Disruptions in Care for Medicare Beneficiaries With Severe Mental Illness During the COVID-19 Pandemic.
Disruptions in Care for Medicare Beneficiaries With Severe Mental Illness During the COVID-19 Pandemic.
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在19日大流行期间，患有严重精神疾病的医疗保险受益人的护理中断。
DOI：
10.1001/jamanetworkopen.2021.45677
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发表时间：
2022-01-04
影响因子：
13.8
通讯作者：
Mehrotra A
中科院分区：
文献类型：
--
作者：
Busch AB;Huskamp HA;Raja P;Rose S;Mehrotra A
COVID-19大流行是否与美国严重精神疾病患者的精神健康相关利用率变化相关？在这项对超过65万名患有精神分裂症或双相I型障碍的医疗保险受益人进行的队列研究中，尽管远程医疗得到了广泛使用，但与精神健康相关的门诊、急诊和住院患者的使用以及药物填充量在统计学上显著下降，特别是在大流行的早期。在黑人、有双重医疗保险-医疗补助资格或有残疾的个体中，观察到门诊利用率的统计学显著差异更大的下降。在这项研究中，患有严重精神疾病的人在大流行期间经历了严重的护理中断，这些中断在弱势群体中更严重。这项队列研究考察了大流行期间精神卫生保健的变化以及患有严重精神疾病的医疗保险受益人在门诊护理中使用远程医疗的情况。在COVID-19大流行期间，对严重精神疾病患者的护理变化知之甚少。检查大流行期间心理健康护理的变化以及患有严重精神疾病的医疗保险受益人在门诊护理中使用远程医疗的情况。这项基于人群的队列研究包括诊断为精神分裂症和精神分裂症相关疾病或双相I型障碍的医疗保险受益人（年龄≥ 18岁）。将2019年定义的队列在2020年1月至9月期间的护理模式与2018年定义的队列在2019年1月至9月期间的护理模式进行了比较。2019冠状病毒病疫情在美国开始，定义为二零二零年第12周。在4周间隔内使用精神健康相关门诊访视、急诊科访视、住院治疗和口服抗精神病药和情绪稳定剂处方。多变量逻辑回归分析研究了大流行是否与不同患者特征的门诊治疗差异变化相关。2019年的686214人队列包括389245人（53.8%）妇女，114 073人（15.8%）（72.8%）白色个体，477 353个体65岁以下者占66.0%; 2020年的723045名受试者包括367140名（53.5%）为女性，106 699人（15.6%）为黑人，497 885人（72.6%）为白色人，442 645人（64.5%）年龄小于65岁。与2019年相比，大流行的第一个月出现了大幅下降（第12 - 15日历周）门诊患者（265 169人[36.7%] vs 200 590人[29.2%];减少20.3%），使用抗精神病药和情绪稳定剂药物处方（216 468例[29.9%] vs 163 796例[23.9%];减少20.3%），急诊就诊（12 383例[1.7%] vs 8503例[1.2%];下降27.7%）和住院（11 564例[1.6%] vs 7912例[1.2%];下降27.9%）。到2020年的第32至35周，利用率有所反弹，但仍低于2019年，相对下降幅度从2.5%（门诊）到12.9%（入院）不等。在2020年的整个大流行期间（第12至39周），2743553次门诊中有1556403次（56.7%）通过远程医疗提供。在多变量分析中，残疾人在2020年第12至25周期间的门诊就诊率较低（比值比，0.95; 95%CI，0.93 - 0.96），在2020年第26至39周期间，黑人与非西班牙裔白色个体之间的比值较低（OR，0.97; 95%CI，0.95 - 0.99）和具有双重医疗补助资格的人（OR，0.96; 95%CI，0.95 - 0.98）。在这项队列研究中，尽管远程医疗的使用越来越多，但患有严重精神疾病的个人在大流行早期的护理中经历了大规模的中断。这些情况有所收窄，但一直持续到2020年9月。一些弱势群体受到的干扰更大。
Was the COVID-19 pandemic associated with changes in mental health–related utilization for individuals with severe mental illness in the United States? In this cohort study of more than 650 000 Medicare beneficiaries with schizophrenia or bipolar I disorders, there were statistically significant decreases in mental health–related outpatient, emergency department, and inpatient use as well as medication fills, particularly early in the pandemic, despite widespread use of telemedicine. Statistically significant differentially greater decreases in outpatient utilization were observed among individuals who were Black, had dual Medicare-Medicaid eligibility, or had disability. In this study, individuals with severe mental illness experienced substantial disruptions in care during the pandemic, and these disruptions were greater among disadvantaged populations. This cohort study examines changes in mental health care during the pandemic and the use of telemedicine in outpatient care among Medicare beneficiaries with severe mental illness. Little is known about changes in care for individuals with severe mental illness during the COVID-19 pandemic. To examine changes in mental health care during the pandemic and the use of telemedicine in outpatient care among Medicare beneficiaries with severe mental illness. This population-based cohort study included Medicare beneficiaries (age ≥18 years) diagnosed with schizophrenia and schizophrenia-related disorders or bipolar I disorder. Care patterns during January to September 2020 for a cohort defined in 2019 were compared with those during January to September 2019 for a cohort defined in 2018. Start of COVID-19 pandemic in the United States, defined as week 12 of 2020. Use of mental health–related outpatient visits, emergency department visits, inpatient care, and oral prescription fills for antipsychotics and mood stabilizers during 4-week intervals. Multivariable logistic regression analyses examined whether the pandemic was associated with differential changes in outpatient care across patient characteristics. The 2019 cohort of 686 214 individuals included 389 245 (53.8%) women, 114 073 (15.8%) Black and 526 301 (72.8%) White individuals, and 477 353 individuals (66.0%) younger than 65 years; the 2020 cohort of 723 045 individuals included 367 140 (53.5%) women, 106 699 (15.6%) Black and 497 885 (72.6%) White individuals, and 442 645 individuals (64.5%) younger than 65 years. Compared with 2019, there were large decreases during the pandemic’s first month (calendar weeks 12-15) in individuals with outpatient visits (265 169 [36.7%] vs 200 590 [29.2%]; 20.3% decrease), with antipsychotic and mood stabilizer medication prescription fills (216 468 [29.9%] vs 163 796 [23.9%]; 20.3% decrease), with emergency department visits (12 383 [1.7%] vs 8503 [1.2%]; 27.7% decrease), and with hospital admissions (11 564 [1.6%] vs 7912 [1.2%]; 27.9% decrease). By weeks 32 to 35 of 2020, utilization rebounded but remained lower than in 2019, ranging from a relative decrease of 2.5% (outpatient visits) to 12.9% (admissions). During the full pandemic period (weeks 12-39) in 2020, 1 556 403 of 2 743 553 outpatient visits (56.7%) were provided via telemedicine. In multivariable analyses, outpatient visit use during weeks 12 to 25 of 2020 was lower among those with disability (odds ratio, 0.95; 95% CI, 0.93-0.96), and during weeks 26 to 39 of 2020, it was lower among Black vs non-Hispanic White individuals (OR, 0.97; 95% CI, 0.95-0.99) and those with dual Medicaid eligibility (OR, 0.96; 95% CI, 0.95-0.98). In this cohort study, despite greater use of telemedicine, individuals with severe mental illness experienced large disruptions in care early in the pandemic. These narrowed but persisted through September 2020. Disruptions were greater for several disadvantaged populations.
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影响因子：
3
作者：
Fullerton CA;Busch AB;Frank RG
通讯作者：
Frank RG
影响因子：
--
作者：
Busch, AB;Frank, RG;Lehman, AF
通讯作者：
Lehman, AF
影响因子：
5.5
作者：
Lieberman-Cribbin, Wil;Tuminello, Stephanie;Taioli, Emanuela
通讯作者：
Taioli, Emanuela
影响因子：
--
作者：
Kopec, Kristin;Janney, Carol A;Achtyes, Eric D
通讯作者：
Achtyes, Eric D
DOI：
10.1136/bmj.f2539
发表时间：
2013-05-21
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Lawrence D;Hancock KJ;Kisely S
通讯作者：
Kisely S