Institut de Recherche et Documentation en Économie de la Santé (IRDES), 75019 Paris, France.
Int J Environ Res Public Health. 2020 May 12;17(10):3367. doi: 10.3390/ijerph17103367.
Individuals with severe mental illnesses (SMI) face a striking excess and premature mortality which has been demonstrated in several national contexts. This phenomenon, which constitutes a red-flag indicator of public health inequities, can be hypothesized to result from healthcare access issues which have been insufficiently documented so far. In this context, our objective was to explore patterns of general somatic healthcare use of individuals treated for SMI in comparison to those of the general population in France using national health administrative data and a matched case-control study. Differences in the use of general and specific somatic preventive care services, primary care, routine specialized somatic care and admissions to non-psychiatric hospital departments for somatic causes were described between cases and controls after adjustment on differing clinical needs, socio-economic status, and living environment. Our results show a lower use of general preventive care services and of routine specialized somatic care in the SMI population, despite more frequent comorbidities, and a higher occurrence of avoidable hospitalizations, despite higher contacts with primary care physicians. These findings suggest that the health system fails to address the specific needs of this vulnerable population and support the development of measures aimed at reducing this gap.
患有严重精神疾病（SMI）的个体面临着明显的超额和过早死亡，这在几个国家的背景下都得到了证实。这种现象构成了公共卫生不平等的一个明显指标，其原因可能是迄今为止医疗保健获取方面的问题记录不足。在这种情况下，我们的目的是使用国家健康管理数据和匹配的病例对照研究，探讨法国 SMI 治疗个体与一般人群的一般躯体保健使用模式。在调整了不同的临床需求、社会经济地位和生活环境后，描述了病例和对照组之间一般和特定躯体预防保健服务、初级保健、常规专业躯体保健以及因躯体原因住院非精神科病房的使用差异。尽管合并症更为常见，但 SMI 人群中一般预防保健服务和常规专业躯体保健的使用率较低，而尽管与初级保健医生的接触更多，但可避免的住院治疗发生率却更高。这些发现表明，卫生系统未能满足这一脆弱人群的特殊需求，并支持制定旨在缩小这一差距的措施。
