Department of Clinical Medicine, Danish Center for Clinical Health Services Research (DACS), Mølleparkvej 10, Aalborg University.
Psychiatry, Aalborg University Hospital, Mølleparkvej 10, North Denmark Region, Aalborg.
Eur J Emerg Med. 2021 Oct 1;28(5):363-372. doi: 10.1097/MEJ.0000000000000806.
People with mental illness have higher use of emergency services than the general population and may experience problems with navigating in complex healthcare systems. Poor physical health contributes to the excess mortality among the mentally ill.
To compare the level of Emergency Medical Services (EMS) response and subsequent contacts emergency between patients with and without a history of mental illness.
DESIGN, SETTING, AND PARTICIPANTS: A nationwide cohort study was conducted in Denmark including medical 1-1-2 calls 2016 2017. The healthcare system is financed through taxation allowing free access to healthcare services including ambulance services.
Exposed groups had a history of major, moderate, or minor mental illness.
We studied seven national prehospital care Performance Indicators (PI 1-7). The selected PI concerned EMS response levels and subsequent contacts to prehospital and in-hospital services. Exposed groups were compared to nonexposed groups using regression analyses.
We included 492 388 medical 1-1-2 calls: 8, 10, and 18% of calls concerned patients with a history of major, moderate, or minor mental illness, respectively.There were no clinically relevant differences regarding response times (PI 1-2) or registration of symptoms (PI 3) between groups.If only telephone advice was offered, patients with a history of major, moderate or minor mental illness were more likely to recall within 24 h (PI 4): adjusted risk ratio (RR) 2.11 (1.88-2.40), 1.96 (1.20-2.21), and 1.38 (1.20-1.60), but less or equally likely to have an unplanned hospital contact within 7 days (PI 6): adjusted RRs 1.05 (0.99-1.12), 1.04 (0.99-1.10), and 0.90 (0.85-0.94), respectively.If released at the scene, the risk of recalling (PI 5) or having an unplanned hospital contact (PI 7) was higher among patients with a history of mental illness: adjusted RRs 2.86 (2.44-3.36), 2.41 (2.05-2.83), and 1.57 (1.35-1.84), and adjusted RRs 2.10 (1.94-2.28), 1.68 (1.55-1.81), and 1.25 (1.17-1.33), respectively.Patients with a history of mental illness were more likely to receive telephone advice only adjusted RRs 1.61 (1.53-1.70), 1.30 (1.24-1.37), and 1.08 (1.04-1.13), and being released at scene adjusted RRs 1.11 (1.08-1.13), 1.03 (1.01-1.04), and 1.05 (1.03-1.07).
More than one-third of the study population had a history of mental illness. These patients received a significantly lighter EMS response than patients with no history of mental illness. They were significantly more likely to use the emergency care system again if released at scene. This risk increased with the increasing severity of the mental illness.
患有精神疾病的人比一般人群使用紧急服务的频率更高，并且在复杂的医疗保健系统中可能会遇到导航问题。身体健康状况不佳是导致精神疾病患者死亡率过高的原因之一。
比较有和没有精神病史的患者的紧急医疗服务（EMS）反应水平和随后的紧急联系。
设计、地点和参与者：在丹麦进行了一项全国性队列研究，包括 2016 年至 2017 年的医疗 1-1-2 呼叫。该医疗保健系统通过税收资助，允许免费获得包括救护车服务在内的医疗服务。
暴露组有重大、中度或轻度精神病史。
我们研究了七个国家院前护理绩效指标（PI 1-7）。所选 PI 涉及 EMS 反应水平以及随后与院前和院内服务的联系。使用回归分析比较暴露组和非暴露组。
我们纳入了 492388 次医疗 1-1-2 呼叫：分别有 8%、10%和 18%的呼叫涉及有重大、中度或轻度精神病史的患者。在反应时间（PI 1-2）或症状登记（PI 3）方面，各组之间没有临床相关差异。如果仅提供电话咨询，有重大、中度或轻度精神病史的患者在 24 小时内回忆的可能性更高（PI 4）：调整后的风险比（RR）为 2.11（1.88-2.40）、1.96（1.20-2.21）和 1.38（1.20-1.60），但在 7 天内计划外住院联系的可能性更小或相等（PI 6）：调整后的 RR 为 1.05（0.99-1.12）、1.04（0.99-1.10）和 0.90（0.85-0.94）。如果在现场释放，有精神病史的患者回忆（PI 5）或计划外住院联系（PI 7）的风险更高：调整后的 RR 为 2.86（2.44-3.36）、2.41（2.05-2.83）和 1.57（1.35-1.84），以及调整后的 RR 为 2.10（1.94-2.28）、1.68（1.55-1.81）和 1.25（1.17-1.33）。有精神病史的患者更有可能仅接受电话咨询，调整后的 RR 为 1.61（1.53-1.70）、1.30（1.24-1.37）和 1.08（1.04-1.13），以及在现场释放的调整后的 RR 为 1.11（1.08-1.13）、1.03（1.01-1.04）和 1.05（1.03-1.07）。
研究人群中有超过三分之一的人有精神病史。这些患者接受的 EMS 反应明显轻于没有精神病史的患者。如果在现场释放，他们再次使用紧急护理系统的可能性显著增加。这种风险随着精神疾病严重程度的增加而增加。
