Depression Treatment Uptake in Integrated Primary Care: How a "Warm Handoff" and Other Factors Affect Decision Making by Latinos
Depression Treatment Uptake in Integrated Primary Care: How a "Warm Handoff" and Other Factors Affect Decision Making by Latinos
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DOI：
10.1176/appi.ps.201400085
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发表时间：
2015-08-01
影响因子：
3.8
通讯作者：
Arean, Patricia A.
中科院分区：
文献类型：
--
作者：
Horevitz, Elizabeth;Organista, Kurt C.;Arean, Patricia A.
目的：综合行为卫生保健有可能减少低收入和少数民族人群的心理健康治疗障碍。本研究旨在确定拉丁美洲患者决定在综合初级保健环境中进行抑郁症治疗的预测因素，包括转诊类型（从初级保健提供者[PCP]到行为保健提供者或指定转诊的“温暖交接”）。作者对431名在综合行为健康服务中接受抑郁症治疗的患者进行了连续的病历回顾，随后进行了定性半结构化访谈，一个子样本的16 patients.Results：讲英语的拉丁美洲人是四倍不太可能参加初次就诊的两个月内的转介，如果他们收到了温暖的交接，而不是规定的转介。强度的患者与供应商的关系和质量的转诊经验，包括PCP是否解决了患者的健康素养和抑郁症护理的期望，影响患者的决定从事抑郁症treatment.Conclusions：从事拉丁美洲人在需要的心理健康治疗是一个挑战，即使在初级保健机构提供治疗。温暖的问候语被认为是参与的有效组成部分，但这项研究表明，温暖的问候语的有效性可能会因患者的主要语言而异。以下因素对拉丁美洲人参与护理至关重要：患者与提供者的关系，转诊过程的质量，解决对抑郁症护理的期望，以及减少沟通障碍，包括健康素养和语言障碍。未来的参与策略研究应该探讨这些因素。
Objective: Integrated behavioral health care has the potential to reduce barriers to mental health treatment among low-income and minority populations. This study aimed to identify predictors of Latino patients' decision to follow through with referrals to depression treatment in an integrated primary care setting, including type of referral (a "warm handoff" from a primary care provider [PCP] to a behavioral health care provider or a prescribed referral).Methods: The authors conducted a sequential medical record review of 431 patients referred for depression treatment in integrated behavioral health services followed by qualitative semistructured interviews with a subsample of 16 patients.Results: English-speaking Latinos were four times less likely to attend an initial visit within two months of a referral if they received a warm handoff rather than a prescribed referral. The strength of the patient-provider relationship and the quality of the referral experience, including whether the PCP addressed patients' health literacy and expectations for depression care, affected patients' decision to engage in depression treatment.Conclusions: Engaging Latinos in needed mental health treatment is a challenge, even when treatment is provided in primary care settings. Warm handoffs are considered effective components of engagement, but this study suggests that the effectiveness of warm handoffs may vary depending on the patient's primary language. The following factors seemimportant to engaging Latinos into care: patient-provider relationship, quality of the referral process, addressing expectations about depression care, and reducing communication barriers, including health literacy and linguistic barriers. Future studies of engagement strategies should explore these factors.