Mental Health Communication in Elderly Primary Care Visits and Economic Outcomes

老年人初级保健就诊和经济成果中的心理健康沟通

• 批准号: 7595412
• 负责人: MING TAI-SEALE
• 金额: $ 49.7万
• 依托单位: TEXAS A&M UNIVERSITY HEALTH SCIENCE CTR
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-05-12 至 2011-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7595412
• 关键词: Address; Adherence; American Medical Association; Area; Behavior; Behavioral; Caring; Client satisfaction; Clinic; Clinical; Clinical Data; Code; Communication; Communication Research; Cost Effectiveness Analysis; Data; Data Sources; Databases; Dimensions; Distal; Economics; Elderly; Elements; Empathy; Environment; Evidence based treatment; Foundations; Funding; Goals; Health; Health Communication; Health Personnel; Health Services; Health Services Research; Health Services for the Aged; Health Status; Health system; Healthcare; Institute of Medicine (U.S.); Integrated Delivery Systems; Intervention; Journals; Length; Link; Location; Malpractice; Measures; Medical; Mental Health; Mental Health Services; Mental disorders; Methods; Michigan; Minority; Morbidity - disease rate; Office Visits; Outcome; Output; Patient Participation; Patient observation; Patients; Perception; Pharmaceutical Preparations; Physicians; Policies; Preventive; Primary Care Physician; Primary Health Care; Probability; Process; Productivity; Psyche structure; Public Health; Race; Randomized Controlled Trials; Recommendation; Records; Research; Research Infrastructure; Risk Factors; Science; Services; Source; Surveys; Testing; Time; Translating; Treatment Cost; Trust; United States National Institutes of Health; Visit; Work; abstracting; base; biopsychosocial; checkup examination; clinical practice; communication behavior; comparative effectiveness; compliance behavior; cost; cost effectiveness; depression; design; economic outcome; effectiveness research; evidence base; innovation; insight; interest; physical conditioning; psychologic; response; social; socioeconomics; statistics; suburb; time use; treatment adherence; treatment planning

The medical office visit is the foundation of medical care and one of the most important professional activities of primary care physicians who are often the only source of mental health services for older adults. Evidence continues to show that the gap between science and clinical practice remains wide: as many as one half of older adults with a recognized mental disorder fail to receive any mental health services, and even fewer receive evidence-based treatments. Racial minority patients fare even worse. It is an urgent public health concern that such a high proportion of patients needing mental health services are without access to evidence-based care and that racial disparities in access to quality mental health care persist despite advancements in efficacious treatments for mental illnesses. Direct observation of how patients and physicians interact has led to research findings that are straightforward and easily understood by the public and policymakers. It offers a new perspective to study physicians' work and patients' contributions with potentially important new insights. We propose to leverage the infrastructure and data afforded by an ongoing NIH- funded study which is audio-recording 800 annual physical exam visits (checkups designed for physicians to comprehensively review their patients' health) among socioeconomically diverse older adults in a large integrated delivery system, the Henry Ford Health System, in Detroit Michigan and its surrounding suburbs. The proposed study is within the scope of the economics of mental health. We plan to apply mixed methods approach and combine perspectives from mental health services research with behavioral economics, communication research, and statistics. We will use data from audio-recordings, administrative benefits, medication dispensing, claims and encounter records, and surveys of patients and physicians to address the Specific Aims of our study: Aim 1: Examine the productivity of physician-patient communication by linking elements of quality of communication on mental health in the context of busy clinics and competing demands from co-morbidities in routine annual checkups with intermediate outcomes such as patient's satisfaction and treatment adherence and distal clinical and economic outcomes including service use and costs. Aim 2: Testing for racial disparities in communication content and time using the definition proposed by the Institute of Medicine in Unequal Treatment. We will first qualitatively compare the content and time devoted to mental health and physical health communications between racially concordant and discordant patient-physician pairs. We will assess the contribution of factors that are germane to the practice environment and malleable to policy, e.g., length of visit, co-location of mental and physical health providers to observed disparities. At the completion of the study, we seek to formulate concrete recommendations about specific organizational or clinical interventions that can address these national priorities: translating evidence to practice and eliminating disparities.

医疗办公室访问是医疗保健的基础，也是初级保健医生最重要的专业活动之一，他们通常是老年人心理健康服务的唯一来源。有证据继续表明，科学与临床实践之间的差距仍然很大：多达一半的患有公认精神障碍的老年人没有得到任何精神卫生服务，得到循证治疗的人更少。少数民族患者的情况更糟。这是一个紧迫的公共卫生问题，如此高比例的需要精神卫生服务的患者无法获得循证护理，尽管在精神疾病的有效治疗方面取得了进展，但在获得优质精神卫生保健方面的种族差异仍然存在。直接观察患者和医生如何互动，导致研究结果是直接的，容易被公众和政策制定者理解。它提供了一个新的视角来研究医生的工作和病人的贡献与潜在的重要的新见解。我们建议利用正在进行的NIH资助的研究提供的基础设施和数据，该研究在密歇根州底特律及其周边郊区的亨利福特健康系统中，对社会经济多样化的老年人进行了800次年度体检（为医生全面审查患者健康状况而设计的检查）。这项拟议的研究属于心理健康经济学的范围。我们计划采用混合方法的方法，并结合联合收割机的角度，从精神卫生服务的研究与行为经济学，传播研究，统计。我们将使用来自录音、行政福利、药物分发、索赔和就诊记录以及患者和医生调查的数据，以解决我们研究的具体目标：目标1：通过将忙碌诊所背景下的心理健康沟通质量要素与合作伙伴的竞争需求联系起来，检查医患沟通的生产力。常规年度检查中的发病率与中间结果（如患者满意度和治疗依从性）以及远端临床和经济结果（包括服务使用和成本）。目标二：测试种族差异的通信内容和时间使用的定义提出的医学研究所在不平等待遇。我们将首先定性比较的内容和时间专门用于心理健康和身体健康的种族和谐和不和谐的医患对之间的沟通。我们将评估与实践环境密切相关并可延展到政策的因素的贡献，例如，访问时间、精神和身体健康提供者同地办公，以观察到的差异。在研究完成后，我们寻求制定具体的建议，具体的组织或临床干预措施，可以解决这些国家的优先事项：将证据转化为实践和消除差距。