Integrated medical care for patients with serious psychiatric illness - A randomized trial
Integrated medical care for patients with serious psychiatric illness - A randomized trial
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DOI：
10.1001/archpsyc.58.9.861
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发表时间：
2001-09-01
影响因子：
--
通讯作者：
Rosenheck, RA
中科院分区：
文献类型：
--
作者：
Druss, BG;Rohrbaugh, RM;Rosenheck, RA
背景：本随机试验评估了一组严重精神障碍患者的初级医疗保健综合模式。方法：共有120名在退伍军人事务部（VA）心理健康诊所登记的个体被随机分组，通过设在心理健康诊所的综合护理计划（n=59）或通过VA综合医学诊所（n=61）接受初级医疗保健。在综合护理诊所接受治疗的退伍军人接受现场初级保健和病例管理，强调预防性医疗保健、患者教育以及与精神卫生提供者密切合作，以改善获得护理的机会和连续性。分析比较了随机分组后一年内各组之间的健康过程（医疗服务的使用、护理质量和满意度）和结果（健康和精神健康状况和成本）。结果：与常规护理组相比，在综合护理诊所接受治疗的患者更有可能进行初级保健访问，并且平均初级保健访问次数更多。他们更有可能接受了临床实践指南中列出的17种预防措施中的15种。综合护理门诊的患者在36项简短健康调查的身体成分总结得分上的健康改善明显大于全科门诊的患者（4.7分vs -0.3分，P < .001）。两组在任何心理健康症状的测量或总医疗保健费用方面均无显著差异。结论：现场综合初级保健可提高医疗保健的质量和效果。
Background: This randomized trial evaluated an integrated model of primary medical care for a cohort of patients with serious mental disorders.Methods: A total of 120 individuals enrolled in a Veterans Affairs (VA) mental health clinic were randomized to receive primary medical care through an integrated care initiative located in the mental health clinic (n=59) or through the VA general medicine clinic (n=61). Veterans who obtained care in the integrated care clinic received on-site primary care and case management that emphasized preventive medical care, patient education, and close collaboration with mental health providers to improve access to and continuity of care. Analyses compared health process (use of medical services, quality of care, and satisfaction) and outcomes (health and mental health status and costs) between the groups in the year after randomization.Results: Patients treated in the integrated care clinic were significantly more likely to have made a primary care visit and had a greater mean number of primary care,visits than those in the usual care group. They were more likely to have received 15 of the 17 preventive measures outlined in clinical practice guidelines. Patients assigned to the integrated care clinic had a significantly greater improvement in health as measured by the physical component summary score of the 36-Item Short-Form Health Survey than patients assigned to the general medicine clinic (4.7 points vs -0.3 points, P < .001). There were no significant differences between the 2 groups in any of the measures of mental health symptoms or in total health care costs.Conclusion: On-site, integrated primary care was associated with improved quality and outcomes of medical care.