scholarly journals Do higher primary care practice performance scores predict lower rates of emergency admissions for persons with serious mental illness? An analysis of secondary panel data

2015 ◽  
Vol 3 (16) ◽  
pp. 1-68 ◽  
Author(s):  
Rowena Jacobs ◽  
Nils Gutacker ◽  
Anne Mason ◽  
Maria Goddard ◽  
Hugh Gravelle ◽  
...  
Keyword(s):  
Primary Care ◽  
Mental Illness ◽  
General Practice ◽  
Hospital Admissions ◽  
Positive Association ◽  
Emergency Admissions ◽  
Physical Conditions ◽  
Patient Level ◽  
Quality Of Primary Care

BackgroundSerious mental illness (SMI) is a set of chronic enduring conditions including schizophrenia and bipolar disorder. SMIs are associated with poor outcomes, high costs and high levels of disease burden. Primary care plays a central role in the care of people with a SMI in the English NHS. Good-quality primary care has the potential to reduce emergency hospital admissions, but also to increase elective admissions if physical health problems are identified by regular health screening of people with SMIs. Better-quality primary care may reduce length of stay (LOS) by enabling quicker discharge, and it may also reduce NHS expenditure.ObjectivesWe tested whether or not better-quality primary care, as assessed by the SMI quality indicators measured routinely in the Quality and Outcomes Framework (QOF) in English general practice, is associated with lower rates of emergency hospital admissions for people with SMIs, for both mental and physical conditions and with higher rates of elective admissions for physical conditions in people with a SMI. We also tested the impact of SMI QOF indicators on LOS and costs.DataWe linked administrative data from around 8500 general practitioner (GP) practices and from Hospital Episode Statistics for the study period 2006/7 to 2010/11. We identified SMI admissions by a mainInternational Classification of Diseases, 10th revision (ICD-10) diagnosis of F20–F31. We included information on GP practice and patient population characteristics, area deprivation and other potential confounders such as access to care. Analyses were carried out at a GP practice level for admissions, but at a patient level for LOS and cost analyses.MethodsWe ran mixed-effects count data and linear models taking account of the nested structure of the data. All models included year indicators for temporal trends.ResultsContrary to expectation, we found a positive association between QOF achievement and admissions, for emergency admissions for both mental and physical health. An additional 10% in QOF achievement was associated with an increase in the practice emergency SMI admission rate of approximately 1.9%. There was no significant association of QOF achievement with either LOS or cost. All results were robust to sensitivity analyses.ConclusionsPossible explanations for our findings are (1) higher quality of primary care, as measured by QOF may not effectively prevent the need for secondary care; (2) patients may receive their QOF checks post discharge, rather than prior to admission; (3) people with more severe SMIs, at a greater risk of admission, may select into practices that are better organised to provide their care and which have better QOF performance; (4) better-quality primary care may be picking up unmet need for secondary care; and (5) QOF measures may not accurately reflect quality of primary care. Patient-level data on quality of care in general practice is required to determine the reasons for the positive association of QOF quality and admissions. Future research should also aim to identify the non-QOF measures of primary care quality that may reduce unplanned admissions more effectively and could potentially be incentivised.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

scholarly journals Impact of mental illness on care for somatic comorbidities in France: a nation-wide hospital-based observational study

2018 ◽  
Vol 28 (5) ◽  
pp. 495-507 ◽  
Author(s):  
J. Gervaix ◽  
G. Haour ◽  
M. Michel ◽  
K. Chevreul
Keyword(s):  
Primary Care ◽  
Mental Illness ◽  
Mentally Ill ◽  
Hospital Admissions ◽  
Psychiatric Hospitals ◽  
Access To Healthcare ◽  
Hospital Death ◽  
High Severity ◽  
Hospitalised Patients

Aims.People with a mental illness have a shorter lifespan and higher rates of somatic illnesses than the general population. They also face multiple barriers which interfere with access to healthcare. Our objective was to assess the effect of mental illness on the timeliness and optimality of access to healthcare for somatic reasons by comparing indicators reflecting the quality of prior somatic care in hospitalised patients.Methods.An observational nation-wide study was carried out using exhaustive national hospital discharge databases for the years 2009–2013. All adult inpatient stays for somatic reasons in acute care hospitals were included with the exception of obstetrics and day admissions. Admissions with coding errors were excluded. Patients with a mental illness were identified by their admissions for a psychiatric reason and/or contacts with psychiatric hospitals. The quality of prior somatic care was assessed using the number of admissions, admissions through the emergency room (ER), avoidable hospitalisations, high-severity hospitalisations, mean length of stay (LOS) and in-hospital death. Generalised linear models studied the factors associated with poor quality of primary care.Results.A total of 17 620 770 patients were included, and 6.58% had been admitted at least once for a mental illness, corresponding to 8.96% of hospital admissions. Mentally ill patients were more often hospitalised (+41% compared with non-mentally patients) and for a longer LOS (+16%). They also had more high-severity hospitalisations (+77%), were more often admitted to the ER (+113%) and had more avoidable hospitalisations (+50%). After adjusting for other covariates, regression models found that suffering from a mental illness was significantly associated with a worse state for each indicator of the quality of care except in-hospital death.Conclusion.Inadequate primary care of mentally ill patients leads to more serious conditions upon admission to hospital and avoidable hospitalisations. It is, therefore, necessary to improve primary care and prevention for those patients.

Quality of Primary Care and Hospital Admissions for Diabetes Mellitus in England

2008 ◽  
Vol 31 (3) ◽  
pp. 226-238 ◽  
Author(s):  
Alex Bottle ◽  
Christopher Millett ◽  
Yu Xie ◽  
Sonia Saxena ◽  
Robert M. Wachter ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Primary Care ◽  
Hospital Admissions ◽  
Quality Of Primary Care

scholarly journals An evaluation of the effectiveness of annual health checks and quality of health care for adults with intellectual disability: an observational study using a primary care database

2017 ◽  
Vol 5 (25) ◽  
pp. 1-170 ◽  
Author(s):  
Iain M Carey ◽  
Fay J Hosking ◽  
Tess Harris ◽  
Stephen DeWilde ◽  
Carole Beighton ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Intellectual Disability ◽  
General Population ◽  
Hospital Admissions ◽  
Health Check ◽  
Ambulatory Care Sensitive Conditions ◽  
Emergency Admissions ◽  
Health Checks

Background People with intellectual disability (ID) have poorer health than the general population; however, there is a lack of comprehensive national data describing their health-care needs and utilisation. Annual health checks for adults with ID have been incentivised through primary care since 2009, but only half of those eligible for such a health check receive one. It is unclear what impact health checks have had on important health outcomes, such as emergency hospitalisation. Objectives To evaluate whether or not annual health checks for adults with ID have reduced emergency hospitalisation, and to describe health, health care and mortality for adults with ID. Design A retrospective matched cohort study using primary care data linked to national hospital admissions and mortality data sets. Setting A total of 451 English general practices contributing data to Clinical Practice Research Datalink (CPRD). Participants A total of 21,859 adults with ID compared with 152,846 age-, gender- and practice-matched controls without ID registered during 2009–13. Interventions None. Main outcome measures Emergency hospital admissions. Other outcomes – preventable admissions for ambulatory care sensitive conditions, and mortality. Data sources CPRD, Hospital Episodes Statistics and Office for National Statistics. Results Compared with the general population, adults with ID had higher levels of recorded comorbidity and were more likely to consult in primary care. However, they were less likely to have long doctor consultations, and had lower continuity of care. They had higher mortality rates [hazard ratio (HR) 3.6, 95% confidence interval (CI) 3.3 to 3.9], with 37.0% of deaths classified as being amenable to health-care intervention (HR 5.9, 95% CI 5.1 to 6.8). They were more likely to have emergency hospital admissions [incidence rate ratio (IRR) 2.82, 95% CI 2.66 to 2.98], with 33.7% deemed preventable compared with 17.3% in controls (IRR 5.62, 95% CI 5.14 to 6.13). Health checks for adults with ID had no effect on overall emergency admissions compared with controls (IRR 0.96, 95% CI 0.87 to 1.07), although there was a relative reduction in emergency admissions for ambulatory care-sensitive conditions (IRR 0.82, 95% CI 0.69 to 0.99). Practices with high health check participation also showed a relative fall in preventable emergency admissions for their patients with ID, compared with practices with minimal participation (IRR 0.73, 95% CI 0.57 to 0.95). There were large variations in the health check-related content that was recorded on electronic records. Limitations Patients with milder ID not known to health services were not identified. We could not comment on the quality of health checks. Conclusions Compared with the general population, adults with ID have more chronic diseases and greater primary and secondary care utilisation. With more than one-third of deaths potentially amenable to health-care interventions, improvements in access to, and quality of, health care are required. In primary care, better continuity of care and longer appointment times are important examples that we identified. Although annual health checks can also improve access, not every eligible adult with ID receives one, and health check content varies by practice. Health checks had no impact on overall emergency admissions, but they appeared influential in reducing preventable emergency admissions. Future work No formal cost-effectiveness analysis of annual health checks was performed, but this could be attempted in relation to our estimates of a reduction in preventable emergency admissions. Funding The National Institute for Health Research Health Services and Delivery Research programme.

scholarly journals Mental Illness in Primary Care Settings

1985 ◽  
Vol 9 (1) ◽  
pp. 12-13 ◽  
Author(s):  
Greg Wilkinson
Keyword(s):  
Primary Care ◽  
Mental Illness ◽  
General Practice ◽  
Social Security ◽  
General Practitioners ◽  
Research Unit ◽  
Practice Research ◽  
Policy Makers ◽  
Department Of Health ◽  
Primary Care Settings

A Conference on the above topic took place at the Institute of Psychiatry, London, on 17 and 18 July 1984. The Conference was sponsored by the Department of Health and Social Security and was organized by the General Practice Research Unit. Over 100 invited clinicians, research workers and policy-makers took part. The majority of the participants were either psychiatrists or general practitioners, but representatives of all relevant disciplines attended.

scholarly journals Creating a ‘reverse’ integrated primary and mental healthcare clinic for those with serious mental illness

2015 ◽  
Vol 17 (05) ◽  
pp. 421-427 ◽  
Author(s):  
Alexandros Maragakis ◽  
Ragavan Siddharthan ◽  
Jill RachBeisel ◽  
Cassandra Snipes
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Illness ◽  
Quality Of Care ◽  
Serious Mental Illness ◽  
Mental Healthcare ◽  
Policy Reforms ◽  
Mental Health Settings ◽  
Primary Care Practitioners

Individuals with serious mental illness (SMI) are more likely to experience preventable medical health issues, such as diabetes, hyperlipidemia, obesity, and cardiovascular disease, than the general population. To further compound this issue, these individuals are less likely to seek preventative medical care. These factors result in higher usage of expensive emergency care, lower quality of care, and lower life expectancy. This manuscript presents literature that examines the health disparities this population experiences, and barriers to accessing primary care. Through the identification of these barriers, we recommend that the field of family medicine work in collaboration with the field of mental health to implement ‘reverse’ integrated care (RIC) systems, and provide primary care services in the mental health settings. By embedding primary care practitioners in mental health settings, where individuals with SMI are more likely to present for treatment, this population may receive treatment for somatic care by experts. This not only would improve the quality of care received by patients, but would also remove the burden of managing complex somatic care from providers trained in mental health. The rationale for this RIC system, as well as training and policy reforms, are discussed.

scholarly journals Effect of family practice contract services on the quality of primary care in Guangzhou, China: a cross-sectional study using PCAT-AE

BMJ Open ◽  
2018 ◽  
Vol 8 (11) ◽  
pp. e021317 ◽  
Author(s):  
Lina Li ◽  
Chenwen Zhong ◽  
Jie Mei ◽  
Yuan Liang ◽  
Li Li ◽  
...  
Keyword(s):  
Primary Care ◽  
Family Practice ◽  
Assessment Tool ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Quality Of Primary Care ◽  
Care Assessment ◽  
First Contact

ObjectiveCurrent healthcare reform in China has an overall goal of strengthening primary care and establishing a family practice system based on contract services. The objective of this study was to determine whether contracting a general practitioner (GP) could improve quality of primary care.DesignA cross-sectional study using two-stage sampling conducted from June to September 2014. Propensity score matching (PSM) was employed to control for confounding between patients with and without contracted GP.SettingThree community health centres in Guangzhou, China.Participants698 patients aged 18–89 years.Main outcome measuresThe quality of primary care was measured using a validated Chinese version of primary care assessment tool (PCAT). Eight domains are included (first contact utilisation, accessibility, continuity, comprehensiveness, coordination, family-centredness, community orientation and cultural competence from patient’s perceptions).ResultsA total of 692 effective samples were included for data analysis. After PSM, 94 pairs of patients were matched between the patients with and without contracted GPs. The total PCAT score, continuity (3.12 vs 2.68, p<0.01), comprehensiveness (2.31 vs 2.04, p<0.01) and family-centredness (2.11 vs 1.79, p<0.01) were higher in patients who contracted GPs than those did not. However, the domains of first contact utilisation (2.74 vs 2.87, p=0.14) and coordination (1.76 vs 1.93, p<0.05) were lower among patients contracted with GPs than in those who did not.ConclusionOur findings demonstrated that patients who had a contracted GP tend to experience higher quality of primary care. Our study provided evidence for health policies aiming to promote the implementation of family practice contract services. Our results also highlight further emphases on the features of primary care, first contact services and coordination services in particular.

scholarly journals Impact of mental illness on in-patient hospital costs for somatic disorders and associated factors

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
M Michel ◽  
A J Hammami ◽  
K Chevreul
Keyword(s):  
Primary Care ◽  
Health Promotion ◽  
Mental Illness ◽  
Mental Disorders ◽  
Economic Burden ◽  
Mentally Ill ◽  
Hospital Costs ◽  
Healthcare Systems ◽  
Interaction Terms

Abstract Background People suffering from mental disorders are in poorer somatic health that the general population. This is due in part to poor quality of care in primary care settings, which can in turn have a major impact on hospitals and healthcare systems, in particular in terms of costs. Our objective was to assess the economic burden of acute care admissions for somatic diseases in patients with a mental illness compared to other patients and analyse the factors associated with it. Methods An exhaustive study using French hospital discharge databases was carried out between 2009 and 2013. Total acute hospital costs were calculated from the all payer perspective (statutory health insurance, private health insurances and patient out-of pocket payments). A multivariate regression modelled the association between mental illness and hospital costs while adjusting for other explanatory variables, with and without interaction terms. Results 37,458,810 admissions were included in the analysis. 1,163,972 patients (6.54%) were identified as being mentally ill. Mean total hospital costs at five years per patient were €8,114. Costs per mentally ill patient were on average 34% higher than for a non-mentally patient (€10,637 vs. €7,949). A longitudinal analysis of costs showed a widening of the gap between the two groups as time went by, from 1.60% in 2009 to 10.51% in 2013. In the multivariate model, mental disorders were significantly associated with increased costs, and interaction terms found an increased impact of mental illness on costs in deprived patients. Conclusions Improving quality of primary care and health promotion in people with a mental illness both for their own sake and to decrease the economic burden on the healthcare system, is of vital importance. Key messages There is a significant increase in hospital costs for somatic care in patients with a mental illness compared to other patients, in particular in patients who are also deprived. It is necessary to improve primary care and health promotion in mentally ill patients, for their sake and for the sake of healthcare systems.

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