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Multimorbidity and its outcomes among patients attending psychiatric care settings: An observational study from Odisha, India


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Pati, S, Mahapatra, P, Dwivedi, R, Athe, R, Sahoo, KC, Samal, M, Das, RC and Hussain, MA ORCID: 0000-0002-6012-3702 2021 , 'Multimorbidity and its outcomes among patients attending psychiatric care settings: An observational study from Odisha, India' , Frontiers in Public Health, vol. 8 , pp. 1-21 , doi: 10.3389/fpubh.2020.616480.

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Background: Multimorbidity, the presence of two or more chronic health conditions is linked to premature mortality among psychiatric patients since the presence of one can further complicate the management of either. Little research has focused on the magnitude and effect of multimorbidity among psychiatric patients in low-and middle-income settings. Our study, provides the first ever data on multimorbidity and its outcomes among patients attending psychiatric clinics in Odisha, India. It further explored whether multimorbidity was associated with higher medical expenditure and the interaction effect of psychiatric illness on this association.Methods: This cross-sectional study included 500 adult patients presenting to the psychiatric clinic of a medical college hospital in Odisha over a period of 6 months (February 2019-July 2019). A validated structured questionnaire, "multimorbidity assessment questionnaire for psychiatric care" (MAQ-PsyC) was used for data collection. We used multinomial logistic model for the effect estimation. Odds ratios (OR) and 95% confidence intervals (CI) for high healthcare utilization and expenditure were calculated by number and pattern of multimorbidity. Data was analyzed by STATA 14. Results: Half (50%) of the psychiatric outpatients had multimorbidity. The relative probabilities of having one additional condition were 5.3 times (RRR = 5.3; 95% CI: 2.3, 11.9) and multiple morbidities were 6.6 times (RRR = 6.6; 95%CI: 3.3, 13.1) higher for patients in 60+ age group. Healthcare utilization i.e., medication use and physician consultation was significantly higher for psychiatric conditions such as mood disorders, schizophrenia, schizotypal and delusional disorders, and for hypertension, cancer, diabetes, among somatic conditions. Out of pocket expenditure (OOPE) was found to be highest for laboratory investigations, followed by medicines and transport expenditure. Within psychiatric conditions, mood disorders incurred highest OOPE ($93.43) while hypertension was the most leading for OOPE in physical morbidities ($93.43). Psychiatric illnesses had a significant interaction effect on the association between multimorbidity and high medical expenditure (P = 0.001). Conclusion: is highly prevalent in psychiatric patients associated with significantly high healthcare utilization and medical expenditure. Such disproportionate effect of psychiatric multimorbidity on healthcare cost and use insinuates the need for stronger financial protection and tailor-made clinical decision making for these vulnerable patient subgroups.

Item Type: Article
Authors/Creators:Pati, S and Mahapatra, P and Dwivedi, R and Athe, R and Sahoo, KC and Samal, M and Das, RC and Hussain, MA
Keywords: LMIC, OOPE, health care utilization, medical expenditure, multimorbidity, physical-mental interface, polypharmacy, psychiatric
Journal or Publication Title: Frontiers in Public Health
Publisher: Frontiers Editorial Office
ISSN: 2296-2565
DOI / ID Number: 10.3389/fpubh.2020.616480
Copyright Information:

Copyright 2021 Pati, Mahapatra, Dwivedi, Athe, Sahoo, Samal, Das andHussain. This is an open-access article distributed under the terms of theCreative Commons Attribution License (CC BY). The use, distribution orreproduction in other forums is permitted, provided the original author(s)and the copyright owner(s) are credited and that the original publication inthis journal is cited, in accordance with accepted academic practice. No use,distribution or reproduction is permitted which does not comply with theseterms.

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