Care Pathways Before First Diagnosis of a Psychotic Disorder in Adolescents and Young Adults
Care Pathways Before First Diagnosis of a Psychotic Disorder in Adolescents and Young Adults
复制标题
DOI：
10.1176/appi.ajp.2017.17080844
复制
发表时间：
2018-05-01
影响因子：
17.7
通讯作者：
Carrell, David S.
中科院分区：
文献类型：
--
作者：
Simon, Gregory E.;Stewart, Christine;Carrell, David S.
目的：作者试图描述在以人群为基础的样本中首次诊断精神障碍之前的卫生保健使用模式。方法：使用来自5个大型综合卫生系统的电子健康记录和保险索赔来确定624名15-29岁的患者，这些患者在任何护理环境中首次被诊断为精神障碍，并记录在过去36个月内接受的卫生服务，分配的诊断和分配的药物。比较首次诊断为精神障碍的患者与普通卫生系统成员和首次诊断为单相抑郁症的成员的匹配样本之间的利用模式。结果：在首次精神障碍诊断前一年，29%的患者接受过精神卫生专科门诊治疗，8%的患者接受过精神卫生住院治疗，24%的患者接受过急诊科精神卫生治疗，29%的患者接受过精神卫生诊断的初级保健就诊，60%的患者至少接受过一次精神卫生诊断（包括物质使用障碍）。与首次诊断为单相抑郁症的患者相比，首次诊断为精神障碍的患者更有可能使用所有类型的卫生服务，特别是更有可能使用精神卫生住院护理（优势比= 2.96,95% CI = 1.97-4.43）和精神卫生急诊科护理（比率比= 3.74,95% CI = 3.39-4.53）。结论：大多数首次被诊断为精神障碍的患者在前一年都有一些精神卫生保健需求的迹象。然而，初级保健或精神卫生服务的普遍使用并不能明确区分后来被诊断为精神障碍的人和后来被诊断为单相抑郁症的人。使用住院或急诊科的精神卫生保健是一个更具体的风险指标。
Objective: The authors sought to describe patterns of health care use prior to first diagnosis of a psychotic disorder in a population-based sample.Method: Electronic health records and insurance claims from five large integrated health systems were used to identify 624 patients 15-29 years old who received a first diagnosis of a psychotic disorder in any care setting and to record health services received, diagnoses assigned, and medications dispensed during the previous 36 months. Patterns of utilization were compared between patients receiving a first diagnosis of a psychotic disorder and matched samples of general health system members and members receiving a first diagnosis of unipolar depression.Results: During the year before a first psychotic disorder diagnosis, 29% of patients had mental health specialty outpatient care, 8% had mental health inpatient care, 24% had emergency department mental health care, 29% made a primary care visit with a mental health diagnosis, and 60% received at least one mental health diagnosis (including substance use disorders). Compared with patients receiving a first diagnosis of unipolar depression, those with a first diagnosis of a psychotic disorder were modestly more likely to use all types of health services and were specifically more likely to use mental health inpatient care (odds ratio = 2.96, 95% CI = 1.97-4.43) and mental health emergency department care (rate ratio = 3.74, 95% CI = 3.39-4.53).Conclusions: Most patients receiving a first diagnosis of a psychotic disorder had some indication of mental health care need during the previous year. General use of primary care or mental health services, however, does not clearly distinguish people who later receive a diagnosis of a psychotic disorder from those who later receive a diagnosis of unipolar depression. Use of inpatient or emergency department mental health care is a more specific indicator of risk.