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Vettini A, Brennan GK, Mercer SW, Jackson CA. Severe mental illness and cardioprotective medication prescribing: a qualitative study in general practice. BJGP Open 2024; 8:BJGPO.2023.0176. [PMID: 38355146 PMCID: PMC11300976 DOI: 10.3399/bjgpo.2023.0176] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 11/28/2023] [Accepted: 12/14/2023] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Patients with severe mental illness (SMI) die 10-20 years earlier than the general population. They have a higher risk of cardiovascular disease (CVD) yet may experience lower cardioprotective medication prescribing. AIM To understand the challenges experienced by GPs in prescribing cardioprotective medication to patients with SMI. DESIGN & SETTING A qualitative study with 15 GPs from 11 practices in two Scottish health boards, including practices servicing highly deprived areas (Deep End). METHOD Semi-structured one-to-one interviews with fully qualified GPs with clinical experience of patients with SMI. Interviews were transcribed verbatim and analysed thematically. RESULTS Participants aimed to routinely prescribe cardioprotective medication to relevant patients with SMI but were hampered by various challenges. These structural and contextual barriers included the following: lack of funding for chronic disease management; insufficient consultation time; workforce shortages; IT infrastructure; and navigating boundaries with mental health services. Patient-related barriers included patients' complex health and social needs, their understandable prioritisation of mental health needs or existing physical conditions, and presentation during crises. Professional barriers comprised GPs' desire to practise holistic medicine rather than treating via cardioprotective prescribing in isolation, and concerns about patients' medication concordance if patients were not prioritising this aspect of their health care at that particular time. In terms of enablers for cardioprotective prescribing, participants emphasised continuity of care as fundamental in engaging this patient group in effective cardiovascular health management. A cross-cutting theme was the current GP workforce crisis leading to 'firefighting' and diminishing capacity for primary prevention. This was particularly acute in Deep End practices, which have a high proportion of patients with complex needs and greater resource challenges. CONCLUSION Although participants aspire to prescribe cardioprotective medication to patients with SMI, professional-, system- and patient-level barriers often make this challenging, particularly in deprived areas owing to patient complexity and the inverse care law.
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Affiliation(s)
- Amanda Vettini
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Gearóid K Brennan
- Faculty of Health Sciences & Sport, University of Stirling, Stirling, UK
| | - Stewart W Mercer
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Caroline A Jackson
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK
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2
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Browne J, Rudolph JL, Jiang L, Bayer TA, Kunicki ZJ, De Vito AN, Bozzay ML, McGeary JE, Kelso CM, Wu WC. Serious mental illness is associated with elevated risk of hospital readmission in veterans with heart failure. J Psychosom Res 2024; 178:111604. [PMID: 38309130 DOI: 10.1016/j.jpsychores.2024.111604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 01/23/2024] [Accepted: 01/29/2024] [Indexed: 02/05/2024]
Abstract
OBJECTIVE Adults with serious mental illness (SMI) have high rates of cardiovascular disease, particularly heart failure, which contribute to premature mortality. The aims were to examine 90- and 365-day all-cause medical or surgical hospital readmission in Veterans with SMI discharged from a heart failure hospitalization. The exploratory aim was to evaluate 180-day post-discharge engagement in cardiac rehabilitation, an effective intervention for heart failure. METHODS This study used administrative data from the Veterans Health Administration (VHA) and Centers for Medicare & Medicaid Services between 2011 and 2019. SMI status and medical comorbidity were assessed in the year prior to hospitalization. Cox proportional hazards models (competing risk of death) were used to evaluate the relationship between SMI status and outcomes. Models were adjusted for VHA hospital site, demographics, and medical characteristics. RESULTS The sample comprised 189,767 Veterans of which 23,671 (12.5%) had SMI. Compared to those without SMI, Veterans with SMI had significantly higher readmission rates at 90 (16.1% vs. 13.9%) and 365 (42.6% vs. 37.1%) days. After adjustment, risk of readmission remained significant (90 days: HR: 1.07, 95% CI: 1.03, 1.11; 365 days: HR: 1.10, 95% CI: 1.07, 1.12). SMI status was not significantly associated with 180-day cardiac rehabilitation engagement (HR: 0.98, 95% CI: 0.91, 1.07). CONCLUSIONS Veterans with SMI and heart failure have higher 90- and 365-day hospital readmission rates even after adjustment. There were no differences in cardiac rehabilitation engagement based on SMI status. Future work should consider a broader range of post-discharge interventions to understand contributors to readmission.
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Affiliation(s)
- Julia Browne
- Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.
| | - James L Rudolph
- Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI, USA; Department of Health Services, Policy & Practice, Brown University, Providence, RI, USA
| | - Lan Jiang
- Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI, USA
| | - Thomas A Bayer
- Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI, USA
| | - Zachary J Kunicki
- Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Alyssa N De Vito
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA; Memory and Aging Program, Butler Hospital, Providence, RI, USA
| | - Melanie L Bozzay
- Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - John E McGeary
- Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Catherine M Kelso
- Veterans Health Administration, Office of Patient Care Services, Geriatrics and Extended Care, Washington DC, USA
| | - Wen-Chih Wu
- Medical Service, VA Providence Healthcare System, Providence, RI, USA
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Bell N, Perera G, Chandran D, Stubbs B, Gaughran F, Stewart R. HbA1c recording in patients following a first diagnosis of serious mental illness: the South London and Maudsley Biomedical Research Centre case register. BMJ Open 2023; 13:e069635. [PMID: 37463814 PMCID: PMC10357777 DOI: 10.1136/bmjopen-2022-069635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 06/23/2023] [Indexed: 07/20/2023] Open
Abstract
OBJECTIVES To investigate factors associated with the recording of glycated haemoglobin (HbA1c) in people with first diagnoses of serious mental illness (SMI) in a large mental healthcare provider, and factors associated with HbA1c levels, when recorded. To our knowledge this is the first such investigation, although attention to dysglycaemia in SMI is an increasing priority in mental healthcare. DESIGN The study was primarily descriptive in nature, seeking to ascertain the frequency of HbA1c recording in the mental healthcare sector for people following first SMI diagnosis. SETTINGS A large mental healthcare provider, the South London and Maudsley National Health Service Trust. PARTICIPANTS Using electronic mental health records data, we ascertained patients with first SMI diagnoses (schizophrenia, schizoaffective disorder, bipolar disorder) from 2008 to 2018. OUTCOME MEASURES Recording or not of HbA1c level was ascertained from routine local laboratory data and supplemented by a natural language processing (NLP) algorithm for extracting recorded values in text fields (precision 0.89%, recall 0.93%). Age, gender, ethnic group, year of diagnosis, and SMI diagnosis were investigated as covariates in relation to recording or not of HbA1c and first recorded levels. RESULTS Of 21 462 patients in the sample (6546 bipolar disorder; 14 916 schizophrenia or schizoaffective disorder; mean age 38.8 years, 49% female), 4106 (19.1%) had at least one HbA1c result recorded from laboratory data, increasing to 6901 (32.2%) following NLP. HbA1c recording was independently more likely in non-white ethnic groups (black compared with white: OR 2.45, 95% CI 2.29 to 2.62), and was negatively associated with age (OR per year increase 0.93, 0.92-0.95), female gender (0.83, 0.78-0.88) and bipolar disorder (0.49, 0.45-0.52). CONCLUSIONS Over a 10-year period, relatively low level of recording of HbA1c was observed, although this has increased over time and ascertainment was increased with text extraction. It remains important to improve the routine monitoring of dysglycaemia in these at-risk disorders.
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Affiliation(s)
- Nikeysha Bell
- Psychological Medicine, King's College London Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Gayan Perera
- Psychological Medicine, King's College London Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - David Chandran
- Psychological Medicine, King's College London Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Brendon Stubbs
- Institute of Psychiatry, Psychology and Neuroscience, Psychosis Studies, King's College London, London, UK
- National Psychosis Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Fiona Gaughran
- Institute of Psychiatry, Psychology and Neuroscience, Psychosis Studies, King's College London, London, UK
- National Psychosis Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Robert Stewart
- Psychological Medicine, King's College London Institute of Psychiatry, Psychology and Neuroscience, London, UK
- National Psychosis Service, South London and Maudsley NHS Foundation Trust, London, UK
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Elstad M, Ahmed S, Røislien J, Douiri A. Evaluation of the reported data linkage process and associated quality issues for linked routinely collected healthcare data in multimorbidity research: a systematic methodology review. BMJ Open 2023; 13:e069212. [PMID: 37156590 PMCID: PMC10174005 DOI: 10.1136/bmjopen-2022-069212] [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] [Indexed: 05/10/2023] Open
Abstract
OBJECTIVE The objective of this systematic review was to examine how the record linkage process is reported in multimorbidity research. METHODS A systematic search was conducted in Medline, Web of Science and Embase using predefined search terms, and inclusion and exclusion criteria. Published studies from 2010 to 2020 using linked routinely collected data for multimorbidity research were included. Information was extracted on how the linkage process was reported, which conditions were studied together, which data sources were used, as well as challenges encountered during the linkage process or with the linked dataset. RESULTS Twenty studies were included. Fourteen studies received the linked dataset from a trusted third party. Eight studies reported variables used for the data linkage, while only two studies reported conducting prelinkage checks. The quality of the linkage was only reported by three studies, where two reported linkage rate and one raw linkage figures. Only one study checked for bias by comparing patient characteristics of linked and non-linked records. CONCLUSIONS The linkage process was poorly reported in multimorbidity research, even though this might introduce bias and potentially lead to inaccurate inferences drawn from the results. There is therefore a need for increased awareness of linkage bias and transparency of the linkage processes, which could be achieved through better adherence to reporting guidelines. PROSPERO REGISTRATION NUMBER CRD42021243188.
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Affiliation(s)
- Maria Elstad
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Saiam Ahmed
- Institute of Clinical Trials and Methodology, UCL, London, UK
| | - Jo Røislien
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Abdel Douiri
- Faculty of Life Sciences and Medicine, King's College London, London, UK
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5
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Rodrigues AM, Kemp E, Aquino MRJ, Wilson R, Vasiljevic M, McBride K, Robson C, Loraine M, Harland J, Haighton C. Understanding the implementation of 'Making Every Contact Count' (MECC) delivered by healthcare professionals in a mental health hospital: protocol for a pragmatic formative process evaluation. Health Psychol Behav Med 2023; 11:2174698. [PMID: 36760477 PMCID: PMC9904297 DOI: 10.1080/21642850.2023.2174698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 01/24/2023] [Indexed: 02/09/2023] Open
Abstract
Background 'Making Every Contact Count' (MECC) is a public health strategy supporting public-facing workers to use opportunities during routine contacts to enable health behaviour change. A mental health hospital in the North East of England is currently implementing a programme to embed MECC across the hospital supporting weight management ('A Weight Off Your Mind'). Bespoke MECC training has been developed to improve staff confidence in discussing physical activity, healthy eating, and related behaviour change with service users. This article describes the protocol for a pragmatic formative process evaluation to inform the implementation plan for MECC and facilitate successful implementation of the bespoke MECC training at scale. Methods/Design An 18-month, mixed method pragmatic formative process evaluation, including qualitative research, surveys, document review and stakeholder engagement. This project is conducted within a mental health inpatient setting in the North East of England. Programme documents will be reviewed, mapped against MECC national guidelines, Behaviour Change Techniques (BCTs) and intervention functions within the Behaviour Change Wheel. A cross-sectional survey (n = 365) and qualitative semi-structured interviews (n = 30) will be conducted with healthcare practitioners delivering MECC to assess capability, opportunity and motivation. Data collection and fidelity procedures will be examined, including design, training and delivery dimensions of fidelity. Interviews with service users (n = 20) will also be conducted. Discussion Anticipated outcomes include developing recommendations to overcome barriers to delivery of and access to MECC, including whether to either support the use of the existing MECC protocol or tailor the MECC training programme. The findings are anticipated to improve fidelity of MECC training within mental health inpatient settings as well as provide evidence for MECC training at a national level. We also expect findings to influence strategic plans, policy, and practice specific to MECC and inform best practice in implementing wider brief intervention programmes.
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Affiliation(s)
- Angela M. Rodrigues
- Department of Psychology, Northumbria University, Newcastle upon Tyne, UK
- Fuse – Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
| | - Emma Kemp
- Department of Psychology, Northumbria University, Newcastle upon Tyne, UK
| | | | - Rob Wilson
- Newcastle Business School, Northumbria University, Newcastle-upon-Tyne, UK
| | - Milica Vasiljevic
- Fuse – Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
- Department of Psychology, Durham University, Durham, UK
| | - Kate McBride
- Cumbria, Northumberland, Tyne & Wear NHS Foundation Trust, St Nicholas Hospital, Newcastle upon Tyne, UK
| | - Craig Robson
- Northumbria Healthcare NHS Foundation TrustNorth Tyneside General Hospital, North Shields, UK
| | | | - Jill Harland
- Northumbria Healthcare NHS Foundation TrustNorth Tyneside General Hospital, North Shields, UK
| | - Catherine Haighton
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle Upon Tyne, UK
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Buzea CA, Manu P, Dima L, Correll CU. Drug-drug interactions involving combinations of antipsychotic agents with antidiabetic, lipid-lowering, and weight loss drugs. Expert Opin Drug Metab Toxicol 2022; 18:729-744. [PMID: 36369828 DOI: 10.1080/17425255.2022.2147425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Patients with severe mental illness (SMI) have a high risk for diabetes, dyslipidemia, and other components of metabolic syndrome. Patients with these metabolic comorbidities and cardiac risk factors should receive not only antipsychotics but also medications aiming to reduce cardiovascular risk. Therefore, many patients may be exposed to clinically relevant drug-drug interactions. AREAS COVERED This narrative review summarizes data regarding the known or potential drug-drug interactions between antipsychotics and medications treating metabolic syndrome components, except for hypertension, which has been summarized elsewhere. A literature search in PubMed and Scopus up to 7/31/2021 was performed regarding interactions between antipsychotics and drugs used to treat metabolic syndrome components, aiming to inform clinicians' choice of medication for patients with SMI and cardiometabolic risk factors in need of pharmacologic interventions. EXPERT OPINION The cytochrome P450 system and, to a lesser extent, the P-glycoprotein transporter is involved in the pharmacokinetic interactions between antipsychotics and some statins or saxagliptin. Regarding pharmacodynamic interactions, the available information is based mostly on small studies, and for newer classes, like PCSK9 inhibitors or SGLT2 inhibitors, data are still lacking. However, there is sufficient information to guide clinicians in the process of selecting safer antipsychotic-cardiometabolic risk reduction drug combinations.
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Affiliation(s)
- Catalin Adrian Buzea
- Department 5 - Internal Medicine, Carol Davila' University of Medicine and Pharmacy, 37 Dionisie Lupu, Bucharest, Romania.,Cardiology, Clinical Hospital Colentina, 19-21 Stefan cel Mare, Bucharest, Romania
| | - Peter Manu
- Department of Psychiatry, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.,Department of Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.,Medical Services, South Oaks Hospital, Northwell Health System, Amityville, NY, USA
| | - Lorena Dima
- Department of Fundamental Disciplines and Clinical Prevention, Faculty of Medicine, Transilvania University of Brasov, Nicolae Balcescu Str 59, 500019, Brașov, Romania
| | - Christoph U Correll
- Department of Child and Adolescent Psychiatry, Charite Universitaetsmedizin, Augustenburger Platz 1, 13353, Berlin, Germany.,Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.,Department of Psychiatry, Zucker Hillside Hospital, Northwell Health System, Glen Oaks, NY, USA
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7
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Owens J, Lovell K, Brown A, Bee P. Parity of esteem and systems thinking: a theory informed qualitative inductive thematic analysis. BMC Psychiatry 2022; 22:650. [PMID: 36261819 PMCID: PMC9583593 DOI: 10.1186/s12888-022-04299-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 10/10/2022] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Parity of Esteem (PoE) is about equality between mental and physical health but is a term lacking definition and clarity. The complexity of the field of mental health and the conversations around PoE add to its opacity. Therefore, the aim of this study is to use systems thinking to explore the strengths and challenges of using PoE. METHODS This is a secondary analysis of descriptive qualitative data, from 27 qualitative interviews, utilising the World Health Organisation (WHO) system domains as a framework for the inductive thematic analysis. RESULTS Examining the current strengths and challenges of systems in mental and physical healthcare using the WHO domains and macro, meso and micro levels, identifies specific actions to redress inequity between mental and physical health provision. CONCLUSION The evidence suggests that moving PoE from rhetoric towards reality requires new configurations with a systems orientation, which uses macro, meso and micro levels to analyse and understand the complexity of relations within and between domain levels and reorienting funding, training and measurement. This requires embedding new competencies, infrastructures and practices within an effective learning healthcare system.
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Affiliation(s)
- Janine Owens
- National Institute for Health and Care Research Applied Research Collaboration Greater Manchester (NIHRARC GM), Faculty of Biology, Medicine and Health, The University of Manchester, Oxford Road, Manchester, M13 9PL, England.
| | - Karina Lovell
- National Institute for Health and Care Research Applied Research Collaboration Greater Manchester (NIHRARC GM), Faculty of Biology, Medicine and Health, The University of Manchester, Oxford Road, Manchester, M13 9PL, England
| | - Abigail Brown
- National Institute for Health and Care Research Applied Research Collaboration Greater Manchester (NIHRARC GM), Faculty of Biology, Medicine and Health, The University of Manchester, Oxford Road, Manchester, M13 9PL, England
| | - Penny Bee
- National Institute for Health and Care Research Applied Research Collaboration Greater Manchester (NIHRARC GM), Faculty of Biology, Medicine and Health, The University of Manchester, Oxford Road, Manchester, M13 9PL, England
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8
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Severe Mental Illness and Cardiovascular Disease: JACC State-of-the-Art Review. J Am Coll Cardiol 2022; 80:918-933. [PMID: 36007991 DOI: 10.1016/j.jacc.2022.06.017] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 06/08/2022] [Accepted: 06/21/2022] [Indexed: 11/23/2022]
Abstract
People with severe mental illness, consisting of schizophrenia, bipolar disorder, and major depression, have a high burden of modifiable cardiovascular risk behaviors and conditions and have a cardiovascular mortality rate twice that of the general population. People with acute and chronic cardiovascular disease are at a higher risk of developing mental health symptoms and disease. There is emerging evidence for shared etiological factors between severe mental illness and cardiovascular disease that includes biological, genetic, and behavioral mechanisms. This state-of-the art review will describe the relationship between severe mental illness and cardiovascular disease, explore the factors that lead to poor cardiovascular outcomes in people with severe mental illness, propose strategies to improve the cardiovascular health of people with severe mental illness, and present areas for future research focus.
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9
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Scheuer SH, Fleetwood KJ, Licence KAM, Mercer SW, Smith DJ, Sudlow CLM, Andersen GS, Wild SH, Jackson CA. Severe mental illness and quality of care for type 2 diabetes: A retrospective population-based cohort study. Diabetes Res Clin Pract 2022; 190:110026. [PMID: 35917991 DOI: 10.1016/j.diabres.2022.110026] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/23/2022] [Accepted: 07/28/2022] [Indexed: 11/25/2022]
Abstract
AIMS To compare quality of care for type 2 diabetes in people with severe mental illness (SMI) versus no mental illness. METHODS We used routinely collected linked data to create a retrospective cohort study. We included 158,901 people diagnosed with type 2 diabetes in Scotland during 2009-2018 of whom 1701 (1%), 768 (0.5%) and 5211 (3%) had a prior hospital admission record for schizophrenia, bipolar disorder, and major depression, respectively. We compared recording of HbA1c, cholesterol, creatinine, blood pressure, urinary albumin, foot examination, retinopathy screening, body mass index and smoking during the first year after diabetes diagnosis using logistic regression and recording of HbA1c and retinopathy screening over longer follow-up using generalised linear mixed effects model, adjusting for confounding factors. RESULTS Receipt of care during the first year was generally similar, or better, for people with each SMI than for people without any mental illness. During mean follow up of 4.8 (SD 2.5) years, depression and bipolar disorder were associated with lower odds of receiving retinopathy screening. CONCLUSIONS Receipt of diabetes care was similar or better among people with SMI versus without SMI. However, mechanisms to support improved retinopathy screening for people with SMI are needed.
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Affiliation(s)
| | | | - Kirsty A M Licence
- Information Services Division, National Services Scotland, NHS Scotland, Edinburgh, UK
| | | | - Daniel J Smith
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Cathie L M Sudlow
- Usher Institute, University of Edinburgh, Edinburgh, UK; British Heart Foundation Data Science Centre, UK
| | | | - Sarah H Wild
- Usher Institute, University of Edinburgh, Edinburgh, UK
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10
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Buzea CA, Dima L, Correll CU, Manu P. Drug-drug interactions involving antipsychotics and antihypertensives. Expert Opin Drug Metab Toxicol 2022; 18:285-298. [PMID: 35658798 DOI: 10.1080/17425255.2022.2086121] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Antipsychotics represent the mainstay in the treatment of patients diagnosed with major psychiatric disorders. Hypertension, among other components of metabolic syndrome, is a common finding in these patients. For their psychiatric and physical morbidity, many patients receive polypharmacy, exposing them to the risk of clinically relevant drug-drug interactions. AREAS COVERED This review summarizes the knowledge regarding the known or potential drug-drug interactions between antipsychotics and the main drug classes used in the treatment of hypertension. We aimed to provide the clinician an insight into the pharmacokinetic and pharmacodynamic interactions between these drugs for a better choice of combinations of drugs to treat both the mental illness and cardiovascular risk factors. For this, we performed a literature search in PubMed and Scopus databases, up to 31 July 2021. EXPERT OPINION The main pharmacokinetic interactions between antipsychotics and antihypertensive drugs involve mainly the cytochrome P450 system. The pharmacodynamic interactions are produced by multiple mechanisms, leading to concurrent binding to the same receptors. The data available regarding drug-drug interactions is mostly based on case reports and small studies and therefore should be interpreted with caution. The current knowledge is sufficiently strong to guide clinicians in selecting safer drug combinations as summarized here.
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Affiliation(s)
- Catalin Adrian Buzea
- Department 5 Internal Medicine, Carol Davila' University of Medicine and Pharmacy, Bucharest, Romania.,Cardiology, Clinical Hospital Colentina, Bucharest, Romania
| | - Lorena Dima
- Department of Fundamental Disciplines and Clinical Prevention, Faculty of Medicine, Transilvania University of Brasov, Brașov, Romania
| | - Christoph U Correll
- Department of Child and Adolescent Psychiatry, Charite Universitaetsmedizin, Berlin, Germany.,Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.,Department of Psychiatry, Zucker Hillside Hospital, Northwell Health System, Glen Oaks, NY, USA
| | - Peter Manu
- Department of Psychiatry, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.,Department of Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.,Medical Services, South Oaks Hospital, Northwell Health System, Amityville, NY, USA
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11
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Minhas S, Patel JR, Malik M, Hana D, Hassan F, Khouzam RN. Mind-Body Connection: Cardiovascular Sequelae of Psychiatric Illness. Curr Probl Cardiol 2021; 47:100959. [PMID: 34358587 DOI: 10.1016/j.cpcardiol.2021.100959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 07/30/2021] [Indexed: 11/03/2022]
Abstract
Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in the world. Mental health disorders are associated with the onset and progression of cardiac disease. The adverse sequelae of this association include worsened quality of life, adverse cardiovascular outcomes, and heightened mortality. The increased prevalence of CVD is partly explained by increased rates of traditional cardiovascular risk factors including hypertension, hyperlipidemia, diabetes mellitus, obesity, and smoking, but mental illness is an independent risk factor for CVD and mortality. Given the association between mental health disorders and poor cardiovascular health, it is vital to have an early and accurate identification and treatment of these disorders. Our review article shares the current literature on the adverse cardiovascular events associated with psychiatric disorders. We present a review on depression, anxiety, bipolar disorder, schizophrenia, type A and D personality disorders, obsessive-compulsive disorder, and stress.
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Affiliation(s)
| | - Jay R Patel
- College of Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Maira Malik
- Department of Internal Medicine, East Tennessee State University, TN
| | - David Hana
- Department of Internal Medicine, West Virginia University, Morgantown, WV
| | - Fatima Hassan
- University of Tennessee Health Science Center, Memphis, TN
| | - Rami N Khouzam
- Interventional Cardiology, University of Tennessee Health Science Center, Memphis, TN; Cardiology Fellowship, University of Tennessee Health Science Center, Memphis, TN; Cardiac Cath Labs, Methodist University Hospital, Memphis, TN
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12
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Woodhead C, Martin P, Osborn D, Barratt H, Raine R. Health system influences on potentially avoidable hospital admissions by secondary mental health service use: A national ecological study. J Health Serv Res Policy 2021; 27:22-30. [PMID: 34337981 PMCID: PMC8772012 DOI: 10.1177/13558196211036739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Objectives Potentially avoidable hospital admissions (PAAs) are costly to health services and potentially harmful for patients. This study aimed to compare area-level PAA rates among people using and not using secondary mental health services in England and to identify health system features that may influence between-area PAA variation. Methods National ecological study using linked English hospital admissions and secondary mental health services data (2016–2018). We calculated two-year average age-sex standardised area-level PAA rates according to primary admission diagnoses for 12 physical conditions, among, first, secondary mental health service users with any non-organic diagnosis, and, second, people not in contact with secondary mental health services. We used penalised regression analyses to identify predictors of area-level variation in PAA rates. Results Area-level PAA rates were over four times greater in the mental health group, at 7,594 per 100,000 population compared to 1,819 per 100,000 in the comparator group. Common predictors of variation were greater density of older age groups (lower PAA rates), higher underlying population morbidity of chronic obstructive pulmonary disease and, to a lesser extent, urbanity (higher PAA rates). For both groups, health system factors such as the number of general practitioners per capita or ambulance despatch rates were significant but weak predictors of variation. Mental health diagnosis data were available for half of secondary mental health care records only and sensitivity analyses found that urbanity remained the sole significant predictor for PAAs in this group. Conclusions Findings support the need for improved management of physical conditions for secondary mental health service users. Understanding and predicting variation in PAAs among mental health service users is constrained by availability of data on mental health diagnosis, physical health care and needs.
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Affiliation(s)
- Charlotte Woodhead
- Lecturer Society and Mental Health, ESRC Centre for Society and Mental Health, Department of Psychological Medicine, King's College London, UK
| | - Peter Martin
- Lecturer Applied Statistics, NIHR ARC North Thames, Department of Applied Health Research, 4919University College London, University College London, UK
| | - David Osborn
- Professor of Psychiatric Epidemiology, Department of Epidemiology and Applied Clinical Research, Division of Psychiatry, University College London and Camden and Islington NHS Foundation Trust, UK
| | - Helen Barratt
- Senior Clinical Research Associate, NIHR ARC North Thames, Department of Applied Health Research, 4919University College London, University College London, UK
| | - Rosalind Raine
- Professor of Health Care Evaluation, NIHR ARC North Thames, Department of Applied Health Research, 4919University College London, University College London, UK
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Bakolis I, Stewart R, Baldwin D, Beenstock J, Bibby P, Broadbent M, Cardinal R, Chen S, Chinnasamy K, Cipriani A, Douglas S, Horner P, Jackson CA, John A, Joyce DW, Lee SC, Lewis J, McIntosh A, Nixon N, Osborn D, Phiri P, Rathod S, Smith T, Sokal R, Waller R, Landau S. Changes in daily mental health service use and mortality at the commencement and lifting of COVID-19 'lockdown' policy in 10 UK sites: a regression discontinuity in time design. BMJ Open 2021; 11:e049721. [PMID: 34039579 PMCID: PMC8159668 DOI: 10.1136/bmjopen-2021-049721] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 05/14/2021] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES To investigate changes in daily mental health (MH) service use and mortality in response to the introduction and the lifting of the COVID-19 'lockdown' policy in Spring 2020. DESIGN A regression discontinuity in time (RDiT) analysis of daily service-level activity. SETTING AND PARTICIPANTS Mental healthcare data were extracted from 10 UK providers. OUTCOME MEASURES Daily (weekly for one site) deaths from all causes, referrals and discharges, inpatient care (admissions, discharges, caseloads) and community services (face-to-face (f2f)/non-f2f contacts, caseloads): Adult, older adult and child/adolescent mental health; early intervention in psychosis; home treatment teams and liaison/Accident and Emergency (A&E). Data were extracted from 1 Jan 2019 to 31 May 2020 for all sites, supplemented to 31 July 2020 for four sites. Changes around the commencement and lifting of COVID-19 'lockdown' policy (23 March and 10 May, respectively) were estimated using a RDiT design with a difference-in-difference approach generating incidence rate ratios (IRRs), meta-analysed across sites. RESULTS Pooled estimates for the lockdown transition showed increased daily deaths (IRR 2.31, 95% CI 1.86 to 2.87), reduced referrals (IRR 0.62, 95% CI 0.55 to 0.70) and reduced inpatient admissions (IRR 0.75, 95% CI 0.67 to 0.83) and caseloads (IRR 0.85, 95% CI 0.79 to 0.91) compared with the pre lockdown period. All community services saw shifts from f2f to non-f2f contacts, but varied in caseload changes. Lift of lockdown was associated with reduced deaths (IRR 0.42, 95% CI 0.27 to 0.66), increased referrals (IRR 1.36, 95% CI 1.15 to 1.60) and increased inpatient admissions (IRR 1.21, 95% CI 1.04 to 1.42) and caseloads (IRR 1.06, 95% CI 1.00 to 1.12) compared with the lockdown period. Site-wide activity, inpatient care and community services did not return to pre lockdown levels after lift of lockdown, while number of deaths did. Between-site heterogeneity most often indicated variation in size rather than direction of effect. CONCLUSIONS MH service delivery underwent sizeable changes during the first national lockdown, with as-yet unknown and unevaluated consequences.
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Affiliation(s)
- Ioannis Bakolis
- Department of Biostatistics and Health Informatics, King's College London Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Robert Stewart
- South London and Maudsley NHS Foundation Trust, London, UK
- Department of Psychological Medicine, King's College London Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - David Baldwin
- Southern Health NHS Foundation Trust, Southampton, UK
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Jane Beenstock
- Lancashire and South Cumbria NHS Foundation Trust, Preston, UK
| | - Paul Bibby
- Lancashire and South Cumbria NHS Foundation Trust, Preston, UK
| | | | - Rudolf Cardinal
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, Cambridgeshire, UK
- Liaison Psychiatry Service, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Shanquan Chen
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, Cambridgeshire, UK
| | | | - Andrea Cipriani
- Department of Psychiatry, University of Oxford Medical Sciences Division, Oxford, Oxfordshire, UK
- Oxford Health NHS Foundation Trust, Oxford, Oxfordshire, UK
| | - Simon Douglas
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Philip Horner
- Lancashire and South Cumbria NHS Foundation Trust, Preston, UK
| | - Caroline A Jackson
- Usher Institute of Population Health Sciences & Informatics, University of Edinburgh Division of Medical and Radiological Sciences, Edinburgh, UK
| | - Ann John
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Dan W Joyce
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Sze Chim Lee
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Jonathan Lewis
- Cambridgeshire and Peterborough NHS Foundation Trust, Fulbourn, Cambridgeshire, UK
| | - Andrew McIntosh
- Division of Psychiatry, University of Edinburgh Division of Medical and Radiological Sciences, Edinburgh, UK
| | - Neil Nixon
- Division of Psychiatry and Applied Psychology, University of Nottingham Faculty of Medicine and Health Sciences, Nottingham, UK
- Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - David Osborn
- Division of Psychiatry, University College London Faculty of Medical Sciences, London, UK
| | - Peter Phiri
- Southern Health NHS Foundation Trust, Southampton, UK
| | | | - Tanya Smith
- Oxford Health NHS Foundation Trust, Oxford, Oxfordshire, UK
| | - Rachel Sokal
- Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - Rob Waller
- Lothian Primary Care NHS Trust, Edinburgh, UK
| | - Sabine Landau
- Department of Biostatistics and Health Informatics, King's College London Institute of Psychiatry, Psychology and Neuroscience, London, UK
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Rogers J, Collins G, Husain M, Docherty M. Identifying and managing functional cardiac symptoms. Clin Med (Lond) 2021; 21:37-43. [PMID: 33479066 DOI: 10.7861/clinmed.2020-0934] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Recurring chest pain and other cardiac symptoms that cannot be adequately explained by organic pathology are common and can be associated with substantial disability, distress and high healthcare costs. Common mental disorders such as depression and anxiety frequently co-occur with these symptoms and, in some cases, account for their presentation, although they are not universally present. Due to the frequency of functional cardiac presentations and risks of iatrogenic harm, physicians should be familiar with strategies to identify, assess and communicate with patients about these symptoms. A systematic and multidisciplinary approach to diagnosis and management is often needed. Health beliefs, concerns and any associated behaviours should be elicited and addressed throughout. Psychiatric comorbidities should be concurrently identified and treated. For those with persistent symptoms, psychosocial outcomes can be poor, highlighting the need for further research and investment in diagnostic and therapeutic approaches and multidisciplinary service models.
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Affiliation(s)
- Jonathan Rogers
- University College London, London, UK and specialty registrar in general adult and old age psychiatry, South London and Maudsley NHS Foundation Trust, London, UK
| | - George Collins
- University College London, London, UK and specialty registrar in cardiology, Barts Health NHS Trust, London, UK
| | - Mujtaba Husain
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Mary Docherty
- South London and Maudsley NHS Foundation Trust, London, UK
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15
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Hafiz N, Hyun K, Knight A, Hespe C, Chow CK, Briffa T, Gallagher R, Reid CM, Hare DL, Zwar N, Woodward M, Jan S, Atkins ER, Laba TL, Halcomb E, Usherwood T, Redfern J. Gender Comparison of Receipt of Government-Funded Health Services and Medication Prescriptions for the Management of Patients With Cardiovascular Disease in Primary Care. Heart Lung Circ 2021; 30:1516-1524. [PMID: 33933363 DOI: 10.1016/j.hlc.2021.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 01/11/2021] [Accepted: 04/08/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cardiovascular disease (CVD) and risk factors remains a major burden in terms of disease, disability, and death in the Australian population and mental health is considered as an important risk factor affecting cardiovascular disease. A multidisciplinary collaborative approach in primary care is required to ensure an optimal outcome for managing cardiovascular patients with mental health issues. Medicare introduced numerous primary care health services and medications that are subsidised by the Australian government in order to provide a more structured approach to reduce and manage CVD. However, the utilisation of these services nor gender comparison for CVD management in primary care has been explored. Therefore, the aim is to compare the provision of subsidised chronic disease management plans (CDMPs), mental health care and prescription of guideline-indicated medications to men and women with CVD in primary care practices for secondary prevention. METHODS De-identified data for all active patients with CVD were extracted from 50 Australian primary care practices. Outcomes included the frequency of receipt of CDMPs, mental health care and prescription of evidence-based medications. Analyses adjusted for demography and clinical characteristics, stratified by gender, were performed using logistic regression and accounted for clustering effects by practices. RESULTS Data for 14,601 patients with CVD (39.4% women) were collected. The odds of receiving the CDMPs was significantly greater amongst women than men (preparation of general practice management plan [GPMP]: (46% vs 43%; adjusted OR [95% CI]: 1.22 [1.12, 1.34]). Women were more likely to have diagnosed with mental health issues (32% vs 20%, p<0.0001), however, the adjusted odds of men and women receiving any government-subsidised mental health care were similar. Women were less often prescribed blood pressure, lipid-lowering and antiplatelet medications. After adjustment, only an antiplatelet medication or agent was less likely to be prescribed to women than men (44% vs 51%; adjusted OR [95% CI]: 0.84 [0.76, 0.94]). CONCLUSION Women were more likely to receive CDMPs but less likely to receive antiplatelet medications than men, no gender difference was observed in the receipt of mental health care. However, the receipt of the CDMPs and the mental health treatment consultations were suboptimal and better use of these existing services could improve ongoing CVD management.
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Affiliation(s)
- Nashid Hafiz
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia. https://twitter.com/HafizNashid
| | - Karice Hyun
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Andrew Knight
- Primary and Integrated Care Unit, South Western Sydney Local Health District, Sydney, NSW, Australia; University of New South Wales, Sydney, NSW, Australia
| | - Charlotte Hespe
- The University of Notre Dame, School of Medicine, Sydney, NSW, Australia
| | - Clara K Chow
- Western Sydney Local Health District, Sydney, NSW, Australia; Westmead Applied Research Centre, The University of Sydney, Sydney, NSW, Australia
| | - Tom Briffa
- School of Population and Global Health, Faculty of Health and Medical Sciences, The University of Western Australia, Sydney, NSW, Australia
| | - Robyn Gallagher
- Sydney Nursing School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Christopher M Reid
- School of Public Health, Curtin University, Perth, WA, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | - David L Hare
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Vic, Australia; Austin Health, Melbourne, Vic, Australia
| | - Nicholas Zwar
- Faculty of Health Sciences & Medicine, Bond University, Brisbane, Qld, Australia
| | - Mark Woodward
- University of New South Wales, Sydney, NSW, Australia; The George Institute for Global Health, Sydney, NSW, Australia
| | - Stephen Jan
- The George Institute for Global Health, Sydney, NSW, Australia
| | - Emily R Atkins
- The George Institute for Global Health, Sydney, NSW, Australia
| | - Tracey-Lea Laba
- University of Technology Sydney Centre for Health Economics Research and Evaluation, Sydney, NSW, Australia
| | - Elizabeth Halcomb
- School of Nursing, University of Wollongong, Wollongong, NSW, Australia
| | - Timothy Usherwood
- The George Institute for Global Health, Sydney, NSW, Australia; The University of Sydney, Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Julie Redfern
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; The George Institute for Global Health, Sydney, NSW, Australia.
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16
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Reilly S, McCabe C, Marchevsky N, Green M, Davies L, Ives N, Plappert H, Allard J, Rawcliffe T, Gibson J, Clark M, Pinfold V, Gask L, Huxley P, Byng R, Birchwood M. Status of primary and secondary mental healthcare of people with severe mental illness: an epidemiological study from the UK PARTNERS2 programme. BJPsych Open 2021; 7:e53. [PMID: 33583478 PMCID: PMC8058911 DOI: 10.1192/bjo.2021.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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
BACKGROUND There is global interest in the reconfiguration of community mental health services, including primary care, to improve clinical and cost effectiveness. AIMS This study seeks to describe patterns of service use, continuity of care, health risks, physical healthcare monitoring and the balance between primary and secondary mental healthcare for people with severe mental illness in receipt of secondary mental healthcare in the UK. METHOD We conducted an epidemiological medical records review in three UK sites. We identified 297 cases randomly selected from the three participating mental health services. Data were manually extracted from electronic patient medical records from both secondary and primary care, for a 2-year period (2012-2014). Continuous data were summarised by mean and s.d. or median and interquartile range (IQR). Categorical data were summarised as percentages. RESULTS The majority of care was from secondary care practitioners: of the 18 210 direct contacts recorded, 76% were from secondary care (median, 36.5; IQR, 14-68) and 24% were from primary care (median, 10; IQR, 5-20). There was evidence of poor longitudinal continuity: in primary care, 31% of people had poor longitudinal continuity (Modified Modified Continuity Index ≤0.5), and 43% had a single named care coordinator in secondary care services over the 2 years. CONCLUSIONS The study indicates scope for improvement in supporting mental health service delivery in primary care. Greater knowledge of how care is organised presents an opportunity to ensure some rebalancing of the care that all people with severe mental illness receive, when they need it. A future publication will examine differences between the three sites that participated in this study.
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Affiliation(s)
- Siobhan Reilly
- Division of Health Research, Lancaster University, UK; and Centre for Applied Dementia Studies, Faculty of Health Studies, University of Bradford, UK
| | | | | | - Maria Green
- Division of Health Research, Lancaster University, UK
| | - Linda Davies
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, UK
| | - Natalie Ives
- Birmingham Clinical Trials Unit, Birmingham University, UK
| | - Humera Plappert
- Institute for Mental Health, School of Psychology, University of Birmingham, UK
| | - Jon Allard
- Cornwall Partnership NHS Foundation Trust, UK; and Community and Primary Care Research Group, Faculty of Medicine, University of Plymouth, UK
| | - Tim Rawcliffe
- Division of Health Research, Lancaster University, UK
| | - John Gibson
- Institute for Mental Health, School of Psychology, University of Birmingham, UK
| | - Michael Clark
- London School of Economics and Political Science, UK
| | | | - Linda Gask
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, UK
| | - Peter Huxley
- Centre for Mental Health and Society, School of Health Sciences, Bangor University, UK
| | - Richard Byng
- Community and Primary Care Research Group, Faculty of Medicine, University of Plymouth, UK
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Morris RM, Sellwood W, Edge D, Colling C, Stewart R, Cupitt C, Das-Munshi J. Ethnicity and impact on the receipt of cognitive-behavioural therapy in people with psychosis or bipolar disorder: an English cohort study. BMJ Open 2020; 10:e034913. [PMID: 33323425 PMCID: PMC7745324 DOI: 10.1136/bmjopen-2019-034913] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES (1) To explore the role of ethnicity in receiving cognitive-behavioural therapy (CBT) for people with psychosis or bipolar disorder while adjusting for differences in risk profiles and symptom severity. (2) To assess whether context of treatment (inpatient vs community) impacts on the relationship between ethnicity and access to CBT. DESIGN Cohort study of case register data from one catchment area (January 2007-July 2017). SETTING A large secondary care provider serving an ethnically diverse population in London. PARTICIPANTS Data extracted for 30 497 records of people who had diagnoses of bipolar disorder (International Classification of Diseases (ICD) code F30-1) or psychosis (F20-F29 excluding F21). Exclusion criteria were: <15 years old, missing data and not self-defining as belonging to one of the larger ethnic groups. The sample (n=20 010) comprised the following ethnic groups: white British: n=10 393; Black Caribbean: n=5481; Black African: n=2817; Irish: n=570; and 'South Asian' people (consisting of Indian, Pakistani and Bangladeshi people): n=749. OUTCOME ASSESSMENTS ORs for receipt of CBT (single session or full course) as determined via multivariable logistic regression analyses. RESULTS In models adjusted for risk and severity variables, in comparison with White British people; Black African people were less likely to receive a single session of CBT (OR 0.73, 95% CI 0.66 to 0.82, p<0.001); Black Caribbean people were less likely to receive a minimum of 16-sessions of CBT (OR 0.83, 95% CI 0.71 to 0.98, p=0.03); Black African and Black Caribbean people were significantly less likely to receive CBT while inpatients (respectively, OR 0.76, 95% CI 0.65 to 0.89, p=0.001; OR 0.83, 95% CI 0.73 to 0.94, p=0.003). CONCLUSIONS This study highlights disparity in receipt of CBT from a large provider of secondary care in London for Black African and Caribbean people and that the context of therapy (inpatient vs community settings) has a relationship with disparity in access to treatment.
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Affiliation(s)
- Rohan Michael Morris
- Division of Health Research, Lancaster University, Lancaster, UK
- Lancashire Care NHS Foundation Trust, Preston, UK
- Pennine Care NHS Foundation Trust, Greater Manchester, England
| | - William Sellwood
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Dawn Edge
- Division of Psychology & Mental Health, School of Health Sciences, The University of Manchester, Manchester, UK
| | - Craig Colling
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Robert Stewart
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Jayati Das-Munshi
- Section of Epidemiology, Department of Health Service & Population Research, King's College London, Institute of Psychiatry, London, UK
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18
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Castillejos Anguiano MC, Martín Pérez C, Bordallo Aragón A, Sepúlveda Muñoz J, Moreno Küstner B. Patterns of primary care among persons with schizophrenia: the role of patients, general practitioners and centre factors. Int J Ment Health Syst 2020; 14:82. [PMID: 33292372 PMCID: PMC7653995 DOI: 10.1186/s13033-020-00409-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 10/26/2020] [Indexed: 11/10/2022] Open
Abstract
Background Patients with schizophrenia and related disorders have more physical problems than the general population. Primary care professionals play an important role in the care of these patients as they are the main entry point into the healthcare system. We aimed to identify patient, general practitioner, and primary care centre factors associated with the number of visits of patients with schizophrenia and related disorders to general practitioners. Methods A descriptive, cross-sectional study was conducted in 13 primary care centres belonging to the Clinical Management Unit of Mental Health of the Regional Hospital of Málaga, Spain. The eligible population was composed of patients with schizophrenia and related disorders attending the primary care centres in the study area, and the general practitioners who attend these patients. Our dependent variable was the total number of general practitioner visits made by patients with schizophrenia and related disorders during the 3.5-year observation period. The independent variables were grouped into three: (a) patient variables (sociodemographic and clinical), (b) general practitioner variables, and (c) primary care centre characteristics. Descriptive, bivariate, and multivariate analyses using the random forest method were performed. Results A total of 259 patients with schizophrenia and related disorders, 96 general practitioners, and 13 primary care centres were included. The annual mean was 3.9 visits per patient. The results showed that younger general practitioners, patients who were women, patients who were married, some primary care centres to which the patient belonged, taking antipsychotic medication, presenting any cardiovascular risk factor, and more frequency of mental health training sessions at the primary care centre were associated with an increased number of visits to general practitioners. Conclusions The only general practitioner variable that was associated with the number of visits was age, the older the less contact. There were also patient variables involved in the number of visits. Finally, mental health training for general practitioners was important for these professionals to manage patients with schizophrenia and related disorders.
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Affiliation(s)
- Mª Carmen Castillejos Anguiano
- Departament of Personality, Assessment and Psychological Treatment, Faculty of Psychology, Andalusian Group of Psychosocial Research (GAP), Biomedical Research Institute of Malaga (IBIMA), University of Malaga, Campus Teatinos, 29071, Malaga, Spain.
| | - Carlos Martín Pérez
- Clinical Management Unit At Marquesado, Andalusian Health Service, Carretera Los Pozos, North East Granada Sanitary District, 18518, AlquifeGranada, Spain
| | - Antonio Bordallo Aragón
- Clinical Management Unit of Mental Health of the Regional Hospital of Malaga, Andalusian Health Service, Paseo Limonar, Malaga, Spain
| | - Jesus Sepúlveda Muñoz
- Alameda-Perchel Basic Primary Care Team, Health District Malaga-Guadalhorce, Andalusian Health Service, Avenida Manuel Agustín Heredia, Malaga, Spain
| | - Berta Moreno Küstner
- Departament of Personality, Assessment and Psychological Treatment, Faculty of Psychology, Andalusian Group of Psychosocial Research (GAP), Biomedical Research Institute of Malaga (IBIMA), University of Malaga, Campus Teatinos, 29071, Malaga, Spain
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Hjell G, Mørch-Johnsen L, Holst R, Tesli N, Bell C, Lunding SH, Rødevand L, Werner MCF, Melle I, Andreassen OA, Lagerberg TV, Steen NE, Haukvik UK. Disentangling the relationship between cholesterol, aggression, and impulsivity in severe mental disorders. Brain Behav 2020; 10:e01751. [PMID: 32681586 PMCID: PMC7507477 DOI: 10.1002/brb3.1751] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 06/26/2020] [Accepted: 06/28/2020] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE Low total cholesterol has been linked with adverse mental symptoms such as aggression and impulsivity in severe mental disorders (SMDs). This putative association may affect the clinician's decision making about cholesterol lowering in this patient group. Here, we investigated the associations between cholesterol levels, aggression, and impulsivity in a large representative sample of in- and outpatients with SMD. METHODS Patients with schizophrenia- or bipolar spectrum disorders (N = 1 001) underwent thorough clinical characterization and blood sampling (total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol). Aggression was characterized by the Positive and Negative Syndrome Scale Excited Component. Impulsivity was measured with the Barratt Impulsiveness Scale in a subsample of patients (N = 288). We used a multinomial logistic regression model to analyze the association between cholesterol and aggression and a multiple linear regression model to analyze the association between cholesterol and impulsivity, while controlling for confounders. RESULTS We found no significant associations between cholesterol levels and aggression or impulsivity. There were no significant interactions between cholesterol and diagnostic group or inpatient versus outpatient status. Controlling for medication use, body mass index, alcohol or illicit substance use did not affect the results. CONCLUSION In this large sample of patients with schizophrenia- and bipolar spectrum disorders, we found no associations between cholesterol levels and aggression or impulsivity. This has clinical implications as patients with SMD are at increased CVD risk and currently undertreated with statins.
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Affiliation(s)
- Gabriela Hjell
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Departments of Psychiatry and Clinical Research, Ostfold Hospital, Gralum, Norway
| | - Lynn Mørch-Johnsen
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Departments of Psychiatry and Clinical Research, Ostfold Hospital, Gralum, Norway
| | - René Holst
- Departments of Psychiatry and Clinical Research, Ostfold Hospital, Gralum, Norway.,Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Natalia Tesli
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Christina Bell
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Synve Hoffart Lunding
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Linn Rødevand
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Maren Caroline Frogner Werner
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ingrid Melle
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ole Andreas Andreassen
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Trine Vik Lagerberg
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Nils Eiel Steen
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Unn Kristin Haukvik
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Adult Psychiatry, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Centre of Research and Education in Forensic Psychiatry, Oslo University Hospital, Oslo, Norway
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Jewell A, Broadbent M, Hayes RD, Gilbert R, Stewart R, Downs J. Impact of matching error on linked mortality outcome in a data linkage of secondary mental health data with Hospital Episode Statistics (HES) and mortality records in South East London: a cross-sectional study. BMJ Open 2020; 10:e035884. [PMID: 32641360 PMCID: PMC7342822 DOI: 10.1136/bmjopen-2019-035884] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Linkage of electronic health records (EHRs) to Hospital Episode Statistics (HES)-Office for National Statistics (ONS) mortality data has provided compelling evidence for lower life expectancy in people with severe mental illness. However, linkage error may underestimate these estimates. Using a clinical sample (n=265 300) of individuals accessing mental health services, we examined potential biases introduced through missed matching and examined the impact on the association between clinical disorders and mortality. SETTING The South London and Maudsley NHS Foundation Trust (SLaM) is a secondary mental healthcare provider in London. A deidentified version of SLaM's EHR was available via the Clinical Record Interactive Search system linked to HES-ONS mortality records. PARTICIPANTS Records from SLaM for patients active between January 2006 and December 2016. OUTCOME MEASURES Two sources of death data were available for SLaM participants: accurate and contemporaneous date of death via local batch tracing (gold standard) and date of death via linked HES-ONS mortality data. The effect of linkage error on mortality estimates was evaluated by comparing sociodemographic and clinical risk factor analyses using gold standard death data against HES-ONS mortality records. RESULTS Of the total sample, 93.74% were successfully matched to HES-ONS records. We found a number of statistically significant administrative, sociodemographic and clinical differences between matched and unmatched records. Of note, schizophrenia diagnosis showed a significant association with higher mortality using gold standard data (OR 1.08; 95% CI 1.01 to 1.15; p=0.02) but not in HES-ONS data (OR 1.05; 95% CI 0.98 to 1.13; p=0.16). Otherwise, little change was found in the strength of associated risk factors and mortality after accounting for missed matching bias. CONCLUSIONS Despite significant clinical and sociodemographic differences between matched and unmatched records, changes in mortality estimates were minimal. However, researchers and policy analysts using HES-ONS linked resources should be aware that administrative linkage processes can introduce error.
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Affiliation(s)
- Amelia Jewell
- South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Richard D Hayes
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Ruth Gilbert
- Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, London, UK
| | - Robert Stewart
- South London and Maudsley NHS Foundation Trust, London, UK
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Johnny Downs
- South London and Maudsley NHS Foundation Trust, London, UK
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
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Heiberg IH, Nesvåg R, Balteskard L, Bramness JG, Hultman CM, Næss Ø, Reichborn‐Kjennerud T, Ystrom E, Jacobsen BK, Høye A. Diagnostic tests and treatment procedures performed prior to cardiovascular death in individuals with severe mental illness. Acta Psychiatr Scand 2020; 141:439-451. [PMID: 32022895 PMCID: PMC7317477 DOI: 10.1111/acps.13157] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/02/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To examine whether severe mental illnesses (i.e., schizophrenia or bipolar disorder) affected diagnostic testing and treatment for cardiovascular diseases in primary and specialized health care. METHODS We performed a nationwide study of 72 385 individuals who died from cardiovascular disease, of whom 1487 had been diagnosed with severe mental illnesses. Log-binomial regression analysis was applied to study the impact of severe mental illnesses on the uptake of diagnostic tests (e.g., 24-h blood pressure, glucose/HbA1c measurements, electrocardiography, echocardiography, coronary angiography, and ultrasound of peripheral vessels) and invasive cardiovascular treatments (i.e., revascularization, arrhythmia treatment, and vascular surgery). RESULTS Patients with and without severe mental illnesses had similar prevalences of cardiovascular diagnostic tests performed in primary care, but patients with schizophrenia had lower prevalences of specialized cardiovascular examinations (prevalence ratio (PR) 0.78; 95% CI 0.73-0.85). Subjects with severe mental illnesses had lower prevalences of invasive cardiovascular treatments (schizophrenia, PR 0.58; 95% CI 0.49-0.70, bipolar disorder, PR 0.78; 95% CI 0.66-0.92). The prevalence of invasive cardiovascular treatments was similar in patients with and without severe mental illnesses when cardiovascular disease was diagnosed before death. CONCLUSION Better access to specialized cardiovascular examinations is important to ensure equal cardiovascular treatments among individuals with severe mental illnesses.
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Affiliation(s)
- I. H. Heiberg
- Center for Clinical Documentation and Evaluation (SKDE)TromsøNorway
| | - R. Nesvåg
- Norwegian Medical AssociationOsloNorway,Department of Clinical MedicineUiT – The Arctic University of NorwayTromsøNorway
| | - L. Balteskard
- Center for Clinical Documentation and Evaluation (SKDE)TromsøNorway
| | - J. G. Bramness
- Department of Clinical MedicineUiT – The Arctic University of NorwayTromsøNorway,Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health DisordersInnlandet Hospital TrustHamarNorway
| | - C. M. Hultman
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden,Icahn School of MedicineMt Sinai HospitalNew YorkNYUSA
| | - Ø. Næss
- Institute of Clinical MedicineUniversity of OsloOsloNorway,Institute of Health and SocietyUniversity of OsloOsloNorway
| | - T. Reichborn‐Kjennerud
- Institute of Clinical MedicineUniversity of OsloOsloNorway,Department of Mental DisordersNorwegian Institute of Public HealthOsloNorway
| | - E. Ystrom
- Department of Mental DisordersNorwegian Institute of Public HealthOsloNorway,Department of PsychologyPROMENTA Research CenterUniversity of OsloOsloNorway,PharmacoEpidemiology and Drug Safety Research GroupSchool of PharmacyUniversity of OsloOsloNorway
| | - B. K. Jacobsen
- Center for Clinical Documentation and Evaluation (SKDE)TromsøNorway,Department of Community MedicineUiT – The Arctic University of NorwayTromsøNorway,Department of Community MedicineCentre for Sami Health ResearchUiT – The Arctic University of NorwayTromsøNorway
| | - A. Høye
- Center for Clinical Documentation and Evaluation (SKDE)TromsøNorway,Department of Clinical MedicineUiT – The Arctic University of NorwayTromsøNorway,Division of Mental Health and Substance AbuseUniversity Hospital of North NorwayTromsøNorway
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Racial Disparities in Healthcare Utilization Among Individuals with Cardiometabolic Risk Factors and Comorbid Anxiety Disorder. J Racial Ethn Health Disparities 2020; 7:1234-1240. [PMID: 32277365 DOI: 10.1007/s40615-020-00748-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 03/24/2020] [Accepted: 03/25/2020] [Indexed: 01/04/2023]
Abstract
OBJECTIVE This study addresses racial/ethnic differences in adverse health care utilization among individuals with comorbid anxiety disorder and cardiometabolic syndrome (CMetS) risk factors. METHODS Utilizing 2011-2015 Medical Expenditure Panel Survey (MEPS) data, logistic regression models were estimated to determine the likelihood of receiving CMetS-related medical treatment in the emergency department (ED) or via inpatient services and to determine if the likelihood is associated with race/ethnicity. Adjusted models controlled for age, sex, and insurance type. RESULTS Significant racial-ethnic differences were observed for utilization (any emergency department and/or inpatient visit). The odds of non-Hispanic Black respondents reporting emergency department and/or inpatient utilization was 2.39 (p < 0.05) times the odds of non-Hispanic White respondents. CONCLUSION Racial-ethnic variation in adverse healthcare utilization suggests an opportunity to improve care and outcomes for persons diagnosed with comorbid anxiety disorder and cardiometabolic syndrome. Integrated interventions could simultaneously improve mental health and facilitate CMetS disease self-management.
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Castillejos MC, Martín-Pérez C, García-Ruiz A, Mayoral-Cleries F, Moreno-Küstner B. Recording of cardiovascular risk factors by general practitioners in patients with schizophrenia. Ann Gen Psychiatry 2020; 19:34. [PMID: 32467716 PMCID: PMC7236925 DOI: 10.1186/s12991-020-00284-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 05/10/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Patients with schizophrenia and related disorders (SRD) are more predisposed to having cardiovascular risk factors (CVRFs) compared to the general population due to a combination of lifestyle factors and exposure to antipsychotic medications. We aimed to analyse the documentation practices of CVRFs by general practitioners (GPs) and its associations with patient variables in a sample of persons with SRD. METHODS An observational, cross-sectional study was conducted in 13 primary care centres (PCCs) in Malaga (Spain). The population comprised all patients with SRD who were in contact with a GP residing in the study area. The number of CVRFs (type 2 diabetes mellitus, hypertension, hypercholesterolaemia, obesity and smoking) recorded by GPs were analysed by considering patients' demographic and clinical variables and use of primary care services. We performed descriptive, bivariate and multivariate regression analyses. RESULTS A total of 494 patients were included; CVRFs were not recorded in 59.7% of the patients. One CVRF was recorded in 42.1% of patients and two or more CVRFs were recorded in 16.1% of patients. Older age, living in an urban area and a higher number of visits to the GP were associated with a higher number of CVRFs recorded. CONCLUSION The main finding in this study is that both patients' demographic variables as well as use of primary care services were found to be related to the documentation of CVRFs in patients with SRD by GPs.
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Affiliation(s)
- Mª Carmen Castillejos
- 1Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology Andalusian Group of Psychosocial Research (GAP), University of Malaga, Campus Teatinos, 29071 Malaga, Spain
| | - Carlos Martín-Pérez
- 2North East Granada Sanitary District, Clinical Management Unit at Marquesado, Andalusian Health Service, Carretera los Pozos, 18518 Alquife, Granada Spain
| | - Antonio García-Ruiz
- 3Department of Health Economics and the Rational Drug Use of Medicines. Faculty of Medicine, University of Malaga, Campus Teatinos, 29071 Malaga, Spain
| | - Fermín Mayoral-Cleries
- 4Clinical Management Unit of Mental Health of the Regional Hospital of Malaga. Andalusian Health Service, Biomedical Research Institute of Malaga (IBIMA), Plaza del Hospital, 29009 Malaga, Spain
| | - Berta Moreno-Küstner
- 5Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology. Andalusian Group of Psychosocial Research (GAP). Biomedical Research Institute of Malaga (IBIMA), University of Malaga, Campus Teatinos, 29071 Malaga, Spain
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Impact of mental illness on care for somatic comorbidities in France: a nation-wide hospital-based observational study. Epidemiol Psychiatr Sci 2019; 28:495-507. [PMID: 29692292 PMCID: PMC6999027 DOI: 10.1017/s2045796018000203] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
AIMS. People with a mental illness have a shorter lifespan and higher rates of somatic illnesses than the general population. They also face multiple barriers which interfere with access to healthcare. Our objective was to assess the effect of mental illness on the timeliness and optimality of access to healthcare for somatic reasons by comparing indicators reflecting the quality of prior somatic care in hospitalised patients. METHODS. An observational nation-wide study was carried out using exhaustive national hospital discharge databases for the years 2009-2013. All adult inpatient stays for somatic reasons in acute care hospitals were included with the exception of obstetrics and day admissions. Admissions with coding errors were excluded. Patients with a mental illness were identified by their admissions for a psychiatric reason and/or contacts with psychiatric hospitals. The quality of prior somatic care was assessed using the number of admissions, admissions through the emergency room (ER), avoidable hospitalisations, high-severity hospitalisations, mean length of stay (LOS) and in-hospital death. Generalised linear models studied the factors associated with poor quality of primary care. RESULTS. A total of 17 620 770 patients were included, and 6.58% had been admitted at least once for a mental illness, corresponding to 8.96% of hospital admissions. Mentally ill patients were more often hospitalised (+41% compared with non-mentally patients) and for a longer LOS (+16%). They also had more high-severity hospitalisations (+77%), were more often admitted to the ER (+113%) and had more avoidable hospitalisations (+50%). After adjusting for other covariates, regression models found that suffering from a mental illness was significantly associated with a worse state for each indicator of the quality of care except in-hospital death. CONCLUSION. Inadequate primary care of mentally ill patients leads to more serious conditions upon admission to hospital and avoidable hospitalisations. It is, therefore, necessary to improve primary care and prevention for those patients.
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Factors associated with visits to general practitioners in patients with schizophrenia in Malaga. BMC FAMILY PRACTICE 2018; 19:180. [PMID: 30486784 PMCID: PMC6264610 DOI: 10.1186/s12875-018-0866-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 11/13/2018] [Indexed: 02/06/2023]
Abstract
Background Patients with psychiatric disorders have more physical problems than other patients, so their follow-up by the general practitioner is particularly important for them. Methods We aimed to elaborate a multilevel explanatory model of general practitioner (GP) visits made by patients with schizophrenia and related disorders (SRD). An observational, cross-sectional study was conducted from January 1, 2008 to July 1, 2011, in the area of the Clinical Management Unit of Mental Health (CMU-MH) of the Regional Hospital of Malaga (Spain). The eligible population consisted of all patients with SRD in contact with a GP residing in the study area. Our dependent variable was total number GP visits. The independent variables were: 1) patient variables (sociodemographic and clinical variables); 2) primary care centre (PCC) variables. We performed descriptive analysis, bivariate analysis and multilevel regression. Results Four hundred ninety four patients were included. Mean annual number of GP visits was 4.1. Female sex, living in a socioeconomically deprived area, a diagnosis of schizoaffective disorder and contact with a GP who had a more active approach to mental health issues were associated with a higher number of visits whilst being single and good communication between the PCC and mental health teams were associated with a lower number of GP visits. Conclusions Number of GP visits was not just associated with patient factors, but also with organisational and the involvement of health professionals, for example GPs with an active approach to mental health issues. Electronic supplementary material The online version of this article (10.1186/s12875-018-0866-7) contains supplementary material, which is available to authorized users.
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A review and study of aspirin utilization for the primary prevention of cardiovascular events in a psychiatric population. Int Clin Psychopharmacol 2018; 33:274-281. [PMID: 29939889 DOI: 10.1097/yic.0000000000000228] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In April 2016, the US Preventive Service Task Force (USPSTF) updated the aspirin guidelines for the primary prevention of cardiovascular disease (CVD) and colorectal cancer. This review assesses the importance of appropriate use of aspirin for the primary prevention of CVD and, specifically, how individuals with psychiatric disorders may benefit from such use. This study examined how current prescribing practices of aspirin in a state psychiatric hospital align with these new guidelines and how inappropriate prescribing may jeopardize patient safety. A retrospective chart review of 93 patients was performed to evaluate whether aspirin therapy would be recommended for primary prevention of CVD based on the new USPSTF guidelines. A secondary analysis of these data was performed using the 2009 USPSTF recommendations to strengthen the assumption that practitioners were no longer using the old guidelines. Drug interactions between aspirin and concurrently prescribed pharmacotherapy were classified based on of severity, and the past events of bleeding were quantified. Based on the 2016 guidelines, 25 of the 93 patients included in this study were identified as potential candidates who would benefit from aspirin use for the primary prevention of CVD; of whom 22 (88%) were not prescribed aspirin. The remaining 68 patients did not meet the criteria for aspirin use for primary prevention, although 11 (16.2%) of these patients were taking low-dose aspirin. Based on the 2009 guidelines, 49 of the 93 patients included in our study would have been identified as potential candidates who would benefit from the use of aspirin for the primary prevention of CVD; 41 (83.7%) of whom were not prescribed aspirin. The remaining 44 patients did not meet the previous criteria for aspirin use for primary prevention, although six (13.6%) of these individuals were taking low-dose aspirin daily. The results above indicate a difference between prescribing practices of aspirin use for the primary prevention of CVD. We identified a similar rate of underuse; however, there was a slight increase in the appropriate prescribing according to the 2016 guidelines compared with the 2009 guidelines (88 vs. 83.7%, respectively). Also, there was a higher incidence of unnecessary prescribing (overutilization) of aspirin for the primary prevention of CVD in 2016 compared with 2009 despite the more restrictive criteria (and smaller candidate pool) published in these newer guidelines. There were 47 drug interactions identified when patients' aspirin and concurrent medication regimens were reviewed for our entire sample population. These interactions could potentially lead to an adverse drug reaction in the future. Our safety analysis revealed that none of the patients who were prescribed aspirin had any bleeding events while on therapy within the period of this study. Inappropriate omission of aspirin (underutilization) was more prevalent in our psychiatric institution than overutilization; however, the overall percentage of both underuse and overuse were greater when patients were evaluated according to the 2016 guidelines and then compared with the 2009 statistics. Overutilization did not pose a serious risk for those on aspirin therapy in this sample, as there were no major episodes of bleeding. However, future harm from aspirin still exists based on the significant number of major and moderate potential drug interactions with aspirin and the increased risk of decreased adherence to critical psychiatric medications due to increased pill burden and regimen complexity. Our findings demonstrate that there is an opportunity to educate prescribers on the updated 2016 USPSTF guidelines to improve preventive care and patient safety, which include harm reduction by initiating aspirin in those who are at a risk of cardiovascular events, continuing aspirin in those who are currently receiving aspirin appropriately, and discontinuing aspirin in those who are not considered to be at a high risk of CVD and who may also be at a risk of experiencing an increased risk of bleeding.
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Moe AM, Rubinstein EB, Gallagher CJ, Weiss DM, Stewart A, Breitborde NJ. Improving access to specialized care for first-episode psychosis: an ecological model. Risk Manag Healthc Policy 2018; 11:127-138. [PMID: 30214330 PMCID: PMC6121768 DOI: 10.2147/rmhp.s131833] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Psychotic spectrum disorders are serious illnesses with symptoms that significantly impact functioning and quality of life. An accumulating body of literature has demonstrated that specialized treatments that are offered early after symptom onset are disproportionately more effective in managing symptoms and improving outcomes than when these same treatments are provided later in the course of illness. Specialized, multicomponent treatment packages are of particular importance, which are comprised of services offered as soon as possible after the onset of psychosis with the goal of addressing multiple care needs within a single care setting. As specialized programs continue to develop worldwide, it is crucial to consider how to increase access to such specialized services. In the current review, we utilize an ecological model of understanding barriers to care, with emphasis on understanding how individuals with first-episode psychosis interact with and are influenced by a variety of systemic factors that impact help-seeking behaviors and engagement with treatment. Future work in this area will be important in understanding how to most effectively design and implement specialized care for individuals early in the course of a psychotic disorder.
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Affiliation(s)
- Aubrey M Moe
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA,
| | - Ellen B Rubinstein
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Colin J Gallagher
- Department of Psychological Sciences, Kent State University, Kent, OH, USA
| | - David M Weiss
- Department of Psychology, The Ohio State University, Columbus, OH, USA
| | - Amanda Stewart
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA,
| | - Nicholas Jk Breitborde
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA,
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Abstract
This article looks at the use of large health records datasets, typically linked with other data sources, and their use in mental health research. The most comprehensive examples of this kind of big data are typically found in Scandinavian countries however there are also many useful sources in the UK. There are a number of promising methodological innovations from studies using big data in UK mental health research, including: hybrid study designs, examples of data linkage and enhanced study recruitment. It is, though, important to be aware of the limitations of research using big data, particularly the various analysis pitfalls. We therefore caution against throwing out the methodological baby with the bathwater and argue that other data sources are equally valuable and ideally research should incorporate a range of data.
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Blackburn R, Osborn D, Walters K, Nazareth I, Petersen I. Statin prescribing for prevention of cardiovascular disease amongst people with severe mental illness: Cohort study in UK primary care. Schizophr Res 2018; 192:219-225. [PMID: 28599749 DOI: 10.1016/j.schres.2017.05.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 05/17/2017] [Accepted: 05/24/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Severe mental illness (SMI) is associated with excess cardiovascular disease (CVD) morbidity, but little is known on provision of preventative interventions. We investigated statin initiation for primary CVD prevention in individuals with and without SMI. METHODS We used primary care data from The Health Improvement Network from 2006 to 2015 for UK patients aged 30-99years with no pre-existing CVD conditions and selected individuals with schizophrenia (n=13,252) or bipolar disorder (n=11,994). In addition, we identified samples of individuals without schizophrenia (n=66,060) and bipolar disorder (n=59,765), but with similar age and gender distribution. Missing data on CVD covariates were estimated using multiple imputation. Statin prescribing differences between individuals with and without SMI were investigated using multivariable Poisson regression models. RESULTS Initiation of statin prescribing was between 2 and 3 fold higher in people aged 30-59years with SMI than in those without after adjusting for CVD covariates. The rates in those aged 60-74years with SMI were similar or slightly higher relative to those without SMI. The incidence rate ratio (IRR) was 1.15 (95% CI 1.03-1.28) for bipolar disorder and 1.00 (0.91-1.11) for schizophrenia. The rate of statin prescribing was lower (IRR 0.81 (0.66-0.98)) amongst the oldest (aged 75+years) with schizophrenia relative to those without schizophrenia. CONCLUSIONS Despite higher rates of new statin prescriptions to younger individuals with SMI relative to individuals without SMI, there was evidence of lower rates of statin initiation for older individuals with schizophrenia, and this group may benefit from additional measures to prevent CVD.
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Affiliation(s)
- R Blackburn
- Division of Psychiatry, W1T 7NF and Institute for Health Informatics, UCL, NW1 2DA, UK.
| | - D Osborn
- Psychiatric Epidemiology, Division of Psychiatry, UCL, W1T 7NF and Camden and Islington NHS Foundation Trust, London NW1 0PE, UK
| | - K Walters
- Primary Care and Population Health, UCL, NW3 2PF, UK
| | - I Nazareth
- Primary Care and Population Health, UCL, NW3 2PF, UK; Primary Care and Population Science, Primary Care and Population Health, UCL, NW3 2PF, UK
| | - I Petersen
- Primary Care and Population Health, UCL, NW3 2PF, UK; Epidemiology and Statistics, Primary Care and Population Health, UCL, NW3 2PF, Department of Clinical Epidemiology, Aarhus University, 8200 Aarhus N, Denmark
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Mitchell AJ, Hardy S, Shiers D. Parity of esteem: Addressing the inequalities between mental and physical healthcare. BJPSYCH ADVANCES 2018. [DOI: 10.1192/apt.bp.114.014266] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SummaryParity of esteem means valuing mental health as much as physical health in order to close inequalities in mortality, morbidity or delivery of care. There is clear evidence that patients with mental illness receive inferior medical, surgical and preventive care. This further exacerbated by low help-seeking, high stigma, medication side-effects and relatively low resources in mental healthcare. As a result, patients with severe mental illness die 10–20 years prematurely and have a high rate of cardiometabolic complications and other physical illnesses. Many physical healthcare guidelines and policy recommendations address parity of esteem, but their implementation to date has been poor. All clinicians should be aware that inequalities in care are adversely influencing mental health outcomes, and managers, healthcare organisations and politicians should provide resources and education to address this gap.Learning Objectives• Understand the concept of parity of esteem• Be aware of the current inequalities in mental healthcare• Appreciate how parity of esteem may be improved
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Das-Munshi J, Chang CK, Dutta R, Morgan C, Nazroo J, Stewart R, Prince MJ. Ethnicity and excess mortality in severe mental illness: a cohort study. Lancet Psychiatry 2017; 4:389-399. [PMID: 28330589 PMCID: PMC5406616 DOI: 10.1016/s2215-0366(17)30097-4] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 01/25/2017] [Accepted: 01/27/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND Excess mortality in severe mental illness (defined here as schizophrenia, schizoaffective disorders, and bipolar affective disorders) is well described, but little is known about this inequality in ethnic minorities. We aimed to estimate excess mortality for people with severe mental illness for five ethnic groups (white British, black Caribbean, black African, south Asian, and Irish) and to assess the association of ethnicity with mortality risk. METHODS We conducted a longitudinal cohort study of individuals with a valid diagnosis of severe mental illness between Jan 1, 2007, and Dec 31, 2014, from the case registry of the South London and Maudsley Trust (London, UK). We linked mortality data from the UK Office for National Statistics for the general population in England and Wales to our cohort, and determined all-cause and cause-specific mortality by ethnicity, standardised by age and sex to this population in 2011. We used Cox proportional hazards regression to estimate hazard ratios and a modified Cox regression, taking into account competing risks to derive sub-hazard ratios, for the association of ethnicity with all-cause and cause-specific mortality. FINDINGS We identified 18 201 individuals with a valid diagnosis of severe mental illness (median follow-up 6·36 years, IQR 3·26-9·92), of whom 1767 died. Compared with the general population, age-and-sex-standardised mortality ratios (SMRs) in people with severe mental illness were increased for a range of causes, including suicides (7·65, 95% CI 6·43-9·04), non-suicide unnatural causes (4·01, 3·34-4·78), respiratory disease (3·38, 3·04-3·74), cardiovascular disease (2·65, 2·45-2·86), and cancers (1·45, 1·32-1·60). SMRs were broadly similar in different ethnic groups with severe mental illness, although the south Asian group had a reduced SMR for cancer mortality (0·49, 0·21-0·96). Within the cohort with severe mental illness, hazard ratios for all-cause mortality and sub-hazard ratios for natural-cause and unnatural-cause mortality were lower in most ethnic minority groups relative to the white British group. INTERPRETATION People with severe mental illness have excess mortality relative to the general population irrespective of ethnicity. Among those with severe mental illness, some ethnic minorities have lower mortality than the white British group, for which the reasons deserve further investigation. FUNDING UK Health Foundation and UK Academy of Medical Sciences.
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Affiliation(s)
- Jayati Das-Munshi
- Department of Health Services and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
| | - Chin-Kuo Chang
- Academic Department of Psychological Medicine, King's College London, London, UK
| | - Rina Dutta
- Academic Department of Psychological Medicine, King's College London, London, UK
| | - Craig Morgan
- Department of Health Services and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - James Nazroo
- Cathie Marsh Institute for Social Research, University of Manchester, Manchester, UK
| | - Robert Stewart
- Academic Department of Psychological Medicine, King's College London, London, UK
| | - Martin J Prince
- Department of Health Services and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Smoking cessation interventions for patients with coronary heart disease and comorbidities: an observational cross-sectional study in primary care. Br J Gen Pract 2016; 67:e118-e129. [PMID: 27919936 DOI: 10.3399/bjgp16x688405] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 09/22/2016] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Little is known about how smoking cessation practices in primary care differ for patients with coronary heart disease (CHD) who have different comorbidities. AIM To determine the association between different patterns of comorbidity and smoking rates and smoking cessation interventions in primary care for patients with CHD. DESIGN AND SETTING Cross-sectional study of 81 456 adults with CHD in primary care in Scotland. METHOD Details of eight concordant physical comorbidities, 23 discordant physical comorbidities, and eight mental health comorbidities were extracted from electronic health records between April 2006 and March 2007. Multilevel binary logistic regression models were constructed to determine the association between these patterns of comorbidity and smoking status, smoking cessation advice, and smoking cessation medication (nicotine replacement therapy) prescribed. RESULTS The most deprived quintile had nearly three times higher odds of being current smokers than the least deprived (odds ratio [OR] 2.76; 95% confidence interval [CI] = 2.49 to 3.05). People with CHD and two or more mental health comorbidities had more than twice the odds of being current smokers than those with no mental health conditions (OR 2.11; 95% CI = 1.99 to 2.24). Despite this, those with two or more mental health comorbidities (OR 0.77; 95% CI = 0.61 to 0.98) were less likely to receive smoking cessation advice, but absolute differences were small. CONCLUSION Patterns of comorbidity are associated with variation in smoking status and the delivery of smoking cessation advice among people with CHD in primary care. Those from the most deprived areas and those with mental health problems are considerably more likely to be current smokers and require additional smoking cessation support.
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