Treating body, treating mind: The experiences of people with psychotic disorders and their general practitioners – Findings from the Australian National Survey of High Impact Psychosis

Waterreus, Anna; Morgan, Vera

doi:10.1177/0004867417728806

Cited by 10 publications

(19 citation statements)

References 37 publications

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“…In contrast, no significant associations were observed for attendance at ED or outpatient services, or for home visits, when adjusting for potential confounders. These findings add to previous evidence linking loneliness in psychosis to increased use of somethough not allforms of health care services (Chrostek et al, 2016;Waterreus and Morgan, 2018). However, these previous studies showed these relationships, with either no adjustment, or adjusting for a more limited range of confounding factors.…”

Section: Discussionsupporting

confidence: 74%

“…For example, recent eWSSASvidence suggests that people who feel lonely and lacking social connectedness visit their general practitioners (GP) more often than those who are not lonely (Cruwys et al, 2018; see also Ellaway et al, 1999). A similar pattern of results has also been reported in people with psychotic disorders (Waterreus and Morgan, 2018). In fact, annual use of GP services by people with psychotic disorders has increased over the last decade, reflecting a shift from in-patient to community-based care (Raudino et al, 2014).…”

Section: Introductionsupporting

confidence: 74%

“…who consulted a GP 12 or more times in the previous year) were significantly more likely to be lonely and socially isolated than less frequent attenders (i.e. who visited a GP between 1 and 11 times) (Waterreus and Morgan, 2018). Such findings merit further investigation, for at least two reasons.…”

Section: Introductionmentioning

confidence: 85%

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Loneliness and its association with health service utilization in people with a psychotic disorder

Badcock

Prinzio

Waterreus

et al. 2020

Schizophrenia Research

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Background: Loneliness is common in people with psychotic disorders and associated with reduced health and well-being. The relationship between loneliness in psychosis and health service use is unclear. This study examined whether loneliness predicts increased health care utilization in this population, independently of sociodemographics, health and functioning. Methods: We used cross-sectional data from the Second Australian National Survey of Psychosis. Loneliness was assessed using a single-item question, rated on a 4-point scale (not lonely; lonely occasionally; some friends but lonely for company; socially isolated and lonely). Health service use (past 12-months) was measured by the number of general practitioner (GP), emergency department (ED) and outpatient visits, inpatient admissions, and home visits by mental health professionals. Frequent hospital users comprised those in the top 15% of users of at least two services. Results: Negative binomial regression analysis showed that loneliness was associated with an increased number of GP visits, ED visits and inpatient admissions, only. Socially isolated and lonely survey participants were more than twice as likely (OR = 2.6) of being 'frequent users' compared to non-lonely responders. Following stringent adjustment for covariates, loneliness remained significantly associated with being a 'frequent user' and showed a non-significant trend to an increased number of GP visits and inpatient admissions. Conclusions: Loneliness is a complex social and personal problem for people with psychosis, related to greater use of some health services. Better strategies for identifying and responding to loneliness in this population have the potential to increase well-being and contain health service utilization costs.

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Section: Discussionsupporting

confidence: 74%

Section: Introductionsupporting

confidence: 74%

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Loneliness and its association with health service utilization in people with a psychotic disorder

Badcock

Prinzio

Waterreus

et al. 2020

Schizophrenia Research

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“…Unit costs for consultations were obtained from national estimates of the cost per minute of general practitioner (GP) and practice nurse time for 2014 [29]. We used visit duration data rather than a standard visit cost because of evidence suggesting that consultations for patients with mental health problems are longer than average [30][31][32][33]. We considered multiple visits in a day for a patient to a single staff member as duplicates, but allowed for visits to different staff members on the same day.…”

Section: Primary Care Costsmentioning

confidence: 99%

Healthcare Costs for People with Serious Mental Illness in England: An Analysis of Costs Across Primary Care, Hospital Care, and Specialist Mental Healthcare

Ride

Kasteridis

Gutacker

et al. 2019

Appl Health Econ Health Policy

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Background Serious mental illness (SMI) is a set of disabling conditions associated with poor outcomes and high healthcare utilisation. However, little is known about patterns of utilisation and costs across sectors for people with SMI. Objective The aim was to develop a costing methodology and estimate annual healthcare costs for people with SMI in England across primary and secondary care settings. Methods A retrospective observational cohort study was conducted using linked administrative records from primary care, emergency departments, inpatient admissions, and community mental health services, covering financial years 2011/12-2013/14. Costs were calculated using bottom-up costing and are expressed in 2013/14 British pounds (GBP). Determinants of annual costs by sector were estimated using generalised linear models. Results Mean annual total healthcare costs for 13,846 adults with SMI were £4989 (median £1208), comprising 19% from primary care (£938, median £531), 34% from general hospital care (£1717, median £0), and 47% from inpatient and community-based specialist mental health services (£2334, median £0). Mean annual costs related specifically to mental health, as distinct from physical health, were £2576 (median £290). Key predictors of total cost included physical comorbidities, ethnicity, neighbourhood deprivation, SMI diagnostic subgroup, and age. Some associations varied across care context; for example, older age was associated with higher primary care and hospital costs, but lower mental healthcare costs. Conclusions Annual healthcare costs for people with SMI vary significantly across clinical and socioeconomic characteristics and healthcare sectors. This analysis informs policy and research, including estimation of health budgets for particular patient profiles, and economic evaluation of health services and policies.

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“…133 We used individual visit duration data to calculate visit costs rather than a standard unit cost because of evidence suggesting that consultations for patients with mental health problems are likely to be longer than average consultations. [137][138][139][140] We considered multiple visits in a day for a patient to a single staff member as duplicates, but included visits to different staff members on the same day.…”

Section: Samplementioning

confidence: 99%

The association between primary care quality and health-care use, costs and outcomes for people with serious mental illness: a retrospective observational study

Jacobs

Aylott

Dare

et al. 2020

Health Serv Deliv Res

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Background Serious mental illness, including schizophrenia, bipolar disorder and other psychoses, is linked with high disease burden, poor outcomes, high treatment costs and lower life expectancy. In the UK, most people with serious mental illness are treated in primary care by general practitioners, who are financially incentivised to meet quality targets for patients with chronic conditions, including serious mental illness, under the Quality and Outcomes Framework. The Quality and Outcomes Framework, however, omits important aspects of quality. Objectives We examined whether or not better quality of primary care for people with serious mental illness improved a range of outcomes. Design and setting We used administrative data from English primary care practices that contribute to the Clinical Practice Research Datalink GOLD database, linked to Hospital Episode Statistics, accident and emergency attendances, Office for National Statistics mortality data and community mental health records in the Mental Health Minimum Data Set. We used survival analysis to estimate whether or not selected quality indicators affect the time until patients experience an outcome. Participants Four cohorts of people with serious mental illness, depending on the outcomes examined and inclusion criteria. Interventions Quality of care was measured with (1) Quality and Outcomes Framework indicators (care plans and annual physical reviews) and (2) non-Quality and Outcomes Framework indicators identified through a systematic review (antipsychotic polypharmacy and continuity of care provided by general practitioners). Main outcome measures Several outcomes were examined: emergency admissions for serious mental illness and ambulatory care sensitive conditions; all unplanned admissions; accident and emergency attendances; mortality; re-entry into specialist mental health services; and costs attributed to primary, secondary and community mental health care. Results Care plans were associated with lower risk of accident and emergency attendance (hazard ratio 0.74, 95% confidence interval 0.69 to 0.80), serious mental illness admission (hazard ratio 0.67, 95% confidence interval 0.59 to 0.75), ambulatory care sensitive condition admission (hazard ratio 0.73, 95% confidence interval 0.64 to 0.83), and lower overall health-care (£53), primary care (£9), hospital (£26) and mental health-care costs (£12). Annual reviews were associated with reduced risk of accident and emergency attendance (hazard ratio 0.80, 95% confidence interval 0.76 to 0.85), serious mental illness admission (hazard ratio 0.75, 95% confidence interval 0.67 to 0.84), ambulatory care sensitive condition admission (hazard ratio 0.76, 95% confidence interval 0.67 to 0.87), and lower overall health-care (£34), primary care (£9) and mental health-care costs (£30). Higher general practitioner continuity was associated with lower risk of accident and emergency presentation (hazard ratio 0.89, 95% confidence interval 0.83 to 0.97) and ambulatory care sensitive condition admission (hazard ratio 0.77, 95% confidence interval 0.65 to 0.92), but not with serious mental illness admission. High continuity was associated with lower primary care costs (£3). Antipsychotic polypharmacy was not statistically significantly associated with the risk of unplanned admission, death or accident and emergency presentation. None of the quality measures was statistically significantly associated with risk of re-entry into specialist mental health care. Limitations There is risk of bias from unobserved factors. To mitigate this, we controlled for observed patient characteristics at baseline and adjusted for the influence of time-invariant unobserved patient differences. Conclusions Better performance on Quality and Outcomes Framework measures and continuity of care are associated with better outcomes and lower resource utilisation, and could generate moderate cost savings. Future work Future research should examine the impact of primary care quality on measures that capture broader aspects of health and functioning. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 25. See the NIHR Journals Library website for further project information.

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Treating body, treating mind: The experiences of people with psychotic disorders and their general practitioners – Findings from the Australian National Survey of High Impact Psychosis

Cited by 10 publications

References 37 publications

Loneliness and its association with health service utilization in people with a psychotic disorder

Loneliness and its association with health service utilization in people with a psychotic disorder

Healthcare Costs for People with Serious Mental Illness in England: An Analysis of Costs Across Primary Care, Hospital Care, and Specialist Mental Healthcare

The association between primary care quality and health-care use, costs and outcomes for people with serious mental illness: a retrospective observational study

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