Faculty of Medicine, University of Calgary, 3280 Hospital Dr., N.W., Ground Floor, Room GE61, Calgary, Alberta T2N 4Z6, Canada.
Psychiatr Serv. 2012 Mar;63(3):237-42. doi: 10.1176/appi.ps.201000363.
Whether access to primary and specialist care has an impact on treatment for people with schizophrenia and comorbid cardiac disease is unclear. The objective of this study was to compare use of general health care and specialized cardiac care by people with schizophrenia and by the rest of the population.
A population-based period-prevalence study was conducted and included adults (N=2,310,391) in Alberta, Canada, by using administrative databases. People with schizophrenia were identified based on billing codes; all others served as the comparator cohort. Multivariable logistic regression analyses were conducted to compare claims for general (general practitioner visits) health care, urgent and emergent (emergency department visits and hospitalizations) health services, and specialized cardiac (cardiologist visits, revascularization) care.
Individuals with schizophrenia (N=28,755) had a higher prevalence of coronary artery disease than those without schizophrenia (N=2,281,636) (20% versus 14%) and were more likely than those without schizophrenia to visit a general practitioner more than four times per year (76% versus 47%; adjusted odds ratio [AOR]=3.60, 95% confidence interval [CI]=3.49-3.71). In contrast, individuals with schizophrenia and coronary artery disease were less likely to visit a cardiologist (50% versus 59%; AOR=. 76, 95% CI=.72-.80) or undergo coronary revascularization (6% versus 12%; AOR=. 55, 95% CI=.49-.61).
In this large population-based study, individuals with schizophrenia were less likely to visit cardiologists or undergo revascularization than were people without schizophrenia. Opportunities exist for better assessment and management of cardiovascular disease and risk factors among people with schizophrenia.
尚不清楚初级保健和专科医疗的可及性是否会对伴有合并心脏疾病的精神分裂症患者的治疗产生影响。本研究的目的是比较精神分裂症患者和普通人群对一般医疗保健和专门心脏护理的使用情况。
本项基于人群的患病率研究采用了加拿大艾伯塔省的行政数据库，纳入了成年人（N=2,310,391）。根据计费代码确定精神分裂症患者；其余所有人均作为对照组。采用多变量逻辑回归分析比较了一般（全科医生就诊）医疗保健、紧急和紧急（急诊就诊和住院）医疗服务以及专门心脏（心脏病专家就诊、血运重建）护理的就诊情况。
患有精神分裂症的个体（N=28,755）比没有精神分裂症的个体（N=2,281,636）更常见冠状动脉疾病（20%比 14%），并且比没有精神分裂症的个体更有可能每年就诊全科医生超过四次（76%比 47%；调整后的优势比 [AOR]=3.60，95%置信区间 [CI]=3.49-3.71）。相比之下，患有精神分裂症和冠状动脉疾病的个体更不可能看心脏病专家（50%比 59%；AOR=.76，95% CI=.72-.80）或接受冠状动脉血运重建（6%比 12%；AOR=.55，95% CI=.49-.61）。
在这项大型基于人群的研究中，与没有精神分裂症的个体相比，精神分裂症患者看心脏病专家或接受血运重建的可能性较低。在精神分裂症患者中，存在更好地评估和管理心血管疾病及其危险因素的机会。
