Université Paris Diderot, Sorbonne Paris Cité, ECEVE, UMR 1123, Paris 75010, France.
Inserm, ECEVE, U1123, Paris 75010, France.
Epidemiol Psychiatr Sci. 2019 Oct;28(5):495-507. doi: 10.1017/S2045796018000203. Epub 2018 Apr 25.
AIMS.: People with a mental illness have a shorter lifespan and higher rates of somatic illnesses than the general population. They also face multiple barriers which interfere with access to healthcare. Our objective was to assess the effect of mental illness on the timeliness and optimality of access to healthcare for somatic reasons by comparing indicators reflecting the quality of prior somatic care in hospitalised patients.
METHODS.: An observational nation-wide study was carried out using exhaustive national hospital discharge databases for the years 2009-2013. All adult inpatient stays for somatic reasons in acute care hospitals were included with the exception of obstetrics and day admissions. Admissions with coding errors were excluded. Patients with a mental illness were identified by their admissions for a psychiatric reason and/or contacts with psychiatric hospitals. The quality of prior somatic care was assessed using the number of admissions, admissions through the emergency room (ER), avoidable hospitalisations, high-severity hospitalisations, mean length of stay (LOS) and in-hospital death. Generalised linear models studied the factors associated with poor quality of primary care.
RESULTS.: A total of 17 620 770 patients were included, and 6.58% had been admitted at least once for a mental illness, corresponding to 8.96% of hospital admissions. Mentally ill patients were more often hospitalised (+41% compared with non-mentally patients) and for a longer LOS (+16%). They also had more high-severity hospitalisations (+77%), were more often admitted to the ER (+113%) and had more avoidable hospitalisations (+50%). After adjusting for other covariates, regression models found that suffering from a mental illness was significantly associated with a worse state for each indicator of the quality of care except in-hospital death.
CONCLUSION.: Inadequate primary care of mentally ill patients leads to more serious conditions upon admission to hospital and avoidable hospitalisations. It is, therefore, necessary to improve primary care and prevention for those patients.
与普通人群相比，患有精神疾病的人群寿命更短，患躯体疾病的比率更高。他们还面临着多种障碍，这些障碍干扰了他们获得医疗保健的机会。我们的目的是通过比较反映住院患者先前躯体护理质量的指标，评估精神疾病对因躯体原因获得医疗保健的及时性和优化程度的影响。
本研究采用了一项全国性的观察性研究，利用 2009-2013 年详尽的全国住院患者数据库进行。所有因急性疾病在急性护理医院住院的成年患者均包括在内，但产科和日间入院除外。排除编码错误的入院患者。通过入院的精神科原因和/或与精神科医院的接触来识别患有精神疾病的患者。通过入院次数、通过急诊室（ER）入院、可避免的住院、高严重程度的住院、平均住院时间（LOS）和院内死亡来评估先前躯体护理的质量。广义线性模型研究了与初级保健质量差相关的因素。
共纳入 17620770 名患者，其中 6.58%至少因精神疾病入院一次，占总入院人数的 8.96%。与非精神疾病患者相比，精神疾病患者住院次数更多（增加 41%），住院时间更长（增加 16%）。他们也有更多的高严重程度住院（增加 77%），更多的人被收入急诊室（增加 113%），更多的可避免住院（增加 50%）。在调整其他协变量后，回归模型发现，与非精神疾病患者相比，患有精神疾病与每个护理质量指标的状态恶化显著相关，除了院内死亡率。
对精神疾病患者的初级保健不足导致入院时病情更严重，可避免的住院治疗更多。因此，有必要改善这些患者的初级保健和预防措施。
