To what extent are psychiatrists aware of the comorbid somatic illnesses of their patients with serious mental illnesses? – a cross-sectional secondary data analysis

Abstract

BackgroundSomatic comorbidities are a serious problem in patients with severe mental illnesses. These comorbidities often remain undiagnosed for a long time. In Germany, physicians are not allowed to access patients’ health insurance data and do not have routine access to documentation from other providers of health care. Against this background, the objective of this article was to investigate psychiatrists’ knowledge of relevant somatic comorbidities in their patients with severe mental illnesses.MethodsCross-sectional secondary data analysis was performed using primary data from a prospective study evaluating a model of integrated care of patients with serious mental illnesses. The primary data were linked with claims data from health insurers. Patients’ diagnoses were derived on the basis of the ICD-10 and the Anatomical Therapeutic Chemical (ATC) classification system. Diabetes, hypertension, coronary artery disease (CAD), hyperlipidaemia, glaucoma, osteoporosis, polyarthritis and chronic obstructive pulmonary disease (COPD) were selected for evaluation. We compared the number of diagnoses reported in the psychiatrists’ clinical report forms with those in the health insurance data.ResultsThe study evaluated records from 1,195 patients with severe mental illnesses. The frequency of documentation of hypertension ranged from 21% in claims data to 4% in psychiatrists’ documentation, for COPD from 12 to 0%, respectively, and for diabetes from 7 to 2%, respectively. The percentage of diagnoses deduced from claims data but not documented by psychiatrists ranged from 68% for diabetes and 83% for hypertension, to 90% for CAD to 98% for COPD.ConclusionsThe majority of psychiatrists participating in the integrated care programme were insufficiently aware of the somatic comorbidities of their patients. We support allowing physicians to access patients’ entire medical records to increase their knowledge of patients’ medical histories and, consequently, to increase the safety and quality of care.

Quality of life in patients with severe mental illness: a cross-sectional survey in an integrated outpatient health care model

“…All potential confounding socio-demographic, psychiatric anamnestic and clinical factors (see Tables 1 , 2 ) were included with the exception of the number of hospital stays and the disease duration that highly correlated with the number of episodes. Additionally, somatic co-diagnoses were not included based on the findings of low validity of documented somatic co-diagnoses in this study [ 71 ].…”

Potential Drug interactions with Drugs used for Bipolar Disorder: A Comparison of 6 Drug Interaction Database Programs

“…For example, the medication list in the EMR is often inaccurate [70,71], with at least 1 medication discrepancy found for 85 % of 438 patients at a psychiatric clinic [72]. Both clinical and mental health data, including diagnoses, may be missing from the EMR [73][74][75] such that both psychiatrists and general doctors are prescribing with an incomplete understanding of the patient history.…”

Health coaching in somatic diseases

“…Do chorób psychicznych, które szczególnie często powodują występowanie schorzeń somatycznych, zaliczamy schizofrenię, chorobę afektywną dwubiegunową i depresję, ponieważ pacjenci nie wykazują chęci współpracy z lekarzem prowadzącym, nie stosują się do zaleceń i nie uczestniczą aktywnie w całym procesie leczenia i diagnozowania. Jest to powodem zbyt późnego zdiagnozowania schorzeń somatycznych i podejmowania leczenia w momencie, kiedy proces chorobowy jest w pełni zaawansowany [12].…”