Outcomes for adult outpatients with depression under prepaid or fee-for-service financing.
Outcomes for adult outpatients with depression under prepaid or fee-for-service financing.
复制标题
预付费或按服务收费融资的成人抑郁症门诊患者的结果。
DOI：
10.1001/archpsyc.1993.01820190019003
复制
发表时间：
1993
影响因子：
--
通讯作者：
M. Burnam
中科院分区：
文献类型：
--
作者：
William H. Rogers;Kenneth B. Wells;Lisa S. Meredith;Roland Sturm;M. Burnam
目的
比较不同临床专业内和不同临床专业间接受预付费或按服务收费治疗的患者抑郁症状随时间的变化以及角色和身体功能的限制。
方法
对美国三个城市的617名精神科医生、心理学家、其他治疗师和普通临床医生治疗的抑郁症患者2年以上结果变化的观察性研究。
结果
精神科医生治疗的心理疾病患者比其他临床医生在所有支付类型。在精神科医生的患者中，那些最初接受预付费治疗的患者随着时间的推移在角色/身体功能方面获得了新的限制，而那些接受收费服务的患者则没有。这一发现在独立的执业协会中最为显著，但因地点和组织而异。精神科医生的患者比其他临床医生的患者更有可能使用抗抑郁药物，但在精神科医生的患者中，随着时间的推移，与按服务收费的治疗相比，预付费治疗中使用此类药物的比例急剧下降。结果没有不同的支付类型的抑郁症患者的其他专业组，或整体。
结论
精神科医生的抑郁症患者由于其高度的心理疾病而值得政策关注。对于这些患者，功能结果较差，在一些预付费的组织。非实验证据支持（但无法证明）基于接受的护理的解释，例如药物的减少，而不是预先存在的疾病差异。
OBJECTIVE
To compare change over time in symptoms of depression and limitations in role and physical functioning of patients receiving prepaid or fee-for-service care within and across clinician specialties.
METHOD
Observational study of change in outcomes over 2 years for 617 depressed patients of psychiatrists, psychologists, other therapists, and general medical clinicians in three urban sites in the United States.
RESULTS
Psychiatrists treated psychologically sicker patients than other clinicians in all payment types. Among psychiatrists' patients, those initially receiving prepaid care acquired new limitations in role/physical functioning over time, while those receiving fee-for-service care did not. This finding was most striking in independent practice associations but varied by site and organization. Patients of psychiatrists were more likely to use antidepressant medication than were patients of other clinicians, but among psychiatrists' patients, there was a sharp decline over time in the use of such medication in prepaid compared with fee-for-service care. Outcomes did not differ by payment type for depressed patients of other specialty groups, or overall.
CONCLUSION
Depressed patients of psychiatrists merit policy interest owing to their high levels of psychological sickness. For these patients, functioning outcomes were poorer in some prepaid organizations. The nonexperimental evidence favors (but cannot prove) an explanation based on care received, such as a reduction in medications, rather than on preexisting sickness differences.
登录
查看更多内容
DOI：
10.1001/jama.1990.03450190056028
发表时间：
1990-11
期刊：
JAMA
影响因子：
--
作者：
W. Broadhead;D. Blazer;L. George;C. Tse
通讯作者：
W. Broadhead;D. Blazer;L. George;C. Tse
DOI：
10.1001/jama.1989.03430070062031
发表时间：
1989-08
期刊：
JAMA
影响因子：
--
作者：
K. Wells;A. Stewart;Ron D. Hays;M. Burnam;W. Rogers;M. Daniels;S. Berry;S. Greenfield;J. Ware-J.
通讯作者：
K. Wells;A. Stewart;Ron D. Hays;M. Burnam;W. Rogers;M. Daniels;S. Berry;S. Greenfield;J. Ware-J.
DOI：
10.1001/jama.1992.03480110054033
发表时间：
1992-03
期刊：
JAMA
影响因子：
--
作者：
James A. Johnson;M. Weissman;G. Klerman
通讯作者：
James A. Johnson;M. Weissman;G. Klerman
检测接受预付费或按服务收费护理的患者的抑郁症。
DOI：
--
发表时间：
1989
期刊：
JAMA : the journal of the American Medical Association
影响因子：
--
作者：
Wells,KB;Hays,RD;Burnam,MA;Rogers,W;Greenfield,S;WareJr,JE
通讯作者：
WareJr,JE
复发性抑郁症维持治疗的五年结果。
影响因子：
--
作者：
Kupfer,DJ;Frank,E;Perel,JM;Cornes,C;Mallinger,AG;Thase,ME;McEachran,AB;Grochocinski,VJ
通讯作者：
Grochocinski,VJ