Programme no. 239-OP
Quality Improvement
Care of patients with schizophrenia in Norwegian general practice – are the comorbidities recognised? Register-based study from 2009
Sturla Gjesdal*1, Øystein Hetlevik2
1Global health and Primary Health Care,University of Bergen,Bergen,Norway, 2Global health and Primary Health Care,University of Bergen,Bergen,Norway
* = Presenting author
Objectives: The aim of the study was to assess how patients diagnosed with schizophrenia use the GP services, using data on population averages for comparison.
Background: Over the last decades, reforms have given primary care increased responsibility for patients with serious mental disorders (SMD). There is also growing awareness of high somatic morbidity among these patients, with decreased life-expectancy, an obvious challenge for their general practitioners (GPs).
Results: Mean consultation rate was 5.0 and average FFS was 2,807 NOK for patients diagnosed with schizophrenia. Only 17% had no consultations, 26.2% had 1-2, 25.3% had 3-5 and 16.1% more than 5 consultations. During 2009 GPs participated in multidisciplinary meetings for 25.7 % of their patients with schizophrenia. The use of diagnostic tests like HbA1c, spirometry and ECG was more frequent among patients with schizophrenia and comorbid somatic conditions, than among similar patients without a SMD. Thus, among patient with schizophrenia, co-morbid DM increased the FFS with NOK 1400, comorbid obstructive lung disease with NOK 1699 and cardiovascular disease with NOK 863. Belonging to a GP with a high proportion of mental health related consultations in his/her practice, increased the FFS for patients with schizophrenia (NOK 115 per percent point increase). Patients with schizophrenia living in municipalities with < 10, 000 inhabitants had at average increase in FFS of NOK 1048 compared to patients living in municipalities with >50,000 inhabitants.
Material/Methods: The Norwegian list patient system is based on fee-for-service (FFS). For each contact the GPs send claims to the National Health Insurance with the diagnosis, the type of contact, procedures performed and the patient’s personal number. Based on the diagnoses used on GP claims from 2007-2009, patients were classified with schizophrenia if the ICPC code P72 was used at least once (N=10,112). Complete GP claims data from 2009 for patients aged 25-60 years were used to assess the utilisation of GP services. Regression models were used to measure the association between patient-, GP- and practice characteristics and FFS per patient as a measure of service utilisation.
Conclusion:

The study indicate that most patients diagnosed with schizophrenia in Norway have regular contact with their GPs, providing opportunities for the GP to care for both mental and somatic health problems among these patients.

Points for discussion: However, the use of appropriate tests to monitor serious somatic illness is still too low among patients with SMD, and gives no reason for complacency. Awareness among GPs on the comorbidities should be increased.