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Sagy YW, Krieger M, Horwitz E, Paltiel O, Ravel-Vilk S, Ben-Yehuda A, Manor O, Calderon-Margalit R. Diabetes care in individuals with severe mental Illnesses in Israel. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz187.193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Cardiovascular disease and risk factors are more common in people with severe mental illness (SMI; schizophrenia, schizoaffective disorders, and bi-polar disorders). For instance, diabetes mellitus (DM) prevalence was reported to be 2-3 times higher, with higher incidence and severity of complications. In 2015, following a reform in mental health services in Israel, services were transferred to the responsibility of the health plans, allowing a comprehensive healthcare. We aimed to compare quality of care indicators and intermediate DM outcomes in individuals with SMI compared to the general population.
Methods
The Israel national program for quality indicators in community healthcare obtains data from electronic medical records from the four health plans, covering the entire civilian population. In 2017, n = 74,226 individuals aged ≥18 years had a registered diagnosis of SMI (prevalence 1.37%). DM prevalence, hemoglobin A1c (HbA1c) testing yearly, and DM control in individuals with SMI were compared with the general population.
Results
DM prevalence in adults with SMI in 2017 was 14.3%, compared with 9.7% among all Israeli adults (RR of 1.5). rates of HbA1c testing and control (HbA1c<7-8%, depending on age and duration of disease) were similar among DM patients with SMI and the general population (testing: 90.1% and 90.9%; Control: 70.8% and 69.7%, SMI and general population, respectively); Similarly, uncontrolled DM (HbA1c>9%) was observed in 10.8% of individuals with SMI and in 10.0% of the general population.
Conclusions
Along with the expected excess of DM prevalence in individuals with SMI, quality of care DM indicators rates were alike among those with SMI as in the general population, suggesting non-inferior quality of care. This is consistent with results reported by the British national diabetes audit for England and Wales. However, our results are limited by a possible under-registration or diagnosis of SMI in the Israeli population.
Key messages
Higher diabetes mellitus prevalence is observed in individuals with severe mental illness. Hemoglobin A1c testing and diabetes mellitus control rates are alike in individuals with severe mental illness compared with the general population, suggesting non-inferior quality of care.
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Affiliation(s)
- Y Wolff Sagy
- Braun School of Public Health & Community Medicine, Hebrew University, Jerusalem, Israel
- National Program for Quality Indicators in Community Healthc, Israel National Institute for Health Policy Research, Tel Hashomer, Israel
| | - M Krieger
- Braun School of Public Health & Community Medicine, Hebrew University, Jerusalem, Israel
- National Program for Quality Indicators in Community Healthc, Israel National Institute for Health Policy Research, Tel Hashomer, Israel
| | - E Horwitz
- National Program for Quality Indicators in Community Healthc, Israel National Institute for Health Policy Research, Tel Hashomer, Israel
- Pharmacy Division, Hadassah Medical Center, Jerusalem, Israel
| | - O Paltiel
- Braun School of Public Health & Community Medicine, Hebrew University, Jerusalem, Israel
- National Program for Quality Indicators in Community Healthc, Israel National Institute for Health Policy Research, Tel Hashomer, Israel
- Hematology, Hadassah Medical Center, Jerusalem, Israel
| | - S Ravel-Vilk
- National Program for Quality Indicators in Community Healthc, Israel National Institute for Health Policy Research, Tel Hashomer, Israel
- Pediatric Hemato-Oncology, Shaare-Zedek, Jerusalem, Israel
| | - A Ben-Yehuda
- National Program for Quality Indicators in Community Healthc, Israel National Institute for Health Policy Research, Tel Hashomer, Israel
- Internal Medicine, Hadassah Medical Center, Jerusalem, Israel
| | - O Manor
- Braun School of Public Health & Community Medicine, Hebrew University, Jerusalem, Israel
- National Program for Quality Indicators in Community Healthc, Israel National Institute for Health Policy Research, Tel Hashomer, Israel
| | - R Calderon-Margalit
- Braun School of Public Health & Community Medicine, Hebrew University, Jerusalem, Israel
- National Program for Quality Indicators in Community Healthc, Israel National Institute for Health Policy Research, Tel Hashomer, Israel
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Wolff Sagy Y, Krieger M, Horwitz E, Ben-Yehuda A, Paltiel O, Ravel-Vilk S, Manor O, Calderon-Margalit R. Diabetes in Israel- do all patients receive equal care? Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz186.223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Diabetes Mellitus (DM) is associated with micro- and macro-vascular complications, leading to high burden of morbidity and mortality. Populations of low socioeconomic position (SEP) in various countries were found to have increased prevalence of the disease, worse glycemic control, and increased complications. We aimed to examine whether there are social disparities in diabetes care in Israel, as reflected in a national program for quality indicators.
Methods
The Israel National Program for Quality Indicators in Community Healthcare obtains data from electronic medical records from all health plans, covering the entire Israeli population. In 2017, 497,397 individuals aged >18 years were identified with DM. DM prevalence, quality of care indicators, including process and intermediate outcomes were explored by SEP categories (1-10), determined according to residential addresses.
Results
DM prevalence in Israeli adults in 2017 was 9.7%, showing a strong SEP gradient, with higher prevalence in individuals of lower SEP. No SEP disparities were observed in process indicators with overall rates of documentation of hemoglobin A1c (HbA1c) of 90.9%, ophthalmologic examinations of 72.5%, and kidney function examinations of 92.5%. However, strong SEP disparities were observed in the prevalence of uncontrolled diabetes (HbA1c≥9%), with an overall rate of 10.0%, and a 5.4-times higher rate in diabetics of the lowest SES level (23.5%) compared with the highest SEP level (4.3%). A somewhat weaker gradient was seen for the well-control of DM (HbA1c<7-8%, according to duration of disease and age), with an overall rate of 69.7%, and a 1.7 ratio, comparing diabetics of the highest vs the lowest SEP level.
Conclusions
These findings suggest that access to care does not explain SEP disparities in diabetes control in Israel. There is a need to explore the underlying social, cultural, and possibly the benefits-policy determinants of poor control among individuals of low SEP.
Key messages
Wide socioeconomic disparities are present among Israeli adults in diabetes mellitus prevalence and control rates, but not in care processes indicators. These findings call for a deeper understanding of the determinants and perhaps a revision of current social benefits policy, which may encourage lack of glycemic control.
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Affiliation(s)
- Y Wolff Sagy
- Braun School of Public Health & Community Medicine, Hebrew University, Jerusalem, Israel
- National Program for Quality Indicators in Community Healthc, Israel National Institute for Health Policy Research, Tel Hashomer, Israel
| | - M Krieger
- Braun School of Public Health & Community Medicine, Hebrew University, Jerusalem, Israel
- National Program for Quality Indicators in Community Healthc, Israel National Institute for Health Policy Research, Tel Hashomer, Israel
| | - E Horwitz
- National Program for Quality Indicators in Community Healthc, Israel National Institute for Health Policy Research, Tel Hashomer, Israel
- Pharmacy Division, Hadassah Medical Center, Jerusalem, Israel
| | - A Ben-Yehuda
- National Program for Quality Indicators in Community Healthc, Israel National Institute for Health Policy Research, Tel Hashomer, Israel
- Internal Medicine, Hadassah Medical Center, Jerusalem, Israel
| | - O Paltiel
- National Program for Quality Indicators in Community Healthc, Israel National Institute for Health Policy Research, Tel Hashomer, Israel
- Hematology, Hadassah Medical Center, Jerusalem, Israel
| | - S Ravel-Vilk
- National Program for Quality Indicators in Community Healthc, Israel National Institute for Health Policy Research, Tel Hashomer, Israel
- Pediatric Hemato-Oncology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - O Manor
- Braun School of Public Health & Community Medicine, Hebrew University, Jerusalem, Israel
- National Program for Quality Indicators in Community Healthc, Israel National Institute for Health Policy Research, Tel Hashomer, Israel
| | - R Calderon-Margalit
- Braun School of Public Health & Community Medicine, Hebrew University, Jerusalem, Israel
- National Program for Quality Indicators in Community Healthc, Israel National Institute for Health Policy Research, Tel Hashomer, Israel
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