The impact of trauma exposure and post-traumatic stress disorder on healthcare utilization among primary care patients
The impact of trauma exposure and post-traumatic stress disorder on healthcare utilization among primary care patients
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DOI：
10.1097/mlr.0b013e31815dc5d2
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发表时间：
2008-04-01
期刊：
影响因子：
3
通讯作者：
Liebschutz, Jane
中科院分区：
文献类型：
--
作者：
Kartha, Anand;Brower, Victoria;Liebschutz, Jane
背景：创伤暴露和创伤后应激障碍 (PTSD) 会增加退伍军人的医疗保健利用率，但它们对其他人群的利用的影响尚不确定。目标：检查平民初级保健患者中创伤暴露和 PTSD 与医疗保健利用率的关联。研究设计：横断面研究。受试者：学术城市初级保健诊所的讲英语的患者。测量：创伤暴露和当前 PTSD 诊断来自综合国际诊断访谈。结果是电子病历中去年的非精神健康门诊和急诊就诊、住院以及精神健康门诊就诊。分析包括根据年龄、性别、收入、物质依赖、抑郁和合并症进行调整的双变量未调整和多变量泊松回归。结果：在 592 名受试者中，80% 患有 >= 1 次创伤暴露，22% 患有当前的 PTSD。在调整回归中，遭受创伤的受试者有更多的心理健康就诊次数[发病率比 (IRR)，3.9； 95% 置信区间 (CI)，1.1-14.1] 但没有其他利用率增加。调整 PTSD 后，创伤暴露的影响减弱（IRR，3.2；95% CI，0.9-11.7）。患有 PTSD 的受试者住院次数较多（IRR，2.2；95% CI，1.4-3.7），住院夜数较多（IRR，2.6；95% CI，1.4-5.0），心理健康就诊次数较多（IRR，2.2；95% CI，1.1-4.1），但门诊和急诊就诊次数没有增加。结论：PTSD 与更多的患者就诊有关。城市初级保健患者的住院时间、住院时间和精神卫生保健利用率的提高。尽管创伤暴露与更多的心理医疗保健利用率独立相关，但 PTSD 介导了这种关联的一部分。
Background: Trauma exposure and post-traumatic stress disorder (PTSD) increase healthcare utilization in veterans, but their impact on utilization in other populations is uncertain.Objectives: To examine the association of trauma exposure and PTSD with healthcare utilization, in civilian primary care patients.Research Design: Cross-sectional study. Subjects: English speaking patients at an academic, urban primary care clinic.Measures: Trauma exposure and current PTSD diagnoses were obtained from the Composite International Diagnostic Interview. Outcomes were nonmental health outpatient and emergency department visits, hospitalizations, and mental health outpatient visits in the prior year from an electronic medical record. Analyses included bivariate unadjusted and multivariable Poisson regressions adjusted for age, gender, income, substance dependence, depression, and comorbidities.Results: Among 592 subjects, 80% had >= 1 trauma exposure and 22% had current PTSD. In adjusted regressions, subjects with trauma exposure had more mental health visits [incidence rate ratio (IRR), 3.9; 95% confidence interval (CI), 1.1-14.1] but no other increased utilization. After adjusting for PTSD, this effect of trauma exposure was attenuated (IRR, 3.2; 95% CI, 0.9-11.7). Subjects with PTSD had more hospitalizations (IRR, 2.2; 95% CI, 1.4-3.7), more hospital nights (IRR, 2.6; 95% CI, 1.4-5.0), and more mental health visits (IRR, 2.2; 95% CI, 1.1-4.1) but no increase in outpatient and emergency department visits.Conclusions: PTSD is associated with more hospitalizations, longer hospitalizations, and greater mental healthcare utilization in urban primary care patients. Although trauma exposure is independently associated with greater mental healthcare utilization, PTSD mediates a portion of this association.