Department of Health Policy and Management, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Dr., Chapel Hill, NC 27599-7411, United States.
Truven Health Analytics, an IBM Company, 4819 Emperor Blvd Ste 125, Durham, NC 27703, United States; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, 725 Martin Luther King Jr. Blvd, Chapel Hill, NC 27599-7590, United States.
Gen Hosp Psychiatry. 2017 Jul;47:14-19. doi: 10.1016/j.genhosppsych.2017.03.002. Epub 2017 Mar 7.
Primary care-based medical homes could improve the coordination of mental health care for individuals with schizophrenia and comorbid chronic conditions. The objective of this paper is to examine whether persons with schizophrenia and comorbid chronic conditions engage in primary care regularly, such that primary care settings have the potential to serve as a mental health home.
We examined the annual primary care and specialty mental health service utilization of adult North Carolina Medicaid enrollees with schizophrenia and at least one comorbid chronic condition who were in a medical home during 2007-2010. Using a fixed-effects regression approach, we also assessed the effect of medical home enrollment on utilization of primary care and specialty mental health care and medication adherence.
A substantial majority (78.5%) of person-years had at least one primary care visit, and 17.9% had at least one primary care visit but no specialty mental health services use. Medical home enrollment was associated with increased use of primary care and specialty mental health care, as well as increased medication adherence.
Medical home enrollees with schizophrenia and comorbid chronic conditions exhibited significant engagement in primary care, suggesting that primary-care-based medical homes could serve a care coordination function for persons with schizophrenia.
以初级保健为基础的医疗之家可以改善合并慢性疾病的精神分裂症患者的精神卫生保健协调。本文的目的是检验患有精神分裂症和合并慢性疾病的患者是否经常接受初级保健，以便初级保健机构有可能成为精神卫生之家。
我们调查了 2007-2010 年期间参加医疗之家的患有精神分裂症和至少一种合并慢性疾病的北卡罗来纳州医疗补助成年患者的年度初级保健和专科精神卫生服务的使用情况。我们还使用固定效应回归方法，评估了医疗之家的参与对初级保健和专科精神卫生保健以及药物依从性的利用的影响。
绝大多数（78.5%）人年至少有一次初级保健就诊，17.9%的人年至少有一次初级保健就诊，但没有专科精神卫生服务使用。医疗之家的参与与初级保健和专科精神卫生保健的使用增加以及药物依从性的增加有关。
患有精神分裂症和合并慢性疾病的医疗之家的参与者在初级保健方面表现出显著的参与，这表明以初级保健为基础的医疗之家可以为精神分裂症患者提供护理协调功能。
