Dr. Jørgensen and Prof. Mainz are with the Department of Psychiatry, Aalborg University Hospital, Aalborg, Denmark. Prof. Carinci is with the Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, United Kingdom. Dr. Thomsen and Dr. Johnsen are with the Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
Psychiatr Serv. 2018 Feb 1;69(2):179-185. doi: 10.1176/appi.ps.201600460. Epub 2017 Oct 16.
Patients with schizophrenia have a high prevalence of diabetes, but data on diabetes care quality for these patients are limited. This nationwide study compared the quality of diabetes care among individuals with and without schizophrenia and identified predictors of care quality.
In a population-based cohort study, 83,813 individuals with diabetes seen at hospital outpatient clinics between 2005 and 2013, including 669 with comorbid schizophrenia, were identified from Danish registries. High-quality diabetes care was defined as having received ≥80% of guideline-recommended process performance measures. Variables assessed as predictors of diabetes care included patient-specific (sex, age, smoking, substance abuse, Global Assessment of Functioning score, and duration of schizophrenia), provider-specific (quality of schizophrenia care), and system-specific (annual patient contact volume of the diabetes clinic) factors.
Compared with individuals with diabetes only, those with diabetes and schizophrenia were less likely to receive high-quality diabetes care (relative risk [RR]=.91, 95% confidence interval [CI]=.88-.95) and less likely to receive several individual process performance measures of diabetes care, including blood pressure monitoring (RR=.98, CI=.96-.99), treatment with antihypertensive drugs (RR=.83, CI=.70-.97) and angiotensin-converting enzyme/angiotensin II receptor inhibitors (RR=.72, CI=.55-.93), screening for albuminuria (RR=.96, CI=.93-.99), eye examination at least once every second year (RR=.97, CI=.94-.99), and foot examination (RR=.96, CI=.93-.99). Predictors of poor diabetes care among individuals with schizophrenia included documented drug abuse and low contact volume of the diabetes clinic.
Individuals with schizophrenia received lower-quality diabetes care compared with those without schizophrenia. However, absolute differences in care were modest.
精神分裂症患者糖尿病的患病率较高，但针对这些患者的糖尿病护理质量数据有限。本项全国性研究比较了伴有和不伴有精神分裂症的个体的糖尿病护理质量，并确定了护理质量的预测因素。
在一项基于人群的队列研究中，从丹麦注册处确定了 2005 年至 2013 年期间在医院门诊就诊的 83813 名患有糖尿病的个体（包括 669 名合并精神分裂症的患者）。高质量的糖尿病护理定义为接受了≥80%的指南推荐的流程表现衡量标准。评估的预测糖尿病护理的变量包括患者特异性（性别、年龄、吸烟、物质滥用、总体功能评估评分和精神分裂症持续时间）、提供者特异性（精神分裂症护理质量）和系统特异性（糖尿病诊所的患者年接触量）因素。
与仅患有糖尿病的个体相比，同时患有糖尿病和精神分裂症的个体接受高质量糖尿病护理的可能性更低（相对风险 [RR]=.91，95%置信区间 [CI]=.88-.95），并且更不可能接受几项糖尿病护理的个别流程表现衡量标准，包括血压监测（RR=.98，CI=.96-.99）、使用抗高血压药物治疗（RR=.83，CI=.70-.97）和血管紧张素转换酶/血管紧张素 II 受体抑制剂（RR=.72，CI=.55-.93）、筛查白蛋白尿（RR=.96，CI=.93-.99）、每两年至少进行一次眼部检查（RR=.97，CI=.94-.99）和足部检查（RR=.96，CI=.93-.99）。精神分裂症患者中较差的糖尿病护理预测因素包括记录的药物滥用和糖尿病诊所的接触量低。
与不伴有精神分裂症的个体相比，伴有精神分裂症的个体接受的糖尿病护理质量较低。但是，护理质量的绝对差异较小。
