West Joyce C, Clarke Diana E, Duffy Farifteh Firoozmand, Barber Keila D, Mojtabai Ramin, Mościcki Eve K, Kroeger Ptakowski Kristin, Levin Saul
Dr. West, Dr. Clarke, Dr. Duffy, Ms. Barber, and Dr. Mościcki are with the American Psychiatric Association Foundation, Arlington, Virginia (e-mail:
Psychiatr Serv. 2016 Sep 1;67(9):983-9. doi: 10.1176/appi.ps.201500423. Epub 2016 Apr 15.
This study sought to examine psychiatrists' perceptions of gaps in the availability of mental health and substance use services and their ability to spend sufficient time and provide enough visits to meet patients' clinical needs.
A cross-sectional probability survey of U.S. psychiatrists was fielded during September through December 2013 by using practice-based research methods, including distribution by priority mail. Psychiatrists (N=2,800) were randomly selected from the American Medical Association Physician Masterfile, and 1,188 of the 2,615 (45%) with deliverable addresses responded. Of those, 93% (N=1,099) reported currently treating psychiatric patients, forming the sample for this study.
Thirty percent or more of psychiatrists reported being unable to provide or find a source for each of the following services in the past 30 days: psychotherapy, housing, supported employment, case management or assertive community treatment, and substance use treatment. Approximately 20% reported being unable to provide or find a source for inpatient treatment, psychosocial rehabilitation, general medical care, pharmacologic treatment, and child and adolescent treatment. Approximately half (52%) of psychiatrists reported not having enough time during patient visits, affecting 28% of patients. More than one-third (37%) reported being unable to provide enough visits to meet patients' clinical needs, affecting 24% of patients.
Psychiatrists reported constrained availability of a range of mental health, substance use, and general medical services. In order for the Affordable Care Act to realize the promise of increased access to care, the infrastructure for mental health and substance use treatment, workforce, and services delivery may require significant enhancement.
本研究旨在调查精神科医生对心理健康和物质使用服务可及性差距的看法，以及他们花足够时间并进行足够次数问诊以满足患者临床需求的能力。
2013年9月至12月，采用基于实践的研究方法，包括优先邮件分发，对美国精神科医生进行了一项横断面概率调查。精神科医生（N = 2800）从美国医学协会医师主文件中随机选取，2615名有可投递地址的医生中有1188名（45%）回复。其中，93%（N = 1099）报告目前正在治疗精神科患者，构成了本研究的样本。
30%或更多的精神科医生报告在过去30天内无法提供或找到以下各项服务的来源：心理治疗、住房、支持性就业、病例管理或积极社区治疗以及物质使用治疗。约20%的医生报告无法提供或找到住院治疗、心理社会康复、普通医疗、药物治疗以及儿童和青少年治疗的来源。约一半（52%）的精神科医生报告在患者问诊期间没有足够时间，这影响了28%的患者。超过三分之一（37%）的医生报告无法进行足够次数的问诊以满足患者的临床需求，这影响了24%的患者。
精神科医生报告一系列心理健康、物质使用和普通医疗服务的可及性受到限制。为使《平价医疗法案》实现增加医疗可及性的承诺，心理健康和物质使用治疗的基础设施、劳动力及服务提供可能需要大幅加强。
