Utilization and Adherence in Medical Homes: An Assessment of Rural-Urban Differences for People With Severe Mental Illness.
Utilization and Adherence in Medical Homes: An Assessment of Rural-Urban Differences for People With Severe Mental Illness.
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DOI：
10.1097/mlr.0000000000000973
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发表时间：
2018-10
期刊：
影响因子：
3
通讯作者：
Silberman P
中科院分区：
文献类型：
--
作者：
Kilany M;Morrissey JP;Domino ME;Thomas KC;Silberman P
严重精神疾病（SMI），包括严重抑郁症，双相情感障碍和精神分裂症患者的护理管理的复杂性，是对初级保健实践的挑战，特别是在农村地区。以团队为基础的医疗之家的重点可能会作为一个重要的促进因素，以帮助减少观察到的农村和城市的护理差异。本研究的目的是检查是否登记在医疗之家改善护理在农村与城市设置的人与SMI。2004-2007年北卡罗来纳州医疗补助申请的二级数据分析，使用倾向评分权重和广义估计方程评估城市、非大都市城市和农村地区之间的差异。诊断为重度抑郁症、双相情感障碍或精神分裂症的接受医疗补助的成年人。医疗保险/医疗补助双杀被排除在外。我们检查了初级保健使用，专业精神卫生使用，住院治疗，急诊室使用和药物依从性的利用措施。农村家庭医疗登记者一般有较高的初级保健使用和药物治疗依从性比农村非家庭医疗登记者。农村家庭医疗登记者比城市家庭医疗登记者有更少的初级保健访问，但两组在其他结局指标上相似。这些结果因SMI诊断而有所不同。研究结果表明，在农村医疗补助受益人的医疗之家注册持有的承诺，减少城乡差异的照顾。城市和农村医疗之家都可以受益于有针对性的资源，以帮助缩小剩余的差距，并提高医疗之家模式在满足重度精神障碍患者的医疗保健需求方面的成功率。
The complex nature of managing care for people with severe mental illness (SMI), including major depression, bipolar disorder and, schizophrenia, is a challenge for primary care practices, especially in rural areas. The team-based emphasis of medical homes may act as an important facilitator to help reduce observed rural-urban differences in care. The objective of this study was to examine whether enrollment in medical homes improved care in rural versus urban settings for people with SMI. Secondary data analysis of North Carolina Medicaid claims from 2004–2007, using propensity score weights and generalized estimating equations to assess differences between urban, non-metropolitan urban and rural areas. Medicaid-enrolled adults with diagnoses of major depressive disorder, bipolar disorder or schizophrenia. Medicare/Medicaid dual eligibles were excluded. We examined utilization measures of primary care use, specialty mental health use, inpatient hospitalizations, and emergency department use and medication adherence. Rural medical home enrollees generally had higher primary care use and medication adherence than rural non-medical home enrollees. Rural medical home enrollees had fewer primary care visits than urban medical home enrollees, but both groups were similar on the other outcome measures. These findings varied somewhat by SMI diagnosis. Findings indicate that enrollment in medical homes among rural Medicaid beneficiaries holds the promise of reducing rural-urban differences in care. Both urban and rural medical homes may benefit from targeted resources to help close the remaining gaps and to improve the success of the medical home model in addressing the health care needs of people with SMI.