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Social Determinants of Health

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Subject:
From:
Graeme Bacque <[log in to unmask]>
Reply To:
Social Determinants of Health <[log in to unmask]>
Date:
Mon, 12 Mar 2007 19:43:04 -0400
Content-Type:
text/plain
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text/plain (155 lines)
The piece referred to 'medically necessary' procedures - which 
psychiatric interventions are not.

Rahul Mediratta wrote:
> 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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