Division of Psychiatry, UCL. 6th Floor Maple House, 149 Tottenham Court Road, London W1T 7NF, UK.
Camden and Islington NHS Foundation Trust, St Pancras Hospital, 4 St Pancras Way, London, NW1 0PE, UK.
Psychol Med. 2023 Sep;53(12):5603-5614. doi: 10.1017/S0033291722002811. Epub 2022 Sep 7.
People with severe mental illness (SMI) have more physical health conditions than the general population, resulting in higher rates of hospitalisations and mortality. In this study, we aimed to determine the rate of emergency and planned physical health hospitalisations in those with SMI, compared to matched comparators, and to investigate how these rates differ by SMI diagnosis.
We used Clinical Practice Research DataLink Gold and Aurum databases to identify 20,668 patients in England diagnosed with SMI between January 2000 and March 2016, with linked hospital records in Hospital Episode Statistics. Patients were matched with up to four patients without SMI. Primary outcomes were emergency and planned physical health admissions. Avoidable (ambulatory care sensitive) admissions and emergency admissions for accidents, injuries and substance misuse were secondary outcomes. We performed negative binomial regression, adjusted for clinical and demographic variables, stratified by SMI diagnosis.
Emergency physical health (aIRR:2.33; 95% CI 2.22-2.46) and avoidable (aIRR:2.88; 95% CI 2.60-3.19) admissions were higher in patients with SMI than comparators. Emergency admission rates did not differ by SMI diagnosis. Planned physical health admissions were lower in schizophrenia (aIRR:0.80; 95% CI 0.72-0.90) and higher in bipolar disorder (aIRR:1.33; 95% CI 1.24-1.43). Accident, injury and substance misuse emergency admissions were particularly high in the year after SMI diagnosis (aIRR: 6.18; 95% CI 5.46-6.98).
We found twice the incidence of emergency physical health admissions in patients with SMI compared to those without SMI. Avoidable admissions were particularly elevated, suggesting interventions in community settings could reduce hospitalisations. Importantly, we found underutilisation of planned inpatient care in patients with schizophrenia. Interventions are required to ensure appropriate healthcare use, and optimal diagnosis and treatment of physical health conditions in people with SMI, to reduce the mortality gap due to physical illness.
患有严重精神疾病（SMI）的人比一般人群有更多的身体健康状况，导致住院率和死亡率更高。在这项研究中，我们旨在确定与匹配的对照组相比，患有 SMI 的人急诊和计划进行的身体健康住院治疗的比率，并研究这些比率如何因 SMI 诊断而有所不同。
我们使用临床实践研究数据链接金和 Aurum 数据库，在 2000 年 1 月至 2016 年 3 月期间在英格兰确定了 20668 名患有 SMI 的患者，并在医院入院统计中与住院记录相关联。患者与最多四名无 SMI 的患者相匹配。主要结局是急诊和计划进行的身体健康入院。可避免的（门诊保健敏感）入院和因事故、伤害和物质使用不当导致的急诊入院为次要结局。我们使用负二项回归，根据临床和人口统计学变量进行调整，按 SMI 诊断进行分层。
与对照组相比，患有 SMI 的患者的急诊身体健康（调整后发病率比[aIRR]：2.33；95%CI 2.22-2.46）和可避免（aIRR：2.88；95%CI 2.60-3.19）入院率更高。急诊入院率因 SMI 诊断而有所不同。精神分裂症患者的计划性身体健康入院率较低（aIRR：0.80；95%CI 0.72-0.90），双相情感障碍患者的计划性身体健康入院率较高（aIRR：1.33；95%CI 1.24-1.43）。SMI 诊断后一年内，因事故、伤害和物质使用不当导致的急诊入院率特别高（aIRR：6.18；95%CI 5.46-6.98）。
与无 SMI 的患者相比，我们发现患有 SMI 的患者急诊身体健康入院率增加了一倍。可避免的入院率特别高，这表明在社区环境中进行干预可能会减少住院治疗。重要的是，我们发现精神分裂症患者计划性住院治疗的利用率较低。需要采取干预措施，以确保适当使用医疗保健，并优化患有 SMI 的人的身体健康状况的诊断和治疗，以减少因身体疾病导致的死亡率差距。
