Taub Sharon, Menkes-Caspi Noa, Fruchtman-Steinbok Tom, Kamhi-Nesher Shiri, Krivoy Amir
Geha Mental Health Center, Petach Tikva, Israel; Geha Mental Health Data Research Center, Petach Tikva, Israel; Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Geha Mental Health Data Research Center, Petach Tikva, Israel.
Gen Hosp Psychiatry. 2025 Jan-Feb;92:100-105. doi: 10.1016/j.genhosppsych.2024.11.014. Epub 2024 Dec 10.
Morbidity and mortality rates are notably higher among individuals with severe mental illnesses (SMI). People with SMI often have lower access to healthcare services, and the medical care they receive is known to be suboptimal. Consequently, treatment in an acute care setting rather than a community setting is more common. We aim to explore medical care in the emergency department (ED) for people with SMI compared to a control population.
In this matched cohort study, data on all adult Clalit Health Services (CHS) members who were referred to the general ED during the years 2018-2021 were extracted. Patients with SMI (ICD-10 codes for schizophrenia, schizoaffective disorder, and bipolar disorder) were matched with a control group of ED patients without SMI in a 1:3 ratio. The two groups were compared regarding ED admission reasons, management, and outcomes.
The total sample (n = 92,848) included ED patients with SMI (n = 23,212) and without (n = 69,636). The most common ED admission reasons in both groups were pain, traumatic injury, and cardiac symptoms. Patients in the SMI group had higher rates of diagnosed diabetes mellitus and obstructive pulmonary disease. ED assessment, measured by resource allocation, was less comprehensive for patients with SMI who presented with subjective complaints such as pain and weakness, while it was comparable between patients with and without SMI for other main presenting complaints. Workup for patients with SMI lasted longer and necessitated hospitalization at higher rates for most admission reasons. Mortality during the study period was almost twice as high among the SMI group (5 % vs. 2.3 %, p < 0.001).
Our findings indicate higher rates of morbidity and treatment complexity among patients with SMI. As expected, the mortality rate was higher in this group. An alarming gap in resource allocation for ED assessment was observed when patients presented with subjective complaints. Enhanced awareness and integrated resources in primary care are required to improve the management and physical healthcare of patients with SMI.
严重精神疾病（SMI）患者的发病率和死亡率显著更高。患有严重精神疾病的人往往难以获得医疗保健服务，而且他们所接受的医疗护理质量欠佳。因此，在急性护理环境而非社区环境中接受治疗更为常见。我们旨在探讨与对照人群相比，严重精神疾病患者在急诊科（ED）接受的医疗护理情况。
在这项匹配队列研究中，提取了2018年至2021年间所有转诊至综合急诊科的成年克拉利特健康服务（CHS）成员的数据。患有严重精神疾病的患者（国际疾病分类第十版（ICD - 10）中精神分裂症、分裂情感性障碍和双相情感障碍的编码）与一组无严重精神疾病的急诊科患者按1:3的比例进行匹配。比较了两组在急诊科的入院原因、管理和结局。
总样本（n = 92,848）包括患有严重精神疾病的急诊科患者（n = 23,212）和无严重精神疾病的患者（n = 69,636）。两组最常见的急诊科入院原因是疼痛、创伤性损伤和心脏症状。患有严重精神疾病的患者中，确诊糖尿病和阻塞性肺病的比例更高。通过资源分配衡量，对于出现疼痛和虚弱等主观症状的严重精神疾病患者，急诊科评估的全面性较低，而对于其他主要就诊症状，有严重精神疾病和无严重精神疾病的患者之间评估情况相当。患有严重精神疾病的患者检查时间更长，且因大多数入院原因住院率更高。在研究期间，严重精神疾病组的死亡率几乎是对照组的两倍（5%对2.3%，p < 0.001）。
我们的研究结果表明，严重精神疾病患者的发病率和治疗复杂性更高。正如预期的那样，该组的死亡率更高。当患者出现主观症状时，在急诊科评估的资源分配方面存在惊人差距。需要提高基层医疗保健中的意识并整合资源，以改善严重精神疾病患者的管理和身体保健。
