Yarborough Bobbi Jo H, Stumbo Scott P, Perrin Nancy A, Hanson Ginger C, Muench John, Green Carla A
Kaiser Permanente Northwest Center for Health Research, 3800 N. Interstate Avenue, Portland, OR, 97227, USA.
Johns Hopkins School of Nursing, 525 N. Wolfe Street, Baltimore, MD, 21205, USA.
BMC Fam Pract. 2018 Jan 12;19(1):16. doi: 10.1186/s12875-017-0693-2.
Although many studies have documented patient-, clinician-, and organizational barriers/facilitators of primary care among people with mental illnesses, few have examined whether these factors predict actual rates of preventive service use. We assessed whether clinician behaviors, beliefs, characteristics, and clinician-reported organizational characteristics, predicted delivery of preventive services in this population.
Primary care clinicians (n = 247) at Kaiser Permanente Northwest (KPNW) or community health centers and safety-net clinics (CHCs), in six states, completed clinician surveys in 2014. Using electronic health record data, we calculated preventive care-gap rates for patients with mental illnesses empaneled to survey respondents (n = 37,251). Using separate multi-level regression models for each setting, we tested whether survey responses predicted preventive service care-gap rates.
After controlling for patient-level characteristics, patients of clinicians who reported a greater likelihood of providing preventive care to psychiatrically asymptomatic patients experienced lower care-gap rates (KPNW γ= - .05, p = .041; CHCs γ= - .05, p = .033). In KPNW, patients of female clinicians had fewer care gaps than patients of male clinicians (γ= - .07, p = .011). In CHCs, patients of clinicians who had practiced longer had fewer care gaps (γ= - .004, p = .010), as did patients whose clinicians believed that organizational quality goals facilitate preventive service provision (γ= - .06, p = .006). Case manager availability in CHCs was associated with higher care-gap rates (γ=.06, p = .028).
Clinicians who report they are likely to address preventive concerns when their mentally ill patients present without apparent psychiatric symptoms had patients with fewer care gaps. In CHCs, care quality goals may facilitate preventive care whereas case managers may not.
尽管许多研究记录了精神疾病患者、临床医生和医疗机构在初级保健方面的障碍/促进因素，但很少有研究考察这些因素是否能预测预防服务的实际使用比率。我们评估了临床医生的行为、信念、特征以及临床医生报告的机构特征是否能预测该人群预防服务的提供情况。
2014年，来自西北凯撒医疗集团（KPNW）或六个州的社区卫生中心及安全网诊所（CHCs）的初级保健临床医生（n = 247）完成了临床医生调查。利用电子健康记录数据，我们计算了接受调查的临床医生所负责的精神疾病患者的预防保健差距率（n = 37,251）。针对每个机构，我们使用单独的多层次回归模型来测试调查回复是否能预测预防服务的保健差距率。
在控制了患者层面的特征后，报告称更有可能为无症状精神疾病患者提供预防保健的临床医生的患者，其保健差距率较低（KPNW：γ = -0.05，p = 0.041；CHCs：γ = -0.05，p = 0.033）。在KPNW，女性临床医生的患者比男性临床医生的患者保健差距更少（γ = -0.07，p = 0.011）。在CHCs，从业时间较长的临床医生的患者保健差距更少（γ = -0.004，p = 0.010），其临床医生认为机构质量目标有助于提供预防服务的患者也是如此（γ = -0.06，p = 0.006）。CHCs中个案管理员的可获得性与较高的保健差距率相关（γ = 0.06，p = 0.028）。
报告称在其精神疾病患者无明显精神症状时可能会关注预防问题的临床医生，其患者的保健差距较少。在CHCs中，护理质量目标可能有助于预防保健，而个案管理员可能并非如此。
