dosReis Susan, Owens Pamela L, Puccia Karen B, Leaf Philip J
Division of Child and Adolescent Psychiatry, Johns Hopkins Medicine, Johns Hopkins Hospital, Baltimore, Maryland 21287, USA.
Psychiatr Serv. 2004 Sep;55(9):1041-8. doi: 10.1176/appi.ps.55.9.1041.
This study compared the use of treatments for attention-deficit hyperactivity disorder (ADHD) among three distinct subpopulations of Medicaid-insured youths who have very different mental health needs and patterns of service use: those with federally documented disability, those in foster care, and those in families with low income.
This one-year, cross-sectional study of community mental health services used administrative data. Individuals who were younger than 20 years, who were continuously enrolled in one Mid-Atlantic state Medicaid program, and who had two or more medical encounters associated with an ADHD diagnosis in 1998 were identified (N=1,296). Measures of the use of mental health services were the number of different classes of psychopharmacologic medications, the psychopharmacologic regimen, and the combined use of pharmacotherapy and psychotherapy treatments (multimodal treatment).
Use of multiple psychopharmacologic agents was greater in the disabled and foster care groups compared with the low-income group. Significantly fewer mental health provider visits, but greater use of stimulant treatment only, were observed in the low-income group compared with the other groups. Youths in the disabled group were significantly more likely than youths in the low-income group, but not more likely than youths in the foster care group, to receive multimodal treatments. Children in foster care were significantly more likely than those in the other groups to use a substance abuse service.
Among a cohort of Medicaid-enrolled youths with ADHD, co-existing psychiatric disorders and complex psychopharmacologic treatments were more common in the disabled and foster care groups than in the low-income group. Youths with disabilities were significantly more likely than youths in the low-income group to receive multimodal treatment.
本研究比较了医疗补助保险覆盖的三类不同亚群体青少年注意力缺陷多动障碍（ADHD）治疗方法的使用情况，这三类亚群体有着截然不同的心理健康需求和服务使用模式：有联邦文件证明残疾的青少年、寄养青少年以及低收入家庭青少年。
这项为期一年的社区心理健康服务横断面研究使用了行政数据。确定了年龄小于20岁、持续参加大西洋中部某州一项医疗补助计划且在1998年有两次或更多次与ADHD诊断相关医疗接触的个体（N = 1296）。心理健康服务使用的衡量指标包括不同种类精神药物的数量、精神药物治疗方案以及药物治疗和心理治疗联合使用（多模式治疗）。
与低收入组相比，残疾组和寄养组使用多种精神药物的情况更多。与其他组相比，低收入组心理健康服务提供者的就诊次数显著减少，但仅兴奋剂治疗的使用更多。残疾组青少年比低收入组青少年接受多模式治疗的可能性显著更高，但不比寄养组青少年更高。寄养儿童比其他组儿童使用药物滥用服务的可能性显著更高。
在参加医疗补助计划的ADHD青少年队列中，残疾组和寄养组比低收入组更常见并存的精神障碍和复杂的精神药物治疗。残疾青少年比低收入组青少年接受多模式治疗的可能性显著更高。
