Importance pour la santé publique

Ce mémoire est le premier qui démontre que la multimorbidité physique et les troubles mentaux interagissent potentiellement entre eux, et ce autant sur les échelles des patients que du système de santé. Nos résultats illustrent l’importance de la prise en charge des troubles mentaux. Étant donné le grand risque associé aux troubles mentaux eux- mêmes et la synergie physique-mentale observée sur l’échelle des systèmes de santé, des

soins améliorés pourraient avoir un double impact, réduisant les admissions dues à la fois aux troubles mentaux eux-mêmes et à leur synergie avec les troubles physiques. Éventuellement, cela pourrait prévenir jusqu’à 5,8 % des admissions parmi la population québécoise entière. Il est crucial que les chercheurs consacrent plus de ressources pour mieux comprendre les facteurs de risque responsables des effets synergiques observés. Ces facteurs peuvent comprendre des caractéristiques des individus et du système de soins, incluant d’éventuelles inégalités systémiques. Les recherches futures pourront à leur tour permettre la mise en place d’éventuelles interventions pour améliorer les soins des personnes atteintes de multimorbidité physique et de troubles mentaux.

Conclusion

Ce mémoire à portée populationnelle (parce qu’il inclut la quasi-totalité des adultes québécois) démontre que la multimorbidité physique est associée aux admissions fréquentes à l’urgence, et que les troubles mentaux modifient cette association. La multimorbidité est en croissance accélérée dans les pays industrialisés, de sorte que la meilleure prise en charge des patients multimorbides est primordiale pour les systèmes de santé. Le fait que la multimorbidité mène aux admissions fréquentes suggère que cette prise en charge est encore inadéquate. Le Chronic Care Model énumère divers éléments qui peuvent améliorer les soins pour les patients multimorbides, nommément l’organisation des soins, l’éducation thérapeutique, le design des systèmes de prestation des soins, le soutien décisionnel, les systèmes informatiques, et les ressources communautaires. La multimorbidité est une problématique complexe qui nécessite des efforts coordonnés à travers les systèmes de santé.

Les troubles mentaux ont un double impact sur les admissions fréquentes à l’urgence. Tant pour les individus que pour le système de santé, les troubles mentaux augmentent le risque d’admissions fréquentes de manière significative. Ils exacerbent aussi l’effet de la multimorbidité physique. La combinaison des troubles mentaux avec la multimorbidité est particulièrement néfaste pour le système de santé ; le nombre absolu d’admissions avec la présence des deux facteurs est plus élevé que celui prédit en additionnant leur effet individuel. Cela pourrait éventuellement s’expliquer par des facteurs comportementaux qui nuisent à l’éducation thérapeutique, par le suivi inadéquat par les professionnels en santé, ou par les étiologies communes des maladies physiques et des troubles mentaux.

L’effet synergique de la multimorbidité physique et des troubles mentaux est un fardeau pour les individus et pour les systèmes de santé. Il pourrait contribuer à l’engorgement des urgences, un problème majeur dans le contexte te québécois et partout dans le monde. La surutilisation des urgences est couteuse et nuisible à la santé de la population. Une meilleure prise en charge des patients, incluant par exemple des programmes de suivi et des soins intégrés, peut réduire le recours à l’urgence et améliorer la santé des patients multimorbides avec des troubles mentaux.

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Annexe 1 : (Article intégré, annexe 1) Studied physical and mental disorders

Dans le document Les impacts de la multimorbidité et des troubles mentaux sur les admissions à l'urgence (Page 72-82)