Tag: Barker

Reading of the Week: Equity & Mental Health Care – Post-Partum Follow Up After ED Visits (Lancet Psych) and Race and Prescribing (Psych Services)

April 21, 2022 /

From the Editor

We often speak of the challenges patients face in accessing mental health care. But, of course, such challenges may vary greatly, depending on demographics – think rural versus urban, young versus older, White versus non-White. How equitable is care? This week, we look at two new papers; one draws on Canadian data while the other on American. And though the studies are different, they point in a similar direction: unique populations face significant challenges accessing care.

In the first selection, Dr. Lucy C. Barker (of the University of Toronto) and her co-authors consider follow-up after an ED visit for patients in the post-partum period. In a new Lancet Psychiatry paper, they drew on Ontario databases, with more than 12 000 visits analyzed. They write: “Fewer than half of emergency department visits for a psychiatric reason in the post-partum period were followed by timely outpatient care, with social-determinants-of-health-based disparities in access to care.” We consider the paper and its implications.

In the second selection, Jocelyn E. Remmert (of the U.S. Department of Veterans Affairs) and her co-authors consider depression care and race. In a new Psychiatric Services paper, they look at antidepressant prescribing, finding big differences between White and Black veterans. “Among veterans, Black patients were almost two times less likely than White patients to have an antidepressant prescription, even after the analyses controlled for depression symptoms, demographic characteristics, psychosocial variables, and other clinical symptoms.”

DG

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Reading of the Week: ED Visits & Follow Ups – the New Psych Services Paper; Also, Antipsychotics and Brains (JAMA Psych) and Physician Biases (NEJM)

March 5, 2020 /

From the Editor

How accessible is urgent outpatient mental health care in Canada? Do antipsychotics affect the brain structure of people with psychotic depression? How can physician biases change cardiac care?

This week, we consider three very different selections, drawing from the latest in the literature.

Outpatient Sign over a Hospital Outpatient Services Entrance

In the first selection, Dr. Lucy C. Barker (University of Toronto) and her co-authors look at follow-ups after an ED visit. As the authors note: “Urgent outpatient mental health care is crucial for ongoing assessment and management and for preventing repeat visits to the ED and other negative outcomes.” Drawing on Ontario data, they find that “fewer than half had a physician follow-up visit within 14 days of the ED visit for outpatient mental health care.” Ouch.

In the second selection, we consider a new paper by Dr. Aristotle N. Voineskos (University of Toronto) et al. In an impressive study across multiple sites, they find a connection between cortical thinning and the use of antipsychotics: “olanzapine exposure was associated with a significant reduction compared with placebo exposure for cortical thickness.” Ouch.

Finally, it’s said about health care that “geography is destiny” – so much of the patient experience is tied to her or his place of care, with incredible variations in services between, say, rural and urban centres. In an unusual research letter for The New England Journal of Medicine, Andrew R. Olenski (Columbia University) and his co-authors consider heart surgery and patient age – that is, within two weeks of a patient’s 80th birthday. They argue that numbers are destiny, with heart surgery influenced by “the occurrence of left-digit bias in clinical decision-making…” Ouch.

Please note that there will be no Readings for the next two weeks.

DG

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