scholarly journals Homelessness at discharge and its impact on psychiatric readmission and physician follow-up: a population-based cohort study

2019 ◽  
Vol 29 ◽  
Author(s):  
V. Laliberté ◽  
V. Stergiopoulos ◽  
B. Jacob ◽  
P. Kurdyak
Keyword(s):  
Mental Health ◽  
Cohort Study ◽  
Outpatient Care ◽  
Service Use ◽  
Significant Proportion ◽  
Population Based ◽  
Psychiatric Hospitalisation ◽  
Health Related ◽  
Ed Visits ◽  
The Impact

Abstract Aims A significant proportion of adults who are admitted to psychiatric hospitals are homeless, yet little is known about their outcomes after a psychiatric hospitalisation discharge. The aim of this study was to assess the impact of being homeless at the time of psychiatric hospitalisation discharge on psychiatric hospital readmission, mental health-related emergency department (ED) visits and physician-based outpatient care. Methods This was a population-based cohort study using health administrative databases. All patients discharged from a psychiatric hospitalisation in Ontario, Canada, between 1 April 2011 and 31 March 2014 (N = 91 028) were included and categorised as homeless or non-homeless at the time of discharge. Psychiatric hospitalisation readmission rates, mental health-related ED visits and physician-based outpatient care were measured within 30 days following hospital discharge. Results There were 2052 (2.3%) adults identified as homeless at discharge. Homeless individuals at discharge were significantly more likely to have a readmission within 30 days following discharge (17.1 v. 9.8%; aHR = 1.43 (95% CI 1.26–1.63)) and to have an ED visit (27.2 v. 11.6%; aHR = 1.87 (95% CI 1.68–2.0)). Homeless individuals were also over 50% less likely to have a psychiatrist visit (aHR = 0.46 (95% CI 0.40–0.53)). Conclusion Homeless adults are at higher risk of readmission and ED visits following discharge. They are also much less likely to receive post-discharge physician care. Efforts to improve access to services for this vulnerable population are required to reduce acute care service use and improve care continuity.

scholarly journals Primary Care Consultations after Hospitalisation for Pneumonia: A Large Population-based Cohort Study

2020 ◽  
pp. BJGP.2020.0890
Author(s):  
Vadsala Baskaran ◽  
Fiona Pearce ◽  
Rowan H Harwood ◽  
Tricia McKeever ◽  
Wei Shen Lim
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Large Population ◽  
Significant Proportion ◽  
Antibiotic Use ◽  
Population Based ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Respiratory Disorder ◽  
The Impact

Background: Up to 70% of patients report ongoing symptoms four weeks after hospitalisation for pneumonia, and the impact on primary care is poorly understood. Aim: To investigate the frequency of primary care consultations after hospitalisation for pneumonia, and the reasons for consultation. Design: Population-based cohort study. Setting: UK primary care database of anonymised medical records (Clinical Practice Research Datalink, CPRD) linked to Hospital Episode Statistics (HES), England. Methods: Adults with the first ICD-10 code for pneumonia (J12-J18) recorded in HES between July 2002-June 2017 were included. Primary care consultation within 30 days of discharge was identified as the recording of any medical Read code (excluding administration-related codes) in CPRD. Competing-risks regression analyses were conducted to determine the predictors of consultation and antibiotic use at consultation; death and readmission were competing events. Reasons for consultation were examined. Results: Of 56,396 adults, 55.9% (n=31,542) consulted primary care within 30 days of discharge. The rate of consultation was highest within 7 days (4.7 per 100 person-days). The strongest predictor for consultation was a higher number of primary care consultations in the year prior to index admission (adjusted sHR 8.98, 95% CI 6.42-12.55). The commonest reason for consultation was for a respiratory disorder (40.7%, n=12,840), 12% for pneumonia specifically. At consultation, 31.1% (n=9,823) received further antibiotics. Penicillins (41.6%, n=5,753) and macrolides (21.9%, n=3,029) were the commonest antibiotics prescribed. Conclusion: Following hospitalisation for pneumonia, a significant proportion of patients consulted primary care within 30 days, highlighting the morbidity experienced by patients during recovery from pneumonia.

scholarly journals Have associations between mental health and health related behaviours changed between 2005 and 2015? A population based cross-cohort study

2020 ◽  
Author(s):  
Suzanne H. Gage ◽  
Praveetha Patalay
Keyword(s):  
Mental Health ◽  
Substance Use ◽  
Cohort Study ◽  
Mental Health Problems ◽  
Weight Perception ◽  
Population Based ◽  
Parents And Children ◽  
Health Related ◽  
Avon Longitudinal Study ◽  
Over Time

AbstractBackgroundPoor adolescent mental health is a growing concern over recent decades with evidence of increasing internalising mental health problems corresponding with decrease in anti-social, smoking and alcohol behaviours. However, understanding whether and how the associations between mental health and health-related behaviours such as substance use, anti-social behaviour and obesity have changed over time is less well-understood.ObjectivesWe investigate whether the associations between different health-related outcomes in adolescence are stable or changing over time in two recent cohorts of adolescents born ten years apart.MethodData from two UK birth cohort studies, the Avon Longitudinal Study of Parents and Children (ALSPAC, born 1991-92, N=5627, 50.7% female) and Millennium Cohort Study (MCS, born 2000-1, N=11318, 50.6% female) at age 14 sweeps are used. The health outcomes of focus are depressive symptom score, substance use (alcohol, smoking, cannabis and other drugs), antisocial behaviours (assault, graffiti, vandalism, shoplifting and rowdy behaviour), weight (BMI), weight perception (perceive self as overweight) and sexual activity (had sexual intercourse).ResultsOur results suggest although directions of associations between mental-health and health-related behaviours (eg smoking) are similar over time, their strength across the distribution has changed. While smoking and alcohol use behaviours are decreasing in adolescents, those that endorse these behaviours in 2015 are more likely to have co-occurring mental-health and other problems than those born in 2005. Similarly, higher body mass index is more strongly associated with depressive symptoms in 2015.ConclusionsOur findings suggest that associations between these factors has changed over time, which has implications for public health and our understanding of the mechanisms underlying their observed associations in the population.

scholarly journals Acute mental health service use is increased in rheumatoid arthritis and ankylosing spondylitis: a population-based cohort study

2020 ◽  
Vol 12 ◽  
pp. 1759720X2092171
Author(s):  
Bindee Kuriya ◽  
Vivian Tia ◽  
Jin Luo ◽  
Jessica Widdifield ◽  
Simone Vigod ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Mental Health ◽  
Ankylosing Spondylitis ◽  
Health Service ◽  
Service Use ◽  
Population Based ◽  
System Level ◽  
Health Service Use ◽  
Increased Risk ◽  
Ed Visits

Background: Rheumatoid arthritis (RA) and ankylosing spondylitis (AS) are associated with mental illness. Whether acute mental health (MH) service utilization (i.e. emergency visits or hospitalizations) is increased in RA or AS is not known. Methods: Two population-based cohorts were created where individuals with RA ( n = 53,240) or AS ( n = 13,964) were each matched by age, sex, and year to unaffected comparators (2002–2016). Incidence rates per 1000 person-years (PY) were calculated for a first MH emergency department (ED) presentation or MH hospitalization. Hazard ratios (HR) and 95% confidence intervals (CI) were calculated, adjusting for demographic, clinical, and health service use variables. Results: Individuals with RA had higher rates of ED visits [6.59/1000 person-years (PY) versus 4.39/1000 PY in comparators] and hospitalizations for MH (3.11/1000 PY versus 1.80/1000 PY in comparators). Higher rates of ED visits (7.92/1000 PY versus 5.62/1000 PY in comparators) and hospitalizations (3.03/1000 PY versus 1.94/1000 PY in comparators) were also observed in AS. Overall, RA was associated with a 34% increased risk for MH hospitalization (HR 1.34, 95% CI 1.22–1.47) and AS was associated with a 36% increased risk of hospitalization (HR 1.36, 95% CI 1.12–1.63). The risk of ED presentation was attenuated, but remained significant, after adjustment in both RA (HR 1.08, 95% CI 1.01–1.15) and AS (HR 1.14, 95% CI 1.02–1.28). Conclusions: RA and AS are both independently associated with a higher rate and risk of acute ED presentations and hospitalizations for mental health conditions. These findings underscore the need for routine evaluation of MH as part of the management of chronic inflammatory arthritis. Additional research is needed to identify the underlying individual characteristics, as well as system-level variation, which may explain these differences, and to help plan interventions to make MH service use more responsive to the needs of individuals living with RA and AS.

scholarly journals Impact of a Publicly Funded Herpes Zoster Immunization Program on the Burden of Disease in Ontario, Canada: A Population-based Study

2020 ◽  
Author(s):  
Diana Martins ◽  
Daniel McCormack ◽  
Mina Tadrous ◽  
Tara Gomes ◽  
Jeffrey C Kwong ◽  
...  
Keyword(s):  
Herpes Zoster ◽  
Service Use ◽  
Moving Average ◽  
Population Based ◽  
Publicly Funded ◽  
Immunization Program ◽  
Population Based Study ◽  
Ed Visits ◽  
The Impact ◽  
Monthly Incidence

Abstract Background In September 2009, a live attenuated herpes zoster vaccine (ZVL) became available in Canada. Beginning in September 2016, ZVL was made available to all Ontario residents aged 65–70 through a publicly funded immunization program. We assessed the impact of ZVL availability and its subsequent public funding on herpes zoster burden in this population. Methods A population-based study of Ontario residents aged 65–70 between January 2005 and September 2018. We used interventional autoregressive integrated moving average models to examine the impact of ZVL market availability and the publicly funded ZVL program on monthly incidence rate of medically attended herpes zoster, defined as an outpatient visit for herpes zoster with a prescription for a herpes zoster antiviral dispensed ≤5 days before or after the visit, or a herpes zoster–related emergency department (ED) visit or hospitalization. In secondary analyses, we examined impacts on any herpes zoster–related ED visits and hospitalizations. Results We found no association between ZVL market availability and monthly incidence of herpes zoster (P = .32) or monthly rates of ED visits and hospitalizations (P = .88). Conversely, the introduction of publicly funded ZVL reduced the monthly rate of medically attended herpes zoster by 19.1% (from 4.8 to 3.8 per 10 000 population; P < .01) and herpes zoster–related ED visits and hospitalizations by 38.2% (from 1.7 to 1.0 per 10 000 population; P < .05). Conclusions The introduction of a publicly funded immunization program for herpes zoster was associated with reduced disease burden and related acute healthcare service use.

Gender Differences in Youth Suicide and Healthcare Service Use

Crisis ◽  
2016 ◽  
Vol 37 (4) ◽  
pp. 290-298 ◽  
Author(s):  
Samantha Gontijo Guerra ◽  
Helen-Maria Vasiliadis
Keyword(s):  
Mental Health ◽  
Gender Differences ◽  
Healthcare Service ◽  
Service Use ◽  
Healthcare Providers ◽  
Healthcare Services ◽  
Outpatient Services ◽  
Health Related ◽  
Healthcare Service Use ◽  
Ed Visits

Abstract. Background: Healthcare service use among suicide decedents must be well characterized and understood since a key strategy for preventing suicide is to improve healthcare providers' ability to effectively detect and treat those in need. Aims: To determine gender differences in healthcare service use 12 months prior to suicide. Method: Data for 1,231 young Quebec residents (≤ 25 years) who died by suicide between 2000 and 2007 were collected from public health insurance agency databases and coroner registers. Healthcare visits were categorized according to the setting (emergency department [ED], outpatient, and hospital) and their nature (mental health vs. non-mental health). Results: Girls were more likely than boys (82.5% vs. 74.9%, p = .011) to have used healthcare services in the year prior to death. A higher proportion of girls had used outpatient services (79.0% vs. 69.5%, p = .003), had been hospitalized (25.7% vs. 15.6%, p < .001) and had received a mental health-related diagnosis (46.7% vs. 33.1%, p < .001). However, no gender differences were observed in ED visits (59.5% vs. 54.5%, p = .150). Conclusion: There is an important proportion of suicide decedents who did not receive a mental health diagnosis and healthcare services in the year prior to death. Future studies should focus on examining gender-specific individual and health system barriers among suicide decedents as well as the quality of care offered regarding detection and treatment.

scholarly journals Temporal Trends in Mental Health Service Utilization across Outpatient and Acute Care Sectors: A Population-Based Study from 2006 to 2014

2018 ◽  
Vol 63 (2) ◽  
pp. 94-102 ◽  
Author(s):  
Maria Chiu ◽  
Evgenia Gatov ◽  
Simone N. Vigod ◽  
Abigail Amartey ◽  
Natasha R. Saunders ◽  
...  
Keyword(s):  
Mental Health ◽  
Acute Care ◽  
Service Use ◽  
Care Service ◽  
Temporal Trends ◽  
Population Based ◽  
Physician Visits ◽  
Outpatient Physician ◽  
Health Related ◽  
Number Of Individuals

Objective: Although evidence suggests that treatment seeking for mental illness has increased over time, little is known about how the health system is meeting the increasing demand for services. We examined trends in physician-based mental health service use across multiple sectors. Method: In this population-based study, we used linked health-administrative databases to measure annual rates of mental health–related outpatient physician visits to family physicians and psychiatrists, emergency department visits, and hospitalizations in adults aged 16+ from 2006 to 2014. We examined absolute and relative changes in visit rates, number of patients, and frequency of visits per patient, and assessed temporal trends using linear regressions. Results: Among approximately 11 million Ontario adults, age- and sex-standardized rates of mental health–related outpatient physician visits declined from 604.8 to 565.5 per 1000 population over the study period ( Ptrend = 0.04). Over time, the rate of visits to family physicians/general practitioners remained stable ( Ptrend = 0.12); the number of individuals served decreased, but the number of visits per patient increased. The rate of visits to psychiatrists declined ( Ptrend < 0.001); the number of individuals served increased, but the number of visits per patient decreased. Concurrently, visit rates to emergency departments and hospitals increased (16.1 to 19.7, Ptrend < 0.001 and 5.6 to 6.0, Ptrend = 0.01, per 1000 population, respectively). Increases in acute care service use were greatest for anxiety and addictions. Conclusions: The increasing acute care service use coupled with the reduction in outpatient visits suggest, overall, an increase in demand for mental health care that is not being met in ambulatory care settings.

scholarly journals Urgent Outpatient Care Following Mental Health ED Visits: A Population-Based Study

2020 ◽  
Vol 71 (6) ◽  
pp. 616-619
Author(s):  
Lucy C. Barker ◽  
Nadiya Sunderji ◽  
Paul Kurdyak ◽  
Vicky Stergiopoulos ◽  
Alejandro Gonzalez ◽  
...  
Keyword(s):  
Mental Health ◽  
Outpatient Care ◽  
Population Based ◽  
Population Based Study ◽  
Ed Visits
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