Mount Sinai Beth Israel Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 317 East 17th Street, 9th Floor, New York, NY, 10003, USA.
Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA.
Psychiatr Q. 2018 Dec;89(4):897-908. doi: 10.1007/s11126-018-9587-2.
Mental illness is a significant cause of disability worldwide, including here in the United States. Given the shortage of trained mental health professionals, a significant portion of patients needing care are managed in the primary care setting. Accountable Care Organizations (ACOs), for example, are seeking to improve the quality of care for this vulnerable population, but many are facing significant challenges relating to integration of new services. We sought to elucidate barriers faced by primary care practitioners (PCPs)-physicians, physician trainees and nurse practitioners-at a New York primary care clinic, which impede delivery of optimal care to those suffering from mental illness. The study was conducted with 32 PCPs in 2016-2017 at Mount Sinai Internal Medicine Associates in New York City. For the quantitative component of the study, a 54-item questionnaire was devised to assess their attitude, behavior and confidence in managing psychiatric patients. For the qualitative component, data was obtained from 3 open-ended questions. Responses were coded for salient themes. Analysis revealed a range of difficulties faced by PCPs. Overall, participants felt that the need to integrate mental health care into primary care was important, however they reported significant barriers in terms of lack of time, lack of resources, low confidence in treating more complex mental health conditions and difficulties with referring patient to mental health specialists. Despite a growing body of evidence that integration of mental health services in primary care leads to improved outcomes, addressing barriers to care will be key to ensuring feasibility of integration measures.
精神疾病是全球范围内导致残疾的一个重要原因，包括在美国也是如此。鉴于受过专业训练的心理健康专业人员短缺，相当一部分需要护理的患者在初级保健环境中得到管理。例如，负责医疗照顾组织（ACO）正在寻求提高对这一弱势群体的护理质量，但许多组织在整合新服务方面面临着重大挑战。我们试图阐明在纽约市一家初级保健诊所中，初级保健医生（包括医生、医学生和执业护士）在为患有精神疾病的患者提供最佳护理方面所面临的障碍。该研究于 2016 年至 2017 年在纽约市西奈山内科医生协会的 32 名初级保健医生中进行。在这项研究的定量部分，设计了一个包含 54 个项目的问卷，以评估他们对管理精神科患者的态度、行为和信心。在定性部分，从 3 个开放式问题中获取数据。对回答进行了编码，以确定突出的主题。分析结果揭示了初级保健医生所面临的一系列困难。总体而言，参与者认为将精神保健纳入初级保健的需求很重要，但他们报告说，在时间、资源、治疗更复杂精神健康状况的信心以及向精神健康专家转介患者的困难方面存在重大障碍。尽管越来越多的证据表明，在初级保健中整合精神卫生服务可改善结果，但解决护理障碍将是确保整合措施可行性的关键。
