Jones Audrey L, Cochran Susan D, Leibowitz Arleen, Wells Kenneth B, Kominski Gerald, Mays Vickie M
Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.
Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA.
J Gen Intern Med. 2015 Dec;30(12):1828-36. doi: 10.1007/s11606-015-3417-0. Epub 2015 Jun 3.
The benefits of the patient-centered medical home (PCMH) over and above that of a usual source of medical care have yet to be determined, particularly for adults with mental health disorders.
To examine qualities of a usual provider that align with PCMH goals of access, comprehensiveness, and patient-centered care, and to determine whether PCMH qualities in a usual provider are associated with the use of mental health services (MHS).
Using national data from the Medical Expenditure Panel Survey, we conducted a lagged cross-sectional study of MHS use subsequent to participant reports of psychological distress and usual provider and practice characteristics.
A total of 2,358 adults, aged 18-64 years, met the criteria for serious psychological distress and reported on their usual provider and practice characteristics.
We defined "usual provider" as a primary care provider/practice, and "PCMH provider" as a usual provider that delivered accessible, comprehensive, patient-centered care as determined by patient self-reporting. The dependent variable, MHS, included self-reported mental health visits to a primary care provider or mental health specialist, counseling, and psychiatric medication treatment over a period of 1 year.
Participants with a usual provider were significantly more likely than those with no usual provider to have experienced a primary care mental health visit (marginal effect [ME] = 8.5, 95 % CI = 3.2-13.8) and to have received psychiatric medication (ME = 15.5, 95 % CI = 9.4-21.5). Participants with a PCMH were additionally more likely than those with no usual provider to visit a mental health specialist (ME = 7.6, 95 % CI = 0.7-14.4) and receive mental health counseling (ME = 8.5, 95 % CI = 1.5-15.6). Among those who reported having had any type of mental health visit, participants with a PCMH were more likely to have received mental health counseling than those with only a usual provider (ME = 10.0, 95 % CI = 1.0-19.0).
Access to a usual provider is associated with increased receipt of needed MHS. Patients who have a usual provider with PCMH qualities are more likely to receive mental health counseling.
以患者为中心的医疗之家（PCMH）相较于常规医疗服务来源的优势尚未确定，尤其是对于患有精神疾病的成年人。
探讨常规医疗服务提供者符合PCMH在可及性、全面性和以患者为中心的医疗服务目标的特质，并确定常规医疗服务提供者具备PCMH特质是否与心理健康服务（MHS）的使用相关。
利用医疗支出面板调查的全国数据，我们在参与者报告心理困扰、常规医疗服务提供者及医疗实践特征之后，对MHS的使用进行了滞后横断面研究。
共有2358名年龄在18 - 64岁之间的成年人符合严重心理困扰标准，并报告了他们的常规医疗服务提供者及医疗实践特征。
我们将“常规医疗服务提供者”定义为初级保健提供者/医疗机构，将“PCMH提供者”定义为通过患者自我报告确定提供可及、全面、以患者为中心的医疗服务的常规医疗服务提供者。因变量MHS包括在1年期间自我报告的到初级保健提供者或心理健康专家处进行的心理健康就诊、咨询以及精神科药物治疗。
有常规医疗服务提供者的参与者比没有常规医疗服务提供者的参与者更有可能接受初级保健心理健康就诊（边际效应[ME] = 8.5，95%置信区间[CI] = 3.2 - 13.8）并接受精神科药物治疗（ME = 15.5，95% CI = 9.4 - 21.5）。拥有PCMH的参与者比没有常规医疗服务提供者的参与者更有可能去看心理健康专家（ME = 7.6，95% CI = 0.7 - 14.4）并接受心理健康咨询（ME = 8.5，95% CI = 1.5 - 15.6）。在报告有任何类型心理健康就诊的参与者中，拥有PCMH的参与者比只有常规医疗服务提供者的参与者更有可能接受心理健康咨询（ME = 10.0，95% CI = 1.0 - 19.0）。
能够获得常规医疗服务提供者与更多地接受所需的MHS相关。拥有具备PCMH特质的常规医疗服务提供者的患者更有可能接受心理健康咨询。
