Griswold Kim S, Servoss Timothy J, Leonard Kenneth E, Pastore Patricia A, Smith Susan J, Wagner Christine, Stephan Margaret, Thrist Mary
Department of Family Medicine, Family Medicine Research Institute, The State University of New York at Buffalo, Buffalo, NY 14215, USA.
J Am Board Fam Pract. 2005 May-Jun;18(3):166-72. doi: 10.3122/jabfm.18.3.166.
Patients presenting with a psychiatric emergency face a unique set of challenges in connecting to primary care.
We tested the hypothesis that, in contrast to usual care, case management will result in higher rates of connection to primary care. We examined variables affecting primary care entry, including insurance status, hospital admission, and concurrent linkages to mental health care.
RESEARCH DESIGN/METHODS: This article reports on a preliminary outcome of an ongoing randomized controlled trial conducted with 101 patients presenting in an urban psychiatric setting. Patients were randomized to a case management team or to usual care. The need for medical care was assessed by documenting medical comorbidity.
Average age of the sample was 37.5; 65% were male, and 78% had low income; 37% were African American and 9% were Hispanic. Within 3 months of study enrollment, 57% of the intervention group was successfully linked to primary care compared with 16% of the usual care group, a difference that was statistically significant (P < .001). Associated positive predictors for linkage to primary care included mental health care visits and success in obtaining health insurance. Inpatient hospital stay at the time of psychiatric crisis was negatively associated with later attendance at primary care.
Case management intervention was effective in establishing linkage to primary care within 3 months. Ongoing work will evaluate primary care retention and physical and mental health outcomes.
出现精神科急症的患者在与初级保健机构建立联系上面临一系列独特的挑战。
我们检验了这样一个假设，即与常规护理相比，个案管理将使与初级保健机构建立联系的比例更高。我们研究了影响进入初级保健机构的变量，包括保险状况、住院情况以及与精神卫生保健的同时联系。
研究设计/方法：本文报告了一项正在进行的随机对照试验的初步结果，该试验对101名在城市精神科环境中就诊的患者进行。患者被随机分配到个案管理团队或接受常规护理。通过记录医疗合并症来评估医疗护理需求。
样本的平均年龄为37.5岁；65%为男性，78%收入较低；37%为非裔美国人，9%为西班牙裔。在研究入组后的3个月内，干预组中有57%成功与初级保健机构建立了联系，而常规护理组为16%，这一差异具有统计学意义（P < .001）。与与初级保健机构建立联系相关的积极预测因素包括精神卫生保健就诊以及成功获得医疗保险。精神科危机发生时的住院治疗与后来到初级保健机构就诊呈负相关。
个案管理干预在3个月内有效建立了与初级保健机构的联系。正在进行的工作将评估初级保健机构的留存率以及身心健康结果。
