Article Abstract

Article Abstract

Online ISSN: 1099-176X Print ISSN: 1091-4358
The Journal of Mental Health Policy and Economics
Volume 18, Issue 1, 2015. Pages: 17-25
Published Online: 1 March 2015

Regional Analysis of Health Service Utilisation by Persons with Borderline Personality Disorders: Implications for Evidence-Informed Policy

Marc Ferrer,¹ Óscar Andión,² Murielle Bendeck,³ Natalia Calvo,⁴ Mònica Prat,⁵ Enric Aragonès,⁶ Carmen Barral,⁷ Miguel Casas,⁸ and Luis Salvador-Carulla⁹*

¹Coordinator, BPD Program, Psychiatry Department, Vall d'Hebron University Hospital, CIBERSAM, and Associate Professor, Psychiatry and Legal Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain
²BPD Program, Psychiatry Department, Vall d'Hebron University Hospital, CIBERSAM, and Associate Professor, Psychiatry and Legal Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain
³InGenis Consulting Group, Barcelona, Spain
⁴BPD Program, Psychiatry Department, Vall d'Hebron University Hospital, CIBERSAM, and Associate Professor, Psychology Faculty, Universitat Autònoma de Barcelona, Barcelona, Spain
⁵BPD Program, Psychiatry Department, Vall d'Hebron University Hospital, CIBERSAM, Barcelona, Spain.
⁶Centre d'Atenció Primària de Constantí, Institut Català de la Salut and Institut d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
⁷BPD Program, Psychiatry Department, Vall d'Hebron University Hospital. Outpatient Drug Clinic (CAS) Vall d'Hebron, Vall d'Hebron University Hospital-Agència de Salut Pública de Barcelona, CIBERSAM, Barcelona, Spain
⁸Head, Psychiatry Department, Vall d'Hebron University Hospital, CIBERSAM, and Professor, Psychiatry and Legal Medicine Department. Universitat Autònoma de Barcelona, Barcelona, Spain
⁹Professor of Disability and Mental Health. Head, Mental Health Policy Unit, Brain and Mind Research Institute, Centre for Disability Research and Policy, Faculty of Health Sciences, Sydney, Australia.

* Correspondence to: Luis Salvador-Carulla, MD, PhDMental Health Policy Unit, Brain and Mind Research Institute, Centre for Disability Research and Policy, Faculty of Health Sciences, T315a Cumberland Campus, The University of Sydney, 75 East Street, Lidcombe, NSW 2141, Australia
Tel.: +61-2-9351 9231
Fax: +61-2-9351 9566

Source of Funding: Financial support was provided by public funds from the Pla Director de Salut Mental i Addiccions (Generalitat de Catalunya Health Department) and grants from the Obra Social-Fundació “la Caixa”.

Abstract

There is little information on the regional patterns of service utilization by patients with Borderline Personality Disorder (BPD). The use of mental healthcare resources by BPD in Catalonia (Spain) was estimated by combining available data on use of services with prior expert knowledge using a mixed quantitative-qualitative approach. BPD estimated prevalence resulted 0.7% but only 9.6% of all BPD patients were in contact with the healthcare system. A significant gap was identified between registered BPD in the official databases and information from empirical evidence and expert knowledge in primary care, specialized outpatient care and hospitalization rates. An overall lack of visibility of BPD was detected in the local, regional and national databases and registries. Basic recommendations to improve evidence-informed mental health policy comprise including BPD information in epidemiological studies and health surveys and prioritizing BPD coding over other mental health disorders in health databases. Under conditions of uncertainty, expert estimates driven by local data provide a useful approach for guiding regional policy.

Background: Borderline Personality Disorder (BPD) has been associated with an intensive use of health resources and a high economic burden.

Aims of the Study: The aim of this study is to analyze the use of mental healthcare resources by BPD patients, to identify the information gaps on BPD at the regional health databases and to describe specific indicators and patterns of care utilization by persons with BPD in order to guide evidence-informed policy planning in Catalonia (Spain).

Methods: A multi-level cross-design synthesis approach was applied following a mixed quantitative-qualitative analysis to estimate the regional service utilisation of patients with BPD. This framing analysis included estimates based on all available data on the use of services combined with prior expert knowledge gathered through a nominal group of key stakeholders in this field.

Results: The estimated year prevalence of BPD was 0.7% but only 9.6% of all BPD patients in Catalonia had any contact with the health care system. Of those, less than half contacted mental health care. BPD represented 1.7% of the total care load in the community mental health centres. A significant information gap was identified in all the official databases and impeded their direct use for planning and resource allocation in BPD. Expert knowledge was required to estimate rates of care utilization at every level of care system (primary care, specialized outpatient care and hospital care). Nevertheless the high pattern of care utilization identified at the databases was accurate according to the experts.

Discussion: Detection of BPD was lower than expected in the local, regional and national databases and registries of Catalonia. Local data was judged highly inaccurate by experts in comparison to data available on other mental disorders in the same databases.

Implications for Health Policy and Research: Specific incentives should be implemented to improve the availability and accuracy of information on BPD at the regional databases. When present, BPD should be coded before other psychiatric disorders in clinical records and health databases. Mental health surveys and psychiatric epidemiological studies should specifically incorporate BPD in their inclusion criteria and further studies on the utilisation pattern of this disorder are needed, both locally and internationally.

Received 9 August 2014; accepted 21 December 2014