Department of Family and Community Medicine, North York General Hospital, Toronto, Canada.
Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada.
PLoS One. 2019 Jan 7;14(1):e0210214. doi: 10.1371/journal.pone.0210214. eCollection 2019.
People with serious mental illness die 10-25 years sooner than people without these conditions. Multiple challenges to accessing and benefitting from healthcare have been identified amongst this population, including a lack of coordination between mental health services and general health services. It has been identified in other conditions such as diabetes that accurate documentation of diagnosis in the primary care chart is associated with better quality of care. It is suspected that if a patient admitted to the hospital with serious mental illness is then discharged without adequate identification of their diagnosis in the primary care setting, follow up (such as medication management and care coordination) may be more difficult. We identified cohorts of patients with schizophrenia and bipolar disorder who accessed care through the North York Family Health Team (a group of 77 family physicians in Toronto, Canada) and North York General Hospital (a large community hospital) between January 1, 2012 and December 31, 2014. We identified whether labeling for these conditions was concordant between the two settings and explored predictors of concordant labeling. This was a retrospective cross-sectional study using de-identified data from the Health Databank Collaborative, a linked primary care-hospital database. We identified 168 patients with schizophrenia and 370 patients with bipolar disorder. Overall diagnostic concordance between primary care and hospital records was 23.2% for schizophrenia and 15.7% for bipolar disorder. Concordance was higher for those with multiple (2+) inpatient visits (for schizophrenia: OR 2.42; 95% CI 0.64-9.20 and for bipolar disorder: OR 8.38; 95% CI 3.16-22.22). Capture-recapture modeling estimated that 37.4% of patients with schizophrenia (95% CI 20.7-54.1) and 39.6% with bipolar disorder (95% CI 25.7-53.6) had missing labels in both settings when adjusting for patients' age, sex, income quintiles and co-morbidities. In this sample of patients accessing care at a large family health team and community hospital, concordance of diagnostic information about serious mental illness was low. Interventions should be developed to improve diagnosis and continuity of care across multiple settings.
患有严重精神疾病的人比没有这些疾病的人早逝 10-25 年。在这一人群中，已经发现了许多获得和受益于医疗保健的挑战，包括精神卫生服务和一般健康服务之间缺乏协调。在其他疾病（如糖尿病）中已经发现，在初级保健图表中准确记录诊断与更好的护理质量相关。有人怀疑，如果因严重精神疾病住院的患者在初级保健环境中出院时没有充分识别其诊断，那么后续（如药物管理和护理协调）可能会更加困难。我们确定了一组在 2012 年 1 月 1 日至 2014 年 12 月 31 日期间通过北约克家庭健康团队（加拿大多伦多的 77 名家庭医生小组）和北约克综合医院（一家大型社区医院）获得护理的精神分裂症和双相情感障碍患者队列。我们确定了这两种环境之间这些疾病的标签是否一致，并探讨了一致标签的预测因素。这是一项使用健康数据银行协作（一个链接的初级保健-医院数据库）的匿名数据进行的回顾性横断面研究。我们确定了 168 名精神分裂症患者和 370 名双相情感障碍患者。初级保健和医院记录之间的总体诊断一致性为精神分裂症的 23.2%，双相情感障碍的 15.7%。对于有多次（2+）住院就诊的患者，一致性更高（精神分裂症：OR 2.42；95%CI 0.64-9.20；双相情感障碍：OR 8.38；95%CI 3.16-22.22）。捕获-再捕获模型估计，在校正患者的年龄、性别、收入五分位数和合并症后，有 37.4%（95%CI 20.7-54.1）的精神分裂症患者和 39.6%（95%CI 25.7-53.6）在两个环境中都有缺失标签。在这个在大型家庭健康团队和社区医院接受治疗的患者样本中，严重精神疾病的诊断信息一致性很低。应制定干预措施以改善多个环境中的诊断和护理连续性。
