BackgroundHealth care disparity is a public health challenge. We compared the prevalence of diabetes, quality of care and outcomes between mental health clients (MHCs) and non-MHCs.MethodsThis was a population-based longitudinal study of 139,208 MHCs and 294,180 matched non-MHCs in Western Australia (WA) from 1990 to 2006, using linked data of mental health registry, electoral roll registrations, hospital admissions, emergency department attendances, deaths, and Medicare and pharmaceutical benefits claims. Diabetes was identified from hospital diagnoses, prescriptions and diabetes-specific primary care claims (17,045 MHCs, 26,626 non-MHCs). Both univariate and multivariate analyses adjusted for socio-demographic factors and case mix were performed to compare the outcome measures among MHCs, category of mental disorders and non-MHCs.ResultsThe prevalence of diabetes was significantly higher in MHCs than in non-MHCs (crude age-sex-standardised point-prevalence of diabetes on 30 June 2006 in those aged ≥20 years, 9.3% vs 6.1%, respectively, P < 0.001; adjusted odds ratio (OR) 1.40, 95% CI 1.36 to 1.43). Receipt of recommended pathology tests (HbA1c, microalbuminuria, blood lipids) was suboptimal in both groups, but was lower in MHCs (for all tests combined; adjusted OR 0.81, 95% CI 0.78 to 0.85, at one year; and adjusted rate ratio (RR) 0.86, 95% CI 0.84 to 0.88, during the study period). MHCs also had increased risks of hospitalisation for diabetes complications (adjusted RR 1.20, 95% CI 1.17 to 1.24), diabetes-related mortality (1.43, 1.35 to 1.52) and all-cause mortality (1.47, 1.42 to 1.53). The disparities were most marked for alcohol/drug disorders, schizophrenia, affective disorders, other psychoses and personality disorders.ConclusionsMHCs warrant special attention for primary and secondary prevention of diabetes, especially at the primary care level.

BackgroundEmerging evidence indicates an association between mental illness and poor quality of physical health care. To test this, we compared mental health clients (MHCs) with non-MHCs on potentially preventable hospitalisations (PPHs) as an indicator of the quality of primary care received.MethodsPopulation-based retrospective cohort study of 139,208 MHCs and 294,180 matched non-MHCs in Western Australia from 1990 to 2006, using linked data from electoral roll registrations, mental health registry (MHR) records, hospital inpatient discharges and deaths. We used the electoral roll data as the sampling frame for both cohorts to enhance internal validity of the study, and the MHR to separate MHCs from non-MHCs. Rates of PPHs (overall and by PPH category and medical condition) were compared between MHCs, category of mental disorders and non-MHCs. Multivariate negative binomial regression analyses adjusted for socio-demographic factors, case mix and the year at the start of follow up due to dynamic nature of study cohorts.ResultsPPHs accounted for more than 10% of all hospital admissions in MHCs, with diabetes and its complications, adverse drug events (ADEs), chronic obstructive pulmonary disease (COPD), convulsions and epilepsy, and congestive heart failure being the most common causes. Compared with non-MHCs, MHCs with any mental disorders were more likely to experience a PPH than non-MHCs (overall adjusted rate ratio (ARR) 2.06, 95% confidence interval (CI) 2.03-2.09). ARRs of PPHs were highest for convulsions and epilepsy, nutritional deficiencies, COPD and ADEs. The ARR of a PPH was highest in MHCs with alcohol/drug disorders, affective psychoses, other psychoses and schizophrenia.ConclusionsMHCs have a significantly higher rate of PPHs than non-MHCs. Improving primary and secondary prevention is warranted in MHCs, especially at the primary care level, despite there may be different thresholds for admission in people with established physical disease that is influenced by whether or not they have comorbid mental illness.

SUMMARY Obstetric and perinatal records have been assembled on 250 infant deaths and an equal number of live controls including 55 deaths associated with congenital anomalies. The information was used to construct a scoring system to identify high-risk infants at birth. Parents of 115 of the cases and their controls were also interviewed and all hospital, general practitioner, and health service records abstracted. Cases and controls were compared item by item in respect of all information available up to the age of one month and a scoring system constructed for use at one month.The 'at birth' and combined scoring systems are presented. The chance of death by age attained is presented for various risk groups. In a small prospective test, the multistage scoring system was nearly 50 % more effective than the birth score alone.In 1973 (Protestos et al.) we reported a retrospective study of the obstetric and perinatal states of children who presented later as unexpected deaths in infancy and compared the findings with a control group. From these data we developed a scoring system designed to identify high-risk infants at the time of birth.The system was evaluated in a 2-year prospective study in Sheffield. The first-year results indicated that the scoring system was highly effective (Carpenter and Emery, 1974, 1975;Emery and Carpenter, 1975). The findings at the end of the study are essentially similar. The high-risk control group had a relative risk of death 6 8 times that of the low-risk infants. It is estimated that 56% of the unexpected home deaths up to the age of 20 weeks occur in the high-risk group, which comprises 15 *7 % of all births, i.e. the sensitivity of the scoring system is 56 % and the specificity 84 -3 %.This scoring at birth was thus partially successful but there were still 44% of infants to be identified. In order to extend the system further we have attempted two things. First, to use data available at birth from a larger number of infants and controls to refine the birth score; and second, we have used recalled and recorded information about the first postnatal month from the parents of infants who died, and from controls, and have used that information to constitute a second scoring system at one Received 3 January 1977 month. We have also supplemented this information with data on hospital admissions.We report the information obtained from these three groups of data and the effect of combining them. Material and methodsOur earlier study was based on obstetric and perinatal records of 135 cases of unexpected infant death and 135 controls. Details of the method of selecting controls and the data abstracted from the medical records are given by Protestos et al. (1973). Since that study, data have been assembled on a further 115 cases of unexpected infant death that have since occurred in Sheffield or Rotherham, and on 115 controls. 39 of the new cases were excluded because death was associated with congenital anomalies, as were 16 in the earlier study, leaving 76 comparable new cases. As be...

While many GPs are currently involved in some aspects of cancer management, with training, good communication and support from specialists this role may be successfully expanded.

While many GPs are currently involved in some aspects of cancer management, detailed and timely communication between specialists and GPs is imperative to support shared care and ensure optimal patient outcomes. This research highlights the need for established channels of communication between specialist and primary care medicine to support greater involvement by GPs in cancer care.