Regional analysis of health service utilisation by persons with borderline personality disorders: Implications for evidence-informed 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.