Carbone L A, Barsky A J, Orav E J, Fife A, Fricchione G L, Minden S L, Borus J F
Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
Psychosomatics. 2000 Nov-Dec;41(6):512-8. doi: 10.1176/appi.psy.41.6.512.
In two studies, the authors evaluated the impact of psychiatric disorders on medical care utilization in a primary care setting. In the first study, 526 consecutive patients in a teaching hospital primary care practice completed the 18-item RAND Mental Health Inventory to identify clinically significant depression and/or anxiety and a questionnaire about the use of psychiatric treatment and psychoactive medications. The medical utilization of those patients defined as depressed and/ or anxious was compared with those defined as not depressed and/or anxious. Patients identified as depressed and/or anxious reported significantly increased medical utilization, but this was not confirmed by the hospital's computerized record system. In the second study, the authors analyzed medical care utilization for the years before and after the first outpatient psychiatry appointment of a sample of 91 patients referred from the same primary care practice to the hospital's outpatient psychiatry clinic over a 1-year period. In both studies there was not a statistically significant difference in medical utilization among those patients receiving psychiatric treatment. The findings demonstrate the difficulties in examining cost offset in a primary care population and raise questions about it as a realistic outcome measure of the effect of psychiatric treatment.
在两项研究中，作者评估了精神障碍对基层医疗环境中医疗服务利用情况的影响。在第一项研究中，一家教学医院基层医疗诊所的526名连续就诊患者完成了18项兰德心理健康量表，以确定具有临床意义的抑郁和/或焦虑情况，并填写了一份关于精神科治疗和精神活性药物使用情况的问卷。将那些被定义为抑郁和/或焦虑的患者的医疗服务利用情况与那些被定义为非抑郁和/或非焦虑的患者进行了比较。被确定为抑郁和/或焦虑的患者报告称医疗服务利用率显著提高，但医院的计算机记录系统并未证实这一点。在第二项研究中，作者分析了在1年时间里从同一家基层医疗诊所转诊至医院门诊精神科诊所的91名患者样本首次门诊精神科预约前后几年的医疗服务利用情况。在两项研究中，接受精神科治疗的患者之间的医疗服务利用情况均无统计学上的显著差异。这些发现表明在基层医疗人群中考察成本抵消存在困难，并对其作为精神科治疗效果的现实结果指标提出了质疑。
