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Geographic variations in involuntary care and associations with the supply of health and social care: results from a nationwide study
BACKGROUND: Involuntary psychiatric care remains controversial. Geographic disparities in its use can challenge the appropriateness of the care provided when they do not result from different health needs of the population. These disparities should be reduced through dedicated health policies. Howev...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5889610/ https://www.ncbi.nlm.nih.gov/pubmed/29625567 http://dx.doi.org/10.1186/s12913-018-3064-3 |
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author | Gandré, Coralie Gervaix, Jeanne Thillard, Julien Macé, Jean-Marc Roelandt, Jean-Luc Chevreul, Karine |
author_facet | Gandré, Coralie Gervaix, Jeanne Thillard, Julien Macé, Jean-Marc Roelandt, Jean-Luc Chevreul, Karine |
author_sort | Gandré, Coralie |
collection | PubMed |
description | BACKGROUND: Involuntary psychiatric care remains controversial. Geographic disparities in its use can challenge the appropriateness of the care provided when they do not result from different health needs of the population. These disparities should be reduced through dedicated health policies. However, their association with the supply of health and social care, which could be targeted by such policies, has been insufficiently studied. Our objectives were therefore to describe geographic variations in involuntary admission rates across France and to identify the characteristics of the supply of care which were associated with these variations. METHODS: Involuntary admission rate per 100,000 adult inhabitants was calculated in French psychiatric sectors’ catchment areas using 2012 data from the national psychiatric discharge database. Its variations were first described numerically and graphically. Several factors potentially associated with these variations were then considered in a negative binomial regression with an offset term accounting for the size of catchment areas. They included characteristics of the supply of care (public and private care, health and social care, hospital and community-based care, specialised and non-specialised care) as well as adjustment factors related to epidemiological characteristics of the population of each sector’s catchment area and its level of urbanization. Such variables were extracted from complementary administrative databases. Supply characteristics associated with geographic variations were identified using a significance level of 0.05. RESULTS: Significant variations in involuntary admission rates were observed between psychiatric sectors’ catchment areas with a coefficient of variation close to 80%. These variations were associated with some characteristics of the supply of health and social care in the sectors’ catchment areas. Notably, an increase in the availability of community-based private psychiatrists and the capacity of housing institutions for disabled individuals was associated with a decrease in involuntary admission rates while an increase in the availability of general practitioners was associated with an increase in those rates. CONCLUSIONS: There is evidence of considerable variations in involuntary admission rates between psychiatric sectors’ catchment areas. Our results provide lines of thoughts to reduce such variations, in particular by supporting an increase in the availability of upstream and downstream care in the community. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12913-018-3064-3) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-5889610 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-58896102018-04-10 Geographic variations in involuntary care and associations with the supply of health and social care: results from a nationwide study Gandré, Coralie Gervaix, Jeanne Thillard, Julien Macé, Jean-Marc Roelandt, Jean-Luc Chevreul, Karine BMC Health Serv Res Research Article BACKGROUND: Involuntary psychiatric care remains controversial. Geographic disparities in its use can challenge the appropriateness of the care provided when they do not result from different health needs of the population. These disparities should be reduced through dedicated health policies. However, their association with the supply of health and social care, which could be targeted by such policies, has been insufficiently studied. Our objectives were therefore to describe geographic variations in involuntary admission rates across France and to identify the characteristics of the supply of care which were associated with these variations. METHODS: Involuntary admission rate per 100,000 adult inhabitants was calculated in French psychiatric sectors’ catchment areas using 2012 data from the national psychiatric discharge database. Its variations were first described numerically and graphically. Several factors potentially associated with these variations were then considered in a negative binomial regression with an offset term accounting for the size of catchment areas. They included characteristics of the supply of care (public and private care, health and social care, hospital and community-based care, specialised and non-specialised care) as well as adjustment factors related to epidemiological characteristics of the population of each sector’s catchment area and its level of urbanization. Such variables were extracted from complementary administrative databases. Supply characteristics associated with geographic variations were identified using a significance level of 0.05. RESULTS: Significant variations in involuntary admission rates were observed between psychiatric sectors’ catchment areas with a coefficient of variation close to 80%. These variations were associated with some characteristics of the supply of health and social care in the sectors’ catchment areas. Notably, an increase in the availability of community-based private psychiatrists and the capacity of housing institutions for disabled individuals was associated with a decrease in involuntary admission rates while an increase in the availability of general practitioners was associated with an increase in those rates. CONCLUSIONS: There is evidence of considerable variations in involuntary admission rates between psychiatric sectors’ catchment areas. Our results provide lines of thoughts to reduce such variations, in particular by supporting an increase in the availability of upstream and downstream care in the community. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12913-018-3064-3) contains supplementary material, which is available to authorized users. BioMed Central 2018-04-06 /pmc/articles/PMC5889610/ /pubmed/29625567 http://dx.doi.org/10.1186/s12913-018-3064-3 Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Article Gandré, Coralie Gervaix, Jeanne Thillard, Julien Macé, Jean-Marc Roelandt, Jean-Luc Chevreul, Karine Geographic variations in involuntary care and associations with the supply of health and social care: results from a nationwide study |
title | Geographic variations in involuntary care and associations with the supply of health and social care: results from a nationwide study |
title_full | Geographic variations in involuntary care and associations with the supply of health and social care: results from a nationwide study |
title_fullStr | Geographic variations in involuntary care and associations with the supply of health and social care: results from a nationwide study |
title_full_unstemmed | Geographic variations in involuntary care and associations with the supply of health and social care: results from a nationwide study |
title_short | Geographic variations in involuntary care and associations with the supply of health and social care: results from a nationwide study |
title_sort | geographic variations in involuntary care and associations with the supply of health and social care: results from a nationwide study |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5889610/ https://www.ncbi.nlm.nih.gov/pubmed/29625567 http://dx.doi.org/10.1186/s12913-018-3064-3 |
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