Mechanic D, Angel R, Davies L
Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, NJ 08903.
J Health Soc Behav. 1991 Mar;32(1):49-64.
This paper examines risk, defined as the threat of danger or disruption, as a contextual concept important for understanding patterns of patient selection and referral. We explore the hypothesis that risks associated with mental disorder, as represented by factors such as thoughts about suicide or problems associated with drinking, increase the probability of referral of patients receiving mental health care from general medical practitioners to the specialty mental health sector. Interview and claims data from the RAND Health Insurance Experiment, a large experimental study of coinsurance, are used to examine referral processes over a five-year period. Risk, and especially a measure of suicide thoughts, increase the probability of referral to specialty care. Women and persons with higher education are more likely to use specialty services; older persons are less likely to use such services. Understanding referral requires attention to the behavioral contingencies and illness behavior surrounding the presentation of mental disorder.
本文将风险定义为危险或干扰的威胁，探讨其作为一个情境概念对于理解患者选择和转诊模式的重要性。我们探究这样一个假设：由自杀念头或饮酒相关问题等因素所代表的与精神障碍相关的风险，会增加从普通医生处接受心理健康护理的患者被转诊至专科心理健康部门的概率。来自兰德健康保险实验（一项关于共保的大型实验研究）的访谈和理赔数据，被用于研究五年期间的转诊过程。风险，尤其是自杀念头的一种衡量指标，会增加转诊至专科护理的概率。女性和受过高等教育的人更有可能使用专科服务；老年人使用此类服务的可能性较小。理解转诊需要关注围绕精神障碍呈现的行为偶然性和疾病行为。
