The double burden of severe mental illness and cancer: a population-based study on colorectal cancer care pathways from screening to end-of-life care.

AIMS: Cancer is one of the main causes of death in persons with severe mental illness (SMI). Although their cancer incidence is similar, or sometimes even potentially lower compared to the general population, their cancer mortality remains higher. The role of healthcare provision and care equity in this mortality is increasingly being addressed in research, but available studies are limited in their scope. In this context, our aim was to compare colorectal cancer (CRC) care pathways from screening to end-of-life care in patients with and without pre-existing SMI on a national scale. METHODS: This research leverages real-world data from the French national health claims database, covering the entire population, to assess cancer screening, diagnosis, treatment and post-treatment follow-up as well as quality of care (QOC) pathways among patients with incident CRC in 2015-2018, considering whether they had pre-existing SMI. We matched patients with SMI with three patients without - on age, sex, region of residence, year of cancer incidence and cancer type and location at presentation - as well as nationally established quality of CRC care indicators and regression models adjusting for relevant socio-economic, clinical and care provider-related covariates. RESULTS: Among patients with incident CRC, 1,532 individuals with pre-existing SMI were matched with individuals without SMI. After adjusting for covariates, both colon and rectal cancer patients with SMI were less likely to participate in the national CRC screening programme and to receive advanced diagnostic examinations (e.g., colonoscopies and several complementary diagnostic examinations). They also had lower odds of receiving combined treatments (e.g., neoadjuvant chemotherapy, radiotherapy and excision) and of having access to targeted therapy or capecitabine but higher odds for invasive care (e.g., stoma). Colon cancer patients with SMI were also more likely to have no treatment at all, and rectal cancer patients with SMI were less likely to receive post-treatment follow-up. Suboptimal QOC was observed for both groups of patients, but to a higher extent for patients with SMI, with statistically significant differences for indicators focusing on diagnosis and post-treatment follow-up. CONCLUSIONS: Our findings reveal discrepancies across the care continuum of CRC between individuals with and without SMI and provide initial avenues on where to focus future efforts to address them, notably at the entry and exit stages of cancer care pathways, while calling for further research on the mechanisms preventing equity of physical healthcare for individuals with SMI.

[Regulating the distribution of health professionals in Germany, Belgium, the United Kingdom, Quebec and the United states: monograph study]. / La régulation démographique de la profession médicale en Allemagne, Belgique, Royaume-Uni, Québec et Etats-Unis: étude monographique.

The Province of Quebec and the United Kingdom have both a strong system of medical manpower regulation. Growth of the number of doctors--and consequently of health expenditures--is kept under control. Shortage of supply of health services increases the queuing process. In the two countries, the main problem is not how to curb health costs but to cope with the unmet demand. In Germany, the control of medical school intake is very weak. However, agreement of young doctors by the Sickness Fund is strictly controlled, the Fund having the right to close the list of "agreed physicians" in areas or specialties where doctor surplus is observed. In Belgium, a numerus clausus system is established very recently for medical school intake. In the USA, the health care system is traditionally regulated by the market forces. The strong increase of health expenditures during the recent decades has shifted the power from the medical profession to the paying bodies (HMO, MCO...) who are now supporting the emergence of new health personnels, less costly.

Analysis of the underestimation of induced abortions in a survey of the general population in France.

INTRODUCTION: A pilot study has been conducted in France to estimate the extent of underreporting of induced abortion and the factors linked to underreporting. METHODS: A representative random sample of 300 women aged between 18 and 44 years of age who had been pregnant during the previous 2 years and 100 women who had not was selected from the telephone directory. Interviews were conducted by telephone. RESULTS: The annual incidence of induced abortion for the 18-44-year-old age group was 6.9 per 1000 (95% confidence interval 2.2-11.6), while the rate derived from national statistics was 15 per 1000. Five women who reported a therapeutic abortion in their lifetime had confused induced abortion and therapeutic abortion. There was no significant difference in the proportion of women reporting induced abortion in their lifetime between those answering with another adult present and those who were alone when answering (13.1% versus 11.1%, p = 0.8). There was also no significant difference according to the sex of the interviewer (10.0% for men versus 12.2% for women, p = 0.6). CONCLUSION: The results suggest that the context in which the questions were asked does not affect the validity of the answers and that there is a problem in the comprehension of the terminology used. Extensive rewriting and reformulation of the questions is required to minimize the underreporting of induced abortion.

[Frequency and costs of hospital stays for hypoglycemia in France in 1995]. / Fréquence et coûts des séjours hospitaliers pour hypoglycémie en France en 1995.

OBJECTIVES: Diabetes is a highly prevalent chronic disease causing serious complications. Hypoglycemia is the most frequent, the most serious, and the most feared by patients and families. Hospitalization may be necessary and can be costly. The main objective of this study was to determine the number of cases of hypoglycemia cared for annually in France in an inpatient setting and to estimate the annual financial impact of hospitalizations. PATIENTS AND METHODS: The number of hypoglycemias seen annually by physician s in France and the frequencies of hospitalizations for hypoglycemia were determined from a literature search. Complementary data on costs were obtained from the national PMSI mission. Our sample included 817 hospital stays between 1994 and 1995. RESULTS: In 1992, physicians in France cared for 40,000 episodes of hypoglycemia. There were 10,800 hospitalizations. In 9 out of 10 cases, the hospital stay lasted several days and, despite hospitalization, 1.9% of the patients died. Mean total medical cost of a hospital stay for hypoglycemia was 14,000 FF ($2,100) (median 10,000 FF, range 1,200-120,000 FF). Mean length of stay was 6.6 days. DISCUSSION: Mean unit cost for hospital stays for hypoglycemia is high. Based on the 1993 SESI survey, the probable annual cost for the society for hospital care of patients with hypoglycemia was an estimated 108 to 151 million FF ($16-22 million) in 1995. This figure only takes into account the visible cost of caring for hypoglycemia patients. Ambulatory care was not taken into consideration. Education, for the patient and family, is fundamental for the prevention and treatment of hypoglycemia. CONCLUSION: It is important to have this estimation due to the absence of a medicoeconomic study on ambulatory and hospital care for hypoglycemia. Complementary studies should be conducted to estimate the total annual cost of hypoglycemia in France.

Outpatient care in emergency departments: feasibility and comparison of three strategies for follow-up.

The outpatient population using the emergency department (ED) is increasing and so is the risk of not admitting people who need it. There is, thus, one important question: are the services delivered appropriate to the needs of these ED outpatients? Follow-up of non-admitted patients after a visit to the ED is a prerequisite for the evaluation of these health services. A multicentric follow-up study was thus performed in order to assess the possibility of contacting outpatients after a visit to the ED. Three randomized follow-up methods were compared: (1) telephone call 1 week after the emergency department visit; (2) telephone call 2 weeks after the visit; (3) telephone call 4 weeks after the visit. The follow-up rate did not change depending on whether patients were contacted at 1, 2 or 4 weeks after the visit. The success rate was 78.6%, 85.6% and 74% respectively (NS). In each strategy, 50% of patients were contacted at the first telephone call, 20% at the second telephone call and 10% by mail. Thus, in a group of outpatients who gave their consent to be called, the follow-up was found to be feasible with a high success rate whatever the time between the visit and the phone recall.