Inequitable access for mentally ill patients to some medically necessary procedures

Kisely, Steve; Smith, Mark; Lawrence, David; Cox, Martha; Campbell, Leslie Anne; Maaten, Sarah

doi:10.1503/cmaj.060482

Cited by 157 publications

(123 citation statements)

References 19 publications

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“…In this case, it's important to anticipate by screening early for health problems since the intensity of cognitive disorders is associated with a lack of initiative (48). The most severely ill patients will therefore not spontaneously go and get treatment and will not be very motivated to change their behavior to develop good personal and dental hygiene (49). Nielsen et al (29) reported that 43% of the PWS, polled out of 21427, declared they visited their dental surgeon during the previous year versus 68% in the general population.…”

Section: Need For Early Screeningmentioning

confidence: 99%

“…Other than time issues, we also observe a poor use of the healthcare system by these patients, which explains the delay in visits and the lack of visits and followup. This insufficiency can be explained by the cost of dental care, which is given as one of the reasons for limiting access of vulnerable populations to healthcare (49,50). Scarce financial resources also widely contribute to a lack of access to the healthcare system (49).…”

Section: Promote Access To Carementioning

confidence: 99%

“…In response to the increase in chronic diseases, the very high rate of treatment non-observance and the need for more patient autonomy, the partner patient concept is gradually emerging as a healthcare approach (35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53)(54). The experiential knowledge of patients in psychiatry was used to establish the charter of citizenship, which opens up prospects in terms of healthcare system reorganization (55,56).…”

Section: The Partner Patient Conceptmentioning

confidence: 99%

“…Problems with executive functions can also explain why these patients have a difficult time getting to a given place at a given time. Other symptoms, such as anxiety, the fear of public transportation, or even scarce financial resources are factors that contribute to the lack of access to the healthcare system (49).…”

Section: Caregiver Trainingmentioning

confidence: 99%

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Oral Health Is a Challenging Problem for Patients with Schizophrenia: A Narrative Review

Denis

Pelletier

Chauvet-Gélinier

et al. 2018

Iran J Psychiatry Behav Sci

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Context: Poor oral health is part of co-morbidities and exposes patients suffering from schizophrenia to excess mortality. The purpose of this review is to make an up-to-date assessment on the oral health of these patients and make suggestions for improvement.Evidence Acquisition: Based on a bibliographic search of Pub Med, we identified, using keywords, all the clinical studies up to 2015 conducted on the oral health of patients with schizophrenia.Results: From 81 articles chosen, we retained 23 clinical studies that met our inclusion criteria. These studies find higher dental and periodontal indexes in patients with schizophrenia than in the general population. Access to healthcare is a problem for these patients. The level of research is insufficiently considered compared to other chronic pathologies. Many factors contribute to poor oral health in these patients such as their mental illness, side effects of psychotropic drugs, and any psychosocial factors they might encounter. Conclusions:For these fragile patients with specific needs, simple measures can be implemented to improve their oral health. Better taken into account, the oral health of these patients should contribute to the overall improvement of quality of life and to the general health of these subjects.

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Section: Need For Early Screeningmentioning

confidence: 99%

Section: Promote Access To Carementioning

confidence: 99%

Section: The Partner Patient Conceptmentioning

confidence: 99%

Section: Caregiver Trainingmentioning

confidence: 99%

See 2 more Smart Citations

Oral Health Is a Challenging Problem for Patients with Schizophrenia: A Narrative Review

Denis

Pelletier

Chauvet-Gélinier

et al. 2018

Iran J Psychiatry Behav Sci

View full text Add to dashboard Cite

show abstract

“…16 Even if physical health problems are diagnosed, this population may be less likely to receive or adhere to adequate treatment. 17,18 For example, people with SMI are less likely to receive appropriate medications, such as beta-blockers and statins following myocardial infarction, 17 even though their physician consultation rates are generally high. 14,19,20 Although patient-based factors may be a partial explanation for these findings, it is also likely that the attitudes of health professionals, inefficient organisation of health services and social stigma are also contributing factors.…”

Section: Introductionmentioning

confidence: 99%

General practitioner management of chronic diseases in adults with severe mental illness: a community intervention trial

Cameron¹,

Nazar²,

Ehrlich³

et al. 2017

Aust. Health Review

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Objective. The aim of the present study was to assess the effects of a community intervention aimed at general practitioners (GPs) by comparing Medicare claims data from patients with severe mental illness (SMI) of GPs exposed to the intervention and controls that were not.Methods. A comparison was made of primary care consultation and pathology data of people with SMI from intervention and control areas. Negative binomial regression models were used to compare the frequency and length of GP consultations, as well as the number and type of pathology examinations.Results. Records of 103 people from intervention area and 98 controls were obtained. Intervention and control areas were not different at baseline in terms of age and claims data, but females had higher consultation rates. After adjusting for gender, people from intervention areas had more GP consultations, especially long consultations (adjusted incidence rate ratio 1.56; 95% confidence interval 1.28-1.91). They also had more pathology screening for chronic diseases, in accordance with implemented guideline recommendations. These benefits persisted after the end of the intervention.Conclusion. These findings suggest that the ACTIVATE program aimed at training GPs to screen and better manage chronic diseases in adults with SMI had a positive effect up to 6 months after the trial, with demonstrated desired changes in medical management practices by GPs in the intervention area during that time.What is known about the topic? People with an SMI have higher mortality and poorer physical health than the general population. What does this paper add? The community intervention had a significant and sustained effect, with demonstrated desired changes in screening and medical management by GPs for adults with SMI in the intervention area. What are the implications for practitioners? GPs are ideally placed to assist in the prevention and better management of health conditions, thereby reducing avoidable illness and deaths in vulnerable populations, such as adults with SMI. HEALTH SERVICE RESEARCHOngoing professional training and dissemination of clinical guidelines are critical for raising awareness about the physical and oral health care needs of people with SMI.Additional keyword: health services research.

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Somatic Hospital Contacts, Invasive Cardiac Procedures, and Mortality From Heart Disease in Patients With Severe Mental Disorder

Laursen¹,

Munk‐Olsen²,

Agerbo³

et al. 2009

Arch Gen Psychiatry

250

181

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Individuals with severe mental disorder had only negligible excess rates of contact for heart disease. Given their excess mortality from heart disease and lower rates of invasive procedures after first contact, it would seem that the treatment for heart disease offered to these individuals in Denmark is neither sufficiently efficient nor sufficiently intensive. This undertreatment may explain part of their excess mortality.

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Inequitable access for mentally ill patients to some medically necessary procedures

Cited by 157 publications

References 19 publications

Oral Health Is a Challenging Problem for Patients with Schizophrenia: A Narrative Review

Oral Health Is a Challenging Problem for Patients with Schizophrenia: A Narrative Review

General practitioner management of chronic diseases in adults with severe mental illness: a community intervention trial

Somatic Hospital Contacts, Invasive Cardiac Procedures, and Mortality From Heart Disease in Patients With Severe Mental Disorder

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