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.
Highlights
Emergency department (ED) and inpatient hospital services are among the costliest forms of healthcare [1, 2], often serving as a barometer for the quality of healthcare systems [3–5]
At 12-month follow-up, 10% of the cohort had made no ED visits, 51% only one, and 39% two or more visits for mental health (MH) reasons, with a mean of 1.82 visits (SD: 2.08; range: 0–26; median: 1; IQR: 1), while 77% were not hospitalized
Following index ED visits, 51% and 68% reported no consultation with their usual General practitioners (GP) or psychiatrist; 37% (CI: 35–39) of the sample had no main physician provider, while GP were assigned as the main providers for 31%
Summary
Patients with mental disorders (MD) including substance-related disorders (SRD) and with chronic physical illnesses (CPI) are high ED users, which contributes substantially to ED overcrowding [7–9]. They are hospitalized and readmitted more often than patients without MD or CPI [10–13]. Mental disorders-chronic physical illnesses are associated with patient disability [19], social dysfunction [20], treatment complications [21], poor quality of life [19], and higher risk of mortality [22]. 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.
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