The impact of mental illness on potentially preventable hospitalisations: a population-based cohort study

Abstract

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.

Depression and ambulatory care sensitive hospitalizations among Medicare beneficiaries with chronic physical conditions

“…In our study, Medicare beneficiaries with depression were at a greater risk of H-ACSC compared to those without depression. This finding is consistent with existing literature that has documented disparities in quality of healthcare by mental health status in a variety of settings [1, 2, 6-10, 24-28]. Our study findings also have implications for the provision of primary care for those with depression.…”

Peer Navigators and Integrated Care to Address Ethnic Health Disparities of People with Serious Mental Illness

“…They show higher incidence and prevalence in cardiovascular and respiratory illness (Badiaga et al, 2009; Diez-Roux, Northridge, Morabia, Bassett, & Shea, 1999), gastro-intestinal disorders (Weinreb, Goldberg, Bassuk, & Perloff, 1998), cancer (Schanzer, Dominguez, Shrout, & Caton, 2007), and orthopedic illnesses including those due to accidents (Takano, Nakamura, Takeuchi, & Watanabe, 1999). As a result, people with serious mental illness are hospitalized for physical health problems at much higher rates (Mai, Homan, Sanfilippo, & Emery, 2011) and die, on average 15 to 30 years younger than their cohort (Saha, Chant, & McGrath, 2007). …”

Mental health stigma and primary health care decisions

“…People with serious mental illness experience health challenges yielding alarming morbidity rates (Mai et al, 2011; WHO, 2005) and die, on average, 15–30 years younger than their cohort (Saha et al, 2007). In part, this occurs because of health system failures: e.g., absence of integrated care services (Lutterman, 2010) or insufficient insurance coverage (Druss and Mauer, 2010).…”