Psychosis Research Unit, Aarhus University Hospital , Risskov , Denmark.
Department of Clinical Medicine, Aarhus University , Aarhus N , Denmark.
Scand J Prim Health Care. 2019 Sep;37(3):358-365. doi: 10.1080/02813432.2019.1639927. Epub 2019 Jul 12.
Schizophrenia is associated with high mortality, somatic comorbidity and reduced life expectancy. The general practitioner (GP) plays a key role in the treatment of mental and physical multimorbidity. Nevertheless, it is unclear how much individuals with schizophrenia use primary healthcare. This study aims to investigate the yearly numbers of consultations in general practice for individuals with schizophrenia. We performed a population-based matched cohort study of 21,757 individuals with schizophrenia and 435,140 age- and gender-matched references from Danish National Registers. Monthly general practice consultations were analysed using a generalized linear model with log link and assuming negative binomial distribution. Consultation rates in general practice up to17 years after index diagnosis. Individuals with schizophrenia attended their GP more than references throughout the study period. The cases had 82% (95% CI: 78-87) and 76% (95% CI: 71-80) more consultations in primary care after 1 year and 5 years, respectively. Individuals with both schizophrenia and comorbid somatic illness attended even more. Individuals with schizophrenia are in regular contact with their GP, especially if they have comorbid illnesses. Whether an average of six consultations per year for individuals with schizophrenia is sufficient is up for debate. The study demonstrates a potential for an increased prevention and treatment of individuals with schizophrenia in general practice. KEY POINTS Schizophrenia is associated with high mortality, somatic comorbidity and reduced life expectancy. Little is known about the attendance pattern in primary care for individuals with schizophrenia. •We found high attendance rates in primary care for individuals diagnosed with schizophrenia from index diagnosis and at least 17 years after diagnosis, which suggests opportunities for earlier intervention to improve their somatic health. •We found an association between high illness comorbidity and increased risk of not attending the general practitioner. The most severely somatically and mentally ill individuals may thus be difficult to reach and support in the current healthcare system.
精神分裂症与高死亡率、躯体共病和预期寿命缩短有关。全科医生（GP）在治疗精神和躯体共病方面发挥着关键作用。然而，目前尚不清楚精神分裂症患者对初级保健的使用程度。本研究旨在调查精神分裂症患者每年在全科医生处就诊的次数。
我们对丹麦国家登记册中的 21757 名精神分裂症患者和 435140 名年龄和性别匹配的对照者进行了一项基于人群的匹配队列研究。使用对数链接和负二项分布的广义线性模型分析每月的全科医生咨询次数。
索引诊断后 17 年内的全科医生咨询次数。
在整个研究期间，精神分裂症患者就诊次数均高于对照者。在第 1 年和第 5 年，病例在初级保健中的就诊次数分别增加了 82%（95%CI：78-87）和 76%（95%CI：71-80）。同时患有精神分裂症和躯体共病的患者就诊次数更多。
精神分裂症患者与他们的全科医生保持定期联系，尤其是如果他们患有共病。每年为精神分裂症患者提供六次咨询是否足够仍存在争议。本研究表明，在全科医生中对精神分裂症患者进行更多的预防和治疗具有潜力。
关键点
精神分裂症与高死亡率、躯体共病和预期寿命缩短有关。
对于精神分裂症患者在初级保健中的就诊模式知之甚少。
我们发现，从诊断索引开始，至少在诊断后 17 年内，精神分裂症患者在初级保健中的就诊率很高，这表明有机会进行早期干预以改善他们的躯体健康。
我们发现高疾病共病与不就诊全科医生的风险增加之间存在关联。
因此，最严重的躯体和精神疾病患者可能难以在当前的医疗保健系统中得到治疗和支持。
