I have a comment re:
"Psychiatric status affects survival with and access to some
procedures for circulatory disease, even in a universal health care system
that is free at the point of delivery."
The Ontario government differentiates between 'mental illness' and 'serious mental illness' in the financing and availability of mental health services. I am not sure what Nova Scotia's framework is, but this is something to consider. Some might argue that access to specialized services cognizant of mental illness is advantageous. Conversely, others argue that mental health services are all too often planned outside the broader realm of health care in provinces (this criticism dates all the way back to the Ontario Council on Health, 1969). Perhaps these thoughts will guide next steps in this area....
Rahul Mediratta
----- Original Message ----
From: Dennis Raphael <[log in to unmask]>
To: [log in to unmask]
Sent: Monday, March 12, 2007 6:02:55 PM
Subject: [SDOH] Inequitable access for mentally ill patients to some medically necessary procedures
Sent by: "The Health Equity Network
FYI Paper in latest issue of the CMAJ that may be of interest to some of
you.
Best wishes
David McDaid
LSE Health and Social Care
Inequitable access for mentally ill patients to some medically necessary
procedures
Stephen Kisely, Mark Smith, David Lawrence, Martha Cox, Leslie Anne
Campbell and Sarah Maaten
http://www.cmaj.ca/cgi/content/full/176/6/779
(see also commentary at http://www.cmaj.ca/cgi/content/full/176/6/787 )
Background: Although universal health care aims for equity in service
delivery, socioeconomic status still affects death rates from ischemic
heart disease and stroke as well as access to revascularization procedures.
We investigated whether psychiatric status is associated with a similar
pattern of increased mortality but reduced access to procedures. We
measured the associations between mental illness, death, hospital
admissions and specialized or revascularization procedures for circulatory
disease (including ischemic heart disease and stroke) for all patients in
contact with psychiatric services and primary care across Nova Scotia.
Methods: We carried out a population-based record-linkage analysis of
related data from 1995 through 2001 using an inception cohort to calculate
rate ratios compared with the general public for each outcome (n = 215
889). Data came from Nova Scotia's Mental Health Outpatient Information
System, physician billings, hospital discharge abstracts and vital
statistics. We estimated patients' income levels from the median incomes of
their residential neighbourhoods, as determined in Canada's 1996 census.
Results: The rate ratio for death of psychiatric patients was significantly
increased (1.34), even after adjusting for potential confounders, including
income and comorbidity (95% confidence interval [CI] 1.29-1.40), which was
reflected in the adjusted rate ratio for first admissions (1.70, 95% CI
1.67-1.72). Their chances of receiving a procedure, however, did not match
this increased risk. In some cases, psychiatric patients were significantly
less likely to undergo specialized or revascularization procedures,
especially those who had ever been psychiatric inpatients. In the latter
case, adjusted rate ratios for cardiac catheterization, percutaneous
transluminal coronary angioplasty and coronary artery bypass grafts were
0.41, 0.22 and 0.34, respectively, in spite of psychiatric inpatients'
increased risk of death.
Conclusions: Psychiatric status affects survival with and access to some
procedures for circulatory disease, even in a universal health care system
that is free at the point of delivery. Understanding how these disparities
come about and how to reduce them should be a priority for future research.
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