Impact of Co-occurring Mental Disorders and Chronic Physical Illnesses on Frequency of Emergency Department Use and Hospitalization for Mental Health Reasons

Abstract

Background: Patients with mental disorders (MD) are at high risk for a wide range of chronic physical illnesses (CPI), often resulting in greater use of acute care services. This study estimated risk of emergency department (ED) use and hospitalization for mental health (MH) reasons among 678 patients with MD and CPI compared to 1,999 patients with MD only.Methods: Patients visiting one of six Quebec (Canada) ED for MH reasons and at onset of a MD in 2014–15 (index year) were included. Negative binomial models comparing the two groups estimated risk of ED use and hospitalization at 12-month follow-up to index ED visit, controlling for clinical, sociodemographic, and service use variables.Results: Patients with MD, more severe overall clinical conditions and those who received more intensive specialized MH care had higher risks of frequent ED use and hospitalization. Continuity of medical care protected against both ED use and hospitalization, while general practitioner (GP) consultations protected against hospitalization only. Patients aged 65+ had lower risk of ED use, whereas risk of hospitalization was higher for the 45–64- vs. 12–24-year age groups, and for men vs. women.Conclusion: Strategies including assertive community treatment, intensive case management, integrated co-occurring treatment, home treatment, and shared care may improve adequacy of care for patients with MD-CPI, as well as those with MD only whose clinical profiles were severe. Prevention and outreach strategies may also be promoted, especially among men and older age groups.

Predictors of Physician Follow-Up Care Among Patients Affected by an Incident Mental Disorder Episode in Quebec (Canada): Prédicteurs des soins du suivi médical des patients affectés par un épisode incident de troubles mentaux au Québec (Canada)

“…The finding that women have a higher probability of receiving follow-up care than men is easily explained by their higher reported rates of service use. 55 Study findings also confirmed the second part of our hypothesis, namely that patients receiving better prior GP follow-up care would be more likely to receive follow-up care after an incident MD episode. Patients followed by a senior GP in family medicine groups and those receiving a high continuity of GP care were particularly more likely to get follow-up care after an incident MD episode-family medicine groups have regulations that ensure prompt and continuous care, especially for vulnerable populations.…”

“…Follow-up care was also higher in the Montreal metropolitan area, which is not surprising considering specialized care and GP walk-in clinics are usually overrepresented in large urban areas 53 and tend to attract more vulnerable patients such as the homeless and individuals with complex health conditions. 52,54 Studies also reveal that hospitalized patients are among the most vulnerable, 55 which supports current trends seeking to improve discharge planning and continuous care, 56 and to provide better follow-up care for these patients. Those with co-occurring MDs-SRDs 57 and chronic physical illnesses 55 are also known for highly using services, and their complex conditions justify improving follow-up care.…”

“…52,54 Studies also reveal that hospitalized patients are among the most vulnerable, 55 which supports current trends seeking to improve discharge planning and continuous care, 56 and to provide better follow-up care for these patients. Those with co-occurring MDs-SRDs 57 and chronic physical illnesses 55 are also known for highly using services, and their complex conditions justify improving follow-up care. GPs reportedly prefer to treat patients with physical illnesses than those with MDs, 58 and those with common rather than complex MDs.…”

“…The finding that women have a higher probability of receiving follow-up care than men is easily explained by their higher reported rates of service use. 55…”

“…A previous study shows that senior GPs play a more active role than their junior counterparts in treating patients with MDs. 58 As for high ED users, those are known to be high outpatient services users 69 as well as a vulnerable clientele with complex health issues, 55 which would explain why they are more likely to receive follow-up care. Overall, these findings align with the view that the Canadian health-care system responds more effectively to the new needs of existing patients than to those of individuals not currently under care, and that facilitating patient access to care could be greatly improved.…”