Mental health service use for adult patients with co-occurring depression and physical chronic health care needs, 2007-2010.
Mental health service use for adult patients with co-occurring depression and physical chronic health care needs, 2007-2010.
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DOI：
10.1097/mlr.0000000000000389
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发表时间：
2015-08
期刊：
影响因子：
3
通讯作者：
Dusetzina SB
中科院分区：
文献类型：
--
作者：
Jolles MP;Haynes-Maslow L;Roberts MC;Dusetzina SB
患有精神疾病的人健康状况不佳，可能因慢性疾病而过早死亡。了解同时发生的慢性身体健康状况是否会使心理健康治疗复杂化是很重要的，特别是在初级保健机构寻求治疗的患者中。检查（1）慢性身体状况的存在是否与抑郁症患者访问初级保健医生的心理健康服务使用相关，以及（2）种族是否改变这种关系。国家门诊医疗调查的二次分析，这是一项每年从办公室环境中随机抽取3,000名医生进行的患者就诊调查。汇总了2007年至2010年门诊就诊的35-85岁成年人，在就诊时诊断出抑郁症（N= 3，659次就诊）。使用二分变量测量心理健康服务，该变量指示在办公室访问或转诊期间是否提供心理健康服务：（1）咨询，包括心理治疗和其他心理健康咨询和/或（2）精神药物处方。大多数患者的办公室访问（70%），其中抑郁症的诊断记录也有共同发生的慢性身体状况记录。至少有一种身体慢性疾病的存在与接受任何心理健康服务的概率下降6%相关（p<0.05）。在控制其他因素后，不同种族/民族的服务使用没有差异。需要对同时发生健康状况的患者的医疗服务进行更多的研究，特别是随着医疗保健系统向综合护理模式发展。
Individuals with mental illness experience poor health and may die prematurely from chronic illness. Understanding whether the presence of co-occurring chronic physical health conditions complicates mental health treatment is important, particularly among patients seeking treatment in primary care settings. Examine (1) whether the presence of chronic physical conditions is associated with mental health service use for individuals with depression who visit a primary care physician, and (2) whether race modifies this relationship. Secondary analysis of the National Ambulatory Medical Care Survey, a survey of patient-visits collected annually from a random sample of 3,000 physicians in office-based settings. Office visits from 2007–2010 were pooled for adults ages 35–85 with a depression diagnosis at the time of visit (N=3,659 visits). Mental health services were measured using a dichotomous variable indicating whether mental health services were provided during the office visit or a referral made for: (1) counseling, including psychotherapy and other mental health counseling and/or (2) prescribing of psychotropic medications. Most patient office visits (70%) where a depression diagnosis was recorded also had co-occurring chronic physical conditions recorded. The presence of at least one physical chronic condition was associated with a 6% decrease in the probability of receiving any mental health services (p<0.05). There were no differences in service use by race/ethnicity after controlling for other factors. Additional research is needed on medical care delivery among patients with co-occurring health conditions, particularly as the health care system moves towards an integrated care model.