Garcia Maria E, Schillinger Dean, Vittinghoff Eric, Creasman Jennifer M, Knapp Penelope, Newcomer John W, Mangurian Christina
Dr. Garcia and Dr. Schillinger are with the Department of Medicine, Dr. Vittinghoff is with the Department of Epidemiology and Biostatistics, Ms. Creasman is with the Clinical and Translational Science Institute, and Dr. Mangurian is with the Department of Psychiatry, all at the University of California, San Francisco, School of Medicine (e-mail:
Psychiatr Serv. 2017 Jul 1;68(7):689-695. doi: 10.1176/appi.ps.201600284. Epub 2017 Mar 1.
Although primary care is associated with better outcomes, many individuals with serious mental illness do not receive general medical services. This study examined patient-level factors associated with not having outpatient general medical visits among individuals with serious mental illness in California.
The study analyzed administrative, pharmacy, and billing data for 56,895 Medicaid-enrolled adults with serious mental illness treated in community mental health clinics between October 1, 2010, and September 20, 2011. Poisson regression estimated independent associations between predictor variables and outpatient general medical visits.
One-third of participants (34%) had no outpatient general medical visits during the study. In multivariate analyses, younger adults (ages 18-27) were less likely than older groups to have such a visit (adjusted relative risk [ARR]=1.07 and 1.19, respectively, for ages 28-47 and 48-67). Women were more likely than men to have such a visit (ARR=1.29). Compared with whites, blacks were less likely to have an outpatient general medical visit (ARR=.93). Rural dwellers were less likely than urban dwellers to have such a visit (ARR=.64). Persons with drug or alcohol use disorders were less likely than those without such disorders to have an outpatient general medical visit (ARR=.95), and those with schizophrenia were less likely than those with any other psychiatric disorder examined to have such a visit.
Individuals with serious mental illness had low use of outpatient general medical services. Integrated care models are needed to engage these individuals and eliminate disparities in morbidity and mortality.
尽管初级保健与更好的治疗效果相关，但许多患有严重精神疾病的个体并未接受常规医疗服务。本研究调查了加利福尼亚州患有严重精神疾病的个体中与未进行门诊常规医疗就诊相关的患者层面因素。
该研究分析了2010年10月1日至2011年9月20日期间在社区精神卫生诊所接受治疗的56895名参加医疗补助计划的患有严重精神疾病的成年人的行政、药房和计费数据。泊松回归估计了预测变量与门诊常规医疗就诊之间的独立关联。
三分之一的参与者（34%）在研究期间未进行门诊常规医疗就诊。在多变量分析中，较年轻的成年人（18 - 27岁）比年长组进行此类就诊的可能性更小（28 - 47岁和48 - 67岁的调整相对风险[ARR]分别为1.07和1.19）。女性比男性更有可能进行此类就诊（ARR = 1.29）。与白人相比，黑人进行门诊常规医疗就诊的可能性更小（ARR = 0.93）。农村居民比城市居民进行此类就诊的可能性更小（ARR = 0.64）。患有药物或酒精使用障碍的人比没有此类障碍的人进行门诊常规医疗就诊的可能性更小（ARR = 0.95），并且患有精神分裂症的人比接受检查的任何其他精神疾病患者进行此类就诊的可能性更小。
患有严重精神疾病的个体对门诊常规医疗服务的利用率较低。需要综合护理模式来促使这些个体接受服务，并消除发病率和死亡率方面的差异。
