Morley Belinda, Pirkis Jane, Sanderson Kristy, Burgess Philip, Kohn Fay, Naccarella Lucio, Blashki Grant
Program Evaluation Unit, School of Population Health, University of Melbourne, Melbourne, Vic. 3010, Australia.
Aust N Z J Psychiatry. 2007 Feb;41(2):142-9. doi: 10.1080/00048670601109915.
One hundred and eight Access to Allied Psychological Services projects have been funded under Australia's Better Outcomes in Mental Health Care programme since July 2001. All projects are run by Divisions of General Practice and enable general practitioners (GPs) to refer patients to allied health professionals for evidence-based care. They differ in the models they use to retain, locate and direct referrals to their allied health professionals. This paper examines the extent to which the projects are achieving positive patient outcomes, and explores the association between different models of service delivery and varying levels of patient outcomes.
The paper draws on two data sources (a purpose-designed minimum dataset and a survey of models of service delivery) to examine the level of patient outcomes within and across projects, and variations in the level of patient outcomes by models of service delivery.
The projects are achieving positive effects and these are mostly of large or medium magnitude. The projects do not differ markedly in terms of the patient outcomes they are achieving, despite differences in the models of service delivery they are using. However, those projects implementing a direct referral model, where the GP refers the patient directly to the allied health professional, have significantly greater effect sizes, indicating that they are achieving greater improvements in patient outcomes. In addition, there are non-significant trends toward direct employment of allied health professionals by Divisions being predictive of greater improvements in patient outcomes, and delivery of services from allied health professionals' own rooms being predictive of weaker patient outcomes.
Overwhelmingly, the Access to Allied Psychological Services projects are having a positive impact for patients in terms of their level of functioning, severity of symptoms and/or quality of life. Preliminary indications suggest that a service delivery model incorporating the use of a direct referral system may be associated with superior outcomes. The findings are discussed in the light of the imminent listing of psychologists' services on the Medicare Benefits Schedule.
自2001年7月以来，澳大利亚“心理健康护理更佳结果”计划已为108个“获得联合心理服务”项目提供了资金。所有项目均由全科医疗部门运营，使全科医生（GP）能够将患者转介给联合健康专业人员以获得循证护理。它们在用于保留、定位和引导向联合健康专业人员转介患者的模式上存在差异。本文研究了这些项目在实现积极患者结果方面的程度，并探讨了不同服务提供模式与不同水平患者结果之间的关联。
本文利用两个数据源（一个专门设计的最小数据集和一项服务提供模式调查）来检查项目内部和项目之间的患者结果水平，以及按服务提供模式划分的患者结果水平差异。
这些项目正在产生积极影响，且大多为中到较大程度的影响。尽管所使用的服务提供模式不同，但这些项目在实现的患者结果方面并无显著差异。然而，那些实施直接转介模式（即全科医生直接将患者转介给联合健康专业人员）的项目，其效应大小显著更大，这表明它们在患者结果方面取得了更大的改善。此外，存在一些不显著的趋势，即全科医疗部门直接雇佣联合健康专业人员预示着患者结果有更大改善，而在联合健康专业人员自己的诊室提供服务预示着患者结果较差。
总体而言，“获得联合心理服务”项目在患者的功能水平、症状严重程度和/或生活质量方面对患者产生了积极影响。初步迹象表明，采用直接转介系统的服务提供模式可能会带来更好的结果。鉴于心理学家服务即将列入医疗保险福利计划，对这些发现进行了讨论。
