关注心理困扰成年患者的基层医疗实践的医疗之家功能：一项横断面研究。
The medical home functions of primary care practices that care for adults with psychological distress: a cross-sectional study.
机构信息
School of Public Health, University of Maryland, 4200 Valley Dr #2242, College Park, MD, 20742, USA.
出版信息
BMC Health Serv Res. 2019 Jan 9;19(1):21. doi: 10.1186/s12913-018-3845-8.
BACKGROUND
Primary care practices are changing the way that they provide care by increasing their medical home functionality. Medical home functionality can improve access to care and increase patient-centeredness, which is essential for persons with mental health issues. This study aims to explore the degree to which medical home functions have been implemented by primary care practices that care for adults with psychological distress.
METHODS
Analysis of the 2015 Medical Expenditure Panel Survey Household Component and Medical Organizations Survey. This unique data set links data from a nationally representative sample of US households to the practices in which they receive primary care. This study focused on adults aged 18 and above.
RESULTS
As compared to adults without psychological distress, adults with psychological distress had significantly higher rates of chronic illness and poverty. Adults with psychological distress were more likely to receive care from practices that include advanced practitioners and are non-profit or hospital-based. Multivariate models that were adjusted for patient-level and practice-level characteristics indicated that adults with psychological distress are as likely to receive primary care from practices with medical home functionality, including case management, electronic health records, flexible scheduling, and PCMH certification, as adults without psychological distress.
CONCLUSIONS
Practices that care for adults with mental health issues have not been left behind in the transition towards medical home models of primary care. Policy makers should continue to prioritize adults with mental health issues to receive primary care through this model of delivery due to this population's great potential to benefit from improved access and care coordination.
TRIAL REGISTRATION
This study does not report the results of a health care intervention on human subject's participants.
背景
初级保健实践正在通过增强其医疗之家功能来改变提供护理的方式。医疗之家功能可以改善获得医疗保健的机会并增强以患者为中心的服务，这对有心理健康问题的人至关重要。本研究旨在探索为有心理困扰的成年人提供护理的初级保健实践实施医疗之家功能的程度。
方法
对 2015 年医疗支出面板调查家庭部分和医疗组织调查进行分析。这个独特的数据集将来自美国具有代表性的家庭样本的数据与他们接受初级保健的实践联系起来。本研究集中在 18 岁及以上的成年人。
结果
与没有心理困扰的成年人相比，有心理困扰的成年人患慢性病和贫困的比例明显更高。有心理困扰的成年人更有可能从包括高级从业者且为非营利或医院所有的实践中获得护理。调整了患者水平和实践水平特征的多变量模型表明，有心理困扰的成年人与没有心理困扰的成年人一样有可能从具有医疗之家功能的初级保健实践中获得初级保健，包括病例管理、电子健康记录、灵活的预约安排和 PCMH 认证。
结论
为心理健康问题成年人提供护理的实践并没有在向初级保健医疗之家模式的转变中落后。政策制定者应该继续优先考虑为有心理健康问题的成年人提供通过这种交付模式获得的初级保健，因为该人群有很大的潜力从改善获得医疗保健的机会和护理协调中受益。
试验注册
本研究没有报告对人类受试者参与者的医疗保健干预的结果。
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