Poss Jeffrey, Mitchell Lori, Mah Jasmine, Keefe Janice
School of Public Health and Health Systems, Faculty of Applied Health Sciences, University of Waterloo, Waterloo, ON, Canada.
Winnipeg Regional Health Authority, Winnipeg, MB, Canada.
Front Psychiatry. 2021 Sep 17;12:712112. doi: 10.3389/fpsyt.2021.712112. eCollection 2021.
Publicly funded home care in Canada supports older adults in the community to delay institutional care, which results in complex care populations with multimorbidity that includes mental health problems. The purpose of this study is to examine prevalence of psychiatric diagnoses and other mental health symptoms among older clients in two publicly funded Home Care (HC) Programs and their psychiatry service utilization (psychiatrist visits) after being admitted to home care. This retrospective cohort study examines clients age 60 years and older in the two Canadian provinces of Manitoba (MB), specifically the Winnipeg Regional Health Authority (WRHA) ( = 5,278), and Nova Scotia (NS) ( = 5,323). Clients were admitted between 2011 and 2013 and followed up to 4 years. Linked data sources include the InterRAI Resident Assessment Instrument for Home Care (RAI-HC), physician visit/billing data and hospital admission data. Both regions had similar proportions (53%) of home care clients with one or more psychiatric diagnoses. However, we observed over 10 times the volume of psychiatry visits in the WRHA cohort (8,246 visits vs. 792 visits in NS); this translated into a 4-fold increased likelihood of receiving psychiatry visits (17.2% of WRHA clients vs. 4.2% of NS clients) and 2.5 times more visits on average per client (9.1 avg. visits in MB vs. 3.6 avg. visits in NS). The location of psychiatry services varied, with a greater number of psychiatry visits occurring while in hospital for WRHA HC clients compared to more visits in the community for NS HC clients. Younger age, psychotropic medication use, depressive symptoms, dementia, and having an unstable health condition were significantly associated with receipt of psychiatry visits in both cohorts. Access to psychiatric care differed between the cohorts despite little to no difference in need. We conclude that many home care clients who could have benefitted from psychiatrist visits did not receive them. This is particularly true for rural areas of NS. By linking the RAI-HC with other health data, our study raises important questions about differential access to psychiatry services by site of care (hospital vs. community), by geographical location (MB vs. NS and urban vs. rural) and by age. This has implications for staff training and mental health resources in home care to properly support the mental health needs of clients in care. Study results suggest the need for a mental health strategy within public home care services.
加拿大的公共资助居家护理服务旨在帮助社区中的老年人延迟进入机构护理，这导致了患有多种疾病（包括心理健康问题）的复杂护理人群。本研究的目的是调查两个公共资助居家护理（HC）项目中老年客户的精神疾病诊断和其他心理健康症状的患病率，以及他们入住居家护理后的精神科服务利用率（精神科就诊次数）。这项回顾性队列研究调查了加拿大曼尼托巴省（MB）和新斯科舍省（NS）两个省份60岁及以上的客户，具体来说，曼尼托巴省是温尼伯地区卫生局（WRHA）（n = 5278），新斯科舍省（n = 5323）。客户于2011年至2013年期间入院，并随访4年。相关数据源包括居家护理的InterRAI居民评估工具（RAI-HC）、医生就诊/计费数据和医院入院数据。两个地区患有一种或多种精神疾病诊断的居家护理客户比例相似（53%）。然而，我们观察到WRHA队列中的精神科就诊量是新斯科舍省队列的10倍以上（分别为8246次就诊和792次就诊）；这意味着接受精神科就诊的可能性增加了4倍（WRHA客户中有17.2%接受了精神科就诊，而新斯科舍省客户中这一比例为4.2%），且每位客户的平均就诊次数多了2.5倍（曼尼托巴省平均每位客户就诊9.1次，新斯科舍省为3.6次）。精神科服务的地点各不相同，WRHA居家护理客户在医院接受精神科就诊的次数更多，而新斯科舍省居家护理客户在社区接受的就诊次数更多。在两个队列中，年龄较小、使用精神药物、有抑郁症状、患有痴呆症以及健康状况不稳定与接受精神科就诊显著相关。尽管需求几乎没有差异，但两个队列获得精神科护理的机会却有所不同。我们得出结论，许多本可从精神科就诊中受益的居家护理客户并未得到此类服务。新斯科舍省的农村地区尤其如此。通过将RAI-HC与其他健康数据相联系，我们的研究提出了一些重要问题，涉及护理地点（医院与社区）、地理位置（曼尼托巴省与新斯科舍省以及城市与农村）和年龄对精神科服务获取差异的影响。这对居家护理中的工作人员培训和心理健康资源有影响，以便妥善支持护理客户的心理健康需求。研究结果表明，公共居家护理服务需要一项心理健康战略。
