Iyer Sharat P, Young Alexander S
VISN3 Mental Illness Research, Education and Clinical Center, James J. Peters VA Medical Center, 130 W Kingsbridge Road, Room 6A-44, Bronx, NY 10468, USA; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1230, New York, NY 10029, USA.
Desert Pacific Mental Illness Research, Education and Clinical Center, West Los Angeles VA Medical Center, 11301 Wilshire Blvd, Building 210, Los Angeles, CA 90073, USA; Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, 10920 Wilshire Blvd, Suite 300, Los Angeles, CA 90024, USA.
Gen Hosp Psychiatry. 2015 Jan-Feb;37(1):60-6. doi: 10.1016/j.genhosppsych.2014.10.003. Epub 2014 Oct 16.
This study sought to determine if primary care visits for people with serious mental illness (SMI) demonstrate different rates of basic physical health services compared to others, and to determine factors associated with differing rates of these measures in people with SMI.
The study used 2005-2010 visit-level primary care data from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey. The provision of health counseling, receipt of any diagnostic or screening test, measurement of blood pressure or weight and evidence of hypertension control were assessed, adjusting for identified patient, provider and visit-level factors.
After adjustment for covariates, we found no significant differences between visits for people with SMI and those without for any outcome. Probability of blood pressure measurement and diagnostic or screening testing significantly increased over time.
The lack of significant differences found here might be due to adjustment for covariates, a focus only on primary care visits, the use of visit-level data or evolution over time. Mortality differences for people with SMI may be attributable to those not receiving primary care, self-management of disease or subsets of the population requiring targeted interventions.
本研究旨在确定患有严重精神疾病（SMI）的人群进行初级保健就诊时，与其他人相比，基本身体健康服务的比率是否存在差异，并确定与患有严重精神疾病的人群中这些指标比率不同相关的因素。
该研究使用了来自国家门诊医疗护理调查和国家医院门诊医疗护理调查的2005 - 2010年就诊层面的初级保健数据。评估了健康咨询的提供情况、接受任何诊断或筛查测试的情况、血压或体重测量以及高血压控制的证据，并对确定的患者、提供者和就诊层面的因素进行了调整。
在对协变量进行调整后，我们发现患有严重精神疾病的人群与未患严重精神疾病的人群在任何结果方面均无显著差异。血压测量和诊断或筛查测试的概率随时间显著增加。
此处发现缺乏显著差异可能是由于对协变量进行了调整、仅关注初级保健就诊、使用就诊层面的数据或随时间的演变。患有严重精神疾病的人群的死亡率差异可能归因于那些未接受初级保健、疾病自我管理或需要有针对性干预的人群亚组。
