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.
Highlights
Emerging evidence indicates an association between mental illness and poor quality of physical health care
Our previous study found that mental health clients (MHCs) had substantially more general practitioner (GP) visits than non-MHCs [11]. This suggests that, in Australia, with its universal health insurance cover provided by Medicare, it appears unlikely that limited access to primary care explains poor physical health outcomes in MHCs
The first three categories were identified using the Australian Institute of Health and Welfare definition [21], with diabetes-related renal dialysis being counted only once for each person. This was because there were a large number of diabetes-related renal dialysis admissions, and for the purpose of this study we considered these as one episode of care per person and counted as one hospital discharge with a length of stay of one day
Summary
Emerging evidence indicates an association between mental illness and poor quality of physical health care. About 1 in 5 Australian adults has a clinically diagnosable mental illness [6] This vulnerable group previous study found that MHCs had substantially more general practitioner (GP) visits than non-MHCs [11]. This suggests that, in Australia, with its universal health insurance cover provided by Medicare, it appears unlikely that limited access to primary care explains poor physical health outcomes in MHCs. We have turned our focus on whether disparities exist in the quality of primary care using potentially preventable hospitalisations (PPHs) as an indicator [12]. These indicators of quality of primary care are useful screening tools for potential problems in preventive and primary care, and that determining whether there is a quality problem requires more in-depth analysis
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