Department of Family Medicine, University of Vermont College of Medicine, Burlington, VT, USA.
J Am Board Fam Med. 2012 Mar-Apr;25(2):255-9. doi: 10.3122/jabfm.2012.02.100125.
Most primary care patients with mental health issues are identified or treated in primary care rather than the specialty mental health system. Primary care physicians report that their patients do not have access to needed mental health care. When referrals are made to the specialty behavioral or mental health care system, rates of patients who initiate treatment are low. Collaborative care models, with mental health clinicians as part of the primary care medical staff, have been suggested as an alternative. The aim of this study is to examine rates of treatment startup in 2 collaborative care settings: a rural family medicine office and a suburban internal medicine office. In both practices referrals for mental health services are made within the practice.
Referral data were drawn from 2 convenience samples of patients referred by primary care physicians for collaborative mental health treatment at Fletcher Allen Health Care in Vermont. The first sample consisted of 93 consecutively scheduled referrals in a family medicine office (sample A) between January 2006 and December 2007. The second sample consisted of 215 consecutive scheduled referrals at an internal medicine office (sample B) between January 2009 and December 2009. Referral data identified age, sex, and presenting mental health/medical problem.
In sample A, 95.5% of those patients scheduling appointments began behavioral health treatment; in sample B this percentage was 82%. In sample B, 69% of all patients initially referred for mental health care both scheduled and initiated treatment.
When referred to a mental health clinician who provides on-site access as part of a primary care mental health collaborative care model, a high percentage of patients referred scheduled care. Furthermore, of those who scheduled care, a high percentage of patients attend the scheduled appointment. Findings persist despite differences in practice type, populations, locations, and time frames of data collection. That the findings persist across the different offices suggests that this model of care may contain elements that improve the longstanding problem of poor treatment initiation rates when primary care physicians refer patients for outpatient behavioral health services.
大多数有心理健康问题的初级保健患者是在初级保健中被识别或治疗的，而不是在专业的心理健康系统中。初级保健医生报告说，他们的患者无法获得所需的心理健康护理。当向专业的行为或心理健康护理系统转介时，开始治疗的患者比例很低。有人建议将心理健康临床医生作为初级保健医务人员的一部分纳入合作护理模式作为替代方法。本研究的目的是检查两种合作护理环境中的治疗启动率：农村家庭医学办公室和郊区内科办公室。在这两种实践中，心理健康服务的转介都是在实践中进行的。
从佛蒙特州弗莱彻艾伦医疗保健中心的两名初级保健医生为合作心理健康治疗转介的便利样本中抽取转介数据。第一个样本由 2006 年 1 月至 2007 年 12 月期间家庭医学办公室的 93 名连续预约转诊患者组成（样本 A）。第二个样本由 2009 年 1 月至 2009 年 12 月期间内科办公室的 215 名连续预约转诊患者组成（样本 B）。转介数据确定了年龄、性别和现有的心理健康/医疗问题。
在样本 A 中，95.5%的预约患者开始进行行为健康治疗；在样本 B 中，这一比例为 82%。在样本 B 中，最初转介接受心理健康护理的所有患者中有 69%预约并开始治疗。
当被转介到作为初级保健心理健康合作护理模式一部分的心理健康临床医生时，很大比例的转介患者预约了护理。此外，在预约护理的患者中，很大比例的患者参加了预约的就诊。尽管实践类型、人群、地点和数据收集时间框架存在差异，但仍存在这些发现。这些发现存在于不同的办公室中，这表明这种护理模式可能包含一些要素，可以改善初级保健医生为门诊行为健康服务转介患者时长期存在的治疗启动率低的问题。
