Fleury Marie-Josée, Fortin Marilyn, Rochette Louis, Grenier Guy, Huỳnh Christophe, Pelletier Éric, Vasiliadis Helen-Maria
Department of Psychiatry, McGill University, Montreal, QC, Canada.
Douglas Mental Health University Institute Research Centre, 6875 LaSalle Blvd., Montreal, QC, H4H 1R3, Canada.
BMC Emerg Med. 2019 Jan 15;19(1):8. doi: 10.1186/s12873-019-0223-8.
This descriptive study compared 2014-15 to 2005-06 data on the quality of mental health services (MHS) in relation to emergency room (ER) use to assess the impact of the 2005 Quebec MH reform regarding access, continuity and appropriateness of care for patients with mental illnesses (PMI).
Data emanated from the Quebec Integrated Chronic Disease Surveillance System (Quebec/Canada). Participants (865,255 for 2014-15; 817,395 for 2005-06) were age 12 or over, with at least one MI, including substance use disorders (SUD), diagnosed during an ER visit, outpatient treatment or hospitalization. Variables included: access (ER use/frequency, hospitalization rates, outpatient consultations preceding an ER visit), care continuity (outpatient consultations following an ER visit/hospitalization, consecutive returns to the ERs), and care appropriateness (high ER use, recurrence of yearly ER visits, length of hospitalization). Frequency distributions were calculated on sex, age and geographic area for ER visits/hospitalizations in 2014-15, and between 2014 and 15 and 2005-06.
PMI accounted for 12 % of the Quebec population in 2014-15 (n = 865,255), of whom 39% visited an ER for any reason. Amount and frequency of ER use and number/length of hospitalizations were almost twice as high for PMI versus patients without MI; 17% of PMI were also high/very high ER users and were frequently hospitalized. Among PMI, ER users were also frequent users of outpatient services despite a lack of follow-up appointments after ER visits or hospitalizations. Findings revealed some positive changes over time, such as decreased ER and hospitalization rates; yet overall access, continuity and appropriateness of care, as measured in this study, remained low.
This study demonstrated that the Quebec reform did not produce a substantial impact on ER use or substantially improved care, as hypothesized. Better access and continuity of care should be promoted to reduce the high prevalence of ER use among PMI. Quality improvement in MHS may be realized if ERs are supported by substantial and well-integrated community MH networks.
本描述性研究比较了2014 - 15年与2005 - 06年心理健康服务（MHS）质量与急诊室（ER）使用情况的数据，以评估2005年魁北克心理健康改革对精神疾病（PMI）患者护理的可及性、连续性和适宜性的影响。
数据源自魁北克综合慢性病监测系统（加拿大魁北克）。参与者（2014 - 15年为865,255人；2005 - 06年为817,395人）年龄在12岁及以上，在急诊就诊、门诊治疗或住院期间至少被诊断出患有一种精神疾病，包括物质使用障碍（SUD）。变量包括：可及性（急诊使用/频率、住院率、急诊就诊前的门诊咨询）、护理连续性（急诊就诊/住院后的门诊咨询、再次前往急诊室）以及护理适宜性（急诊高使用、每年急诊就诊复发、住院时长）。计算了2014 - 15年以及2014 - 15年与2005 - 06年期间按性别、年龄和地理区域划分的急诊就诊/住院的频率分布。
2014 - 15年，精神疾病患者占魁北克人口的12%（n = 865,255），其中39%因任何原因前往急诊室就诊。与无精神疾病的患者相比，精神疾病患者的急诊使用量和频率以及住院次数/时长几乎高出一倍；17%的精神疾病患者也是急诊高使用或非常高使用人群，且频繁住院。在精神疾病患者中，尽管急诊就诊或住院后缺乏随访预约，但急诊使用者也是门诊服务的频繁使用者。研究结果显示随着时间推移有一些积极变化，如急诊和住院率下降；然而，本研究衡量的护理总体可及性、连续性和适宜性仍然较低。
本研究表明，魁北克改革并未如预期那样对急诊使用产生重大影响或显著改善护理。应促进更好的护理可及性和连续性，以降低精神疾病患者中急诊高使用率。如果急诊室得到强大且整合良好的社区心理健康网络的支持，心理健康服务质量可能会得到提升。
