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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
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
2044-6055
Ride, Jemimah
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Kasteridis, Panagiotis
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Gutacker, Nils
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Kronenberg, Christoph
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Doran, Tim
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Mason, Anne
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Rice, Nigel
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Gravelle, Hugh
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Goddard, Maria
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Kendrick, Tony
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Siddiqi, Najma
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Gilbody, Simon
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Dare, Ceri R.J.
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Aylott, Lauren
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Williams, Rachael
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Jacobs, Rowena
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Ride, Jemimah
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Kasteridis, Panagiotis
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Gutacker, Nils
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Kronenberg, Christoph
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Doran, Tim
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Mason, Anne
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Rice, Nigel
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Gravelle, Hugh
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Goddard, Maria
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Kendrick, Tony
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Siddiqi, Najma
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Gilbody, Simon
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Dare, Ceri R.J.
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Aylott, Lauren
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Williams, Rachael
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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).

Record type: Article

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.

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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
ORCID for Tony Kendrick: ORCID iD orcid.org/0000-0003-1618-9381

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Date deposited: 18 Dec 2018 17:30
Last modified: 16 Mar 2024 03:00

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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: Tony Kendrick ORCID iD
Author: Najma Siddiqi
Author: Simon Gilbody
Author: Ceri R.J. Dare
Author: Lauren Aylott
Author: Rachael Williams
Author: Rowena Jacobs

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