Do care plans and annual reviews of physical health influence unplanned hospital utilisation for people with serious mental illness? Analysis of linked longitudinal primary and secondary healthcare records in England
Do care plans and annual reviews of physical health influence unplanned hospital utilisation for people with serious mental illness? Analysis of linked longitudinal primary and secondary healthcare records in England
Objective To investigate whether two primary care activities that are framed as indicators of primary care quality (comprehensive care plans and annual reviews of physical health) influence unplanned utilisation of hospital services for people with serious mental illness (SMI). Design, setting, participants Retrospective observational cohort study using linked primary care and hospital records (Hospital Episode Statistics) for 5158 patients diagnosed with SMI between April 2006 and March 2014, who attended 213 primary care practices in England that contribute to the Clinical Practice Research Datalink GOLD database. Outcomes and analysis Cox survival models were used to estimate the associations between two primary care quality indicators (care plans and annual reviews of physical health) and the hazards of three types of unplanned hospital utilisation: presentation to accident and emergency departments (A&E), admission for SMI and admission for ambulatory care sensitive conditions (ACSC). Results Risk of A&E presentation was 13% lower (HR 0.87, 95% CI 0.77 to 0.98) and risk of admission to hospital for ACSC was 23% lower (HR 0.77, 95% CI 0.60 to 0.99) for patients with a care plan documented in the previous year compared with those without a care plan. Risk of A&E presentation was 19% lower for those who had a care plan documented earlier but not updated in the previous year (HR: 0.81, 95% CI 0.67 to 0.97) compared with those without a care plan. Risks of hospital admission for SMI were not associated with care plans, and none of the outcomes were associated with annual reviews. Conclusions Care plans documented in primary care for people with SMI are associated with reduced risk of A&E attendance and reduced risk of unplanned admission to hospital for physical health problems, but not with risk of admission for mental health problems. Annual reviews of physical health are not associated with risk of unplanned hospital utilisation.
data linkage, hospital utilisation, primary care, quality in health care, schizophrenia & psychotic disorders
Ride, Jemimah
07af37dd-1e92-4fa1-a0ba-78e923924eab
Kasteridis, Panagiotis
13b753ba-79bd-49a4-8e91-bf59cca1dca3
Gutacker, Nils
d2ab100e-25fe-421a-a25e-b935e8bce4a4
Kronenberg, Christoph
0b2664f4-21a1-4a75-aec8-10f21c22e1ab
Doran, Tim
10a4fd47-ed06-49ec-ad8a-26a124730fd8
Mason, Anne
f23014c5-0733-4a71-9c3f-2cad48797ca2
Rice, Nigel
8fe595c4-447e-4282-861a-e9301044836e
Gravelle, Hugh
7bded0be-eaaa-4612-b246-5b0b3f132cce
Goddard, Maria
06cc3cde-3794-4419-aa74-dad7030ab10a
Kendrick, Tony
c697a72c-c698-469d-8ac2-f00df40583e5
Siddiqi, Najma
ed605626-563f-4d6c-b2e1-6f9c25dcc249
Gilbody, Simon
6d135882-a8df-444c-85aa-980dddef45a5
Dare, Ceri R.J.
ef0362ac-3b92-4530-8bbd-002842ad7ed9
Aylott, Lauren
0a8328e9-c5bb-408f-9703-37982af32ffb
Williams, Rachael
37651ae7-0861-4588-b050-bc406bf0b839
Jacobs, Rowena
49686cdf-0222-4e1a-9d81-1914187fcec9
November 2018
Ride, Jemimah
07af37dd-1e92-4fa1-a0ba-78e923924eab
Kasteridis, Panagiotis
13b753ba-79bd-49a4-8e91-bf59cca1dca3
Gutacker, Nils
d2ab100e-25fe-421a-a25e-b935e8bce4a4
Kronenberg, Christoph
0b2664f4-21a1-4a75-aec8-10f21c22e1ab
Doran, Tim
10a4fd47-ed06-49ec-ad8a-26a124730fd8
Mason, Anne
f23014c5-0733-4a71-9c3f-2cad48797ca2
Rice, Nigel
8fe595c4-447e-4282-861a-e9301044836e
Gravelle, Hugh
7bded0be-eaaa-4612-b246-5b0b3f132cce
Goddard, Maria
06cc3cde-3794-4419-aa74-dad7030ab10a
Kendrick, Tony
c697a72c-c698-469d-8ac2-f00df40583e5
Siddiqi, Najma
ed605626-563f-4d6c-b2e1-6f9c25dcc249
Gilbody, Simon
6d135882-a8df-444c-85aa-980dddef45a5
Dare, Ceri R.J.
ef0362ac-3b92-4530-8bbd-002842ad7ed9
Aylott, Lauren
0a8328e9-c5bb-408f-9703-37982af32ffb
Williams, Rachael
37651ae7-0861-4588-b050-bc406bf0b839
Jacobs, Rowena
49686cdf-0222-4e1a-9d81-1914187fcec9
Ride, Jemimah, Kasteridis, Panagiotis, Gutacker, Nils, Kronenberg, Christoph, Doran, Tim, Mason, Anne, Rice, Nigel, Gravelle, Hugh, Goddard, Maria, Kendrick, Tony, Siddiqi, Najma, Gilbody, Simon, Dare, Ceri R.J., Aylott, Lauren, Williams, Rachael and Jacobs, Rowena
(2018)
Do care plans and annual reviews of physical health influence unplanned hospital utilisation for people with serious mental illness? Analysis of linked longitudinal primary and secondary healthcare records in England.
BMJ Open, 8 (11), [e023135].
(doi:10.1136/bmjopen-2018-023135).
Abstract
Objective To investigate whether two primary care activities that are framed as indicators of primary care quality (comprehensive care plans and annual reviews of physical health) influence unplanned utilisation of hospital services for people with serious mental illness (SMI). Design, setting, participants Retrospective observational cohort study using linked primary care and hospital records (Hospital Episode Statistics) for 5158 patients diagnosed with SMI between April 2006 and March 2014, who attended 213 primary care practices in England that contribute to the Clinical Practice Research Datalink GOLD database. Outcomes and analysis Cox survival models were used to estimate the associations between two primary care quality indicators (care plans and annual reviews of physical health) and the hazards of three types of unplanned hospital utilisation: presentation to accident and emergency departments (A&E), admission for SMI and admission for ambulatory care sensitive conditions (ACSC). Results Risk of A&E presentation was 13% lower (HR 0.87, 95% CI 0.77 to 0.98) and risk of admission to hospital for ACSC was 23% lower (HR 0.77, 95% CI 0.60 to 0.99) for patients with a care plan documented in the previous year compared with those without a care plan. Risk of A&E presentation was 19% lower for those who had a care plan documented earlier but not updated in the previous year (HR: 0.81, 95% CI 0.67 to 0.97) compared with those without a care plan. Risks of hospital admission for SMI were not associated with care plans, and none of the outcomes were associated with annual reviews. Conclusions Care plans documented in primary care for people with SMI are associated with reduced risk of A&E attendance and reduced risk of unplanned admission to hospital for physical health problems, but not with risk of admission for mental health problems. Annual reviews of physical health are not associated with risk of unplanned hospital utilisation.
Text
e023135.full
- Version of Record
More information
Accepted/In Press date: 18 October 2018
e-pub ahead of print date: 28 November 2018
Published date: November 2018
Keywords:
data linkage, hospital utilisation, primary care, quality in health care, schizophrenia & psychotic disorders
Identifiers
Local EPrints ID: 426930
URI: http://eprints.soton.ac.uk/id/eprint/426930
ISSN: 2044-6055
PURE UUID: c0772314-3567-4273-a179-992bdfe4c717
Catalogue record
Date deposited: 18 Dec 2018 17:30
Last modified: 06 Jun 2024 01:37
Export record
Altmetrics
Contributors
Author:
Jemimah Ride
Author:
Panagiotis Kasteridis
Author:
Nils Gutacker
Author:
Christoph Kronenberg
Author:
Tim Doran
Author:
Anne Mason
Author:
Nigel Rice
Author:
Hugh Gravelle
Author:
Maria Goddard
Author:
Najma Siddiqi
Author:
Simon Gilbody
Author:
Ceri R.J. Dare
Author:
Lauren Aylott
Author:
Rachael Williams
Author:
Rowena Jacobs
Download statistics
Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.
View more statistics
