Rentas Karen G, Buckley Laura, Wiest Dawn, Bruno Cortney A
Providence Health & Services, 11333 Sepulveda Blvd, Mission Hills, CA, 91345, USA.
Camden Coalition of Healthcare Providers, 800 Cooper Street, 7th Floor, Camden, NJ, 08102, USA.
BMC Health Serv Res. 2019 Feb 8;19(1):81. doi: 10.1186/s12913-019-3894-7.
A small percentage of patients relies extensively on hospital-based care and account for a disproportionately high share of health care spending in the United States. Evidence shows that behavioral health conditions are common among these individuals, but understanding of their behavioral health needs is limited. This study aimed to understand the behavioral health characteristics and needs of patients with high hospital utilization patterns in Camden, New Jersey.
The sample consisted of patients in a care management intervention for individuals with patterns of high hospital utilization who were referred for behavioral health assessments (N = 195). A clinical psychologist conducted the assessments, which informed a multiaxial evaluation with diagnostic criteria from the Diagnostic and Statistical Manual of Mental Disorders and a Mental Status Examination, to facilitate accurate diagnosis. Demographic characteristics, housing instability, exposure to trauma, and health care service utilization data were also collected through self-report and chart reviews.
Ninety percent of patients were diagnosed with a psychiatric and/or active substance use disorder. Depression was the most common psychiatric disorder and alcohol use was the most common substance use disorder. However, only 10% of patients with an active substance use disorder were in treatment, and only 17% of patients with a mental health diagnosis were receiving mental health treatment. Nearly all (91%) patients reported having a primary care provider at the time of assessment and most had seen their primary care provider within three months of their last hospital discharge. Non-medical barriers to health and wellness, specifically housing instability and exposure to trauma, were also common (35 and 61% of patients, respectively) among patients.
Findings highlight the importance of identifying and treating patients with behavioral health needs in the primary care setting. Developing connections with community agencies who provide behavioral health and substance use treatment can enhance primary care providers' efforts to address their patients' non-medical barriers to treatment, as can embedding behavioral health providers within primary care offices. The study also underscores the need for trauma-informed care in primary care settings.
在美国，一小部分患者高度依赖医院护理，且在医疗保健支出中所占份额极高。有证据表明，行为健康问题在这些人中很常见，但对他们行为健康需求的了解有限。本研究旨在了解新泽西州卡姆登市医院利用率高的患者的行为健康特征和需求。
样本包括参与针对医院利用率高的个体的护理管理干预并被转介进行行为健康评估的患者（N = 195）。由一名临床心理学家进行评估，评估依据《精神疾病诊断与统计手册》的诊断标准和精神状态检查进行多轴评估，以促进准确诊断。还通过自我报告和病历审查收集了人口统计学特征、住房不稳定情况、创伤暴露情况以及医疗保健服务利用数据。
90%的患者被诊断患有精神疾病和/或存在物质使用障碍。抑郁症是最常见的精神疾病，酒精使用是最常见的物质使用障碍。然而，只有10%存在物质使用障碍的患者正在接受治疗，只有17%被诊断患有精神疾病的患者正在接受心理健康治疗。几乎所有（91%）患者在评估时报告有初级保健提供者，且大多数患者在最后一次出院后三个月内见过他们的初级保健提供者。健康和幸福的非医疗障碍，特别是住房不稳定和创伤暴露，在患者中也很常见（分别为35%和61%的患者）。
研究结果凸显了在初级保健环境中识别和治疗有行为健康需求患者的重要性。与提供行为健康和物质使用治疗的社区机构建立联系，可以加强初级保健提供者解决患者治疗非医疗障碍的努力，在初级保健办公室内配备行为健康提供者也能起到同样的作用。该研究还强调了初级保健环境中提供创伤知情护理的必要性。
