Fontanella Cynthia A, Guada Joseph, Phillips Gary, Ranbom Lorin, Fortney John C
Department of Psychiatry, The Ohio State University, 1670 Upham Drive, Columbus, OH, 43210, USA,
Adm Policy Ment Health. 2014 Sep;41(5):572-87. doi: 10.1007/s10488-013-0500-x.
This retrospective cohort study examined rates of conformance to continuity of care treatment guidelines and factors associated with conformance for persons with schizophrenia. Subjects were 8,621 adult Ohio Medicaid recipients, aged 18-64, treated for schizophrenia in 2004. Information on individual-level (demographic and clinical characteristics) and contextual-level variables (county socio-demographic, economic, and health care resources) were abstracted from Medicaid claim files and the Area Resource File. Outcome measures captured four dimensions of continuity of care: (1) regularity of care; (2) transitions; (3) care coordination, and (4) treatment engagement. Multilevel modeling was used to assess the association between individual and contextual-level variables and the four continuity of care measures. The results indicated that conformance rates for continuity of care for adults with schizophrenia are below recommended guidelines and that variations in continuity of care are associated with both individual and contextual-level factors. Efforts to improve continuity of care should target high risk patient groups (racial/ethnic minorities, the dually diagnosed, and younger adults with early onset psychosis), as well as community-level risk factors (provider supply and geographic barriers of rural counties) that impede access to care.
这项回顾性队列研究调查了精神分裂症患者遵循连续性护理治疗指南的比率以及与遵循情况相关的因素。研究对象为2004年接受精神分裂症治疗的8621名年龄在18至64岁之间的俄亥俄州成年医疗补助受助者。关于个体层面（人口统计学和临床特征）以及背景层面变量（县社会人口统计学、经济和医疗保健资源）的信息从医疗补助理赔档案和区域资源档案中提取。结果指标涵盖了连续性护理的四个维度：（1）护理的规律性；（2）转诊；（3）护理协调，以及（4）治疗参与度。采用多层次模型来评估个体和背景层面变量与连续性护理的四项指标之间的关联。结果表明，成年精神分裂症患者的连续性护理遵循率低于推荐指南，且连续性护理的差异与个体和背景层面的因素均有关联。改善连续性护理的努力应针对高风险患者群体（少数族裔、双重诊断患者以及患有早发性精神病的年轻成年人），以及阻碍获得护理的社区层面风险因素（农村县的医疗服务提供者供应和地理障碍）。
