Mentally Ill Medicare Patients Less Likely Than Others To Receive Certain Types Of Surgery

ArticleinHealth Affairs 30(7):1307-15 · July 2011with9 Reads
DOI: 10.1377/hlthaff.2010.1084 · Source: PubMed
Abstract
Mentally ill people may face barriers to receiving elective surgical procedures as a result of societal stigma and the cognitive, behavioral, and interpersonal deficits associated with mental illness. Using data from a cohort of elderly Medicare beneficiaries in 2007, we examined whether the mentally ill have less access than people without mental illness to several common procedures that are typically not for emergencies and are performed at the discretion of the provider and the patient. Results suggest that Medicare patients with mental illness are 30-70 percent less likely than others to receive these "referral-sensitive" surgical procedures. Those who did undergo an elective procedure generally experienced poorer outcomes both in the hospital and after discharge. Efforts to improve access to and outcomes of nonpsychiatric care for mentally ill patients are warranted.
    • "One might expect that, compared to the general public, stigma toward mental illness would be less common in health care providers considering their commitment to the health of their patients. However, studies indicate that stigma toward people with mental illness is a worldwide problem, including among health care providers, with potentially adverse effects on treatment quality and outcomes [1][2][3]. In 2009, a task force of the World Psychiatric Association called for initiatives to reduce stigma toward people with mental illness [1]. "
    [Show abstract] [Hide abstract] ABSTRACT: Objectives Stigma among health care providers toward people with mental illness is a worldwide problem. This study at a large US university examined medical student attitudes toward mental illness and its causes, and whether student attitudes change as they progress in their education. Methods An electronic questionnaire focusing on attitudes toward people with mental illness, causes of mental illness, and treatment efficacy was used to survey medical students at all levels of training. Exploratory factor analysis was used to establish attitudinal factors, and analysis of variance was used to identify differences in student attitudes among these factors. Independent-samples t tests were used to assess attitudes toward efficacy of treatments for six common psychiatric and medical conditions. Results The study response rate was 42.6 % (n = 289). Exploratory factor analysis identified three factors reflecting social acceptance of mental illness, belief in supernatural causes, and belief in biopsychosocial causes. Stages of student education did not differ across these factors. Students who had completed the psychiatry clerkship were more likely to believe that anxiety disorders and diabetes could be treated effectively. Students reporting personal experiences with mental illness showed significantly more social acceptance, and people born outside the USA were more likely to endorse supernatural causes of mental illness. Conclusions Sociocultural influences and personal experience with mental illness have a greater effect than medical education on attitudes toward people with mental illness. Psychiatric education appears to have a small but significant effect on student attitudes regarding treatment efficacy.
    Full-text · Article · Mar 2016
    • "This literature review has added five further studies examining associations between mental disorder and LOS. All five of these studies showed those with mental disorder were more likely to have a longer LOS than those without mental disorder (Bourgeois et al., 2005; Bressi et al., 2006; Hoover et al., 2004; Li et al., 2011; Sayers et al., 2007). As noted above, it is feasible that these outcomes provide a rationale for the disparity in treatment. "
    [Show abstract] [Hide abstract] ABSTRACT: People with mental disorder experience a heavy burden of physical ill-health. This, alongside structural health-system changes, means more people with mental disorder are being cared for in non-psychiatric hospitals. This article reports on 32 studies that have investigated the care and outcomes of people with comorbid mental and physical health problems in non-psychiatric hospitals. Prevalence of mental disorder ranged between 4%-46%, and rates of psychiatric referral was 2%-10%. The receipt of invasive cardiac procedures was markedly reduced for those with mental disorder. Likelihood of experiencing an adverse event, post-operative complication or increased length of stay was also elevated for those with mental disorder.
    Full-text · Article · Apr 2014
  • [Show abstract] [Hide abstract] ABSTRACT: Background Studies in a few countries (including the US) have reported that mortality rates in the population from psychiatric disorders are much higher when they are based on all causes of death (“multiple causes” or “mentions”) coded on death certificates versus only the underlying cause. Studies appear to be lacking on geographic variation within the US in mortality rates from psychiatric disorders based on multiple causes of death. Method The present study examined the US age-standardized rate (ASR) for death with depression using multiple causes versus underlying cause alone in each of the Census Bureau’s four regions and nine divisions. ASRs for schizophrenia were also examined for comparison. Results For the entire US, the ratio of the ASR based on multiple causes to the ASR based on underlying cause was 20.9 for depression and 9.2 for schizophrenia; in analyses by region and division, these ratios showed limited variation. The most consistent finding for both depression and schizophrenia was that ASRs, whether based on multiple causes or only on underlying cause, were highest in the Midwest region (especially the East North Central division) and lowest in the South (and in each of its three divisions). For ASRs (using multiple causes of death) from depression, these regional differences were evident within each of several levels of urbanization. For deaths with depression coded as other than the underlying cause, ASRs for each of the three most common underlying causes (cardiovascular diseases, intentional injuries, and neoplasms) were highest in the Midwest and lowest in the South. Conclusion Studies are needed to determine if these regional differences in mortality from depression are due to regional differences in: certifier practices (i.e., in assigning causes of death among persons with psychiatric conditions); the prevalence (among persons with psychiatric disorders) of lifestyle-related factors (e.g., tobacco use and obesity) that mediate mortality risks; and/or in unmet need for psychiatric treatment and medical care for other chronic diseases in persons with psychiatric conditions. Similar studies are needed of regional variation within other countries.
    Article · Apr 2012
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