Receipt of nutrition and exercise counseling among medical outpatients with psychiatric and substance use disorders
Receipt of nutrition and exercise counseling among medical outpatients with psychiatric and substance use disorders
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DOI：
10.1046/j.1525-1497.2002.10660.x
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发表时间：
2002-07-01
影响因子：
5.7
通讯作者：
Perlin, JB
中科院分区：
文献类型：
--
作者：
Desai, MM;Rosenheck, RA;Perlin, JB
目的：精神病患者代表了一个潜在的弱势群体，接受质量较差的医疗服务。本研究探讨了精神障碍与接受推荐营养和运动咨询的可能性之间的关系。设计：结合图表审查数据和管理数据库记录的横断面研究。设置：全国147个退伍军人事务部（VA）医疗中心。患者/参与者：样本包括90，240名肥胖和/或高血压患者，他们在过去一年中有超过或等于3次的医疗门诊就诊。关注的结果是在过去2年中接受营养咨询和接受运动咨询的图表记录。该图表信息与VA住院和门诊管理数据库合并，用于识别诊断为精神障碍的人。在过去2年中，大多数患者接受了营养咨询（90.4%）、运动咨询（88.5%）和两者兼而有之（85.7%）。心理健康状况的咨询率差异显着，但适度。最低的发生率在双重诊断为精神病和物质使用障碍共病的患者中发现;然而，差异的幅度很小，在结果中的范围为2%至4%。这些结果是不变的人口统计学，健康状况，和设施的特点，使用多变量广义估计方程modeling.CONCLUSIONS：在患者从事积极的医疗，营养和运动咨询率高，在VA医疗中心，精神疾病的诊断是不是一个实质性的障碍，这样的咨询。需要做更多的工作来确定这些研究结果是否适用于非VA环境，并了解VA等综合系统在减少弱势群体差异方面的潜在作用。
OBJECTIVE: Mentally ill persons represent a population that is potentially vulnerable to receiving a poorer quality of medical care. This study examines the relationship between mental disorders and the likelihood of receiving recommended nutrition and exercise counseling.DESIGN: Cross-sectional study combining chart-review data and administrative database records.SETTING: One hundred forty-seven Veterans Affairs (VA) medical centers nationwide.PATIENTS/PARTICIPANTS: The sample included 90,240 patients with obesity and/or hypertension who had greater than or equal to3 medical outpatient visits in the previous year.MEASUREMENTS AND MAIN RESULTS: The outcomes of interest were chart-documented receipt of nutrition counseling and receipt of exercise counseling in the past 2 years. This chart information was merged with VA inpatient and outpatient administrative databases, which were used to identify persons with diagnosed mental disorders. Most patients received nutrition counseling (90.4%), exercise counseling (88.5%), and counseling for both (85.7%) in the past 2 years. The rates of counseling differed significantly but modestly by mental health status. The lowest rates were found among patients dually diagnosed with comorbid psychiatric and substance use disorders; however, the magnitude of the disparities was small, ranging from 2% to 4% across outcomes. These results were unchanged after controlling for demographics, health status, and facility characteristics using multivariable generalized estimating equation modeling.CONCLUSIONS: Among patients engaged in active medical treatment, rates of nutrition and exercise counseling were high at VA medical centers, and the diagnosis of mental illness was not a substantial barrier to such counseling. More work is needed to determine whether these findings generalize to non-VA settings and to understand the potential role that integrated systems such as the VA can play in reducing disparities for vulnerable populations.