Continuity of care protects mental health patients

Jan 28 2014

By Eleanor McDermid, Senior medwireNews Reporter

Research shows that seeing the same psychiatrist over time is associated with reduced mortality in patients using mental health services, particularly those with bipolar disorder, major depressive disorder, or schizophrenia.

The study authors say that “the association is plausible as a stable therapeutic relationship between a practitioner and [their] patients can lead to a better understanding of patients’ psychiatric disorder and may underpin a better management of mental disorders to reduce suicidal risk as well as enhance a better holistic monitoring of these patients to decrease the risk of death due to physical health risk factors.”

The team calculated the continuity of care (COC) index for 14,515 patients receiving regular psychiatrist care, defined as at least two visits in 6 months. Most patients had perfect continuity, ie, they saw the same psychiatrist on every visit.

Nevertheless, over 3 years of follow-up, each 0.1 increase in COC was associated with a 17% reduction in the likelihood for mortality, after accounting for age, gender, comorbidities, social status, and the interaction between comorbidities and the COC index.

Perfect COC was associated with a 47% reduction in mortality risk relative to any lapse in continuity.

The effect of continuity on mortality risk was most notable for patients with bipolar disorder, who had a 16% reduction per 0.1 increase in COC, followed by those with schizophrenia and major depressive disorder, who each had 13% risk reductions. Patients with anxiety or personality disorders had a 10% reduction and those with drug or alcohol use disorders had a still significant 7% reduction in risk.

“The challenge then becomes to increase continuity and collaboration in systems plagued by high staff turnover,” write lead researcher Nicolas Hoertel (Corentin-Celton Hospital, Paris, France) and co-workers in European Psychiatry.

They believe that this “will lead to decrease[d] mortality and to better satisfaction from patients and more relevant activity by professionals.”

However, the team notes that “bridging the boundary between primary and specialist mental health care is particularly challenging and requires an imaginative range of initiatives.”

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