Hospitalization for mental health related ambulatory care sensitive conditions: what are the trends for First Nations in British Columbia?

Abstract

BackgroundIndigenous peoples globally experience a disproportionate burden of mental illness due to forced policies and practices of colonization and cultural disruption. The objective of this study was to provide a baseline profile of hospitalization rates for mental health-related Ambulatory Care Sensitive Conditions among First-Nations living both on and off reserve in British Columbia, Canada, and explore the relationship between local access to health services and mental health-related hospitalization rates.MethodsA population-based time trend analysis of mental health-related Ambulatory Care Sensitive Conditions hospitalizations was conducted using de-identified administrative health data. The study population included all residents eligible under the universal British Columbia Medical Services Plan and living on and off First Nations reserves between 1994/95 and 2009/10. The definition of mental health-related Ambulatory Care Sensitive Conditions included mood disorders and schizophrenia, and three different change measures were used to operationalize avoidable hospitalizations: 1) rates of episodes of hospital care, 2) rates of length of stay, and 3) readmission rates. Data were analyzed using generalized estimating equations approach, controlling for age, sex, and socio-economic status, to account for change over time.ResultsOur findings show that First Nations living on reserve have higher hospitalization rates for mental disorders compared to other British Columbia residents up until 2008. Those living off reserve had significantly higher hospitalization rates throughout the study period. On-reserve communities served by nursing stations had the lowest rates of hospitalization whereas communities with limited local services had the highest rates. Compared to other British Columbia residents, all First Nations have a shorter length of stay and lower readmission rates.ConclusionsThis study suggests that despite reduced rates of hospitalization for mental-health related Ambulatory Care Sensitive Conditions over time for First Nations, gaps in mental health care still exist. We argue greater investments in primary mental health care are needed to support First Nations health. However, these efforts should place equal importance on prevention and the social determinants of health.

Admissions for ambulatory care sensitive conditions on rural islands and their association with patient experience: a multicentred prospective cohort study

“…Fourth, though data related to the reasons for referral and the severity of illnesses are essential for assessing the association between admissions for ACSCs and PX, we could not gather this information. Moreover, although a premature mortality rate and length of stay in a hospital are more relevant outcomes for patients,22 54 55 we could not collect the information on them due to lack of the data in the primary care clinic-based database. As a next step, an assessment of the severity/appropriateness of referrals, a premature mortality rate and length of stay may be required.…”

“…Quality of primary care is also a problem in rural areas,17 and many studies have revealed higher rates of admissions for ACSCs in rural areas than in urban areas 10 18–21. One of the reasons could be that patients tend to be admitted at low threshold to compensate lower access to healthcare in comparison with that in urban areas 22 23. However, whether other domains of PX such as coordination, comprehensiveness or community orientation can affect admissions for ACSCs to remains unclear.…”

Population-based study of the association between food insecurity and preventable hospitalization among persons with diabetes using linked survey and administrative data

“…While the causal direction of mental illness and diabetes is not clear, there is growing recognition that depression and other mood and anxiety disorders are a complication of diabetes [2,8]. Hospitalizations for diabetes and many of its chronic physical and mental comorbidities are considered ambulatory care sensitive, that is, potentially avoidable through appropriate management in primary care and by acting on the key underlying patient factors, such as socioeconomic status, that may place individuals at greater risk of hospitalization [9,10,11].…”

Is geographical isolation associated with poorer outcomes for Northern Manitoba First Nation communities?

“…Hospitalization for ACSC is a very well recognized tool to measure access to PHC services (3,(12)(13)(14)(15)(16). Several studies have reported that higher rates of ACSC indicate barriers to PHC services (3,(17)(18)(19). We have previously used these indicators to identify gaps in the delivery of PHC in previous studies, and provided recommendations to policy makers to transform the healthcare system within these communities (3,17,20,21).…”

“…Several studies have reported that higher rates of ACSC indicate barriers to PHC services (3,(17)(18)(19). We have previously used these indicators to identify gaps in the delivery of PHC in previous studies, and provided recommendations to policy makers to transform the healthcare system within these communities (3,17,20,21). We acknowledge that hospitalizations are linked to diagnoses and referrals: rates of hospitalization may decline as a result of barriers to PHC resulting in undiagnosed conditions and potentially premature mortality; or rates may decline as a result of early diagnosis and effective management in PHC.…”