Association of Integrated Mental Health Services with Physical Health Quality Among VA Primary Care Patients.
Association of Integrated Mental Health Services with Physical Health Quality Among VA Primary Care Patients.
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DOI：
10.1007/s11606-021-07287-2
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发表时间：
2022-10
影响因子：
5.7
通讯作者：
Rosland, Ann-Marie
中科院分区：
文献类型：
--
作者：
Leung, Lucinda B.;Rubenstein, Lisa, V;Jaske, Erin;Taylor, Leslie;Post, Edward P.;Nelson, Karin M.;Rosland, Ann-Marie
在随机对照试验中，对合并抑郁症和慢性医学疾病的综合护理改善了身心健康结果。退伍军人健康管理局（VA）在全国所有初级保健诊所实施初级保健-心理健康整合（PC-MHI），以增加心理/行为健康治疗和身体健康管理的可及性。研究广泛、实用的PC-MHI实施是否与慢性病护理质量的提高有关。这项回顾性队列研究包括828,050名初级保健患者，在2013年10月至2016年9月期间，在396家提供PC-MHI服务的VA诊所中至少有一项质量指标。对于结果测量，图表抽象者评估每个诊所患者的糖尿病和心血管质量指标是否满足，作为VA既定质量报告计划的一部分。解释变量是每年在每家诊所接受综合心理健康专家治疗的初级保健患者的比例。多水平logistic回归模型检验了临床PC-MHI比例与患者水平质量指标之间的关系，调整了区域、患者和时间水平的影响以及临床和患者特征。每个诊所PC-MHI患者的中位比例为6.4% （IQR= 4.7-8.7%）。19%的糖尿病患者血糖控制不佳（糖化血红蛋白占9%）。5%的人血压严重升高（160/100毫米汞柱）。临床PC-MHI比例每增加两倍，糖尿病患者血糖控制不良的校正几率降低2% （95% CI= 0.96-0.99; p=0.046）。虽然诊断为高血压的患者与质量没有关联，但未诊断为高血压的患者血压升高的调整几率降低了5% （CI= 0.92-0.99; p=0.046）。在初级保健诊所中，综合精神卫生保健的患者比例更高，但在关键的慢性护理质量指标上取得了适度的、尽管在统计上具有显著意义的进展，这让人们对大规模实施个人健康保健计划对身体健康的预期影响感到乐观。在线版本包含补充材料，可在10.1007/s11606-021-07287-2获得。
Integrated care for comorbid depression and chronic medical disease improved physical and mental health outcomes in randomized controlled trials. The Veterans Health Administration (VA) implemented Primary Care–Mental Health Integration (PC-MHI) across all primary care clinics nationally to increase access to mental/behavioral health treatment, alongside physical health management. To examine whether widespread, pragmatic PC-MHI implementation was associated with improved care quality for chronic medical diseases. This retrospective cohort study included 828,050 primary care patients with at least one quality metric among 396 VA clinics providing PC-MHI services between October 2013 and September 2016. For outcome measures, chart abstractors rated whether diabetes and cardiovascular quality metrics were met for patients at each clinic as part of VA’s established quality reporting program. The explanatory variable was the proportion of primary care patients seen by integrated mental health specialists in each clinic annually. Multilevel logistic regression models examined associations between clinic PC-MHI proportion and patient-level quality metrics, adjusting for regional, patient, and time-level effects and clinic and patient characteristics. Median proportion of patients seen in PC-MHI per clinic was 6.4% (IQR=4.7–8.7%). Nineteen percent of patients with diabetes had poor glycemic control (hemoglobin A1c >9%). Five percent had severely elevated blood pressure (>160/100 mmHg). Each two-fold increase in clinic PC-MHI proportion was associated with 2% lower adjusted odds of poor glycemic control (95% CI=0.96–0.99; p=0.046) in diabetes. While there was no association with quality for patients diagnosed with hypertension, patients without diagnosed hypertension had 5% (CI=0.92–0.99; p=0.046) lower adjusted odds of having elevated blood pressures. Primary care clinics where integrated mental health care reached a greater proportion of patients achieved modest albeit statistically significant gains in key chronic care quality metrics, providing optimism about the expected effects of large-scale PC-MHI implementation on physical health. The online version contains supplementary material available at 10.1007/s11606-021-07287-2.
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DOI：
10.1097/01.jom.0000100000.70011.bb
发表时间：
2003-12-01
影响因子：
3.2
作者：
Kessler, RC;Ormel, J;Stang, PE
通讯作者：
Stang, PE
影响因子：
1.3
作者：
Post, Edward P.;Metzger, Maureen;Lehmann, Laurent
通讯作者：
Lehmann, Laurent
影响因子：
13.8
作者：
Chang, Evelyn T.;Zulman, Donna M.;Rubenstein, Lisa, V
通讯作者：
Rubenstein, Lisa, V
影响因子：
9.7
作者：
Leung, Lucinda B.;Rubenstein, Lisa, V;Trivedi, Ranak B.
通讯作者：
Trivedi, Ranak B.
影响因子：
4.4
作者：
Solberg, Leif I.;Crain, A. Lauren;Glasgow, Russell E.
通讯作者：
Glasgow, Russell E.