Predictors of outpatient mental health utilization by primary care patients in a health maintenance organization.
Predictors of outpatient mental health utilization by primary care patients in a health maintenance organization.
复制标题
健康维护组织中初级保健患者门诊心理健康利用的预测因素。
DOI：
10.1176/ajp.151.6.908
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发表时间：
1994
期刊：
影响因子：
--
通讯作者：
Durham,ML
中科院分区：
文献类型：
--
作者：
Simon,GE;VonKorff,M;Durham,ML
目的探讨某大型职员型卫生保健机构（HMO）初级保健病人门诊心理健康利用的数量及其预测因素。方法采用12项《一般健康问卷》对连续就诊的初级保健患者1810例进行筛查，分层随机抽样373例完成28项《一般健康问卷》和《综合国际诊断访谈》。在接下来的三个月里，电话访谈和电脑记录被用来检查HMO内部和外部的心理健康服务的使用情况。结果在3个月的时间里，有6.7%的筛查患者使用了HMO的精神卫生服务。一般健康问卷得分越高，使用率越高（得分0分者为2.9%，得分8分及以上者为22.3%），心理健康就诊自付费用越高，使用率越低（无变化者为7.5%，每次就诊支付30美元者为3.3%）。受访对象中，5.1%使用HMO内的精神卫生服务（平均2.92次），8.9%使用外部精神卫生服务（平均8.86次）。外部服务的使用与社会人口因素关系更密切，而内部服务的使用与心理障碍的严重程度关系更密切。结论受访人群心理健康服务使用率较高，且在HMO外购买的服务多于在HMO内购买的服务。提高共同支付水平会逐步减少需求，而不考虑疾病的严重程度。控制门诊精神卫生费用的尝试必须解决公平和临床需要。
ObjectiveThe authors examined the volume and predictors of outpatient mental health utilization among primary care patients in a large staff-model health maintenance organization (HMO).MethodConsecutive primary care patients (N= 1,810) were screened by using the 12-item General Health Questionnaire, and a stratified random sample (N= 373) completed the 28-item General Health Questionnaire and Composite International Diagnostic Interview. Telephone interviews and computerized records were used to examine use of mental health services inside and outside the HMO over the following 3 months.ResultsOver 3 months, 6.7% of the screened patients used mental health services within the HMO. Utilization increased with higher General Health Questionnaire score (2.9% among those scoring 0, 22.3% among those scoring 8 or more) and decreased with higher out-of-pocket cost for mental health visits (7.5% for those with no change, 3.3% for those paying $30/visit). Among the interviewed subjects, 5.1% used mental health services within the HMO (mean= 2.92 visits) and 8.9% used outside mental health services (mean= 8.86 visits). Use of outside services was more strongly related to sociodemographic factors, and use of inside services was more related to severity of psychological disorder.ConclusionsAmong these subjects, use of mental health care was high and services purchased outside the HMO exceeded those inside the HMO. Increasing copayment levels progressively reduced demand without respect to severity of illness. Attempts to control outpatient mental health costs must address equity and clinical need.