Integrating Mental Health in Safety-net Primary Care: A Five-year Observational Study on Visits in a County Health System.
Integrating Mental Health in Safety-net Primary Care: A Five-year Observational Study on Visits in a County Health System.
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DOI：
10.1097/mlr.0000000000001637
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发表时间：
2021-11-01
期刊：
影响因子：
3
通讯作者：
Braslow, Joel T.
中科院分区：
文献类型：
--
作者：
Leung, Lucinda B.;Benitez, Christopher T.;Dorsey, Charmaine;Mahajan, Anish P.;Hellemann, Gerhard S.;Whelan, Fiona;Park, Nina J.;Braslow, Joel T.
从2010年开始，洛杉矶县卫生服务部门和精神卫生部门合作，增加获得有效精神卫生保健的机会。心理健康整合计划（MHIP）将行为健康专家安置在初级保健诊所，为初级保健处方的精神药物提供简短的、以问题为中心的治疗和精神病学咨询支持。比较MHIP实施前后与精神病诊断相关的初级保健就诊情况。这项回顾性队列研究（2009 -2014）调查了来自洛杉矶8个安全网诊所的62945名患者，这些诊所以交错的方式实施了MHIP。患者的初级保健就诊（n=695,354）与先前确定的或“新”（定义为在前一年没有诊断）精神病学诊断相关或不相关。在控制时间、诊所和患者特征的情况下，多水平回归模型使用MHIP实现来预测就诊与精神病诊断相关的几率。9.4%的就诊与精神诊断有关（6.4%为抑郁症，3.1%为焦虑症，<1%为酒精和物质使用障碍）。与实施MHIP之前相比，就诊与精神病诊断相关的几率增加了9%(95%可信区间[CI]= 1.05-1.13; p=< 0.0001)，新诊断的几率增加了10% （CI= 1.04-1.16; p=0.002）。这似乎与mhip后抑郁症就诊次数增加有关（OR=1.11； CI= 1.06-1.15; p=< 0.0001）。MHIP的实施与在安全网初级保健访问中编码的更多精神病学诊断相关。扩大这一努力将需要更多地关注患者群体和语言之间的显著差异，以及初级保健中酒精和物质使用服务的编码明显较低。
Beginning in 2010, Los Angeles County Departments of Health Services and Mental Health collaborated to increase access to effective mental health care. The Mental Health Integration Program (MHIP) embedded behavioral health specialists in primary care clinics to deliver brief, problem-focused treatments and psychiatric consultation support for primary care-prescribed psychotropic medications. To compare primary care visits associated with psychiatric diagnoses before and after MHIP implementation. This retrospective cohort study (2009 –2014) examined 62,945 patients from eight safety-net clinics that implemented MHIP in a staggered fashion in Los Angeles. Patients’ primary care visits (n=695,354) were either associated or not with a previously identified or “new” (defined as having no diagnosis within the prior year) psychiatric diagnosis. Multilevel regression models used MHIP implementation to predict odds of visits being associated with psychiatric diagnoses, controlling for time, clinic, and patient characteristics. 9.4% of visits were associated with psychiatric diagnoses (6.4% depression, 3.1% anxiety, <1% alcohol and substance use disorders). Odds of visits being associated with psychiatric diagnoses were 9% higher (95% confidence interval [CI]=1.05–1.13; p=<.0001), and 10% higher for diagnoses that were new (CI=1.04–1.16; p=0.002), after MHIP implementation than before. This appeared to be fueled by increased visits for depression post-MHIP (OR=1.11; CI=1.06–1.15; p=<.0001). MHIP implementation was associated with more psychiatric-diagnoses coded in safety-net primary care visits. Scaling up this effort will require greater attention to the notable differences across patient populations and languages, as well as the markedly low coding of alcohol and substance use services in primary care.