背景:英国国家卫生局承诺提供3.65亿英镑,以通过社区围产期心理健康小组(CPMHTs)改善获得精神保健服务的机会,并降低患有严重精神疾病的妇女的围产期复发率。这项研究旨在探讨在英格兰具有专业精神保健史的孕妇中实施CPMHTs后服务使用模式的变化。并对这些变化进行成本分析。
方法:本研究使用基于现有常规管理数据的纵向队列设计。研究人群是所有居住在英格兰的妇女,在2016年4月1日或之后怀孕,并且在2018年3月31日或之前分娩并患有精神疾病(N=70,323)。比较了实施CPMHTs前后的资源使用和成本。经济角度仅限于二级精神卫生服务,时间范围是围产期(从怀孕开始到出生后1年,~21个月)。
结果:在有CPMHTs的地区,围产期使用社区精神保健服务的女性比例较高(30.96%,n=9,653)与没有CPMHTs的地区(24.72%,n=9,615)。在使用CPMHTs的地区,围产期使用急性护理服务(住院和危机解决小组)的妇女总体百分比较低(4.94%,n=1,540vs.5.58%,n=2,171),包括减少的危机解决团队联系人(4.41%,n=1,375vs.5.23%,n=2,035),但精神病住院人数增加(1.43%,n=445vs.1.13%,n=441)。对于使用CPMHTs的地区,围产期的总精神医疗费用明显更高(完全调整后的增量成本为111英镑,95%CI为29英镑至192英镑,p值0.008)。
结论:在实施CPMHTs之后,使用急性护理的女性比例下降,而使用社区护理的女性比例上升.然而,与不使用CPMHT相比,CPMHT组女性更多使用住院患者以及更多使用社区护理,导致女性使用二级精神卫生服务的平均成本显著较高.必须谨慎考虑成本的增加,因为没有有关生活质量或服务满意度等相关结果的数据。
BACKGROUND: The National Health Service in England pledged >£365 million to improve access to mental healthcare services via Community Perinatal Mental Health Teams (CPMHTs) and reduce the rate of perinatal relapse in women with severe mental illness. This study aimed to explore changes in service use patterns following the implementation of CPMHTs in pregnant women with a history of specialist mental healthcare in England, and conduct a cost-analysis on these changes.
METHODS: This study used a longitudinal cohort design based on existing routine administrative data. The study population was all women residing in England with an onset of pregnancy on or after 1st April 2016 and who gave birth on or before 31st March 2018 with pre-existing mental illness (N = 70,323). Resource use and costs were compared before and after the implementation of CPMHTs. The economic perspective was limited to secondary mental health services, and the time horizon was the perinatal period (from the start of pregnancy to 1-year post-birth, ~ 21 months).
RESULTS: The percentage of women using community mental healthcare services over the perinatal period was higher for areas with CPMHTs (30.96%, n=9,653) compared to areas without CPMHTs (24.72%, n=9,615). The overall percentage of women using acute care services (inpatient and crisis resolution teams) over the perinatal period was lower for areas with CPMHTs (4.94%, n=1,540 vs. 5.58%, n=2,171), comprising reduced crisis resolution team contacts (4.41%, n=1,375 vs. 5.23%, n=2,035) but increased psychiatric admissions (1.43%, n=445 vs. 1.13%, n=441). Total mental healthcare costs over the perinatal period were significantly higher for areas with CPMHTs (fully adjusted incremental cost £111, 95% CI £29 to £192, p-value 0.008).
CONCLUSIONS: Following implementation of CPMHTs, the percentage of women using acute care decreased while the percentage of women using community care increased. However, the greater use of inpatient admissions alongside greater use of community care resulted in a significantly higher mean cost of secondary mental health service use for women in the CPMHT group compared with no CPMHT. Increased costs must be considered with caution as no data was available on relevant outcomes such as quality of life or satisfaction with services.