Horevitz Elizabeth, Organista Kurt C, Arean Patricia A
Dr. Horevitz and Dr. Arean are with the Department of Psychiatry, University of California, San Francisco (e-mail:
Psychiatr Serv. 2015 Aug 1;66(8):824-30. doi: 10.1176/appi.ps.201400085. Epub 2015 Apr 15.
Integrated behavioral health care has the potential to reduce barriers to mental health treatment among low-income and minority populations. This study aimed to identify predictors of Latino patients' decision to follow through with referrals to depression treatment in an integrated primary care setting, including type of referral (a "warm handoff" from a primary care provider [PCP] to a behavioral health care provider or a prescribed referral).
The authors conducted a sequential medical record review of 431 patients referred for depression treatment in integrated behavioral health services followed by qualitative semistructured interviews with a subsample of 16 patients.
English-speaking Latinos were four times less likely to attend an initial visit within two months of a referral if they received a warm handoff rather than a prescribed referral. The strength of the patient-provider relationship and the quality of the referral experience, including whether the PCP addressed patients' health literacy and expectations for depression care, affected patients' decision to engage in depression treatment.
Engaging Latinos in needed mental health treatment is a challenge, even when treatment is provided in primary care settings. Warm handoffs are considered effective components of engagement, but this study suggests that the effectiveness of warm handoffs may vary depending on the patient's primary language. The following factors seem important to engaging Latinos into care: patient-provider relationship, quality of the referral process, addressing expectations about depression care, and reducing communication barriers, including health literacy and linguistic barriers. Future studies of engagement strategies should explore these factors.
综合行为健康护理有潜力减少低收入和少数族裔人群接受心理健康治疗的障碍。本研究旨在确定在综合初级保健环境中，拉丁裔患者决定接受抑郁症治疗转诊的预测因素，包括转诊类型（从初级保健提供者[PCP]到行为健康护理提供者的“热情交接”或规定的转诊）。
作者对431名被转诊至综合行为健康服务机构接受抑郁症治疗的患者进行了连续的病历审查，随后对16名患者的子样本进行了定性半结构化访谈。
如果接受的是热情交接而非规定的转诊，说英语的拉丁裔在转诊后两个月内就诊的可能性要低四倍。患者与提供者之间关系的强度以及转诊体验的质量，包括初级保健提供者是否解决了患者的健康素养和对抑郁症护理的期望，影响了患者接受抑郁症治疗的决定。
即使在初级保健环境中提供治疗，让拉丁裔接受所需的心理健康治疗仍是一项挑战。热情交接被认为是参与治疗的有效组成部分，但本研究表明，热情交接的有效性可能因患者的主要语言而异。以下因素对于让拉丁裔参与护理似乎很重要：患者与提供者之间的关系、转诊过程的质量、解决对抑郁症护理的期望以及减少沟通障碍，包括健康素养和语言障碍。未来关于参与策略的研究应探讨这些因素。
