Arthur Labatt Family School of Nursing (Booth), Western University; ICES Western (Richard, Li, Shariff), London, Ont.; Alliance for Healthier Communities (Rayner), Toronto, Ont
Arthur Labatt Family School of Nursing (Booth), Western University; ICES Western (Richard, Li, Shariff), London, Ont.; Alliance for Healthier Communities (Rayner), Toronto, Ont.
CMAJ Open. 2020 May 23;8(2):E391-E399. doi: 10.9778/cmajo.20190089. Print 2020 Apr-Jun.
Community Health Centre (CHC) client populations with a history of mental illness or substance use disorders, or both, are not described well in the literature. We identified CHC clients in Ontario with a history of health care related to mental health or substance use disorders, or both, and describe their demographic characteristics, health system use and related health risks in comparison to other people in the province with similar diagnoses who did not use CHC services.
We conducted a population-based cohort study using provincial health administrative data among Ontario residents aged 21-105 years with a previously established medical history of a mental illness or substance use disorder, or both. We examined 3 groups: clients of CHC sites that serve at-risk priority populations (PPCHCs) who presented for care at a CHC between Apr. 1, 2014, and Mar. 31, 2015, clients of CHC sites that serve nonpriority populations (NPPCHCs) who presented for care at a CHC over the same period, and a community control group of patients with a history of health care use related to mental illness or substance use disorders, or both, in the 2 years before the index date who were not CHC clients. We used descriptive statistics and multivariable logistic regression to estimate the odds of psychiatric care and emergency department use within 1 year of the index date.
Compared to the community control patients ( = 1 673 200), clients of PPCHCs ( = 6575) and NPPCHCs ( = 15 208) were younger, experienced more residential instability and had an increased prevalence of medical comorbidities; they had higher odds of receiving care from a psychiatrist (adjusted odds ratio [OR] 1.26, 95% confidence interval [CI] 1.20-1.33, and 1.47, 95% CI 1.41-1.53, respectively) and visiting an emergency department (adjusted OR 1.15, 95% CI 1.10-1.20, and 1.13, 95% CI 1.09-1.17, respectively) in the 1-year follow-up period.
Ontario CHC clients with mental health or substance use disorders had medically complex needs and were intensive users of the health care system. Specific interventions should be developed to better serve this vulnerable population.
社区健康中心（CHC）的客户群体中，有精神疾病或药物使用障碍病史，或兼有这两种病史的人，在文献中并未得到充分描述。我们确定了安大略省有过与精神健康或药物使用障碍相关的医疗保健史，或兼有这两种病史的 CHC 客户，并描述了他们的人口统计学特征、卫生系统使用情况和相关健康风险，同时与该省具有类似诊断但未使用 CHC 服务的人群进行了比较。
我们使用省级卫生行政数据进行了一项基于人群的队列研究，该研究纳入了年龄在 21-105 岁之间的安大略省居民，这些居民之前有过精神疾病或药物使用障碍的病史，或兼有这两种病史。我们研究了三组人群：2014 年 4 月 1 日至 2015 年 3 月 31 日期间在为高危优先人群提供服务的 CHC 站点就诊的 CHC 客户（高危优先人群 CHC 客户）、在同期在为非优先人群提供服务的 CHC 站点就诊的 CHC 客户（非优先人群 CHC 客户），以及在索引日期前 2 年内有过与精神疾病或药物使用障碍相关的医疗保健使用史但不是 CHC 客户的社区对照组患者。我们使用描述性统计和多变量逻辑回归来估计在索引日期后 1 年内接受精神病护理和急诊治疗的几率。
与社区对照组患者（n=1673200）相比，高危优先人群 CHC 客户（n=6575）和非优先人群 CHC 客户（n=15208）年龄较小，经历了更多的居住不稳定，并有更高的共病患病率；他们接受精神科医生治疗的几率更高（调整后的优势比[OR]为 1.26，95%置信区间[CI]为 1.20-1.33，和 1.47，95%CI 为 1.41-1.53，分别），并且在 1 年的随访期间去急诊的几率更高（调整后的 OR 为 1.15，95%CI 为 1.10-1.20，和 1.13，95%CI 为 1.09-1.17，分别）。
安大略省有精神健康或药物使用障碍的 CHC 客户有复杂的医疗需求，并且是卫生保健系统的密集使用者。应制定具体的干预措施，以更好地为这一弱势群体服务。
