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主要な精神疾患における身体的健康指標:英国における品質と成果の枠組みからのデータ
Julie Langan Martin1, Richard Lowrie2, Alex McConnachie1
1University of Glasgow, Glasgow, UK.
Lancet (London, England)
|August 28, 2015
まとめ
一般医は,英国全土で糖尿病や慢性腎臓病の患者と比較して,重度の精神疾患の患者でボディマス指数 (BMI) と血圧 (BP) をより頻繁に記録しました. これは重度の精神疾患を持つ人々の医療へのアクセスにおける 不平等の可能性を示しています
科学分野:
- 公衆衛生
- 医療サービス研究
- メンタルヘルスの研究
背景:
- イギリスのQuality and Outcome Framework (QOF) は,重度の精神疾患,糖尿病,慢性腎臓疾患の患者の体量指数 (BMI) と血圧 (BP) を記録するよう一般医に奨励しています.
- 介護へのインセンティブにもかかわらず,重要な健康指標 (統合失調症,双極性障害,および関連する精神病) の記録に影響を与える可能性があります.
研究 の 目的:
- 主要な精神疾患と糖尿病や慢性腎臓疾患の人の間で特定のBMIとBPの記録率を比較する.
- 重度の精神疾患の患者に対する 医療の提供における潜在的な格差を特定し,改善すべき分野を特定する.
主な方法:
- 品質と成果の枠組み (QOF) の2012-2013年のデータを分析した.
- BMIとBP指標の平均報酬,人口の達成率,例外率の計算
- 主要な精神疾患のコホートと糖尿病/慢性腎疾患のコホートの割合の統計的比較,クォンチル回帰を用いたクロスカントリー分析を含む.
主要な成果:
- 英国の糖尿病と比べて 精神疾患のBMIを記録する際の 賃金や 成績率が著しく低下し,例外率も高かった.
- 英国の慢性腎臓病と比較して 重要な精神疾患で BP 記録の例外率が著しく低い
- 主要な精神疾患におけるBMIとBPの両方の平均的な達成率はスコットランドでイングランドと比較して低かったが,慢性腎臓疾患と糖尿病ではそのような管轄区間差は認められなかった.
結論:
- イギリス全土で,重度の精神疾患を持つ人は,糖尿病や慢性腎臓病の患者と比較して,BMIとBPの記録率が低い.
- 英国各国間の記録率の変動は,重度の精神疾患を持つ人々の医療アクセスにおける潜在的な不平等を示唆しています.
- この集団のケアを改善するために,多要素の患者,臨床医,および組織的要因に対処する必要性を強調しています.
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