in Epidemiology and Population Health, Epidemiology of Occupational and Social Determinants of Health, INSERM U1018Villejuif, France,Université de Versailles St QuentinVillejuif, France
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Trend in rates for deaths with mention of schizophrenia on death certificates of US residents, 1999-2010. Soc Psychiatry Psychiatr Epidemiol 2014; 49:1083-91. [PMID: 24562389 DOI: 10.1007/s00127-014-0846-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 02/03/2014] [Indexed: 01/19/2023]
Abstract
BACKGROUND Trends in mortality rates for schizophrenia using multiple causes of death (including contributory causes) coded on death certificates in the US resident population apparently have not been reported. METHODS Age-standardized rates for deaths per 100,000 in 1999-2010 at age 15+ years (and for 15-64 and 65+ years) with mention of schizophrenia were examined for the US resident population, including variation by age, gender, race (blacks/African Americans and whites) and region. RESULTS Deaths at age 15+ years coded with schizophrenia as underlying cause were only 12 % of all deaths with mention of schizophrenia, for which the rate declined from 1.58 in 1999 (3,407 deaths) to 1.32 in 2010 (3,422 deaths) (percentage change or PC = -16 %). Declines were larger in females than males, in whites than blacks, and occurred in the Northeast, Midwest and South but not the West. The rate increased for age 15-64 years (PC = +28 %) (mainly in males), however, while declining for age 65+ years (PC = -35 %). For deaths at age 15-64 years with schizophrenia coded as other than the underlying cause, the largest continuous increase was for endocrine-metabolic diseases (predominantly diabetes mellitus) as underlying cause, with smaller increases in males for cardiovascular diseases, external causes and neoplasms. CONCLUSION Trends in the US rate for deaths with mention of schizophrenia varied among the sociodemographic groups examined. The lack of decline for age 15-64 years requires further study especially with regard to mediators (e.g., obesity) of excess mortality in schizophrenia identified from cohort studies.
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Chmiel C, Rosemann T, Senn O. Demand and characteristics of a psychiatric 24-hour emergency service performed by mandatory rotation of licensed psychiatrists in Swiss primary care. Patient Prefer Adherence 2014; 8:383-90. [PMID: 24707172 PMCID: PMC3972023 DOI: 10.2147/ppa.s53950] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND To investigate characteristics of and satisfaction with psychiatric 24-hour emergency primary care performed by mandatory rotation of licensed psychiatrists as a viable baseline for possible reorganizational measures. METHODS This was a questionnaire-based cross-sectional study (November 2010-April 2011). The number of patient-psychiatrist encounters, modes of contact, and patient and psychiatrist characteristics were assessed. Diagnoses were coded with ICD-10 (International Classification of Diseases, version 10). RESULTS From 167 duty episodes, 74 (44%) were recorded. Of the psychiatrists (n=44), 52% were female, and mean age (standard deviation) was 49.9 (5.2) years. The median number of encounters per episode was 4 (interquartile range 0-8), mainly in the evenings. Demand for "face-to-face" (direct) patient visits was significantly more common (64.0%) than practice (1.3%) or telephone consultations (34.7%). In 83.8%, psychiatrists judged the encounter as adequate at the patient's location. A total of 43 different diagnoses were recorded: mainly schizophrenic disorders (23.9%), suicidal behavior (15.2%), and acute stress reactions (10.3%). Psychiatrists felt burdened by services (62.5%): in 39.2%, they felt threatened; and in 6.8%, violence occurred. In 32.4%, bills were not paid for. If services were optional, 45.2% would participate. CONCLUSION Our findings indicate justified demand for direct mobile patient visits, suggesting that emergency care should be multifaceted, and sole provision of psychiatric care at stationed emergency facilities may not always be appropriate. Reorganization of 24-hour emergency services should carefully evaluate patient and provider's needs before changing established structures.
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Affiliation(s)
- Corinne Chmiel
- Institute of General Practice and Health Services Research, University of Zurich, Raemistrasse, Zurich, Switzerland
- Correspondence: Corinne Chmiel, University of Zurich, Institute of General Practice and Health Services Research, Raemistrasse 100, 8091 Zurich, Switzerland, Tel +41 44 255 8509, Fax +41 44 255 9097, Email
| | - Thomas Rosemann
- Institute of General Practice and Health Services Research, University of Zurich, Raemistrasse, Zurich, Switzerland
| | - Oliver Senn
- Institute of General Practice and Health Services Research, University of Zurich, Raemistrasse, Zurich, Switzerland
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