School of Population Health, The University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia.
BMC Psychiatry. 2011 Oct 10;11:163. doi: 10.1186/1471-244X-11-163.
Emerging evidence indicates an association between mental illness and poor quality of physical health care. To test this, we compared mental health clients (MHCs) with non-MHCs on potentially preventable hospitalisations (PPHs) as an indicator of the quality of primary care received.
Population-based retrospective cohort study of 139,208 MHCs and 294,180 matched non-MHCs in Western Australia from 1990 to 2006, using linked data from electoral roll registrations, mental health registry (MHR) records, hospital inpatient discharges and deaths. We used the electoral roll data as the sampling frame for both cohorts to enhance internal validity of the study, and the MHR to separate MHCs from non-MHCs. Rates of PPHs (overall and by PPH category and medical condition) were compared between MHCs, category of mental disorders and non-MHCs. Multivariate negative binomial regression analyses adjusted for socio-demographic factors, case mix and the year at the start of follow up due to dynamic nature of study cohorts.
PPHs accounted for more than 10% of all hospital admissions in MHCs, with diabetes and its complications, adverse drug events (ADEs), chronic obstructive pulmonary disease (COPD), convulsions and epilepsy, and congestive heart failure being the most common causes. Compared with non-MHCs, MHCs with any mental disorders were more likely to experience a PPH than non-MHCs (overall adjusted rate ratio (ARR) 2.06, 95% confidence interval (CI) 2.03-2.09). ARRs of PPHs were highest for convulsions and epilepsy, nutritional deficiencies, COPD and ADEs. The ARR of a PPH was highest in MHCs with alcohol/drug disorders, affective psychoses, other psychoses and schizophrenia.
MHCs have a significantly higher rate of PPHs than non-MHCs. Improving primary and secondary prevention is warranted in MHCs, especially at the primary care level, despite there may be different thresholds for admission in people with established physical disease that is influenced by whether or not they have comorbid mental illness.
新出现的证据表明，精神疾病与身体健康护理质量差之间存在关联。为了验证这一点，我们将心理健康患者（MHC）与非 MHC 患者进行了比较，以潜在可预防的住院治疗（PPH）作为衡量初级保健质量的指标。
这是一项基于人群的回顾性队列研究，纳入了 1990 年至 2006 年期间澳大利亚西部的 139208 名 MHC 和 294180 名匹配的非 MHC 患者，数据来自选民登记册、心理健康登记册（MHR）记录、医院住院和死亡记录的链接。我们使用选民登记册数据作为两个队列的抽样框架，以增强研究的内部有效性，并使用 MHR 将 MHC 与非 MHC 患者区分开来。比较了 MHC、精神障碍类别和非 MHC 患者的 PPH 发生率（总体和按 PPH 类别和医疗条件）。由于研究队列的动态性质，多变量负二项回归分析调整了社会人口因素、病例组合和随访开始时的年份。
PPH 占 MHC 患者所有住院治疗的 10%以上，最常见的原因是糖尿病及其并发症、药物不良反应（ADE）、慢性阻塞性肺疾病（COPD）、癫痫发作和癫痫、充血性心力衰竭。与非 MHC 患者相比，任何精神障碍的 MHC 患者发生 PPH 的可能性都高于非 MHC 患者（总体调整后的发病率比（ARR）为 2.06，95%置信区间（CI）为 2.03-2.09）。癫痫发作和癫痫、营养缺乏、COPD 和 ADE 的 PPH ARR 最高。酒精/药物障碍、情感性精神病、其他精神病和精神分裂症 MHC 的 PPH ARR 最高。
MHC 患者的 PPH 发生率明显高于非 MHC 患者。尽管在患有已确诊的身体疾病的人群中，入院的门槛可能因是否患有共病精神疾病而有所不同，但仍需要在 MHC 患者中加强初级和二级预防，尤其是在初级保健层面。
