New study shows poorer healthcare for Ontarians living with serious mental illness and diabetes

01/03/2017

In a new study published today in General Hospital Psychiatry, researchers at the Centre for Addiction and Mental Health (CAMH) and the Institute for Clinical Evaluative Sciences (ICES) have highlighted the urgent need for individuals with severe mental illness to receive better, integrated healthcare for their co-existing diabetes condition.

The study was based on records of more than one million Ontarians with diabetes, of whom 2.3 per cent had schizophrenia. These latter individuals faced poorer quality of care compared to other people with diabetes. On average, the lives of these individuals are 15 to 20 years shorter than individuals without a serious mental illness, and this reduced life span has been attributed to cardiovascular illnesses, with diabetes being a major risk factor.

“There is no question that we simply have to do better to integrate mental and physical healthcare for these individuals,” says Dr. Paul Kurdyak, senior author and director of health outcomes with the Medical Psychiatry Alliance (MPA), which supported the study. “Our work highlights the urgent need to improve on the quality gaps identified in this study.” Dr. Kurdyak is also a scientist and medical director of performance improvement at CAMH, a scientist at ICES and an associate professor at the University of Toronto.

Researchers in this study identified all Ontario residents with diabetes as of April 1, 2011, with and without a diagnosis of schizophrenia. The study looked at the quality of diabetes care provided to both groups and diabetes-related Emergency Department visits and hospitalizations over a two-year period.

Researchers found that individuals with schizophrenia received poorer quality of care for their diabetes, and had worse diabetes-related outcomes. Three out of four did not receive guideline-level diabetes care, versus two out of three individuals without schizophrenia, despite having more access to primary care physicians than those without schizophrenia. They were also 34 per cent more likely to have diabetes-related hospitalizations after researchers adjusted for age, sex, rurality, material deprivation, comorbidities and duration of diabetes.

“We know that providing high quality medical and psychiatric care to individuals with both a physical illness and severe mental illness is challenging. We do not have much evidence on how to address these deficits in quality of care or poor outcomes in this population,” says Dr. Kurdyak. “We really need to develop more innovative and integrated ways to address both mental and physical illness in a large population that is burdened by both types of conditions.”

The Medical Psychiatry Alliance is a collaborative health partnership of CAMH, The Hospital for Sick Children, Trillium Health Partners, the University of Toronto, the Ministry of Health and Long-Term Care (MOHLTC), and an anonymous donor. The MPA is currently developing interventions to improve the quality of care and quality of life for individuals with mental and physical illnesses. The study, which used population-based data to understand the burden of illness for individuals with a serious mental illness and diabetes, serves as a baseline effort to improve the quality of care for these individuals.

The study was also supported by ICES and grants from the MOHLTC.

The Institute for Clinical Evaluative Sciences (ICES) is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy. For the latest ICES news, follow us on Twitter: @ICESOntario