A joint choice model of the decision to seek depression treatment and choice of provider sector.
A joint choice model of the decision to seek depression treatment and choice of provider sector.
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寻求抑郁症治疗的决定和提供者部门的选择的联合选择模型。
DOI：
10.1097/00005650-199803000-00008
复制
发表时间：
1998
期刊：
影响因子：
3
通讯作者：
Zhang,M
中科院分区：
文献类型：
--
作者：
Fortney,J;Rost,K;Zhang,M
目的：本研究以社区为基础，对目前抑郁症患者进行抽样调查，模拟寻求抑郁症治疗的共同决定和提供者的选择（初级保健或专业精神卫生）。其目的是确定这些主题特定的病例组合因素和供应商部门特定的访问措施，显着影响这一共同decision. Methods的。一个基于社区的样本435阿肯色州与当前抑郁症状汇编使用随机数字拨号和Burnam抑郁症筛选。对研究对象进行了基线和6个月的随访调查。所有的医疗，药物和保险记录收集和提取，以验证服务使用和抑郁症治疗。三个离散选择模型规格进行了测试：序贯二进制logit模型，多项logit模型和嵌套logit模型。嵌套logit模型使限制性较低的假设模式的替代治疗的替代品比其他模型specifications.Results.In基线后6个月，73.3%的样本没有寻求抑郁症治疗，18.9%的人寻求从初级保健提供者的照顾，7.8%的人寻求从心理健康专家的照顾。似然比检验将嵌套logit模型确定为首选模型规范（χ 2≤ 0.05），表明部门选择的预期最大效用显著影响寻求治疗的决定。提供者部门特有的准入措施（如保险覆盖面和可获得性）对部门选择产生重大影响，从而影响寻求治疗的决定。受试者特定的casemix因素（如，年龄，性别，就业状况，抑郁症的严重程度，精神科合并症）显着影响的决定寻求treatment.Conclusions.Sector-specific访问措施显着影响供应商部门的选择和决定寻求治疗。由于初级保健和专科保健治疗方案之间的可替代性比没有治疗方案之间的可替代性更强，因此，获得机会的变化对部门选择的影响大于寻求治疗的决定。
Objectives.Using a community-based sample of currently depressed subjects, this research modeled the joint decision to seek depression treatment and choice of provider sector (primary care or specialty mental health). The objective was to identify those subject-specific casemix factors and those provider sector-specific access measures that significantly impacted this joint decision.Methods.A community-based sample of 435 Arkansans with current depression symptoms was compiled using random digit dialing and the Burnam depression screener. Study subjects were administered baseline and 6-month follow-up surveys. All medical, pharmaceutical, and insurance records were collected and abstracted to verify service use and depression treatment. Three discrete choice model specifications were tested: sequential binary logit models, a multinomial logit model, and a nested logit model. The nested logit model makes less restrictive assumptions about the patterns of substitution across treatment alternatives than the other model specifications.Results.In the 6 months after baseline, 73.3% of the sample did not seek depression treatment, 18.9% sought care from a primary care provider, and 7.8% sought care from a mental health specialist. A likelihood ratio test identified the nested logit model as the preferred model specification (χ 2≤ 0.05), indicating that the expected maximum utility of sector choice significantly affects the decision to seek treatment. Provider sector-specific access measures (eg, insurance coverage and availability) significantly impacted sector choice and, thus, the decision to seek treatment. Subject-specific casemix factors (eg, age, gender, employment status, depression severity, and psychiatric comorbidity) significantly affected the decision to seek treatment.Conclusions.Sector-specific access measures significantly impact both provider sector choice and the decision to seek treatment. Because the primary care and specialty care treatment alternatives were more substitutable with one another than with the no treatment option, changes in access affected sector choice more than the decision to seek treatment.
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期刊：
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The American journal of psychiatry
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DOI：
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发表时间：
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期刊：
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影响因子：
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作者：
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