Introduction Emerging evidence indicates the association between mental illness and poor quality of physical healthcare. To test this, we compared mental health clients (MHCs) with non-MHCs for the quality of primary care, using potentially preventable hospitalisations (PPHs) as an indicator.
Methods Population-based retrospective cohort study of 139 208 MHCs and 294 180 matched non-MHCs in Western Australia from 1990 to 2006, using linked data of electoral roll registrations, mental health registry, hospital admissions and deaths. We used the electoral roll as the sampling frame for both cohorts to enhance internal validity and the mental health registry to separate MHCs from non-MHCs. Rates of first PPHs (overall and by PPH categories and conditions) were compared between MHCs, type of mental disorders and non-MHCs. Both unadjusted and adjusted analyses controlled for sociodemographic factors and case mix were performed using Cox regression models.
Results PPHs accounted for >43% of all hospital admissions in both cohorts, predominantly chronic PPHs (88% in MHCs and 90% in non-MHCs). MHCs with any mental disorders were more likely to be hospitalised for any PPH conditions than non-MHCs (overall adjusted rate ratio (ARR), 1.14; 95% CI 1.13 to 1.16). ARRs were highest for chronic PPHs (1.18, 1.16 to 1.21), especially congestive heart failure (1.27, 1.21 to 1.32), chronic obstructive pulmonary disease (1.24, 1.18 to 1.31) and diabetes complications (1.19, 1.15 to 1.23); and highest for other psychoses (1.51, 1.46 to 1.56), alcohol/drug disorders (1.34, 1.29 to 1.39), schizophrenia (1.15, 1.09 to 1.21) and depressive disorders (1.14, 1.08 to 1.19).
Conclusion People with mental illness deserve special attention in improving the quality of physical healthcare at primary care level.
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