Yale School of Medicine, New Haven, CT, USA.
Department of Psychiatry, Yale School of Medicine, 300 George St #901, New Haven, CT, 06511, USA.
J Clin Psychol Med Settings. 2021 Jun;28(2):221-228. doi: 10.1007/s10880-020-09706-8.
Posttraumatic stress disorder (PTSD) is a serious mental health disorder that may not be adequately detected or treated in primary care (PC). The purpose of this study was to compare the clinical characteristics and health care utilization of PTSD patients diagnosed in PC versus in specialty mental health care (MHC) across five large, civilian, not-for-profit healthcare systems. Electronic claims and medical record data on patients treated during 2014 were analyzed. Treatment was considered in terms of initiation and dose (i.e., psychotherapy sessions; pharmacotherapy-prescription psychotropics). Of 5256 patients aged 15-88 with a diagnosis of PTSD, 84.4% were diagnosed by a MHC provider. Patients diagnosed by MHC providers had 4 times the rate of and more enduring psychotherapy than those diagnosed by PC providers. Receipt of psychotropics varied by provider type, with generally higher prescription fill levels for patients in MHC. Strategies to better align patient needs with access and treatment modality in PC settings are needed.
创伤后应激障碍（PTSD）是一种严重的心理健康障碍，在初级保健（PC）中可能无法得到充分的发现或治疗。本研究的目的是比较在五个大型的、民营的非营利性医疗保健系统中，在 PC 中诊断出的 PTSD 患者和在专业精神保健（MHC）中诊断出的 PTSD 患者的临床特征和医疗保健利用情况。对 2014 年期间接受治疗的患者的电子索赔和医疗记录数据进行了分析。治疗是根据治疗的开始和剂量（即心理治疗次数；精神类药物治疗-精神类药物处方）来评估的。在 5256 名年龄在 15-88 岁之间的 PTSD 患者中，84.4%是由 MHC 提供者诊断的。与 PC 提供者诊断的患者相比，MHC 提供者诊断的患者接受心理治疗的比例高出四倍，且治疗时间更持久。接受精神类药物的情况因提供者类型而异，MHC 中的患者的处方配药水平通常更高。需要制定策略，以便更好地根据 PC 环境中的患者需求来调整获得治疗的机会和治疗模式。
