BackgroundPatients with psychiatric disorders have more physical problems than other patients, so their follow-up by the general practitioner is particularly important for them.MethodsWe aimed to elaborate a multilevel explanatory model of general practitioner (GP) visits made by patients with schizophrenia and related disorders (SRD). An observational, cross-sectional study was conducted from January 1, 2008 to July 1, 2011, in the area of the Clinical Management Unit of Mental Health (CMU-MH) of the Regional Hospital of Malaga (Spain). The eligible population consisted of all patients with SRD in contact with a GP residing in the study area. Our dependent variable was total number GP visits. The independent variables were: 1) patient variables (sociodemographic and clinical variables); 2) primary care centre (PCC) variables. We performed descriptive analysis, bivariate analysis and multilevel regression.ResultsFour hundred ninety four patients were included. Mean annual number of GP visits was 4.1. Female sex, living in a socioeconomically deprived area, a diagnosis of schizoaffective disorder and contact with a GP who had a more active approach to mental health issues were associated with a higher number of visits whilst being single and good communication between the PCC and mental health teams were associated with a lower number of GP visits.ConclusionsNumber of GP visits was not just associated with patient factors, but also with organisational and the involvement of health professionals, for example GPs with an active approach to mental health issues.Electronic supplementary materialThe online version of this article (10.1186/s12875-018-0866-7) contains supplementary material, which is available to authorized users.

Background. To analyze the impact of the COVID-19 pandemic on mental health hospital admissions, the use of mechanical restraint and number of aggressions to the staff. Methods. Outcomes in the period from March 14, 2020–December 31, 2020 were compared to the same period in 2019. A multivariate logistic regression analysis was carried out to compare the risk of mechanical restraint during admissions in the two periods, controlling for potential confounding variables. Results. There was a 30.7% reduction in the number of inpatient admissions with significant changes in the profiles of the patients admitted. There were no differences in the risk of restraint and aggressions. Violence was less frequent as a reason for restraint in the pandemic period, while agitation increased. Conclusions. The COVID-19 pandemic has had a significant impact on the functioning of the hospitalization ward. Measures introduced during pandemic did not seem to have a meaningful effect on mechanical restraint procedures or violent behavior towards the staff.

Homelessness continues to be a major social and clinical problem. The homeless population has a higher burden of disease that includes psychiatric disorders. In addition, they have a lower use of ambulatory health services and a higher use of acute care. Few investigations analyze the use of services of this population group in the long term. We analyzed the risk of psychiatric readmission of homeless individuals through survival analysis. All admissions to a mental health hospitalization unit in the city of Malaga, Spain, from 1999 to 2005, have been analyzed. Three analyses were carried out: two intermediate analyses at 30 days and 1 year after starting follow-up; and one final analysis at 10 years. In all cases, the event was readmission to the hospitalization unit. The adjusted Hazard Ratio at 30 days, 1-year, and 10-year follow-ups were 1.387 (p = 0.027), 1.015 (p = 0.890), and 0.826 (p = 0.043), respectively. We have found an increased risk of readmission for the homeless population at 30 days and a decreased risk of readmission at 10 years. We hypothesize that this lower risk of long-term readmission may be due to the high mobility of the homeless population, its low degree of adherence to long-term mental health services, and its high mortality rate. We suggest that time-critical intervention programs in the short term could decrease the high rate of early readmission of the homeless population, and long-term interventions could link them with services and avoid its dispersion and abandonment.

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