School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom.
Sheffield Health and Social Care NHS Foundation Trust, Sheffield, United Kingdom.
PLoS One. 2023 Feb 13;18(2):e0281667. doi: 10.1371/journal.pone.0281667. eCollection 2023.
People with serious mental illness experience worse physical health and greater mortality than the general population. Crude rates of A&E attendance and acute hospital admission are higher in people with serious mental illness than other hospital users. We aimed to further these findings by undertaking a standardised comparison of urgent and emergency care pathway use among users of mental health services and the general population.
Retrospective cohort analysis using routine data from 2013-2016 from the CUREd dataset for urgent and emergency care contacts (NHS 111, ambulance, A&E and acute admissions) and linked mental health trust data for Sheffield, England. We compared annual age- and sex-standardised usage rates for each urgent and emergency care service between users of mental health services and those without a recent history of mental health service use.
We found marked differences in usage rates for all four urgent and emergency care services between the general population and users of mental health services. Usage rates and the proportion of users were 5-6 times and 3-4 times higher in users of mental health services, respectively, for all urgent and emergency care services. Users of mental health services were often more likely to experience the highest or lowest acuity usage characteristics.
Current users of mental health services were heavily over-represented among urgent and emergency care users, and they made more contacts per-person. Higher service use among users of mental health services could be addressed by improved community care, more integrated physical and mental health support, and more proactive primary care. A complex pattern of service use among users of mental health services suggests this will need careful targeting to reduce avoidable contacts and optimise patient outcomes.
严重精神疾病患者的身体健康状况较差，死亡率高于一般人群。与其他医院使用者相比，严重精神疾病患者的急症室就诊和急性住院率更高。我们旨在通过对精神卫生服务使用者和一般人群的紧急和急诊护理途径使用情况进行标准化比较，进一步了解这些发现。
使用 2013-2016 年来自英格兰谢菲尔德 CUREd 数据集的常规数据（NHS 111、救护车、急症室和急性入院）和相关的精神卫生信托数据，对 2013-2016 年的精神卫生服务使用者和无近期精神卫生服务使用史者进行回顾性队列分析。我们比较了精神卫生服务使用者和无近期精神卫生服务使用史者在每一种紧急和急诊服务中的年度年龄和性别标准化使用率。
我们发现，在普通人群和精神卫生服务使用者之间，所有四种紧急和急诊服务的使用率都存在显著差异。在所有紧急和急诊服务中，精神卫生服务使用者的使用率和使用者比例分别高出 5-6 倍和 3-4 倍。精神卫生服务使用者往往更有可能经历最高或最低的急性使用特征。
目前使用精神卫生服务的人在紧急和急诊服务使用者中所占比例过高，而且每个人的就诊次数也更多。通过改善社区护理、更多地整合身心健康支持，以及更积极主动的初级保健，可以解决精神卫生服务使用者的高服务使用率问题。精神卫生服务使用者的服务使用模式复杂，这表明需要有针对性地减少不必要的接触，优化患者的治疗效果。
