Kurdyak Paul, Vigod Simone, Duchen Raquel, Jacob Binu, Stukel Thérèse, Kiran Tara
Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Women's College Hospital, Toronto, Ontario, Canada; Women's College Research Institute, Toronto, Ontario, Canada.
Gen Hosp Psychiatry. 2017 May;46:7-13. doi: 10.1016/j.genhosppsych.2017.02.001. Epub 2017 Feb 11.
Individuals with schizophrenia are more likely to develop diabetes than individuals without schizophrenia. The objective of this study was to determine the quality of diabetes care and diabetes-related health outcomes among individuals with and without schizophrenia.
We conducted a retrospective cohort study. As of April 1, 2011, we identified all individuals with diabetes in Ontario with and without a diagnosis of schizophrenia. The main outcomes were quality of diabetes care (guideline-concordant testing for HbA1c, lipid testing, eye exams) and diabetes-related Emergency Department (ED) visits and hospitalizations between April 1, 2011 and March 31, 2013. We compared quality of care and diabetes outcomes among those with and without schizophrenia, adjusting for demographic, illness severity, and health service utilization variables.
We identified 1,131,375 individuals with diabetes, among whom 25,628 (2.3%) had schizophrenia. Schizophrenia was associated with reduced likelihood of optimal diabetes care (all 3 of HbA1c, lipid testing, and eye exams) (adjusted OR (95% CI): 0.64 (0.61-0.67)) and increased likelihood of diabetes-related ED visits (adjusted OR (95% CI): 1.34 (1.28-1.41)) and hospitalizations (adjusted OR (95% CI): 1.36 (1.28-1.43)).
Individuals with diabetes and schizophrenia have lower rates of recommended testing and higher rates of diabetes-related hospital visits than those with diabetes but without schizophrenia. Research is needed to understand patient, provider, and system factors underlying these disparities and test related interventions to close the gaps in quality of care.
与无精神分裂症的个体相比，精神分裂症患者患糖尿病的可能性更高。本研究的目的是确定有和无精神分裂症个体的糖尿病护理质量及糖尿病相关健康结局。
我们进行了一项回顾性队列研究。截至2011年4月1日，我们确定了安大略省所有患有和未患有精神分裂症诊断的糖尿病患者。主要结局为糖尿病护理质量（糖化血红蛋白（HbA1c）的指南一致性检测、血脂检测、眼科检查）以及2011年4月1日至2013年3月31日期间与糖尿病相关的急诊科就诊和住院情况。我们比较了有和无精神分裂症患者的护理质量及糖尿病结局，并对人口统计学、疾病严重程度和卫生服务利用变量进行了调整。
我们确定了1131375例糖尿病患者，其中25628例（2.3%）患有精神分裂症。精神分裂症与最佳糖尿病护理（HbA1c、血脂检测和眼科检查全部达标）可能性降低相关（校正比值比（95%置信区间）：0.64（0.61 - 0.67）），且与糖尿病相关的急诊科就诊（校正比值比（95%置信区间）：1.34（1.28 - 1.41））和住院（校正比值比（95%置信区间）：1.36（1.28 - 1.43））可能性增加相关。
与患有糖尿病但无精神分裂症的患者相比，患有糖尿病和精神分裂症的个体推荐检测率较低，糖尿病相关住院就诊率较高。需要开展研究以了解这些差异背后的患者、医疗服务提供者和系统因素，并测试相关干预措施以缩小护理质量差距。
