Bradford Daniel W, Kim Mimi M, Braxton Loretta E, Marx Christine E, Butterfield Marian, Elbogen Eric B
Psychosocial Rehabilitation and Recovery Center, Durham VA Medical Center, MHSL (116D)/Hillandale 2, 508 Fulton St., Durham, NC 27705, USA.
Psychiatr Serv. 2008 Aug;59(8):847-52. doi: 10.1176/ps.2008.59.8.847.
People with serious mental illness have higher mortality rates than the general population, and this difference is not explained by such causes as suicide or accidents. This study therefore examined access and barriers to medical care among persons with serious mental illness.
Using a nationally representative sample, the authors examined access and barriers to medical care among individuals reporting psychotic and mood disorders. The National Health Interview Survey (NHIS) and NHIS-Disability Component for 1994 and 1995 were merged to provide a sample of 156,475 people over age 18. Individuals with psychotic disorders, bipolar disorder, or major depression were compared with persons without mental disorders on the following outcomes: having a primary care physician, being unable to get needed medical care, being unable to get a needed prescription medication, and delaying medical care because of cost.
Persons with psychotic disorders (odds ratio [OR]=.55, 95% confidence interval [CI]=.44-.69) and bipolar disorder (OR=.74, CI=.56-.98) had significantly reduced odds of having a primary care physician compared with people without mental disorders. For any barriers to care, persons with psychotic disorders, bipolar disorder, or major depressive disorder had greatly increased odds (ORs=2.5-7.0) of reporting difficulties in accessing care.
Persons with psychotic disorders and bipolar disorder reported markedly more difficulty in obtaining a primary care physician and greater barriers to care than the general population. Interventions are needed to improve provision of primary medical care to this population.
患有严重精神疾病的人群死亡率高于普通人群，且这种差异无法用自杀或事故等原因来解释。因此，本研究调查了患有严重精神疾病的人群获得医疗服务的情况及障碍。
作者利用具有全国代表性的样本，调查了报告患有精神障碍和情绪障碍的个体获得医疗服务的情况及障碍。将1994年和1995年的全国健康访谈调查（NHIS）及其残疾部分进行合并，以提供一个18岁以上的156,475人的样本。将患有精神障碍、双相情感障碍或重度抑郁症的个体与未患精神障碍的个体在以下方面进行比较：是否有初级保健医生、是否无法获得所需医疗服务、是否无法获得所需处方药以及是否因费用问题而推迟医疗服务。
与未患精神障碍的人群相比，患有精神障碍（优势比[OR]=0.55，95%置信区间[CI]=0.44 - 0.69）和双相情感障碍（OR = 0.74，CI = 0.56 - 0.98）的个体拥有初级保健医生的几率显著降低。对于任何医疗服务障碍，患有精神障碍、双相情感障碍或重度抑郁症的个体报告在获得医疗服务方面存在困难的几率大幅增加（OR = 2.5 - 7.0）。
与普通人群相比，患有精神障碍和双相情感障碍的个体在获得初级保健医生方面明显困难更多，且医疗服务障碍更大。需要采取干预措施来改善对这一人群的初级医疗服务提供情况。
