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Specialist psychiatric health care utilization among older people with intellectual disability - predictors and comparisons with the general population: a national register study.
BMC Psychiatry ( IF 4.4 ) Pub Date : 2020-02-17 , DOI: 10.1186/s12888-020-02491-6
G Ahlström 1 , A Axmon 2 , M Sandberg 1 , J Hultqvist 1
Affiliation  

BACKGROUND People with intellectual disability (ID) face considerable barriers to accessing psychiatric health care, thus there is a risk for health disparity. The aims of the present study were 1) to compare specialist psychiatric health care utilization among older people with ID to that with their age peers in the general population, taking into account demographic factors and co-morbidities associated with specialist psychiatric health care utilization and 2) to determine a model for prediction of specialist psychiatric health care utilization among older people with ID. MATERIAL AND METHODS We identified a national cohort of people with ID (ID cohort), aged 55+ years and alive at the end of 2012 (n = 7936), and a referent cohort from the general population (gPop cohort) one-to-one matched by year of birth and sex. Data on utilization of inpatient and outpatient specialist psychiatric health care, as well as on co-morbidities identified in either psychiatric or somatic specialist health care, were collected from the National Patient Register for the time period 2002-2012. RESULTS After adjusting for sex, age, specialist psychiatric health care utilization the previous year, and co-morbidities, people in the ID cohort still had an increased risk of visits to unplanned inpatient (relative risk [RR] 1.95), unplanned outpatient (RR 1.59), planned inpatient (RR 2.02), and planned outpatient (RR 1.93) specialist psychiatric health care compared with the general population. Within the ID cohort, increasing age was a predictor for less health care, whereas psychiatric health care the previous year predicted increased risk of health care utilization the current year. As expected, mental and behavioral disorders predicted increased risk for psychiatric health care. Furthermore, episodic and paroxysmal disorders increased the risk of planned psychiatric health care. CONCLUSIONS Older people with ID have a high need for psychiatric specialist health care due to a complex pattern of diagnoses. Further research needs to investigate the conditions that can explain the lesser psychiatric care in higher age groups. There is also a need of research on health care utilization among people with ID in the primary health care context. This knowledge is critical for policymakers' plans of resources to meet the needs of these people.

中文翻译:

智障老年人中特殊精神病医疗的利用-预测指标和与一般人群的比较:一项国家注册研究。

背景技术智力障碍(ID)的人在获得精神病医疗保健方面面临相当大的障碍,因此存在健康差异的风险。本研究的目的是:1)比较ID老年人与普通人群中同龄人的专科精神卫生保健利用率,并考虑与专科精神卫生保健利用率相关的人口统计学因素和合并症,2 ),以确定一个可预测ID老年人的专科精神科医疗利用率的模型。材料和方法我们确定了一个全国性人群,即ID人群(ID人群),年龄在55岁以上,并于2012年底活着(n = 7936),并且是普通人群中的参照人群(gPop人群)一种与出生年份和性别相匹配。住院和门诊专科精神卫生保健的利用数据,以及在精神科或躯体专科卫生保健中确定的合并症,是从2002-2012年期间的国家患者登记表中收集的。结果在调整了性别,年龄,上一年的精神病专科医疗使用率和合并症后,ID队列中的人仍然有计划外住院(相对风险[RR] 1.95),计划外门诊(RR)的风险增加。与普通人群相比,计划住院患者(RR 2.02)和计划门诊患者(RR 2.02)和计划门诊患者(RR 1.93))。在ID队列中,年龄增长是医疗保健减少的预测因素,而前一年的精神病医疗保健预测本年医疗保健利用的风险会增加。正如预期的那样,精神和行为障碍预计会增加精神病医疗保健的风险。此外,突发性和阵发性疾病增加了计划的精神病保健的风险。结论患有ID的老年人由于诊断方式复杂,对精神病专科医疗保健的需求很高。进一步的研究需要调查可以解释较高年龄组中较少精神病治疗的情况。还需要研究在初级卫生保健背景下有身份的人之间的卫生保健利用情况。这些知识对于决策者满足这些人需求的资源计划至关重要。精神和行为障碍预计会增加精神病医疗保健的风险。此外,突发性和阵发性疾病增加了计划的精神病保健的风险。结论患有ID的老年人由于诊断方式复杂,对精神病专科医疗保健的需求很高。进一步的研究需要调查可以解释较高年龄组中较少精神病治疗的情况。还需要研究在初级卫生保健背景下有身份的人之间的卫生保健利用情况。这些知识对于决策者满足这些人需求的资源计划至关重要。精神和行为障碍预计会增加精神病医疗保健的风险。此外,突发性和阵发性疾病增加了计划的精神病保健的风险。结论患有ID的老年人由于诊断方式复杂,对精神病专科医疗保健的需求很高。进一步的研究需要调查可以解释较高年龄组中较少精神病治疗的情况。还需要研究在初级卫生保健背景下有身份的人之间的卫生保健利用情况。这些知识对于决策者满足这些人需求的资源计划至关重要。结论患有ID的老年人由于诊断方式复杂,对精神病专科医疗保健的需求很高。进一步的研究需要调查可以解释较高年龄组中较少精神病治疗的情况。还需要研究在初级卫生保健背景下有身份的人之间的卫生保健利用情况。这些知识对于决策者满足这些人需求的资源计划至关重要。结论患有ID的老年人由于诊断方式复杂,对精神病专科医疗保健的需求很高。进一步的研究需要调查可以解释较高年龄组中较少精神病治疗的情况。还需要研究在初级卫生保健背景下有身份的人之间的卫生保健利用情况。这些知识对于决策者满足这些人需求的资源计划至关重要。
更新日期:2020-02-18
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