Gandré Coralie, Gervaix Jeanne, Thillard Julien, Macé Jean-Marc, Roelandt Jean-Luc, Chevreul Karine
ECEVE, UMRS 1123, Université Paris Diderot, Sorbonne Paris Cité, INSERM, Paris, France.
AP-HP, URC Eco, Paris, France.
BMC Health Serv Res. 2018 Apr 6;18(1):253. doi: 10.1186/s12913-018-3064-3.
Involuntary psychiatric care remains controversial. Geographic disparities in its use can challenge the appropriateness of the care provided when they do not result from different health needs of the population. These disparities should be reduced through dedicated health policies. However, their association with the supply of health and social care, which could be targeted by such policies, has been insufficiently studied. Our objectives were therefore to describe geographic variations in involuntary admission rates across France and to identify the characteristics of the supply of care which were associated with these variations.
Involuntary admission rate per 100,000 adult inhabitants was calculated in French psychiatric sectors' catchment areas using 2012 data from the national psychiatric discharge database. Its variations were first described numerically and graphically. Several factors potentially associated with these variations were then considered in a negative binomial regression with an offset term accounting for the size of catchment areas. They included characteristics of the supply of care (public and private care, health and social care, hospital and community-based care, specialised and non-specialised care) as well as adjustment factors related to epidemiological characteristics of the population of each sector's catchment area and its level of urbanization. Such variables were extracted from complementary administrative databases. Supply characteristics associated with geographic variations were identified using a significance level of 0.05.
Significant variations in involuntary admission rates were observed between psychiatric sectors' catchment areas with a coefficient of variation close to 80%. These variations were associated with some characteristics of the supply of health and social care in the sectors' catchment areas. Notably, an increase in the availability of community-based private psychiatrists and the capacity of housing institutions for disabled individuals was associated with a decrease in involuntary admission rates while an increase in the availability of general practitioners was associated with an increase in those rates.
There is evidence of considerable variations in involuntary admission rates between psychiatric sectors' catchment areas. Our results provide lines of thoughts to reduce such variations, in particular by supporting an increase in the availability of upstream and downstream care in the community.
非自愿精神科护理仍存在争议。当非自愿精神科护理的使用存在地理差异并非源于人群不同的健康需求时，这些差异会对所提供护理的适宜性构成挑战。应通过专门的卫生政策来减少这些差异。然而，它们与卫生和社会护理供应之间的关联（而此类政策可能针对的正是这种供应）尚未得到充分研究。因此，我们的目标是描述法国各地非自愿住院率的地理差异，并确定与这些差异相关的护理供应特征。
利用国家精神科出院数据库2012年的数据，计算法国精神科部门服务区域内每10万成年居民的非自愿住院率。首先以数字和图表形式描述其差异。然后，在负二项回归中考虑几个可能与这些差异相关的因素，并设置一个偏移项以考虑服务区域的规模。这些因素包括护理供应特征（公立和私立护理、卫生和社会护理、医院和社区护理、专科和非专科护理）以及与每个部门服务区域人口的流行病学特征及其城市化水平相关的调整因素。此类变量从补充行政数据库中提取。使用0.05的显著性水平确定与地理差异相关的供应特征。
在精神科部门服务区域之间观察到非自愿住院率存在显著差异，变异系数接近80%。这些差异与部门服务区域内卫生和社会护理供应的某些特征相关。值得注意的是，社区私立精神科医生的可及性增加以及残疾人住房机构的容量增加与非自愿住院率降低相关，而全科医生的可及性增加则与非自愿住院率升高相关。
有证据表明精神科部门服务区域之间的非自愿住院率存在相当大的差异。我们的结果为减少此类差异提供了思路，特别是通过支持增加社区上下游护理的可及性。
